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Verdonk F, Lambert P, Gakuba C, Nelson AC, Lescot T, Garnier F, Constantin JM, Saurel D, Lasocki S, Rineau E, Diemunsch P, Dreyfuss L, Tavernier B, Bezu L, Josserand J, Mebazaa A, Coroir M, Nouette-Gaulain K, Macouillard G, Glasman P, Lemesle D, Minville V, Cuvillon P, Gaudilliere B, Quesnel C, Abdel-Ahad P, Sharshar T, Molliex S, Gaillard R, Mantz J. Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients: A multicenter randomized blinded placebo-controlled trial. Anaesth Crit Care Pain Med 2024:101387. [PMID: 38710325 DOI: 10.1016/j.accpm.2024.101387] [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: 12/31/2023] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Preventive anesthetic impact on the high rates of postoperative neurocognitive disorders in elderly patients is debated. The Prevention of postOperative Cognitive dysfunction by Ketamine (POCK) study aimed to assess the effect of ketamine on this condition. METHODS This is a multicenter, randomized, double-blind, interventional study. Patients ≥60 years undergoing major orthopedic surgery were randomly assigned in a 1:1 ratio to receive preoperative ketamine 0.5 mg/kg as an intravenous bolus (n = 152) or placebo (n = 149) in random blocks stratified according to the study site, preoperative cognitive status and age. The primary outcome was the proportion of objective delayed neurocognitive recovery (dNR) defined as a decline of one or more neuropsychological assessment standard deviations on postoperative day 7. Secondary outcomes included a three-month incidence of objective postoperative neurocognitive disorder (POND), as well as delirium, anxiety, and symptoms of depression seven days and three months after surgery. RESULTS Among 301 patients included, 292 (97%) completed the trial. Objective dNR occurred in 50 (38.8%) patients in the ketamine group and 54 (40.9%) patients in the placebo group (OR [95% CI] 0.92 [0.56;1.51], p = 0.73) on postoperative day 7. Incidence of objective POND three months after surgery did not differ significantly between the two groups nor did incidence of delirium, anxiety, apathy, and fatigue. Symptoms of depression were less frequent in the ketamine group three months after surgery (OR [95%CI] 0.34 [0.13-0.86]). CONCLUSIONS A single preoperative bolus of intravenous ketamine does not prevent the occurrence of dNR or POND in elderly patients scheduled for major orthopedic surgery. (Clinicaltrials.gov NCT02892916.).
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Affiliation(s)
- Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris.Sorbonne Université, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, and UMRS_938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université-Inserm, Paris, 75012, France.
| | - Pierre Lambert
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Nord, Saint Etienne, France
| | - Clément Gakuba
- Normandie Univ, UNICAEN, CHU de Caen, Service d'Anesthésie-Réanimation chirurgicale, Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders" and Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Anais Charles Nelson
- INSERM, Centre d'Investigation Clinique 1418 Épidémiologie Clinique, Paris, France and Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris.Sorbonne Université, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, and UMRS_938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université-Inserm, Paris, 75012, France
| | - Fanny Garnier
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Danielle Saurel
- Department of Perioperative Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Emmanuel Rineau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers, France
| | - Pierre Diemunsch
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Lucas Dreyfuss
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Benoît Tavernier
- Department of Anesthesiology and Intensive Care Medicine, Lille University Hospital and Université de Lille, ULR 2694 - METRICS, Lille, France
| | - Lucillia Bezu
- Department of Anesthesiology, Gustave Roussy Cancer Campus, Villejuif, France and Department of Anesthesiology and Intensive Care, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Coroir
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karine Nouette-Gaulain
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Bordeaux, France
| | - Gerard Macouillard
- CHU Bordeaux, Service d'Anesthésie Réanimation Pellegrin, Hôpital Pellegrin, Bordeaux, France
| | - Pauline Glasman
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
| | - Denis Lemesle
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Paris, France
| | - Vincent Minville
- Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Toulouse, France
| | - Philippe Cuvillon
- Department of Anaesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Nimes, France
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christophe Quesnel
- Department of Anesthesiology and Intensive Care, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Pierre Abdel-Ahad
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France
| | - Tarek Sharshar
- Neuro-Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| | - Serge Molliex
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Nord, and Sainbiose INSERM Unit 1059, Jean Monnet University, Saint Etienne, France
| | - Raphael Gaillard
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France
| | - Jean Mantz
- Department of Anesthesiology and Intensive Care, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Boussier J, Lemasle A, Hantala N, Scatton O, Vaillant JC, Paye F, Langeron O, Lescot T, Quesnel C, Verdonk F, Eyraud D, Sitbon A, Delorme L, Monsel A. Lung Ultrasound Score on Postoperative Day 1 Is Predictive of the Occurrence of Pulmonary Complications after Major Abdominal Surgery: A Multicenter Prospective Observational Study. Anesthesiology 2024; 140:417-429. [PMID: 38064713 DOI: 10.1097/aln.0000000000004855] [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: 02/15/2024]
Abstract
BACKGROUND Postoperative pulmonary complications after major abdominal surgery are frequent and carry high morbidity and mortality. Early identification of patients at risk of pulmonary complications by lung ultrasound may allow the implementation of preemptive strategies. The authors hypothesized that lung ultrasound score would be associated with pulmonary postoperative complications. The main objective of the study was to evaluate the performance of lung ultrasound score on postoperative day 1 in predicting pulmonary complications after major abdominal surgery. Secondary objectives included the evaluation of other related measures for their potential prediction accuracy. METHODS A total of 149 patients scheduled for major abdominal surgery were enrolled in a bicenter observational study. Lung ultrasound score was performed before the surgery and on days 1, 4, and 7 after surgery. Pulmonary complications occurring before postoperative day 10 were recorded. RESULTS Lung ultrasound score on postoperative day 1 was higher in patients developing pulmonary complications before day 10 (median, 13; interquartile range, 8.25 to 18; vs. median, 10; interquartile range, 6.5 to 12; Mann-Whitney P = 0.002). The area under the curve for predicting postoperative pulmonary complications before day 10 was 0.65 (95% CI, 0.55 to 0.75; P = 0.003). Lung ultrasound score greater than 12 had a sensitivity of 0.54 (95% CI, 0.40 to 0.67), specificity of 0.77 (95% CI, 0.67 to 0.85), and negative predictive value of 0.74 (95% CI, 0.65 to 0.83). Lung ultrasound score greater than 17 had sensitivity of 0.33 (95% CI, 0.21 to 0.47), specificity of 0.95 (95% CI, 0.88 to 0.98), and positive predictive value of 0.78 (95% CI, 0.56 to 0.93). Anterolateral lung ultrasound score and composite scores using lung ultrasound score and other patient characteristics showed similar predictive accuracies. CONCLUSIONS An elevated lung ultrasound score on postoperative day 1 is associated with the occurrence of pulmonary complications within the first 10 days after major abdominal surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jeremy Boussier
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Aymeric Lemasle
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Nicolas Hantala
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Jean-Christophe Vaillant
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - François Paye
- Department of Surgery, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Greater Paris University Hospitals, University Paris-Est-Créteil, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Daniel Eyraud
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Alexandre Sitbon
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Louis Delorme
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France; Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy, Paris, France; Biotherapy (CIC-BTi), La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Paris, France
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Pardo E, Lescot T, Preiser JC, Massanet P, Pons A, Jaber S, Fraipont V, Levesque E, Ichai C, Petit L, Tamion F, Taverny G, Boizeau P, Alberti C, Constantin JM, Bonnet MP. Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study. Crit Care 2023; 27:7. [PMID: 36611211 PMCID: PMC9826592 DOI: 10.1186/s13054-022-04298-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. METHODS The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. RESULTS During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11). CONCLUSIONS In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.
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Affiliation(s)
- Emmanuel Pardo
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Thomas Lescot
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Jean-Charles Preiser
- Service des Soins intensifs, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pablo Massanet
- Département Anesthésie-Réanimation, Centre Hospitalier Universitaire Nîmes, 30000, Nîmes, France
| | - Antoine Pons
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier. PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France
| | - Vincent Fraipont
- Service de Soins Intensifs, Centre Hospitalier Régional de Liège, 4000, Liège, Citadelle, Belgium
| | - Eric Levesque
- Service d'anesthésie-réanimation chirurgicale, GHU Henri-Mondor, 94000, Créteil, France
| | - Carole Ichai
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Département Anesthésie-Réanimation, Nice, France
| | - Laurent Petit
- Service de réanimation chirurgicale et traumatologique Pellegrin place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, CHU Rouen, Université de Normandie, UNIROUEN, INSERM U1096, 76000, Rouen, France
| | - Garry Taverny
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Priscilla Boizeau
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Corinne Alberti
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Jean-Michel Constantin
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Département Anesthésie-Réanimation, Hôpital Armand Trousseau, DMU DREAM, GRC 29, AP-HP, Paris, France
- Université Paris Cité, INSERM, INRA, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Maternité Port Royal, 53 avenue de l'Observatoire, 75014, Paris, France
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4
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Cavagna P, Bizet S, Fieux F, Houillez E, Chirk C, Zulian C, Perreux J, Fernandez C, Lescot T, Antignac M. Assessment of Good Practice Guidelines for Administration of Drugs via Feeding Tubes by a Clinical Pharmacist in the Intensive Care Unit. Crit Care Nurse 2022; 42:54-65. [DOI: 10.4037/ccn2022395] [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: 12/05/2022]
Abstract
Background
In intensive care units, patients are frequently unable to take oral drugs because of orotracheal intubation or sedation.
Local Problem
Adverse events occurred during the administration of drugs by feeding tube. This study assessed the impact of implementing good practice guidelines by a clinical pharmacist on the prescription and administration of drugs through feeding tubes.
Methods
Nonconformity of drug prescription and administration in patients with feeding tubes was assessed before and after implementation of good practice guidelines in the intensive care unit of a large teaching hospital. Data were collected from medical records and interviews with physicians and nurses using a standardized form. Assessment of prescription nonconformity included compatibility of a drug’s absorption site with the administration route. Assessment of administration nonconformity included the preparation method.
Results
The analysis included 288 prescriptions and 80 administrations before implementation and 385 prescriptions and 211 administrations after implementation. Prescriptions in which the drug’s absorption site was not compatible with the administration route decreased significantly after implementation (19.8% vs 7.5%, P < .01). Administration nonconformity decreased significantly in regard to crushing tablets and opening capsules (51.2% vs 4.3%, P < .01) and the solvent used (67.1% vs 3.5%, P < .01). Simultaneous mixing of drugs in the same syringe did not decrease significantly (71.2% vs 62.9%, P = .17).
Conclusion
Implementation of good practice guidelines by a multidisciplinary team in the intensive care unit significantly improved practices for administering crushed, opened, and dissolved oral forms of drugs by feeding tube.
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Affiliation(s)
- Pauline Cavagna
- Pauline Cavagna is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University, Paris, France
| | - Simon Bizet
- Simon Bizet is a physician, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Fabienne Fieux
- Fabienne Fieux is a physician, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Emilie Houillez
- Emilie Houillez is a nurse, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Caroline Chirk
- Caroline Chirk is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Chloé Zulian
- Chloé Zulian is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Jennifer Perreux
- Jennifer Perreux is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Christine Fernandez
- Christine Fernandez is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Thomas Lescot
- Thomas Lescot is a physician, surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, AP-HP Sorbonne University
| | - Marie Antignac
- Marie Antignac is a pharmacist, Department of Pharmacy, Saint-Antoine Hospital, AP-HP Sorbonne University
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5
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Duceau B, Blatzer M, Bardon J, Chaze T, Giai Gianetto Q, Castelli F, Fenaille F, Duarte L, Lescot T, Tresallet C, Riou B, Matondo M, Langeron O, Rocheteau P, Chrétien F, Bouglé A. Using a multiomics approach to unravel a septic shock specific signature in skeletal muscle. Sci Rep 2022; 12:18776. [PMID: 36335235 PMCID: PMC9637214 DOI: 10.1038/s41598-022-23544-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Sepsis is defined as a dysregulated host response to infection leading to organs failure. Among them, sepsis induces skeletal muscle (SM) alterations that contribute to acquired-weakness in critically ill patients. Proteomics and metabolomics could unravel biological mechanisms in sepsis-related organ dysfunction. Our objective was to characterize a distinctive signature of septic shock in human SM by using an integrative multi-omics approach. Muscle biopsies were obtained as part of a multicenter non-interventional prospective study. Study population included patients in septic shock (S group, with intra-abdominal source of sepsis) and two critically ill control populations: cardiogenic shock (C group) and brain dead (BD group). The proteins and metabolites were extracted and analyzed by High-Performance Liquid Chromatography-coupled to tandem Mass Spectrometry, respectively. Fifty patients were included, 19 for the S group (53% male, 64 ± 17 years, SAPS II 45 ± 14), 12 for the C group (75% male, 63 ± 4 years, SAPS II 43 ± 15), 19 for the BD group (63% male, 58 ± 10 years, SAPS II 58 ± 9). Biopsies were performed in median 3 days [interquartile range 1-4]) after intensive care unit admission. Respectively 31 patients and 40 patients were included in the proteomics and metabolomics analyses of 2264 proteins and 259 annotated metabolites. Enrichment analysis revealed that mitochondrial pathways were significantly decreased in the S group at protein level: oxidative phosphorylation (adjusted p = 0.008); branched chained amino acids degradation (adjusted p = 0.005); citrate cycle (adjusted p = 0.005); ketone body metabolism (adjusted p = 0.003) or fatty acid degradation (adjusted p = 0.008). Metabolic reprogramming was also suggested (i) by the differential abundance of the peroxisome proliferator-activated receptors signaling pathway (adjusted p = 0.007), and (ii) by the accumulation of fatty acids like octanedioic acid dimethyl or hydroxydecanoic. Increased polyamines and depletion of mitochondrial thioredoxin or mitochondrial peroxiredoxin indicated a high level of oxidative stress in the S group. Coordinated alterations in the proteomic and metabolomic profiles reveal a septic shock signature in SM, highlighting a global impairment of mitochondria-related metabolic pathways, the depletion of antioxidant capacities, and a metabolic shift towards lipid accumulation.ClinicalTrial registration: NCT02789995. Date of first registration 03/06/2016.
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Affiliation(s)
- Baptiste Duceau
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France ,grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, University Hospital Pitié-Salpêtrière (AP-HP. Sorbonne Université), GRC 29, Assistance Publique, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Michael Blatzer
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Jean Bardon
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France ,grid.412116.10000 0001 2292 1474AP-HP, Department of Anesthesiology and Critical Care Medicine, Hôpital Henri Mondor, Créteil, France
| | - Thibault Chaze
- grid.428999.70000 0001 2353 6535Institut Pasteur, Proteomics Core Facility, Mass Spectrometry for Biology Unit USR CNRS 2000, Bioinformatics and Biostatistics Hub Computational Biology Department USR CNRS 3756, Paris, France
| | - Quentin Giai Gianetto
- grid.428999.70000 0001 2353 6535Institut Pasteur, Proteomics Core Facility, Mass Spectrometry for Biology Unit USR CNRS 2000, Bioinformatics and Biostatistics Hub Computational Biology Department USR CNRS 3756, Paris, France
| | - Florence Castelli
- grid.457334.20000 0001 0667 2738Département Médicaments Et Technologies Pour La Santé (MTS), Université Paris Saclay, CEA, INRAE, MetaboHUB, Gif-Sur-Yvette, France
| | - François Fenaille
- grid.457334.20000 0001 0667 2738Département Médicaments Et Technologies Pour La Santé (MTS), Université Paris Saclay, CEA, INRAE, MetaboHUB, Gif-Sur-Yvette, France
| | - Lucie Duarte
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France ,grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, University Hospital Pitié-Salpêtrière (AP-HP. Sorbonne Université), GRC 29, Assistance Publique, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Thomas Lescot
- grid.50550.350000 0001 2175 4109Department of Anesthesiology and Critical Care Medicine, Hôpital Saint-Antoine, Sorbonne Université, GRC 29, AP-HP, Paris, France
| | - Christophe Tresallet
- grid.50550.350000 0001 2175 4109Department of General and Endocrine Surgery, Hôpital La Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Bruno Riou
- grid.50550.350000 0001 2175 4109Emergency Department, Hôpital La Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Mariette Matondo
- grid.428999.70000 0001 2353 6535Institut Pasteur, Proteomics Core Facility, Mass Spectrometry for Biology Unit USR CNRS 2000, Bioinformatics and Biostatistics Hub Computational Biology Department USR CNRS 3756, Paris, France
| | - Olivier Langeron
- grid.412116.10000 0001 2292 1474AP-HP, Department of Anesthesiology and Critical Care Medicine, Hôpital Henri Mondor, Créteil, France
| | - Pierre Rocheteau
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Fabrice Chrétien
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France ,grid.414435.30000 0001 2200 9055Hôpital Sainte Anne, GHU Paris Psychiatrie Et Neurosciences, Paris, France
| | - Adrien Bouglé
- grid.428999.70000 0001 2353 6535Experimental Neuropathology Unit, Institut Pasteur, Paris, France ,grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, University Hospital Pitié-Salpêtrière (AP-HP. Sorbonne Université), GRC 29, Assistance Publique, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
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Picard L, Duceau B, Cambriel A, Voron T, Makoudi S, Tsai AS, Yazid L, Soulier A, Paugam C, Lescot T, Bonnet F, Verdonk F. Risk factors for prolonged time to hospital discharge after ambulatory cholecystectomy under general anaesthesia. A retrospective cohort study. Int J Surg 2022; 104:106706. [PMID: 35697325 DOI: 10.1016/j.ijsu.2022.106706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although predictive models have already integrated demographic factors and comorbidities as risk factors for a prolonged hospital stay, factors related to anaesthesia management in ambulatory surgery have not been yet characterized. This study aims to identify anaesthetic factors associated with a prolonged discharge time in ambulatory surgery. METHODS All clinical records of patients who underwent ambulatory cholecystectomy in a French University Hospital (Hôpital Saint Antoine, Paris) between January 1st, 2012 and December 31st, 2018 were retrospectively reviewed. The primary endpoint was the discharge time, defined as the time between the end of surgery and discharge. A multivariable Cox proportional-hazards model was fitted to investigate the factors associated with a prolonged discharge time. RESULTS Five hundred and thirty-five (535) patients were included. The median time for discharge was 150 min (interquartile range - IQR [129-192]). A bivariable analysis highlighted a positive correlation between discharge timeline and the doses-weight of ketamine and sufentanil. In the multivariable Cox proportional hazards model analysis, the anaesthesia-related factors independently associated with prolonged discharge time were the dose-weight of ketamine in interaction with the dose weight of sufentanil (HR 0.10 per increment of 0.1 mg/kg of ketamine or 0.2 μg/kg of sufentanil, CI 95% [0.01-0.61], p = 0.013) and the non-use of a non-steroidal anti-inflammatory drug (NSAID) (HR 0.81 [0.67-0.98], p = 0.034). Twenty patients (4%) had unscheduled hospitalization following surgery. CONCLUSION Anaesthesia management, namely the use of ketamine and the non-use of NSAID, affects time to hospital discharge.
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Affiliation(s)
- Lucile Picard
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Baptiste Duceau
- Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière University Hospital, Sorbonne University, Public Hospitals of Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Amélie Cambriel
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Voron
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Saint Antoine University Hospital, Department of Digestive Surgery, Paris, France
| | - Sarah Makoudi
- Department of Anesthesiology, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - Amy S Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA
| | - Lassaad Yazid
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Soulier
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles Paugam
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francis Bonnet
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA; Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Birnbaum R, Bitton R, Pirracchio R, Féral-Pierssens AL, Constant AL, Dubost C, Chousterman B, Lescot T, Lortat-Jacob B, Harrois A, Abback PS, Belbachir A, Basto E, Castier Y, Laitselart P, Carli P, Lapostolle F, Tourtier JP, Langlois M, Raux M, Mounier R. Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries. Anaesth Crit Care Pain Med 2021; 40:100908. [PMID: 34174462 DOI: 10.1016/j.accpm.2021.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to assess the incidence and the risk factors for secondary wound infections associated to high-energy ammunition injuries (HEAI) in the cohort of civilian casualties from the 2015 terrorist attacks in Paris. METHODS This retrospective multi-centric study included casualties presenting at least one HEAI who underwent surgery during the first 48 h following hospital admission. HEAI-associated infection was defined as a wound infection occurring within the initial 30 days following trauma. Risk factors were assessed using univariate and multivariate analysis. RESULTS Among the 200 included victims, the rate of infected wounds was 11.5%. The median time between admission and the surgical revision for secondary wound infection was 11 days [IQR 9-20]. No patient died from an infectious cause. Infections were polymicrobial in 44% of the cases. The major risk factors for secondary wound infection were ISS (p < 0.001), SAPS II (p < 0.001), MGAP (p < 0.001), haemorrhagic shock (p = 0.003), use of vasopressors (p < 0.001), blood transfusion (p < 0.001), abdominal penetrating trauma (p = 0.003), open fracture (p = 0.01), vascular injury (p = 0.001), duration of surgery (p = 0.009), presence of surgical material (p = 0.01). In the multivariate analysis, the SAPS II score (OR 1.07 [1.014-1.182], p = 0.019) and the duration of surgery (OR 1.005 [1.000-1.012], p = 0.041) were the only risk factors identified. CONCLUSION We report an 11.5% rate of secondary wound infection following high-energy ammunition injuries. Risk factors were an immediately severe condition and a prolonged surgery.
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Affiliation(s)
- Ron Birnbaum
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Rudy Bitton
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Anne-Laure Féral-Pierssens
- Emergency Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Laure Constant
- Anaesthesia and Intensive Care Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clément Dubost
- Intensive Care Unit, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Benjamin Chousterman
- Anaesthesia and Intensive Care Department, Paris-Nord University, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Anaesthesia and Intensive Care Department, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brice Lortat-Jacob
- Anaesthesia and Intensive Care Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anatole Harrois
- Anaesthesia and Intensive Care Department, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Paer-Selim Abback
- Anaesthesia and Intensive Care Department, Paris-Nord University, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Anissa Belbachir
- Anaesthesia and Intensive Care Department, Paris-Centre University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Basto
- Anaesthesia and Intensive Care Department, Paris-Nord University, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Thoracic and Vascular Surgery Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Laitselart
- Anaesthesia and Intensive Care Department, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Carli
- SAMU de Paris, Anaesthesia and Intensive Care Unit Department, Paris-Centre University, Necker Hospital, Paris, France
| | - Frédéric Lapostolle
- SAMU 93, UF Research-Teaching-Quality, Paris-Nord University, Avicenne Hospital, Bobigny, France, INSERM U942, Sorbonne University, Paris, France
| | | | | | - Mathieu Raux
- Anaesthesia and Intensive Care Department, Paris-Sorbonne University, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Roman Mounier
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; Paris-Est Créteil University, INSERM U955, Team 15, Créteil, France
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8
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Asehnoune K, Le Moal C, Lebuffe G, Le Penndu M, Josse NC, Boisson M, Lescot T, Faucher M, Jaber S, Godet T, Leone M, Motamed C, David JS, Cinotti R, El Amine Y, Liutkus D, Garot M, Marc A, Le Corre A, Thomasseau A, Jobert A, Flet L, Feuillet F, Pere M, Futier E, Roquilly A. Effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery: multicentre, double blind, randomised controlled trial. BMJ 2021; 373:n1162. [PMID: 34078591 PMCID: PMC8171383 DOI: 10.1136/bmj.n1162] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery. DESIGN Phase III, randomised, double blind, placebo controlled trial. SETTING 34 centres in France, December 2017 to March 2019. PARTICIPANTS 1222 adults (>50 years) requiring major non-cardiac surgery with an expected duration of more than 90 minutes. The anticipated time frame for recruitment was 24 months. INTERVENTIONS Participants were randomised to receive either dexamethasone (0.2 mg/kg immediately after the surgical procedure, and on day 1) or placebo. Randomisation was stratified on the two prespecified criteria of cancer and thoracic procedure. MAIN OUTCOMES MEASURES The primary outcome was a composite of postoperative complications or all cause mortality within 14 days after surgery, assessed in the modified intention-to-treat population (at least one treatment administered). RESULTS Of the 1222 participants who underwent randomisation, 1184 (96.9%) were included in the modified intention-to-treat population. 14 days after surgery, 101 of 595 participants (17.0%) in the dexamethasone group and 117 of 589 (19.9%) in the placebo group had complications or died (adjusted odds ratio 0.81, 95% confidence interval 0.60 to 1.08; P=0.15). In the stratum of participants who underwent non-thoracic surgery (n=1038), the primary outcome occurred in 69 of 520 participants (13.3%) in the dexamethasone group and 93 of 518 (18%) in the placebo group (adjusted odds ratio 0.70, 0.50 to 0.99). Adverse events were reported in 288 of 613 participants (47.0%) in the dexamethasone group and 296 of 609 (48.6%) in the placebo group (P=0.46). CONCLUSIONS Dexamethasone was not found to significantly reduce the incidence of complications and death in patients 14 days after major non-cardiac surgery. The 95% confidence interval for the main result was, however, wide and suggests the possibility of important clinical effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT03218553.
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Affiliation(s)
- Karim Asehnoune
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - Charlene Le Moal
- Service d'Anesthésie, Centre Hospitalier Le Mans, Le Mans, France
| | - Gilles Lebuffe
- Centre Hospitalier Universitaire (CHU) Lille, Pôle Anesthésie Réanimation, Lille, France
| | - Marguerite Le Penndu
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | | | - Matthieu Boisson
- CHU de Poitiers, Université de Poitiers, Service d'Anesthésie-Réanimation, Poitiers, France
| | - Thomas Lescot
- Hôpital Saint Antoine, Service d'Anesthésie Réanimation Chirurgicale, Assistance publique des hôpitaux de Paris, Paris, France
| | - Marion Faucher
- Institut Paoli Calmette, Service d'Anesthésie, Marseille, France
| | - Samir Jaber
- Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Thomas Godet
- Service d'Anesthésie et Réanimation, Hôpital Estaing, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Marc Leone
- Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Cyrus Motamed
- Département d'Anesthésie & VVC, Gustave Roussy Cancer Center, Villejuif, France
| | - Jean Stephane David
- Service d'Anesthésie Réanimation, Groupe Hospitalier Sud, Civils de Lyon, Pierre Benite, France
| | - Raphael Cinotti
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Guillaume et René Laennec, Saint-Herblain, France
| | | | - Darius Liutkus
- Service d'Anesthésie, Centre Hospitalier Le Mans, Le Mans, France
| | - Matthias Garot
- Centre Hospitalier Universitaire (CHU) Lille, Pôle Anesthésie Réanimation, Lille, France
| | - Antoine Marc
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - Anne Le Corre
- Service d'Anesthésie, Hôpital Privé du Confluent, Nantes, France
| | - Alexandre Thomasseau
- CHU de Poitiers, Université de Poitiers, Service d'Anesthésie-Réanimation, Poitiers, France
| | - Alexandra Jobert
- CHU de Nantes, Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Nantes, France
| | - Laurent Flet
- CHU Nantes, Service Pharmacie, Hôtel Dieu, Nantes, France
| | - Fanny Feuillet
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France
| | - Morgane Pere
- CHU de Nantes, Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Nantes, France
| | - Emmanuel Futier
- Service d'Anesthésie et Réanimation, Hôpital Estaing, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Antoine Roquilly
- CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
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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).
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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
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Lescot T. Covid 19 – Journal de Bord – 25 mars 2020 – La création d’une réanimation éphémère – Entretien avec Thomas Lescot. La Presse Médicale Formation 2020. [PMCID: PMC7194993 DOI: 10.1016/j.lpmfor.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Futier E, Garot M, Godet T, Biais M, Verzilli D, Ouattara A, Huet O, Lescot T, Lebuffe G, Dewitte A, Cadic A, Restoux A, Asehnoune K, Paugam-Burtz C, Cuvillon P, Faucher M, Vaisse C, El Amine Y, Beloeil H, Leone M, Noll E, Piriou V, Lasocki S, Bazin JE, Pereira B, Jaber S. Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery: The FLASH Randomized Clinical Trial. JAMA 2020; 323:225-236. [PMID: 31961418 PMCID: PMC6990683 DOI: 10.1001/jama.2019.20833] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE It is not known if use of colloid solutions containing hydroxyethyl starch (HES) to correct for intravascular deficits in high-risk surgical patients is either effective or safe. OBJECTIVE To evaluate the effect of HES 130/0.4 compared with 0.9% saline for intravascular volume expansion on mortality and postoperative complications after major abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, parallel-group, randomized clinical trial of 775 adult patients at increased risk of postoperative kidney injury undergoing major abdominal surgery at 20 university hospitals in France from February 2016 to July 2018; final follow-up was in October 2018. INTERVENTIONS Patients were randomized to receive fluid containing either 6% HES 130/0.4 diluted in 0.9% saline (n = 389) or 0.9% saline alone (n = 386) in 250-mL boluses using an individualized hemodynamic algorithm during surgery and for up to 24 hours on the first postoperative day, defined as ending at 7:59 am the following day. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or major postoperative complications at 14 days after surgery. Secondary outcomes included predefined postoperative complications within 14 days after surgery, durations of intensive care unit and hospital stays, and all-cause mortality at postoperative days 28 and 90. RESULTS Among 826 patients enrolled (mean age, 68 [SD, 7] years; 91 women [12%]), 775 (94%) completed the trial. The primary outcome occurred in 139 of 389 patients (36%) in the HES group and 125 of 386 patients (32%) in the saline group (difference, 3.3% [95% CI, -3.3% to 10.0%]; relative risk, 1.10 [95% CI, 0.91-1.34]; P = .33). Among 12 prespecified secondary outcomes reported, 11 showed no significant difference, but a statistically significant difference was found in median volume of study fluid administered on day 1: 1250 mL (interquartile range, 750-2000 mL) in the HES group and 1500 mL (interquartile range, 750-2150 mL) in the saline group (median difference, 250 mL [95% CI, 83-417 mL]; P = .006). At 28 days after surgery, 4.1% and 2.3% of patients had died in the HES and saline groups, respectively (difference, 1.8% [95% CI, -0.7% to 4.3%]; relative risk, 1.76 [95% CI, 0.79-3.94]; P = .17). CONCLUSIONS AND RELEVANCE Among patients at risk of postoperative kidney injury undergoing major abdominal surgery, use of HES for volume replacement therapy compared with 0.9% saline resulted in no significant difference in a composite outcome of death or major postoperative complications within 14 days after surgery. These findings do not support the use of HES for volume replacement therapy in such patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02502773.
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Affiliation(s)
- Emmanuel Futier
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Matthias Garot
- CHU de Lille, Pôle Anesthésie Réanimation, Hôpital Claude Huriez, Lille, France
| | - Thomas Godet
- CHU de Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France
| | - Matthieu Biais
- CHU de Bordeaux, Département Anesthésie et Réanimation, Hôpital Pellegrin, Bordeaux, France
| | - Daniel Verzilli
- CHU Montpellier, Département Anesthésie et Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Montpellier, France
| | - Alexandre Ouattara
- CHU de Bordeaux, Service Anesthésie et Réanimation, Centre Medico-chirugical Magellan, Bordeaux, France
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Olivier Huet
- CHU de Brest, Département Anesthésie et Réanimation, Hôpital La cavale Blanche, Brest, France
| | | | - Gilles Lebuffe
- CHU de Lille, Pôle Anesthésie Réanimation, Hôpital Claude Huriez, Lille, France
| | - Antoine Dewitte
- CHU de Bordeaux, Service Anesthésie et Réanimation, Centre Medico-chirugical Magellan, Bordeaux, France
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Anna Cadic
- CHU de Brest, Département Anesthésie et Réanimation, Hôpital La cavale Blanche, Brest, France
| | - Aymeric Restoux
- AP-HP, Département Anesthésie et Réanimation, Hôpital Beaujon, Clichy, Paris, France
| | - Karim Asehnoune
- CHU de Nantes, Département Anesthésie et Réanimation, Hôpital Hôtel Dieu, Nantes, France
| | | | - Philippe Cuvillon
- CHU de Nîmes, Section d’Anesthésie, Département Anesthésie et Réanimation, Nîmes, France
| | - Marion Faucher
- Institut Paoli Calmettes, Département Anesthésie et Réanimation, Marseille, France
| | - Camille Vaisse
- Assistance Publique Hôpitaux de Marseille (AP-HM), Service Anesthésie et Réanimation, Hôpital Timone, Marseille, France
| | - Younes El Amine
- Centre Hospitalier de Valenciennes, Département Anesthésie et Réanimation, Valenciennes, France
| | - Hélène Beloeil
- Université de Rennes, Inserm, INRA, CHU Rennes, CIC 1414, Numecan, Pôle Anesthésie et Réanimation, Rennes, France
| | - Marc Leone
- AP-HM, Service Anesthésie et Réanimation, Hôpital Nord, Université Aix Marseille, Marseille, France
| | - Eric Noll
- Hôpitaux Universitaires de Strasbourg, Service d’Anesthésie Réanimation Chirurgicale, Hôpital Hautepierre, Strasbourg, France
| | - Vincent Piriou
- Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Service d’Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Lyon, France
| | | | - Jean-Etienne Bazin
- CHU de Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Samir Jaber
- CHU Montpellier, Département Anesthésie et Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Montpellier, France
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Montravers P, Kantor E, Constantin JM, Lefrant JY, Lescot T, Nesseler N, Paugam C, Jabaudon M, Dupont H. Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study. Crit Care 2019; 23:393. [PMID: 31805988 PMCID: PMC6896276 DOI: 10.1186/s13054-019-2681-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
Background Recent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP. Methods Using a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model. Results In this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057). Conclusions High proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.
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Affiliation(s)
- Philippe Montravers
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, 48 rue Henri Huchard, F-75018, Paris, France. .,Université de Paris, Paris, France. .,INSERM UMR 1152 - Université de Paris, Paris, France.
| | - Elie Kantor
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, 48 rue Henri Huchard, F-75018, Paris, France.,Université de Paris, Paris, France
| | - Jean-Michel Constantin
- Département de Médecine Post-opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Jean-Yves Lefrant
- Division of Anaesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, and EA 2992, Université Montpellier, Nîmes, France
| | - Thomas Lescot
- Department of Anaesthesia and Critical Care, Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Nicolas Nesseler
- Surgical Intensive Care Unit, Hôpital Pontchaillou, and Inserm U 991, Université de Rennes 1, Rennes, France
| | - Catherine Paugam
- Université de Paris, Paris, France.,Department of Anaesthesiology and Critical Care Medicine, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Jabaudon
- Département de Médecine Post-opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Hervé Dupont
- Medical and Surgical ICU, Amiens University Hospital and INSERM U1088, University of Picardy Jules Verne, Amiens, France
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13
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Pardo E, Lescot T. Nutrition entérale intermittente en réanimation. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Lefrant JY, Lorne E, Asehnoune K, Ausset S, Beaulieu P, Biais M, Brichant JF, Charbit B, Constantin JM, Cuvillon P, Dadure C, Dahmani S, David JS, Fuchs-Buder T, Geeraerts T, Godier A, Hanouz JL, Joannes-Boyau O, Kipnis E, Laudenbach V, Le Guen M, Legrand M, Lescot T, Marret E, Mongardon N, Ouattara A, Pierre S, Roberts J, Schneider A, Tourtier JP, Tran L, Pirracchio R, Capdevila X. Determining the editorial policy of Anaesthesia Critical Care and Pain Medicine (ACCPM). Anaesth Crit Care Pain Med 2019; 37:299-301. [PMID: 30055826 DOI: 10.1016/j.accpm.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jean-Yves Lefrant
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Université de Montpellier-Nîmes, CHU de Nîmes, 30029 Nîmes, France.
| | - Emmanuel Lorne
- Department of Anesthesiology, Amiens University Hospital, avenue René-Laennec, 80054 Amiens cedex 01, France
| | - Karim Asehnoune
- Department of Anaesthesia and Intensive Care Unit, Nantes Hotel-Dieu University Hospital, place Alexis-Ricordeau, 44000 Nantes, France
| | - Sylvain Ausset
- Department of Anaesthesia and Intensive care, Hôpital d'Instruction des Armées, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Pierre Beaulieu
- Department of Anaesthesiology and Pain Medicine, CHUM, 1000, rue St-Denis, H2X 0C1 Montréal, Québec, Canada
| | - Matthieu Biais
- Department of Anaesthesia and Intensive Care, Pellegrin Hospital, place Amélie-Raba-Leon, 33076 Bordeaux, France
| | - Jean-François Brichant
- Department of Anaesthesia and Intensive Care, Liège University Hospital, 4000 Liège, Belgium
| | - Beny Charbit
- Department of Anaesthesia and Intensive Care, Robert-Debré Hospital, avenue du Général Koenig, 51092 Reims, France
| | - Jean-Michel Constantin
- Department of Anaesthesia and Intensive Care, Estaing University Hospital, 1, place Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Philippe Cuvillon
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Université de Montpellier-Nîmes, CHU de Nîmes, 30029 Nîmes, France
| | - Christophe Dadure
- Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, Robert-Debré Hospital, boulevard Serurier, 75019 Paris, France
| | - Jean-Stéphane David
- Department of Anaesthesia and Intensive Care, South Lyon University Hospital, 165, chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - Thomas Fuchs-Buder
- Department of Anaesthesia and Intensive Care, Nancy University Hospital, rue Morvan, 54511 Vandoeuvres-les-Nancy, France
| | - Thomas Geeraerts
- Department of Anaesthesia and Intensive Care, Pierre-Paul-Riquet Hospital, place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9, France
| | - Anne Godier
- Fondation Adolphe-de-Rotschild, 25, rue Manin, 75019 Paris, France
| | - Jean-Luc Hanouz
- Department of Anaesthesia and Intensive Care, Caen University Hospital, avenue de la côte de Nacre, 41033 Caen, France
| | - Olivier Joannes-Boyau
- Department of Anaesthesia and Intensive Care, Magellan University Hospital, 1, avenue de Magellan, 33600 Pessac, France
| | - Eric Kipnis
- Department of Anaesthesia and Intensive Care, Lille University Hospital, 1, rue Michel-Polonowski, 59037 Lille, France
| | - Vincent Laudenbach
- Charles Nicole University Hospital, 1, rue de Germont, 76031 Rouen, France
| | | | - Matthieu Legrand
- Department of Anaesthesia and Intensive Care, Saint-Louis Hospital, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Thomas Lescot
- Department of Anaesthesia and Intensive Care, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Emmanuel Marret
- American Hospital of Paris, 63, boulevard Victor-Hugo, 92200 Neuilly, France
| | - Nicolas Mongardon
- Henri Mondor University Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Alexandre Ouattara
- Department of Anaesthesia and Intensive care, Bordeaux University Hospital, 12, rue Dubernat, 33404 Talence, France
| | - Sébastien Pierre
- IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Jason Roberts
- Bruns Trauma and Critical Care Research Centre, University of Queensland, Royal Brisbane and Women's Hospital Herston Qld, 4029 Brisbane, Australia
| | - Antoine Schneider
- Intensive Care Unit, Vaudois Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Pierre Tourtier
- Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Laurie Tran
- Pasteur 2 Hospital, 30, voie Romaine, 06001 Nice cedex 1, France
| | - Romain Pirracchio
- Georges-Pompidou European Hospital, 20, rue Leblanc, 75015 Paris, France
| | - Xavier Capdevila
- Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
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Taverny G, Lescot T, Pardo E, Thonon F, Maarouf M, Alberti C. Outcomes used in randomised controlled trials of nutrition in the critically ill: a systematic review. Crit Care 2019; 23:12. [PMID: 30642377 PMCID: PMC6332589 DOI: 10.1186/s13054-018-2303-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/26/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND No evidence exists to date on which to base the selection of outcome measures for assessing nutritional interventions in critically ill patients. We conducted a systematic literature review to describe the outcomes used in recent randomised controlled trials (RCTs) assessing nutritional interventions in critically ill patients. Our objective was to set the foundation for the development of a core set of outcome measures for use in future RCTs. METHODS We searched the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for RCTs of nutritional interventions in critically ill patients aged 18 years or older, published and/or registered between January 2000 and August 2018. Outcomes were divided into six categories (mortality, length of stay, duration of organ dysfunction, complications, functional outcomes, and others) and analysed according to the study characteristics and publication year. RESULTS Of the 885 references retrieved, 170 were included in the review. Of these, 136 (80%) defined a primary outcome, 114 (67%) defined secondary outcomes (two per study on average), and 34 (20%) did not specify whether outcomes were primary or secondary. We identified 24 different outcomes in all, of which 19 were primary. Complications were the most widely used primary outcome (65/136, 48%). Mortality was the primary outcome in 17/136 (13%) studies, with six different timepoints. The main secondary outcomes were length of stay (90/114, 79%), mortality (82/114, 72%), and duration of organ dysfunction (75/114, 65%). CONCLUSIONS This systematic review highlights the heterogeneity of outcomes used in recent randomized controlled trials evaluating nutritional interventions in critically ill patients. The results of our systematic review may have implications for designing future RCTs of nutritional interventions in the ICU.
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Affiliation(s)
- Garry Taverny
- Paris Diderot University, Sorbonne Paris-Cité, INSERM U1123, Paris, France.,Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, CHU Robert Debré, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Sorbonne Université, UPMC Univ Paris 06, Paris, France.
| | - Emmanuel Pardo
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frederique Thonon
- EA 7334 REMES (Recherche Clinique ville hôpital, Méthodologies et Sociétés), Paris Diderot University, Paris, France
| | - Manar Maarouf
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Corinne Alberti
- Paris Diderot University, Sorbonne Paris-Cité, INSERM U1123, Paris, France.,Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, CHU Robert Debré, Paris, France
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16
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Affiliation(s)
- Thomas Lescot
- Sorbonne Université, department of anaesthesiology and critical care, Saint-Antoine hospital, assistance publique Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine 75012 Paris, France.
| | - Jean Charles Preiser
- Department of intensive care, Erasme university hospital, université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
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Pardo E, El Behi H, Boizeau P, Verdonk F, Alberti C, Lescot T. Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients. BMC Anesthesiol 2018; 18:205. [PMID: 30591032 PMCID: PMC6309087 DOI: 10.1186/s12871-018-0647-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [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: 08/28/2018] [Accepted: 11/22/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Muscle wasting in critically ill patients is associated with negative clinical outcomes. Ultrasound quadriceps femoris muscle assessment may constitute a convenient tool to evaluate muscle wasting. Nevertheless, its reliability remains uncertain. Our primary aim was to study the intra- and inter-observer reliability of this technique. Our secondary aim was to assess the evolution of the quadriceps muscle during the first 3 weeks after ICU admission and its possible association with nutritional intake. METHODS This observational study included patients expected to stay more than 7 days in the ICU. Ultrasound quadriceps muscle thickness was measured with a 12 MHz linear transducer, by two trained physicians, on D1, D3, D5, D7 and D21. Two measurements sites were evaluated: on the midpoint or on the two-thirds of the length between the anterior superior iliac spine and the upper border of the patella. Intra and inter-observer reliability was assessed by calculating the intra-class correlation coefficient (ICC). RESULTS A total of 280 ultrasound quadriceps thickness measurements were performed on 29 critically ill patients. Intra-observer reliability's ICC was 0.74 [95% CI 0.63; 0.84] at the "midpoint" site and 0.83 [95% CI 0.75; 0.9] at the "two-thirds" site. Inter-observer reliability's ICC was 0.76 [95% CI, 0.66; 0.86] at the "midpoint" site and 0.81 [95% CI, 0.7; 0.9] at the "two-thirds" site. Quadriceps femoris muscle thickness decreased over 16% within the first week after ICU admission. No correlation was found between muscle loss and caloric (p = 0.96) or protein (p = 0.80) debt over the first week. CONCLUSION The assessment by ultrasonography of the quadriceps muscle thickness reveals good intra- and inter-observer reliability and may constitute a promising tool to evaluate the effect of nutritional-based interventions on muscle wasting in critically ill patients. TRIAL REGISTRATION "Committee for the Protection of Human Subjects in Biomedical Research" - Paris Ile de France VI Pitié-Salpêtrière - 10/07/2014. French Data Protection Committee ("Commission Nationale Informatique et Libertés") - #1771144.
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Affiliation(s)
- Emmanuel Pardo
- Anesthesiology and Critical Care Department, Saint-Antoine Hospital, Assistance publique-hôpitaux de Paris, Paris, France
| | - Hanen El Behi
- Anesthesiology and Critical Care Department, Saint-Antoine Hospital, Assistance publique-hôpitaux de Paris, Paris, France
| | - Priscilla Boizeau
- AP-HP, Inserm, Université de Paris Diderot, Sorbonne Paris Cité, Hôpital Robert Debré, Unité d’épidémiologie clinique, CIC-EC 1426, Paris, France
| | - Franck Verdonk
- Anesthesiology and Critical Care Department, Saint-Antoine Hospital, Assistance publique-hôpitaux de Paris, Paris, France
- Sorbonne Universités, UPMC Université de Paris 06, Paris, France
| | - Corinne Alberti
- AP-HP, Inserm, Université de Paris Diderot, Sorbonne Paris Cité, Hôpital Robert Debré, Unité d’épidémiologie clinique, CIC-EC 1426, Paris, France
| | - Thomas Lescot
- Anesthesiology and Critical Care Department, Saint-Antoine Hospital, Assistance publique-hôpitaux de Paris, Paris, France
- Sorbonne Universités, UPMC Université de Paris 06, Paris, France
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18
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Darrivere L, Lapidus N, Colignon N, Chafai N, Chaput U, Verdonk F, Paye F, Lescot T. Minimally invasive drainage in critically ill patients with severe necrotizing pancreatitis is associated with better outcomes: an observational study. Crit Care 2018; 22:321. [PMID: 30466472 PMCID: PMC6249885 DOI: 10.1186/s13054-018-2256-x] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/04/2018] [Indexed: 12/17/2022]
Abstract
Background Infected pancreatic necrosis, which occurs in about 40% of patients admitted for acute necrotizing pancreatitis, requires combined antibiotic therapy and local drainage. Since 2010, drainage by open surgical necrosectomy has been increasingly replaced by less invasive methods such as percutaneous radiological drainage, endoscopic necrosectomy, and laparoscopic surgery, which proved effective in small randomized controlled trials in highly selected patients. Few studies have evaluated minimally invasive drainage methods used under the conditions of everyday hospital practice. The aim of this study was to determine whether, compared with conventional open surgery, minimally invasive drainage was associated with improved outcomes of critically ill patients with infection complicating acute necrotizing pancreatitis. Methods A single-center observational study was conducted in patients admitted to the intensive care unit for severe acute necrotizing pancreatitis to compare the characteristics, drainage techniques, and outcomes of the 62 patients managed between September 2006 and December 2010, chiefly with conventional open surgery, and of the 81 patients managed between January 2011 and August 2015 after the introduction of a minimally invasive drainage protocol. Results Surgical necrosectomy was more common in the early period (74% versus 41%; P <0.001), and use of minimally invasive drainage increased between the early and late periods (19% and 52%, respectively; P <0.001). The numbers of ventilator-free days and catecholamine-free days by day 30 were higher during the later period. The proportions of patients discharged from intensive care within the first 30 days and from the hospital within the first 90 days were higher during the second period. Hospital mortality was not significantly different between the early and late periods (19% and 22%, respectively). Conclusion In our study, the implementation of a minimally invasive drainage protocol in patients with infected pancreatic necrosis was associated with shorter times spent with organ dysfunction, in the intensive care unit, and in the hospital. Mortality was not significantly different. These results should be interpreted bearing in mind the limitations inherent in the before-after study design.
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Affiliation(s)
- Lucie Darrivere
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathanael Lapidus
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Public Health Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nikias Colignon
- Radiology Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Najim Chafai
- Digestive Surgery Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ulriikka Chaput
- Endoscopy Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Sorbonne University, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Paye
- Sorbonne University, Digestive Surgery Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Sorbonne University, Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Bensignor T, Lefevre JH, Creavin B, Chafai N, Lescot T, Hor T, Debove C, Paye F, Balladur P, Tiret E, Parc Y. Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and Mortality, a Cohort of 191 Patients. World J Surg 2018; 42:3589-3598. [PMID: 29850950 DOI: 10.1007/s00268-018-4687-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/09/2023]
Abstract
BACKGROUND Postoperative peritonitis (POP) following gastrointestinal surgery is associated with significant morbidity and mortality, with no clear management option proposed. The aim of this study was to report our surgical management of POP and identify pre- and perioperative risk factors for morbidity and mortality. METHODS All patients with POP undergoing relaparotomy in our department between January 2004 and December 2013 were included. Pre- and perioperative data were analyzed to identify predictors of morbidity and mortality. RESULTS A total of 191 patients required relaparotomy for POP, of which 16.8% required >1 reinterventions. The commonest cause of POP was anastomotic leakage (66.5%) followed by perforation (20.9%). POP was mostly treated by anastomotic takedown (51.8%), suture with derivative stoma (11.5%), enteral resection and stoma (12%), drainage of the leak (8.9%), stoma on perforation (8.4%), duodenal intubation (7.3%) or intubation of the leak (3.1%). The overall mortality rate was 14%, of which 40% died within the first 48 h. Major complications (Dindo-Clavien > 2) were seen in 47% of the cohort. Stoma formation occurred in 81.6% of patients following relaparotomy. Independent risk factors for mortality were: ASA > 2 (OR = 2.75, 95% CI = 1.07-7.62, p = 0.037), multiorgan failure (MOF) (OR = 5.22, 95% CI = 2.11-13.5, p = 0.0037), perioperative transfusion (OR = 2.7, 95% CI = 1.05-7.47, p = 0.04) and upper GI origin (OR = 3.55, 95% CI = 1.32-9.56, p = 0.013). Independent risk factors for morbidity were: MOF (OR = 2.74, 95% CI = 1.26-6.19, p = 0.013), upper GI origin (OR = 3.74, 95% CI = 1.59-9.44, p = 0.0034) and delayed extubation (OR = 0.27, 95% CI = 0.14-0.55, p = 0.0027). CONCLUSION Mortality following POP remains a significant issue; however, it is decreasing due to effective and aggressive surgical intervention. Predictors of poor outcomes will help tailor management options.
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Affiliation(s)
- Thierry Bensignor
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Jérémie H Lefevre
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Ben Creavin
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Najim Chafai
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Thomas Lescot
- Department of Surgical Intensive Care, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Thévy Hor
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Clotilde Debove
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - François Paye
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Pierre Balladur
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Emmanuel Tiret
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Yann Parc
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
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Pardo E, Rocheteau P, Briand D, Lescot T, Chrétien F. Beneficial effects of whey protein supplementation on muscle metabolism in a mouse model of sepsis. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1592] [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: 11/24/2022]
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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.
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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
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Beaussier M, Parc Y, Guechot J, Cachanado M, Rousseau A, Lescot T. Ropivacaine preperitoneal wound infusion for pain relief and prevention of incisional hyperalgesia after laparoscopic colorectal surgery: a randomized, triple-arm, double-blind controlled evaluation vs intravenous lidocaine infusion, the CATCH study. Colorectal Dis 2018; 20:509-519. [PMID: 29352518 DOI: 10.1111/codi.14021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/20/2017] [Indexed: 02/08/2023]
Abstract
AIM The abdominal incision for specimen extraction could trigger postoperative pain after laparoscopic colorectal resections (LCRs). Continuous wound infusion (CWI) of ropivacaine may be a valuable option for postoperative analgesia. This study was undertaken to evaluate the potential benefits of ropivacaine CWI on pain relief, metabolic stress reaction, prevention of wound hyperalgesia and residual incisional pain after LCR. A subgroup with intravenous lidocaine infusion (IVL) was added to discriminate between the peripheral and systemic effects of local anaesthetic infusions. METHOD Patients were randomly allocated to three subgroups: CWI (0.2% ropivacaine 10 ml/h for 48 h); IVL (lidocaine 1.5% at 4 ml/h for 48 h); control group. RESULTS In all, 95 patients were randomized (86 patients analysed). Postoperative pain intensity did not differ significantly between groups. Within the first 24 h after surgery, morphine requirement was significantly lower in the CWI group compared with the IVL group, but there was no significant difference compared with the control group (P = 0.02 and P = 0.15, respectively). The area of hyperalgesia did not differ significantly between subgroups, nor did the hyperalgesia ratio which was 1.2 cm (0.0-6.7) vs 1.9 cm (0.4-4.0) vs 2.0 cm (0.5-7.0) in the CWI, IVL and control groups respectively (P = 0.35). The number of patients reporting residual incisional pain after 3 months (3/26 vs 4/23 vs 4/23 in the CWI, IVL and control groups respectively) did not differ significantly between the groups, nor did their metabolic stress reactions. CONCLUSION Ropivacaine CWI at the site of the abdominal incision did not provide any significant benefit either on analgesia or on the prevention of wound hyperalgesia after LCR.
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Affiliation(s)
- M Beaussier
- Department of Anaesthesiology and Critical Care Medicine, St-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - Y Parc
- Department of Digestive Surgery, St-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - J Guechot
- Department of Biology, St-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | - M Cachanado
- Unité de Recherche Clinique de l'Est Parisien (URC-Est), Paris, France
| | - A Rousseau
- Unité de Recherche Clinique de l'Est Parisien (URC-Est), Paris, France
| | - T Lescot
- Department of Anaesthesiology and Critical Care Medicine, St-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Universités, Paris, France
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Montravers P, Tubach F, Lescot T, Veber B, Esposito-Farèse M, Seguin P, Paugam C, Lepape A, Meistelman C, Cousson J, Tesniere A, Plantefeve G, Blasco G, Asehnoune K, Jaber S, Lasocki S, Dupont H. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Med 2018; 44:300-310. [PMID: 29484469 DOI: 10.1007/s00134-018-5088-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown. METHODS A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomisation (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multidrug-resistant (MDR) bacteria and reoperation rate, with 45-day follow-up. RESULTS Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6-20] vs 12 [6-13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99-6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI - 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or reoperation rate, while subsequent drainages between day 8 and day 45 were observed following short-course ABT (P = 0.041). CONCLUSION Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit. CLINICALTRIALS. GOV IDENTIFIER NCT01311765.
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Affiliation(s)
- Philippe Montravers
- Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, INSERM, UMR 1152, Paris Diderot Sorbonne Cite University, Paris, France.
- Département d'Anesthésie-Réanimation, CHU Bichat Claude Bernard, 48 rue Henri Huchard, 75018, Paris, France.
| | - Florence Tubach
- Département de Biostatistique, Santé Publique et Information Médicale (BIOSPIM), Hôpital Pitié-Salpêtrière, AP-HP, INSERM, UMR 1123, ECEVE, CIC-EC 1425, Sorbonne Universités, UPMC Univ Paris 06, 75013, Paris, France
| | - Thomas Lescot
- Department of Anaesthesiology and Critical Care Medicine, St Antoine Hospital, APHP, Sorbonne Universites, UPMC Univ Paris 06, Paris, France
| | - Benoit Veber
- Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France
| | - Marina Esposito-Farèse
- INSERM CIC-EC 1425, Unité de Recherche Clinique, HUPNVS, CHU Bichat-Claude Bernard, APHP, Paris, France
| | - Philippe Seguin
- Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Rennes, Rennes, France
| | - Catherine Paugam
- Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Beaujon, Clichy, Paris Diderot Sorbonne Cite University, Paris, France
| | - Alain Lepape
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | | | - Joel Cousson
- Pôle Anesthésie-Réanimation, CHU Reims, Reims, France
| | - Antoine Tesniere
- Surgical Intensive Care Unit, CHU Cochin, Paris Descartes University, Paris, France
| | | | - Gilles Blasco
- Service d'Anesthésie Réanimation Chirurgicale, CHU Besancon, Besançon, France
| | - Karim Asehnoune
- Service d'Anesthésie et Réanimation Chirurgicale, Hotel Dieu, CHU Nantes, Nantes, France
| | - Samir Jaber
- Service d'Anesthésie Réanimation, Hopital St Eloi, CHU Montpellier, Montpellier, France
| | - Sigismond Lasocki
- Département d'Anesthésie Réanimation, CHU Angers, L'UBL, Université d'Angers, Angers, France
| | - Herve Dupont
- Critical Care Medicine Department, Amiens University Hospital, INSERM U1088, University of Picardy Jules Verne, Amiens, France
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Mateo J, Payen D, Ghout I, Vallée F, Lescot T, Welschbillig S, Tazarourte K, Azouvi P, Weiss JJ, Aegerter P, Vigué B. Impact of extended monitoring-guided intensive care on outcome after severe traumatic brain injury: A prospective multicentre cohort study (PariS-TBI study). Brain Inj 2017; 31:1642-1650. [PMID: 28925746 DOI: 10.1080/02699052.2017.1370554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We evaluated whether an integrated monitoring with systemic and specific monitoring affect mortality and disability in adults with severe traumatic brain injury (sTBI). METHODS Adults with severeTBI (Glasgow Coma Scale [GCS] ≤ 8) admitted alive in intensive care units (ICUs) were prospectively included. Primary endpoints were in-hospital 30-day mortality and extended Glasgow outcome score (GOSE) at 3 years. Association with the intensity of monitoring and outcome was studied by comparing a high level of monitoring (HLM) (systemic and ≥3 specific monitoring) and low level of monitoring (LLM) (systemic and 0-2 specific monitoring) and using inverse probability weighting procedure. RESULTS 476 patients were included and IPW was used to improve the balance between the two groups of treatments (HLM/LMM). Overall hospital mortality (at 30 days) was 43%, being significantly lower in HLM than LLM group (27% vs. 53%: RR, 1.63: 95% CI: 1.23-2.15). The 14-day hospital mortality was also lower in the HLM group than expected, based upon the CRASH prediction model (35%). At 3 years, disability was not significantly different between the monitoring groups. CONCLUSIONS After adjustment, HLM group improved short-term mortality but did not show any improvement in the 3-year outcome compared with LLM.
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Affiliation(s)
- Joaquim Mateo
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Didier Payen
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Idir Ghout
- b Unité de Recherche Clinique Paris-Ouest , Hôpital Ambroise Paré, AP-HP , Boulogne , France
| | - Fabrice Vallée
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Thomas Lescot
- c Department of Anesthesiology and Critical Care , Pitié-Salpêtrière University Hospital, APHP, University Paris 6 , Paris , France
| | - Stephane Welschbillig
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Karim Tazarourte
- d SAMU 77, Mobile Care Unit , Marc Jacquet Hospital , Melun , France
| | - Philippe Azouvi
- e Department of Physical Medicine and Rehabilitation , Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris , Garches , France
| | - Jean-Jacques Weiss
- f Department of Public Health , Centre Ressources Francilien du Traumatisme Crânien , Paris , France
| | - Philippe Aegerter
- g UMR-S 1168, INSERM , Université Versailles St-Quentin , Paris , France
| | - Bernard Vigué
- h Department of Anesthesiology and Intensive Care , Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Sud , Le Kremlin Bicêtre , France
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Boddaert G, Mordant P, Le Pimpec-Barthes F, Martinod E, Aguir S, Leprince P, Raux M, Couëtil JP, Fiore A, Lescot T, Malgras B, Pons F, Castier Y. Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015. Eur J Cardiothorac Surg 2017; 51:1195-1202. [DOI: 10.1093/ejcts/ezx036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
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Ghrenassia E, Guihot A, Dong Y, Robinet P, Fontaine T, Lacombe K, Lescot T, Meyohas MC, Elbim C. First Report of CD4 Lymphopenia and Defective Neutrophil Functions in a Patient with Amebiasis Associated with CMV Reactivation and Severe Bacterial and Fungal Infections. Front Microbiol 2017; 8:203. [PMID: 28243230 PMCID: PMC5303735 DOI: 10.3389/fmicb.2017.00203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/27/2017] [Indexed: 11/20/2022] Open
Abstract
We report the case of a patient with acute necrotizing colitis due to invasive amebiasis associated with CD4 lymphopenia and impaired neutrophil responses. The course of the disease was characterized by CMV reactivation and severe and recurrent bacterial and fungal infections, which might be related to the decreased CD4 T cell count and the impaired functional capacities of neutrophils, respectively. The clinical outcome was positive with normalization of both CD4 cell count and neutrophil functions.
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Affiliation(s)
- Etienne Ghrenassia
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales Paris, France
| | - Amélie Guihot
- Département d'Immunologie, AP-HP, Hôpital Pitié-SalpêtrièreParis, France; DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universités, UPMC Univ Paris 06Paris, France; Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-ParisParis, France
| | - Yuan Dong
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Saint-Antoine, UMR-S 938 Paris, France
| | - Pauline Robinet
- DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universités, UPMC Univ Paris 06Paris, France; Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-ParisParis, France
| | | | - Karine Lacombe
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales Paris, France
| | - Thomas Lescot
- Unité de Réanimation Chirurgicale Digestive, Département D'anesthésie et de Réanimation Chirurgicale, AP-HP, Hôpital Saint-Antoine Paris, France
| | - Marie-Caroline Meyohas
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales Paris, France
| | - Carole Elbim
- DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universités, UPMC Univ Paris 06Paris, France; Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-ParisParis, France
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, Rodriguez J, Taddei M, Di Bari M, Hickmann C, Castanares-Zapatero D, Sayed FE, Deldicque L, Van Den Bergh P, Caty G, Roeseler J, Francaux M, Laterre PF, Dupuis B, Machayeckhi S, Sarfati C, Moore A, Dinh A, Mendialdua P, Rodet E, Pilorge C, Stephan F, Rezaiguia-Delclaux S, Dugernier J, Hesse M, Jumetz T, Bialais E, Depoortere V, Charron C, Michotte JB, Wittebole X, Jamar F, Geri G, Vieillard-Baron A, Repessé X, Kallel H, Mayence C, Houcke S, Guegueniat P, Hommel D, Dhifaoui K, Hajjej Z, Fatnassi A, Sellami W, Labbene I, Ferjani M, Dachraoui F, Nakkaa S, M’ghirbi A, Adhieb A, Braiek DB, Hraiech K, Ousji A, Ouanes I, Zaineb H, Abdallah SB, Ouanes-Besbes L, Abroug F, Klein S, Miquet M, Thouret JM, Peigne V, Daban JL, Boutonnet M, Lenoir B, Merhbene T, Derreumaux C, Seguin T, Conil JM, Kelway C, Blasco V, Nafati C, Harti K, Reydellet L, Albanese J, Aicha NB, Meddeb K, Khedher A, Ayachi J, Fraj N, Sma N, Chouchene I, Boussarsar M, Yedder SB, Samoud W, Radhouene B, Mariem B, Ammar A, Cheikh AB, Lakhal HB, Khelfa M, Hamdaoui Y, Bouafia N, Trampont T, Daix T, Legarçon V, Karam HH, Pichon N, Essafi F, Foudhaili N, Thabet H, Blel Y, Brahmi N, Ezzouine H, Kerrous M, Haoui SE, Ahdil S, Benslama A, Abidi K, Dendane T, Oussama S, Belayachi J, Madani N, Abouqal R, Zeggwagh AA, Ghadhoune H, Chaari A, Jihene G, Allouche H, Trabelsi I, Brahmi H, Samet M, Ghord HE, Habiba BSA, Hajer N, Tilouch N, Yaakoubi S, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Arcizet J, Leroy B, Abdulmalack C, Renzullo C, Hamet M, Doise JM, Coutet J, Cheikh CM, Quechar Z, Joris M, Beauport DT, Kontar L, Lebon D, Gruson B, Slama M, Marolleau JP, Maizel J, Gorham J, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP, Guillot M, Ledoux MP, Braun T, Maestraggi Q, Michard B, Castelain V, Herbrecht R, Schneider F, Couffin S, Lobo D, Mongardon N, Dhonneur G, Mounier R, Le Borgne P, Couraud S, Herbrecht JE, Boivin A, Lefebvre F, Bilbault P, Zelmat SA, Batouche DD, Mazour F, Chaffi B, Benatta N, Sik AH, Talik I, Perrier M, Gouteix E, Koubi C, Escavy A, Guilbaut V, Fosse JP, Jazia RB, Abdelghani A, Cungi PJ, Bordes J, Nguyen C, Pierrou C, Cruc M, Benois A, Duprez F, Bonus T, Cuvelier G, Ollieuz S, Machayekhi S, Paciorkowski F, Reychler G, Coudroy R, Thille AW, Drouot X, Diaz V, Meurice JC, Robert R, Turki O, Ben HC, Assefi M, Deransy R, Brisson H, Monsel A, Conti F, Scatton O, Langeron O, Ghezala HB, Snouda S, Ben CI, Kaddour M, Armel A, Youness L, Abdelhak B, Youssef M, Najib AH, Mustapha A, Noufel M, Mohamed Z, Salma EK, Ghizlane M, Mohamed B, Benyounes R, Montini F, Moschietto S, Gregoire E, Claisse G, Guiot J, Morimont P, Krzesinski JM, Mariat C, Lambermont B, Cavalier E, Delanaye P, Benbernou S, Ilies S, Azza A, Bouyacoub K, Louail M, Mokhtari-Djebli H, Arrestier R, Daviaud F, Francois XL, Brocas E, Choukroun G, Peñuelas O, Lorente JA, Cardinal-Fernandez P, Rodriguez JM, Aramburu JA, Esteban A, Frutos-Vivar F, Bitker L, Costes N, Le Bars D, Lavenne F, Devouassoux M, Richard JC, Mechati M, Gainnier M, Papazian L, Guervilly C, Garnero A, Arnal JM, Roze H, Richard JC, Repusseau B, Dewitte A, Joannes-Boyau O, Ouattara A, Harbouze N, Amine AM, Olandzobo AG, Herbland A, Richard M, Girard N, Lambron L, Lesieur O, Wainschtein S, Hubert S, Hugues A, Tran M, Bouillard P, Loteanu V, Leloup M, Laurent A, Lheureux F, Prestifilippo A, Cruz MDM, Romain R, Antonelli M, Blanch TL, Bonnetain F, Grazzia-Bocci M, Mancebo J, Samain E, Paul H, Capellier G, Zavgorodniaia T, Soichot M, Malissin I, Voicu S, Garçon P, Goury A, Kerdjana L, Deye N, Bourgogne E, Megarbane B, Mejri O, Hmida MB, Tannous S, Chevillard L, Labat L, Risede P, Fredj H, Léger M, Brunet M, Le Roux G, Boels D, Lerolle N, Farah S, Amiel-Niemann H, Kubis N, Declèves X, Peyraux N, Baud F, Serafini M, Alvarez JC, Heinzelman A, Jozwiak M, Millasseau S, Teboul JL, Alphonsine JE, Depret F, Richard N, Attal P, Richard C, Monnet X, Chemla D, Jerbi S, Khedhiri W, Necib H, Scarfo P, Chevalier C, Piagnerelli M, Lafont A, Galy A, Mancia C, Zerhouni A, Tabeliouna K, Gaja A, Hamrouni B, Malouch A, Fourati S, Messaoud R, Zarrouki Y, Ziadi A, Rhezali M, Zouizra Z, Boumzebra D, Samkaoui MA, Brunet J, Canoville B, Verrier P, Ivascau C, Seguin A, Valette X, Du Cheyron D, Daubin C, Bougouin W, Aissaoui N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Dumas F, Marijon E, Jouven X, Cariou A, Poirson F, Chaput U, Beeken T, Maxime L, Haikel O, Vodovar D, Chelly J, Marteau P, Chocron R, Juvin P, Loeb T, Adnet F, Lecarpentier E, Riviere A, De Cagny B, Soupison T, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Leteurtre S, Fresco M, Bubenheim M, Beduneau G, Carpentier D, Grange S, Artaud-Macari E, Misset B, Tamion F, Girault C, Dumas G, Chevret S, Lemiale V, Mokart D, Mayaux J, Pène F, Nyunga M, Perez P, Moreau AS, Bruneel F, Vincent F, Klouche K, Reignier J, Rabbat A, Azoulay E, Frat JP, Ragot S, Constantin JM, Prat G, Mercat A, Boulain T, Demoule A, Devaquet J, Nseir S, Charpentier J, Argaud L, Beuret P, Ricard JD, Teiten C, Marjanovic N, Palamin N, L’Her E, Bailly A, Boisramé-Helms J, Champigneulle B, Kamel T, Mercier E, Le Thuaut A, Lascarrou JB, Rolle A, De Jong A, Chanques G, Jaber S, Hariri G, Baudel JL, Dubée V, Preda G, Bourcier S, Joffre J, Bigé N, Ait-Oufella H, Maury E, Mater H, Merdji H, Grimaldi D, Rousseau C, Mira JP, Chiche JD, Sedghiani I, Benabderrahim A, Hamdi D, Jendoubi A, Cherif MA, Hechmi YZE, Zouheir J, Bagate F, Bousselmi R, Schortgen F, Asfar P, Guérot E, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Dreyfuss D, Radermacher P, Frère A, Martin-Lefèvre L, Colin G, Fiancette M, Henry-Laguarrigue M, Lacherade JC, Lebert C, Vinatier I, Yehia A, Joret A, Menunier-Beillard N, Benzekri-Lefevre D, Desachy A, Bellec F, Plantefève G, Quenot JP, Meziani F, Tavernier E, Ehrmann S, Chudeau N, Raveau T, Moal V, Houillier P, Rouve E, Lakhal K, Gandonnière CS, Jouan Y, Bodet-Contentin L, Balmier A, Messika J, De Montmollin E, Pouyet V, Sztrymf B, Thiagarajah A, Roux D, De Chambrun MP, Luyt CE, Beloncle F, Zapella N, Ledochowsky S, Terzi N, Mazou JM, Sonneville R, Paulus S, Fedun Y, Landais M, Raphalen JH, Combes A, Amoura Z, Jacquemin A, Guerrero F, Marcheix B, Hernandez N, Fourcade O, Georges B, Delmas C, Makoudi S, Genton A, Bernard R, Lebreton G, Amour J, Mazet C, Bounes F, Murat G, Cronier L, Robin G, Biendel C, Silva S, Boubeche S, Abriou C, Wurtz V, Scherrer V, Rey N, Gastaldi G, Veber B, Doguet F, Gay A, Dureuil B, Besnier E, Rouget A, Gantois G, Magalhaes E, Wanono R, Smonig R, Lermuzeaux M, Lebut J, Olivier A, Dupuis C, Radjou A, Mourvillier B, Neuville M, D’ortho MP, Bouadma L, Rouvel-Tallec A, Rudler M, Weiss N, Perlbarg V, Galanaud D, Thabut D, Rachdi E, Mhamdi G, Trifi A, Abdelmalek R, Abdellatif S, Daly F, Nasri R, Tiouiri H, Lakhal SB, Rousseau G, Asmolov R, Grammatico-Guillon L, Auvet A, Laribi S, Garot D, Dequin PF, Guillon A, Fergé JL, Abgrall G, Hinault R, Vally S, Roze B, Chaplain A, Chabartier C, Savidan AC, Marie S, Cabie A, Resiere D, Valentino R, Mehdaoui H, Benarous L, Soda-Diop M, Bouzana F, Perrin G, Bourenne J, Eon B, Lambert D, Trebuchon A, Poncelet G, Le Bourgeois F, Michael L, Camille G, Naudin J, Deho A, Dauger S, Sauthier M, Bergeron-Gallant K, Emeriaud G, Jouvet P, Tiebergien N, Jacquet-Lagrèze M, Fellahi JL, Baudin F, Essouri S, Javouhey E, Guérin C, Lampin M, Mamouri O, Devos P, Karaca-Altintas Y, Vinchon M, Brossier D, Eltaani R, Teyssedre S, Sabine M, Bouchut JC, Peguet O, Petitdemange L, Guilbert AS, Aoul NT, Addou Z, Aouffen N, Anas B, Kalouch S, Yaqini K, Chlilek A, Abdou R, Gravellier P, Chantreuil J, Travers N, Listrat A, Le Reun C, Favrais G, Coppere Z, Blanot S, Montmayeur J, Bronchard R, Rolando S, Orliaguet G, Leger PL, Rambaud J, Thueux E, De Larrard A, Berthelot V, Denot J, Reymond M, Amblard A, Morin-Zorman S, Lengliné E, Pichereau C, Mariotte E, Emmanuel C, Poujade J, Trumpff G, Janssen-Langenstein R, Harlay ML, Zaid N, Ait-Ammar N, Bonnal C, Merle JC, Botterel F, Levesque E, Riad Z, Mezidi M, Yonis H, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Louis B, Forel JM, Bisbal M, Lehingue S, Rambaud R, Adda M, Hraiech S, Marchi E, Roch A, Guerin V, Rozencwajg S, Schmidt M, Hekimian G, Bréchot N, Trouillet JL, Besset S, Franchineau G, Nieszkowska A, Pascal L, Loiselle M, Sarah C, Laurence D, Guillemette T, Jacquens A, Kerever S, Guidet B, Aegerter P, Das V, Fartoukh M, Hayon J, Desmard M, Fulgencio JP, Zuber B, Soufi A, Khaleq K, Hamoudi D, Garret C, Peron M, Coron E, Bretonnière C, Audureau E, Audrey W, Christophe D, Christian J, Daniel A, Cyrille F, Aissaoui W, Rghioui K, Haddad W, Barrou H, Carteaux-Taeib A, Lupinacci R, Manceau G, Jeune F, Tresallet C, Habacha S, Fathallah I, Zoubli A, Aloui R, Kouraichi N, Jouet E, Badin J, Fermier B, Feller M, Serie M, Pillot J, Marie W, Gisbert-Mora C, Vinclair C, Lesbordes P, Mathieu P, De Brabant F, Muller E, Robaux MA, Giabicani M, Marchalot A, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Meunier-Beillard N, Devilliers H, Rigaud JP, Verrière C, Ardisson F, Kentish-Barnes N, Jacq G, Chermak A, Lautrette A, Legrand M, Soummer A, Thiery G, Cottereau A, Canet E, Caujolle M, Allyn J, Valance D, Brulliard C, Martinet O, Jabot J, Gallas T, Vandroux D, Allou N, Durand A, Nevière R, Delguste F, Boulanger E, Preau S, Martin R, Cochet H, Ponthus JP, Amilien V, Tchir M, Barsam E, Ayoub M, Georger JF, Guillame I, Assaraf J, Tripon S, Mallet M, Barbara G, Louis G, Gaudry S, Barbarot N, Jamet A, Outin H, Gibot S, Bollaert PE, Holleville M, Legriel S, Chateauneuf AL, Cavelot S, Moyer JD, Bedos JP, Merle P, Laine A, Natalie DS, Cornuault M, Libot J, Asehnoune K, Rozec B, Dantal J, Videcoq M, Degroote T, Jaillette E, Zerimech F, Malika B, Llitjos JF, Amara M, Lacave G, Pangon B, Mavinga J, Makunza JN, Mafuta ME, Yanga Y, Eric A, Ilunga J, Kilembe M, Alby-Laurent F, Toubiana J, Mokline A, Laajili A, Amri H, Rahmani I, Mensi N, Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bernard D, Brandely A, Scatton O, Schoeffler P, Futier E, Lescot T, Beaussier M. Positive end-expiratory pressure does not decrease cardiac output during laparoscopic liver surgery: A prospective observational evaluation. HPB (Oxford) 2017; 19:36-41. [PMID: 27889250 DOI: 10.1016/j.hpb.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/25/2016] [Accepted: 10/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) has beneficial pulmonary effects but may worsen the hemodynamic repercussions induced by pneumoperitoneum (PNP) in patients undergoing laparoscopic liver resection. However, by increasing intraluminal vena cava (VC) pressures, PEEP may prevent PNP-induced VC collapse. The aim of this study was to test the validity of this hypothesis. METHODS After IRB approval and written informed consent, 20 patients were evaluated prospectively. Measurements were performed before and after the application of 10 cmH2O PEEP on patients without PNP (Control group) and during a 12 cmH20 PNP. Results are provided as means [95%CI]. Comparison used paired-sample t test. RESULTS PEEP induced a decrease in CI in Control subgroup (2.3 [2.0-2.6] and 2.1 [1.8-2.4] l min-1 m-2 before and after PEEP. P < 0.05). In contrast, PEEP on a pre-established PNP did not significantly modify cardiac index (CI). Transmural pressure on the abdominal vena cava decreased with PNP but was partly reversed by the addition of PEEP. CONCLUSION The application of PEEP on a pre-established PNP during laparoscopic liver resection in normovolemic patients did not decrease CI. Analysis of transmural VC pressure variations confirms that the addition of PEEP may prevent the vena caval collapse induced by PNP.
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Affiliation(s)
- Denis Bernard
- Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France
| | - Antoine Brandely
- Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, St-Antoine University Hospital, Paris, France
| | - Pierre Schoeffler
- Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Lescot
- Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology and Critical Care Medicine, St-Antoine University Hospital, Paris, France.
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Debout C, Lescot T, Loyer F, Ambrosino F. [Prescribing, the perspectives of health professionals]. Soins 2016; 61:46-49. [PMID: 27814807 DOI: 10.1016/j.soin.2016.08.009] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While, in France, various health professionals are authorised to prescribe, they approach this activity in a different way, depending on the professional category to which they belong. The areas and products concerned are specific to each profession, and inevitably evolve. This article presents the different perspectives of a doctor, a midwife and a nurse.
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Affiliation(s)
- Christophe Debout
- c/o Revue Soins, Elsevier Masson, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France.
| | - Thomas Lescot
- Réanimation chirurgicale digestive, Département d'anesthésie-réanimation, Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Frédérique Loyer
- c/o Revue Soins, Elsevier Masson, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France
| | - Florence Ambrosino
- c/o Revue Soins, Elsevier Masson, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France
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Jaber S, Lescot T, Futier E, Paugam-Burtz C, Seguin P, Ferrandiere M, Lasocki S, Mimoz O, Hengy B, Sannini A, Pottecher J, Abback PS, Riu B, Belafia F, Constantin JM, Masseret E, Beaussier M, Verzilli D, De Jong A, Chanques G, Brochard L, Molinari N. Effect of Noninvasive Ventilation on Tracheal Reintubation Among Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery: A Randomized Clinical Trial. JAMA 2016; 315:1345-53. [PMID: 26975890 DOI: 10.1001/jama.2016.2706] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE It has not been established whether noninvasive ventilation (NIV) reduces the need for invasive mechanical ventilation in patients who develop hypoxemic acute respiratory failure after abdominal surgery. OBJECTIVE To evaluate whether noninvasive ventilation improves outcomes among patients developing hypoxemic acute respiratory failure after abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, parallel-group clinical trial conducted between May 2013 and September 2014 in 20 French intensive care units among 293 patients who had undergone abdominal surgery and developed hypoxemic respiratory failure (partial oxygen pressure <60 mm Hg or oxygen saturation [SpO2] ≤90% when breathing room air or <80 mm Hg when breathing 15 L/min of oxygen, plus either [1] a respiratory rate above 30/min or [2] clinical signs suggestive of intense respiratory muscle work and/or labored breathing) if it occurred within 7 days after surgical procedure. INTERVENTIONS Patients were randomly assigned to receive standard oxygen therapy (up to 15 L/min to maintain SpO2 of 94% or higher) (n = 145) or NIV delivered via facial mask (inspiratory pressure support level, 5-15 cm H2O; positive end-expiratory pressure, 5-10 cm H2O; fraction of inspired oxygen titrated to maintain SpO2 ≥94%) (n = 148). MAIN OUTCOMES AND MEASURES The primary outcome was tracheal reintubation for any cause within 7 days of randomization. Secondary outcomes were gas exchange, invasive ventilation-free days at day 30, health care-associated infections, and 90-day mortality. RESULTS Among the 293 patients (mean age, 63.4 [SD, 13.8] years; n=224 men) included in the intention-to-treat analysis, reintubation occurred in 49 of 148 (33.1%) in the NIV group and in 66 of 145 (45.5%) in the standard oxygen therapy group within+ 7 days after randomization (absolute difference, -12.4%; 95% CI, -23.5% to -1.3%; P = .03). Noninvasive ventilation was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (25.4 vs 23.2 days; absolute difference, -2.2 days; 95% CI, -0.1 to 4.6 days; P = .04), while fewer patients developed health care-associated infections (43/137 [31.4%] vs 63/128 [49.2%]; absolute difference, -17.8%; 95% CI, -30.2% to -5.4%; P = .003). At 90 days, 22 of 148 patients (14.9%) in the NIV group and 31 of 144 (21.5%) in the standard oxygen therapy group had died (absolute difference, -6.5%; 95% CI, -16.0% to 3.0%; P = .15). There were no significant differences in gas exchange. CONCLUSIONS AND RELEVANCE Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days. These findings support use of NIV in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01971892.
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Affiliation(s)
- Samir Jaber
- Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Fouad Belafia
- Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France
| | | | | | | | - Daniel Verzilli
- Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France
| | - Audrey De Jong
- Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France
| | - Gerald Chanques
- Saint Eloi University Hospital and Montpellier School of Medicine, Research Unit INSERM U1046, Montpellier, France
| | | | - Nicolas Molinari
- Lapeyronie University Hospital and Montpellier School of Pharmacy, Research Unit IMAG U5149, Montpellier, France
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Bégneu E, Aïssou M, Lescot T, Cabane JP, Beaussier M. [Perioperative management of patients with systemic scleroderma]. ACTA ACUST UNITED AC 2014; 33:669-76. [PMID: 25447779 DOI: 10.1016/j.annfar.2014.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022]
Abstract
Systemic sclerosis (SSc) is an auto-immune disease characterized by vasculopathy and the combination of microangiopathy and tissue collagen deposit leading to skin, digestive, pulmonary, myocardial and renal injuries. These repercussions could be challenging for anesthesiologists and associated with difficulties in airway management, and occurrence of congestive right heart failure or acute kidney crisis. The aim of this review is to review the physiopathology and the progression of the SSc, as well as to provide a strategy of perioperative management of these patients.
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Affiliation(s)
- E Bégneu
- Département d'anesthésie réanimation, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - M Aïssou
- Département d'anesthésie réanimation, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - T Lescot
- Département d'anesthésie réanimation, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - J P Cabane
- Département d'anesthésie réanimation, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - M Beaussier
- Département d'anesthésie réanimation, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Tan V, Charachon A, Lescot T, Chafaï N, Le Baleur Y, Delchier JC, Paye F. Endoscopic transgastric versus surgical necrosectomy in infected pancreatic necrosis. Clin Res Hepatol Gastroenterol 2014; 38:770-6. [PMID: 25153999 DOI: 10.1016/j.clinre.2014.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/22/2014] [Accepted: 06/13/2014] [Indexed: 02/04/2023]
Abstract
Surgical necrosectomy, but is still associated with a high morbidity. Indications of the endoscopic route, a new less invasive technique are not defined yet. To compare characteristics and clinical outcome of patients treated by the two techniques, a bi-centric retrospective comparison of 21 patients treated by surgical necrosectomy in one center (group S) with 11 patients treated in another center by endoscopic transgastric necrosectomy (group E) was performed. Clinical severity scores were significantly higher in group S although CT severity score did not differ between groups. Acute postoperative complications including pancreatic fistula occurred more frequently in group S (86% vs. 27%, P=0.002). ICU and hospital length of stay were higher in group S (84 vs. 4 days; P=0.008 and 58 vs. 15 days; P=0.005 respectively). Long-term complication did not differ between groups. Compared to surgery, endoscopic necrosectomy exhibited lower rate of complications and reduced hospital length of stays. Endoscopic transgastric necrosectomy appears as a safe and effective procedure and has to be included in the therapeutic algorithm of infected pancreatic necrosis.
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Affiliation(s)
- Virianne Tan
- AP-HP, Saint-Antoine University Hospital, Department of Digestive Surgery, 75012 Paris, France
| | - Antoine Charachon
- AP-HP, Henri-Mondor University Hospital, Department of Gastroenterology, 94000 Créteil, France
| | - Thomas Lescot
- AP-HP, Saint-Antoine University Hospital, Surgical Intensive Care Unit, 75012 Paris, France; UPMC University Paris 06, 75005 Paris, France
| | - Najim Chafaï
- AP-HP, Saint-Antoine University Hospital, Department of Digestive Surgery, 75012 Paris, France
| | - Yann Le Baleur
- AP-HP, Henri-Mondor University Hospital, Department of Gastroenterology, 94000 Créteil, France
| | - Jean-Charles Delchier
- AP-HP, Henri-Mondor University Hospital, Department of Gastroenterology, 94000 Créteil, France
| | - François Paye
- AP-HP, Saint-Antoine University Hospital, Department of Digestive Surgery, 75012 Paris, France; UPMC University Paris 06, 75005 Paris, France.
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Beaussier M, Genty T, Lescot T, Aissou M. Influence of pain on postoperative ventilatory disturbances. Management and expected benefits. ACTA ACUST UNITED AC 2014; 33:484-6. [DOI: 10.1016/j.annfar.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Noelker C, Morel L, Osterloh A, Alvarez-Fischer D, Lescot T, Breloer M, Gold M, Oertel WH, Henze C, Michel PP, Dodel RC, Lu L, Hirsch EC, Hunot S, Hartmann A. Heat shock protein 60: an endogenous inducer of dopaminergic cell death in Parkinson disease. J Neuroinflammation 2014; 11:86. [PMID: 24886419 PMCID: PMC4018945 DOI: 10.1186/1742-2094-11-86] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 11/20/2013] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that inflammation associated with microglial cell activation in the substantia nigra (SN) of patients with Parkinson disease (PD) is not only a consequence of neuronal degeneration, but may actively sustain dopaminergic (DA) cell loss over time. We aimed to study whether the intracellular chaperone heat shock protein 60 (Hsp60) could serve as a signal of CNS injury for activation of microglial cells. METHODS Hsp60 mRNA expression in the mesencephalon and the striatum of C57/BL6 mice treated with MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) and the Hsp60/TH mRNA ratios in the SN of PD patients and aged-matched subjects were measured. To further investigate a possible link between the neuronal Hsp60 response and PD-related cellular stress, Hsp60 immunoblot analysis and quantification in cell lysates from SH-SY5Y after treatment with 100 μM MPP+ (1-methyl-4-phenylpyridinium) at different time points (6, 12, 24 and 48 hours) compared to control cells were performed. Additional MTT and LDH assay were used. We next addressed the question as to whether Hsp60 influences the survival of TH+ neurons in mesencephalic neuron-glia cultures treated either with MPP+ (1 μM), hHsp60 (10 μg/ml) or a combination of both. Finally, we measured IL-1β, IL-6, TNF-α and NO-release by ELISA in primary microglial cell cultures following treatment with different hHsp60 preparations. Control cultures were exposed to LPS. RESULTS In the mesencephalon and striatum of mice treated with MPTP and also in the SN of PD patients, we found that Hsp60 mRNA was up-regulated. MPP+, the active metabolite of MPTP, also caused an increased expression and release of Hsp60 in the human dopaminergic cell line SH-SY5Y. Interestingly, in addition to being toxic to DA neurons in primary mesencephalic cultures, exogenous Hsp60 aggravated the effects of MPP+. Yet, although we demonstrated that Hsp60 specifically binds to microglial cells, it failed to stimulate the production of pro-inflammatory cytokines or NO by these cells. CONCLUSIONS Overall, our data suggest that Hsp60 is likely to participate in DA cell death in PD but via a mechanism unrelated to cytokine release.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Stéphane Hunot
- CR-ICM, INSERM UMR_S1127, Université Pierre et Marie Curie Paris 06 UMR_S1127, CNRS UMR 7225, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France.
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Bonnot B, Nion-Larmurier I, Desaint B, Chafai N, Paye F, Beaussier M, Lescot T. Fatal gas embolism after endoscopic transgastric necrosectomy for infected necrotizing pancreatitis. Am J Gastroenterol 2014; 109:607-8. [PMID: 24698875 DOI: 10.1038/ajg.2013.473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Benjamin Bonnot
- Anesthesiology and Critical Care, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - Isabelle Nion-Larmurier
- Gastroenterology, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - Benoit Desaint
- Gastroenterology, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - Najim Chafai
- Digestive Surgery; Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - François Paye
- Digestive Surgery; Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - Marc Beaussier
- Anesthesiology and Critical Care, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - Thomas Lescot
- Anesthesiology and Critical Care, Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
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Jourdan C, Bosserelle V, Azerad S, Ghout I, Bayen E, Aegerter P, Weiss JJ, Mateo J, Lescot T, Vigué B, Tazarourte K, Pradat-Diehl P, Azouvi P. Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): Results from the PariS-TBI study. Brain Inj 2013; 27:1000-7. [DOI: 10.3109/02699052.2013.794971] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paye F, Lupinacci RM, Kraemer A, Lescot T, Chafaï N, Tiret E, Balladur P. Surgical treatment of severe pancreatic fistula after pancreaticoduodenectomy by wirsungostomy and repeat pancreatico-jejunal anastomosis. Am J Surg 2013; 206:194-201. [PMID: 23706258 DOI: 10.1016/j.amjsurg.2012.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/09/2012] [Accepted: 10/03/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND After pancreaticoduodenectomy, severe pancreatic fistula may require salvage relaparotomy in patients with largely disrupted pancreaticojejunal anastomosis. Completion pancreatectomy remains the gold standard but yields high mortality and severe long-term repercussions. The authors report the results of a pancreas-preserving strategy used in this life-threatening condition. METHODS Two hundred fifty-four pancreaticoduodenectomies with pancreaticojejunal anastomosis were performed between 2005 and 2011; 21 patients underwent salvage relaparotomy for grade C pancreatic fistula. Largely dehiscent pancreaticojejunal anastomoses were dismantled in 16 patients. Four patients underwent completion pancreatectomy, whereas in 12 patients detailed here, the remaining pancreas was preserved and drained by wirsungostomy with exteriorization or closure of the jejunal stump. Repeat pancreaticojejunal anastomosis was later planned to preserve pancreatic function. RESULTS One patient died of recurrent hemorrhage on day 1 after wirsungostomy (8.3%). All but 1 survivor developed postoperative complications, and 3 needed reoperation before hospital discharge. The median hospital stay was 62 days (range, 29 to 156 days). After a median delay of 130 days (range, 91 to 240 days) from salvage relaparotomy, repeat pancreaticojejunostomy was attempted in 10 patients and was successful in 9 (1 completion pancreatectomy was performed). One patient died postoperatively (10%). Long-term endocrine function was unaltered in 66% of patients who benefited from this conservative strategy. CONCLUSIONS This pancreas-preserving strategy yielded a whole mortality rate of 17% for largely disrupted pancreaticojejunal anastomosis requiring salvage relaparotomy. It compares favorably with systematic completion pancreatectomy and achieved preservation of remnant pancreatic function in 75% of patients.
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Affiliation(s)
- François Paye
- Department of Digestive Surgery, Hospital Saint Antoine, Paris, France; Université Pierre et Marie Curie, UPMC Univ Paris 06, France.
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Noelker C, Morel L, Lescot T, Osterloh A, Alvarez-Fischer D, Breloer M, Henze C, Depboylu C, Skrzydelski D, Michel PP, Dodel RC, Lu L, Hirsch EC, Hunot S, Hartmann A. Toll like receptor 4 mediates cell death in a mouse MPTP model of Parkinson disease. Sci Rep 2013; 3:1393. [PMID: 23462811 PMCID: PMC3589722 DOI: 10.1038/srep01393] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [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: 05/29/2012] [Accepted: 01/18/2013] [Indexed: 01/18/2023] Open
Abstract
In mammalians, toll-like receptors (TLR) signal-transduction pathways induce the expression of a variety of immune-response genes, including inflammatory cytokines. It is therefore plausible to assume that TLRs are mediators in glial cells triggering the release of cytokines that ultimately kill DA neurons in the substantia nigra in Parkinson disease (PD). Accordingly, recent data indicate that TLR4 is up-regulated by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) treatment in a mouse model of PD. Here, we wished to evaluate the role of TLR4 in the acute mouse MPTP model of PD: TLR4-deficient mice and wild-type littermates control mice were used for the acute administration way of MPTP or a corresponding volume of saline. We demonstrate that TLR4-deficient mice are less vulnerable to MPTP intoxication than wild-type mice and display a decreased number of Iba1+ and MHC II+ activated microglial cells after MPTP application, suggesting that the TLR4 pathway is involved in experimental PD.
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Affiliation(s)
- Carmen Noelker
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France,Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Lydie Morel
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Thomas Lescot
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Anke Osterloh
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, 20324 Germany
| | - Daniel Alvarez-Fischer
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France,Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Minka Breloer
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, 20324 Germany
| | - Carmen Henze
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Candan Depboylu
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Delphine Skrzydelski
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Patrick P. Michel
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Richard C. Dodel
- Department of Neurology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Lixia Lu
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Etienne C. Hirsch
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Stéphane Hunot
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France,
| | - Andreas Hartmann
- INSERM UMR_S975, Université Pierre et Marie Curie Paris 06 UMR_S975, CNRS UMR 7225, CR-ICM, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France,
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Karvellas CJ, Lescot T, Goldberg P, Sharpe MD, Ronco JJ, Renner EL, Vahidy H, Poonja Z, Chaudhury P, Kneteman NM, Selzner M, Cook EF, Bagshaw SM. Liver transplantation in the critically ill: a multicenter Canadian retrospective cohort study. Crit Care 2013; 17:R28. [PMID: 23394270 PMCID: PMC4056692 DOI: 10.1186/cc12508] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/25/2013] [Indexed: 12/21/2022]
Abstract
Introduction Critically ill cirrhosis patients awaiting liver transplantation (LT) often receive prioritization for organ allocation. Identification of patients most likely to benefit is essential. The purpose of this study was to examine whether the Sequential Organ Failure Assessment (SOFA) score can predict 90-day mortality in critically ill recipients of LT and whether it can predict receipt of LT among critically ill cirrhosis listed awaiting LT. Methods We performed a multicenter retrospective cohort study consisting of two datasets: (a) all critically-ill cirrhosis patients requiring intensive care unit (ICU) admission before LT at five transplant centers in Canada from 2000 through 2009 (one site, 1990 through 2009), and (b) critically ill cirrhosis patients receiving LT from ICU (n = 115) and those listed but not receiving LT before death (n = 106) from two centers where complete data were available. Results In the first dataset, 198 critically ill cirrhosis patients receiving LT (mean (SD) age 53 (10) years, 66% male, median (IQR) model for end-stage liver disease (MELD) 34 (26-39)) were included. Mean (SD) SOFA scores at ICU admission, at 48 hours, and at LT were 12.5 (4), 13.0 (5), and 14.0 (4). Survival at 90 days was 84% (n = 166). In multivariable analysis, only older age was independently associated with reduced 90-day survival (odds ratio (OR), 1.07; 95% CI, 1.01 to 1.14; P = 0.013). SOFA score did not predict 90-day mortality at any time. In the second dataset, 47.9% (n = 106) of cirrhosis patients listed for LT died in the ICU waiting for LT. In multivariable analysis, higher SOFA at 48 hours after admission was independently associated with lower probability of receiving LT (OR, 0.89; 95% CI, 0.82 to 0.97; P = 0.006). When including serum lactate and SOFA at 48 hours in the final model, elevated lactate (at 48 hours) was also significantly associated with lower likelihood of receiving LT (0.32; 0.17 to 0.61; P = 0.001). Conclusions SOFA appears poor at predicting 90-day survival in critically ill cirrhosis patients after LT, but higher SOFA score and elevated lactate 48 hours after ICU admission are associated with a lower probability receiving LT. Older critically ill cirrhosis patients (older than 60) receiving LT have worse 90-day survival and should be considered for LT with caution.
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Lescot T, Boroli F, Reina V, Chauvet D, Boch AL, Puybasset L. Effect of continuous cerebrospinal fluid drainage on therapeutic intensity in severe traumatic brain injury. Neurochirurgie 2012; 58:235-40. [DOI: 10.1016/j.neuchi.2012.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 03/19/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
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Degos V, Lescot T, Icke C, Le Manach Y, Fero K, Sanchez P, Hadiji B, Zouaoui A, Boch AL, Abdennour L, Apfel CC, Puybasset L. Computed tomography-estimated specific gravity at hospital admission predicts 6-month outcome in mild-to-moderate traumatic brain injury patients admitted to the intensive care unit. Anesth Analg 2012; 114:1026-33. [PMID: 22366842 DOI: 10.1213/ane.0b013e318249fe7a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is clear that patients with a severe traumatic brain injury (TBI) develop secondary, potentially lethal neurological deterioration. However, it is difficult to predict which patients with mild-to-moderate TBI (MM-TBI), even after intensive care unit (ICU) admission, will experience poor outcome at 6 months. Standard computed tomography (CT) imaging scans provide information that can be used to estimate specific gravity (eSG). We have previously demonstrated that higher eSG measurements in the standard CT reading were associated with poor outcomes after severe TBI. The aim of this study was to determine whether eSG of the intracranial content predicts 6-month outcome in MM-TBI. METHODS We analyzed admission clinical and CT scan data (including eSG) of 66 patients with MM-TBI subsequently admitted to our neurosurgical ICU. Primary outcome was defined as a Glasgow Outcome Scale score of 1 to 3 after 6 months. Discriminating power (area under the receiver operating characteristic curve [ROC-AUC], 95% confidence interval) of eSG to predict 6-month poor outcome was calculated. The correlation of eSG with the main ICU characteristics was then compared. RESULTS Univariate and stepwise multivariate analyses showed an independent association between eSG and 6-month poor outcome (P = 0.001). ROC-AUC of eSG for the prediction of 6-month outcomes was 0.87 (confidence interval: 0.77-0.96). Admission eSG values were correlated with the main ICU characteristics, specifically 14-day mortality (P = 0.004), length of mechanical ventilation (P = 0.01), length of ICU stay (P = 0.045), and ICU procedures such as intracranial pressure monitoring (P < 0.001). CONCLUSIONS In this MM-TBI cohort admitted to the ICU, eSG of routine CT scans was correlated with mortality, ICU severity, and predicted 6-month poor outcome. An external validation with studies that include the spectrum of TBI severities is warranted to confirm our results.
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Affiliation(s)
- Vincent Degos
- Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Karvellas C, Lescot T, Vahidy H, Goldberg P, Chaudhury P, Metrakos P, Kneteman N, Meeberg G, Sharpe M, Ronco J, Renner E, Cook E, Bagshaw S. Liver transplantation in the critically ill: a Canadian collaboration. Crit Care 2012; 16. [PMCID: PMC3363813 DOI: 10.1186/cc11002] [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: 11/10/2022] Open
Affiliation(s)
| | - T Lescot
- Hôpital Saint-Antoine, Paris, France
| | - H Vahidy
- University of Alberta, Edmonton, Canada
| | | | | | | | | | - G Meeberg
- University of Alberta, Edmonton, Canada
| | - M Sharpe
- University of Western Ontario, London, Canada
| | - J Ronco
- University of British Columbia, Vancouver, Canada
| | | | - E Cook
- Harvard School of Public Health, Boston, MA, USA
| | - S Bagshaw
- University of Alberta, Edmonton, Canada
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Chhor V, Le Manach Y, Clarençon F, Nouet A, Daban JL, Abdennour L, Puybasset L, Lescot T. Admission risk factors for cerebral vasospasm in ruptured brain arteriovenous malformations: an observational study. Crit Care 2011; 15:R190. [PMID: 21831293 PMCID: PMC3387632 DOI: 10.1186/cc10345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 03/20/2011] [Revised: 06/25/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Cerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs). Here, our purpose was to identify risk factors for cerebral vasospasm after BAVM rupture in patients requiring intensive care unit (ICU) admission. Methods Patients admitted to our ICU from January 2003 to May 2010 for BAVM rupture were included in this observational study. Clinical, laboratory and radiological features from admission to ICU discharge were recorded. The primary endpoint was cerebral vasospasm by transcranial Doppler (TCD-VS) or cerebral infarction (CI) associated with vasospasm. Secondary endpoints included the Glasgow Outcome Scale (GOS) at ICU discharge. Results Of 2,734 patients admitted to our ICU during the study period, 72 (2.6%) with ruptured BAVM were included. TCD-VS occurred in 12 (17%) and CI in 6 (8%) patients. All patients with CI had a previous diagnosis of TCD-VS. A Glasgow Coma Scale score <8 was a risk factor for both TCD-VS (relative risk (RR), 4.7; 95% confidence interval (95% CI), 1.6 to 26) and CI (RR, 7.8; 95% CI, 0.1 to 63). Independent risk factors for TCD-VS by multivariate analysis were lower Glasgow Coma Scale score (odds ratio (OR) per unit decrease, 1.38; 95% CI, 1.13 to 1.80), female gender (OR, 4.86; 95% CI, 1.09 to 25.85), and younger age (OR per decade decrease, 1.39; 95% CI, 1.05 to 1.82). The risk of a poor outcome (GOS <4) at ICU discharge was non-significantly increased in the patients with TCD-VS (RR, 4.9; 95% CI, 0.7 to 35; P = 0.09). All six patients with CI had poor outcomes. Conclusions This is the first cohort study describing the incidence and risk factors for cerebral vasospasm after BAVM rupture. Larger studies are needed to investigate the significance of TCD-vasospasm and CI in these patients.
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Affiliation(s)
- Vibol Chhor
- Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie- Paris 6, 47-83 boulevard de l'hôpital, Paris 75651, France
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Chhor V, Karachi C, Bonnet AM, Puybasset L, Lescot T. Anesthésie et maladie de Parkinson. ACTA ACUST UNITED AC 2011; 30:559-68. [DOI: 10.1016/j.annfar.2011.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
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Lescot T, Reina V, Le Manach Y, Boroli F, Chauvet D, Boch AL, Puybasset L. In vivo accuracy of two intraparenchymal intracranial pressure monitors. Intensive Care Med 2011; 37:875-9. [PMID: 21359608 DOI: 10.1007/s00134-011-2182-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/04/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the in vivo accuracy of the new Pressio(®) device for intraparenchymal monitoring of intracranial pressure (ICP) versus the Codman(®) device and intraventricular measurement external ventricular drainage (EVD). METHODS Data were collected retrospectively for 30 consecutive patients admitted into a 25-bed neurosurgical intensive care unit of a university hospital between January and December 2009. Patients received both intraventricular and intraparenchymal ICP monitoring with Pressio(®) (n = 15) or Codman(®) (n = 15). RESULTS We obtained 3,089 data points from the 30 patients. Mean difference between intraparenchymal and EVD pressure (bias) was -0.6 mmHg, and limits of agreement (1.96 SD of the bias) were -8.1 to 6.9 mmHg with Pressio(®) and 0.3 mmHg with limits of agreement of -6.7 to 7.1 mmHg with Codman(®) (NS). The temporal difference was -0.7 ± 1.6 mmHg/100 h of monitoring with Pressio(®) and 0.1 ± 1.6 mmHg/100 h of monitoring with Codman(®) over the study period (NS). CONCLUSIONS Intraparenchymal pressure measured with both transducers approximates intraventricular cerebrospinal fluid pressure with an accuracy of ±7 mmHg.
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Affiliation(s)
- Thomas Lescot
- Anaesthesiology and Critical Care Department, Assistance Publique-Hôpitaux de Paris et Université Pierre et Marie Curie, Paris, France.
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Lescot T, Fulla-Oller L, Palmier B, Po C, Beziaud T, Puybasset L, Plotkine M, Gillet B, Meric P, Marchand-Leroux C. Effect of Acute Poly(ADP-Ribose) Polymerase Inhibition by 3-AB on Blood–Brain Barrier Permeability and Edema Formation after Focal Traumatic Brain Injury in Rats. J Neurotrauma 2010; 27:1069-79. [DOI: 10.1089/neu.2009.1188] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas Lescot
- Equipe de recherche “Pharmacologie de la Circulation Cérébrale” (EA 2510), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
- Réanimation neurochirurgicale–Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) et Université Pierre et Marie Curie, Paris, France
| | - Laurence Fulla-Oller
- Réanimation neurochirurgicale–Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) et Université Pierre et Marie Curie, Paris, France
- Laboratoire de Résonance Magnétique Nucléaire Biologique, Institut de Chimie des Substances Naturelles (ICSN) et Centre National de la Recherche Scientifique (CNRS), Gif sur Yvette, France
| | - Bruno Palmier
- Equipe de recherche “Pharmacologie de la Circulation Cérébrale” (EA 2510), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Christelle Po
- Laboratoire de Résonance Magnétique Nucléaire Biologique, Institut de Chimie des Substances Naturelles (ICSN) et Centre National de la Recherche Scientifique (CNRS), Gif sur Yvette, France
| | - Tiphaine Beziaud
- Equipe de recherche “Pharmacologie de la Circulation Cérébrale” (EA 2510), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Louis Puybasset
- Réanimation neurochirurgicale–Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) et Université Pierre et Marie Curie, Paris, France
| | - Michel Plotkine
- Equipe de recherche “Pharmacologie de la Circulation Cérébrale” (EA 2510), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Brigitte Gillet
- Laboratoire de Résonance Magnétique Nucléaire Biologique, Institut de Chimie des Substances Naturelles (ICSN) et Centre National de la Recherche Scientifique (CNRS), Gif sur Yvette, France
| | - Philippe Meric
- Laboratoire de Résonance Magnétique Nucléaire Biologique, Institut de Chimie des Substances Naturelles (ICSN) et Centre National de la Recherche Scientifique (CNRS), Gif sur Yvette, France
| | - Catherine Marchand-Leroux
- Equipe de recherche “Pharmacologie de la Circulation Cérébrale” (EA 2510), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
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Lescot T, Fulla-Oller L, Fulla-Oller L, Po C, Chen XR, Puybasset L, Gillet B, Plotkine M, Meric P, Marchand-Leroux C. Temporal and regional changes after focal traumatic brain injury. J Neurotrauma 2010; 27:85-94. [PMID: 19705964 DOI: 10.1089/neu.2009.0982] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Magnetic resonance imaging (MRI) is widely used to evaluate the consequences of traumatic brain injury (TBI) in both experimental and clinical studies. Improved assessment of experimental TBI using the same methods as those used in clinical investigations would help to translate laboratory research into clinical advances. Here our goal was to characterize lateral fluid percussion-induced TBI, with special emphasis on differentiating the contused cortex from the pericontusional subcortical tissue. We used both in vivo MRI and proton magnetic resonance spectroscopy ((1)H-MRS) to evaluate adult male Sprague-Dawley rats 24 h and 48 h and 7 days after TBI. T2 and apparent diffusion coefficient (ADC) maps were derived from T2-weighted and diffusion-weighted images, respectively. Ratios of N-acetylaspartate (NAA), choline compounds (Cho), and lactate (Lac) over creatine (Cr) were estimated by (1)H-MRS. T2 values were high in the contused cortex 24 h after TBI, suggesting edema development; ADC was low, consistent with cytotoxic edema. At the same site, NAA/Cr was decreased and Lac/Cr elevated during the first week after TBI. In the ipsilateral subcortical area, NAA/Cr was markedly decreased and Lac/Cr was elevated during the first week, although MRI showed no evidence of edema, suggesting that (1)H-MRS detected "invisible" damage. (1)H-MRS combined with MRI may improve the detection of brain injury. Extensive assessments of animal models may increase the chances of developing successful neuroprotective strategies.
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Affiliation(s)
- Thomas Lescot
- Equipe de recherche Pharmacologie de la Circulation Cérébrale (EA 2510), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France.
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Degos V, Lescot T, Puybasset L. Quantitative CT Scan and CT-Estimated Brain Specific Gravity in TBI. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Traumatic brain injury (TBI) occurs abruptly, involves multiple specialized teams, calls on the health-care system in its emergency dimension, and engages the well-being of the patient and his relatives for a lifetime period. Clinicians in charge of these patients are faced with issues of uppermost importance: medical issues such as predicting the long-term neurological outcome of the comatose patient; ethical issues because of the influence of intensive care on the long-term survival of patients in a vegetative and minimally conscious state; legal issues because of the law that has set the concept of proportionality of care as the legal rule; and social issues as the result of the very high cost of these pathologies. Today's larger availability of magnetic resonance imaging (MRI) in ventilated patients and the recent improvements in hardware and in imaging techniques that have made the last-developed imaging techniques such as diffusion tensor imaging and magnetic resonance spectroscopy available in brain-trauma patients, are changing the paradigm in neurointensive care regarding outcome prediction. The old paradigm that no individual prognosis could be made at the subacute phase in TBI patients does not hold true anymore. This major change opens new challenging ethical questions. This review focuses on the brain explorations that are required, such as MRI, magnetic resonance spectroscopy, and diffusion tensor imaging, to provide the clinician with a multimodal assessment of the brain state to predict outcome of coma. Such an assessment will become mandatory in the near future to answer the crucial question of proportionality of care in these patients.
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Affiliation(s)
- Thomas Lescot
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital and Pierre et Marie Curie University, Paris, France
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Degos V, Pereira AR, Lescot T, Sanchez-Peña P, Daoudi M, Zouaoui A, Coriat P, Puybasset L. Does brain swelling increase estimated specific gravity? Neurocrit Care 2008; 9:338-43. [PMID: 18818888 DOI: 10.1007/s12028-008-9131-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 07/21/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE At the acute phase of traumatic brain injury (TBI), brain swelling contributes substantially to the development of secondary neurological lesions. Elucidating the pathophysiology of brain swelling is crucial to improve TBI management. In a previous study, specific gravity (SG) of the noncontused hemisphere, as estimated by computed tomography (CT), was higher in patients with high Marshall CT scores and severe brain swelling. The aim of this study was to investigate the relationship between estimated specific gravity (eSG) and clinical variable suggestive of brain swelling. DESIGN Retrospective study of data from a prospectively established database. SETTING Neurology ICU in a teaching hospital in Paris, France. PARTICIPANTS We studied 20 patients with severe traumatic brain injury (TBI), 20 patients with high-grade subarachnoid hemorrhage (SAH) presenting similar brain-swelling criteria, 20 patients with low-grade SAH, and 20 healthy controls. INTERVENTIONS None. MEASUREMENTS AND RESULTS Estimated brain specific gravity was acquired from CT images obtained at ICU admission. eSG was estimated in the overall intracerebral content and in a region-of-interest composed of white matter and the diencephalon. eSG in the region of interest was significantly higher in the TBI patients than in the high-grade SAH patients (1.0350 +/- 0.0041 vs. 1.0310 +/- 0.0019 g/ml, P < 0.05). eSG was similar in the high-grade SAH, low-grade SAH, and control groups. CONCLUSIONS Our findings do not support a causal link between brain swelling and eSG elevation. The eSG increase in severe TBI patients is not due to brain swelling.
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Affiliation(s)
- Vincent Degos
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Paris 6 University, Paris, France
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