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Agbakou M, Combet M, Martin M, Blonz G, Desmedt L, Seguin A, Lemarié J, Zambon O, Reignier J, Lascarrou JB, Ehrmann S, Canet E. Post-intensive care syndrome screening: a French multicentre survey. Ann Intensive Care 2024; 14:109. [PMID: 38980434 PMCID: PMC11233491 DOI: 10.1186/s13613-024-01341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Post-intensive care syndrome (PICS), defined as physical, cognitive, and mental-health symptoms persisting long after intensive-care-unit (ICU) discharge, is increasingly recognised as a healthcare priority. Data on screening for PICS are sparse. Our objective here was to describe post-ICU screening in France, with special attention to visit availability and evaluations done during visits. METHODS We conducted an online multicentre survey by emailing an anonymous 43-item questionnaire to French ICUs. For each ICU, a single survey was sent to either the head or the intensivist in charge of follow-up visits. RESULTS Of 252 ICUs invited to participate, 161 (63.9%) returned the completed survey. Among them, 46 (28.6%) offered follow-up visits. Usually, a single visit led by an intensivist was scheduled 3 to 6 months after ICU discharge. Approximately 50 patients/year/ICU, that is, about 5% of admitted patients, attended post-ICU visits. The main criteria used to select patients for follow-up were ICU stay and/or invasive mechanical ventilation duration longer than 48 h, cardiac arrest, septic shock, and acute respiratory distress syndrome. Among ICUs offering visits, 80% used validated instruments to screen for PICS. Of the 115 ICUs not offering follow-up, 50 (43.5%) indicated an intention to start follow-up within the next year. The main barriers to offering follow-up were lack of available staff and equipment or not viewing PICS screening as a priority. Half the ICUs offering visits worked with an established network of post-ICU care professionals, and another 17% were setting up such a network. Obstacles to network creation were lack of interest among healthcare professionals and lack of specific training in PICS. CONCLUSION Only a small minority of ICU survivors received follow-up designed to detect PICS. Less than a third of ICUs offered follow-up visits but nearly another third planned to set up such visits within the next year. Recommendations issued by French health authorities in 2023 can be expected to improve the availability and standardisation of post-ICU follow-up.
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Affiliation(s)
- Maïté Agbakou
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France.
| | - Margot Combet
- Intensive Care Unit, Kremlin-Bicêtre University Hospital, Assistance Publique- Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Maëlle Martin
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Gauthier Blonz
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Luc Desmedt
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Amélie Seguin
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Jérémie Lemarié
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Olivier Zambon
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Jean Reignier
- Intensive Care Unit, Nantes University Hospital, Movement - Interactions - Performance Research Unit (MIP, (MIP, UR 4334), Nantes, France
| | - Jean-Baptiste Lascarrou
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
| | - Stephan Ehrmann
- Intensive Care Unit, Tours University Hospital, Tours, France
- INSERM CIC 1415, Tours University, Tours University Hospital, Tours, France
- Research Center for Respiratory Diseases, INSERM U110, Tours University, Tours, France
- Clinical Research in Intensive Care and Sepsis-Trial Group for Global Evaluation and Research in Sepsis (CRICS_TRIGGERSep), Tours, France
| | - Emmanuel Canet
- Intensive Care Unit, Nantes University Hospital, Nantes University, 30 Bd. Jean Monnet, Nantes, Cedex 1 44093, France
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Dantan E, Foucher Y, Simon-Pimmel J, Léger M, Campfort M, Lasocki S, Lakhal K, Bouras M, Roquilly A, Cinotti R. Long-term survival of traumatic brain injury and intra-cerebral haemorrhage patients: A multicentric observational cohort. J Crit Care 2024; 83:154843. [PMID: 38875914 DOI: 10.1016/j.jcrc.2024.154843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/13/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Mortality is often assessed during ICU stay and early after, but rarely at later stage. We aimed to compare the long-term mortality between TBI and ICH patients. MATERIALS AND METHODS From an observational cohort, we studied 580 TBI patients and 435 ICH patients, admitted from January 2013 to February 2021 in 3 ICUs and alive at 7-days post-ICU discharge. We performed a Lasso-penalized Cox survival analysis. RESULTS We estimated 7-year survival rates at 72.8% (95%CI from 67.3% to 78.7%) for ICH patients and at 84.9% (95%CI from 80.9% to 89.1%) for TBI patients: ICH patients presenting a higher mortality risk than TBI patients. Additionally, we identified variables associated with higher mortality risk (age, ICU length of stay, tracheostomy, low GCS, absence of intracranial pressure monitoring). We also observed anisocoria related with the mortality risk in the early stage after ICU stay. CONCLUSIONS In this ICU survivor population with a prolonged follow-up, we highlight an acute risk of death after ICU stay, which seems to last longer in ICH patients. Several variables characteristic of disease severity appeared associated with long-term mortality, raising the hypothesis that the most severe patients deserve closer follow-up after ICU stay.
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Affiliation(s)
- E Dantan
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France.
| | - Y Foucher
- Poitiers Université, CHU de Poitiers, CIC INSERM 1402, Poitiers, France
| | - J Simon-Pimmel
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - M Léger
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - M Campfort
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - S Lasocki
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - K Lakhal
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Laennec, Nantes F-44093, France
| | - M Bouras
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR, 1064 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC0004, 1413 Nantes, France
| | - A Roquilly
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR, 1064 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC0004, 1413 Nantes, France
| | - R Cinotti
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes F-44093, France
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Aarab Y, Debourdeau T, Garnier F, Capdevila M, Monet C, De Jong A, Capdevila X, Charbit J, Dagod G, Pensier J, Jaber S. Management and outcomes of COVID-19 patients admitted in a newly created ICU and an expert ICU, a retrospective observational study. Anaesth Crit Care Pain Med 2024; 43:101321. [PMID: 37944861 DOI: 10.1016/j.accpm.2023.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic abruptly increased the inflow of patients requiring intensive care units (ICU). French health institutions responded by a twofold capacity increase with temporary upgraded beds, supplemental beds in pre-existing ICUs, or newly created units (New-ICU). We aimed to compare outcomes according to admission in expert pre-existing ICUs or in New-ICU. METHODS This multicenter retrospective observational study was conducted in two 20-bed expert ICUs of a University Hospital (Expert-ICU) and in one 16-bed New-ICU in a private clinic managed respectively by 3 and 2 physicians during daytime and by one physician during the night shift. All consecutive adult patients with COVID-19-related acute hypoxemic respiratory failure admitted after centralized regional management by a dedicated crisis cell were included. The primary outcome was 180-day mortality. Propensity score matching and restricted cubic spline for predicted mortality over time were performed. RESULTS During the study period, 165 and 176 patients were enrolled in Expert-ICU and New-ICU respectively, 162 (98%) and 157 (89%) patients were analyzed. The unadjusted 180-day mortality was 30.8% in Expert-ICU and 28.7% in New-ICU, (log-rank test, p = 0.7). After propensity score matching, 123 pairs (76 and 78%) of patients were matched, with no significant difference in mortality (32% vs. 32%, OR 1.00 [0.89; 1.12], p = 1). Adjusted predicted mortality decreased over time (p < 0.01) in both Expert-ICU and New-ICU. CONCLUSIONS In COVID-19 patients with acute hypoxemic respiratory failure, hospitalization in a new ICU was not associated with mortality at day 180.
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Affiliation(s)
- Yassir Aarab
- Intensive Care Unit, Clinique Saint-Jean Sud de France, Montpellier, France; Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France.
| | - Theodore Debourdeau
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Fanny Garnier
- Intensive Care Unit, Clinique Saint-Jean Sud de France, Montpellier, France
| | - Mathieu Capdevila
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Clément Monet
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Audrey De Jong
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Jonathan Charbit
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Geoffrey Dagod
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Joris Pensier
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesiology and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
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Boulet N, Boussere A, Mezzarobba M, Sofonea MT, Payen D, Lipman J, Laupland KB, Rello J, Lefrant JY, Muller L, Roger C, Pirracchio R, Mura T, Boudemaghe T. Intensive Care Unit activity in France from the national database between 2013 and 2019: More critically ill patients, shorter stay and lower mortality rate. Anaesth Crit Care Pain Med 2023; 42:101228. [PMID: 37031815 DOI: 10.1016/j.accpm.2023.101228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/10/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Knowledge of the occurrence and outcome of admissions to Intensive Care Units (ICU) over time is important to inform healthcare services planning. This observational study aims at describing the activity of French ICUs between 2013 and 2019. METHODS Patient admission characteristics, organ dysfunction scores, therapies, ICU and hospital lengths of stay and case fatality were collected from the French National Hospital Database (population-based cohort). Logistic regression models were developed to investigate the association between age, sex, SAPS II, organ failure, and year of care on in-ICU case fatality. FINDINGS Among 1,594,801 ICU admissions, the yearly ICU admission increased from 3.3 to 3.5 per year per 1000 inhabitants (bed occupancy rate between 83.4 and 84.3%). The mean admission SAPS II was 42 ± 22, with a gradual annual increase. The median lengths of stay in ICU and in hospital were 3 (interquartile range (IQR) = [1-7]) and 11 days (IQR = [6-21]), respectively, with a progressive decrease over time. The in-ICU and hospital mortality case fatalities decreased from 18.0% to 17.1% and from 21.1% to 19.9% between 2013 and 2019, respectively. Male sex, age, SAPS II score, and the occurrence of any organ failure were associated with a higher case fatality rate. After adjustment on age, sex, SAPS II and organ failure, in-ICU case fatality decreased in 2019 as compared to 2013 (adjusted Odds Ratio = 0.87 [95% confidence interval, 0.85-0.89]). INTERPRETATION During the study, an increasing incidence of ICU admission was associated with higher severity of illness but lower in-ICU case fatality.
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Affiliation(s)
- Nicolas Boulet
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Amal Boussere
- Service Information Médicale, Méthodes et Recherche (SIMMER), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | - Myriam Mezzarobba
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | | | | | - Jeffrey Lipman
- Scientific consultant at Nimes University Hospital, University of Montpellier, Nimes, France; Mayne Academy of Critical Care, The University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia
| | - Jordi Rello
- Clinical Research/Epidemiology In Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain; Scientific consultant at Nimes University Hospital, University of Montpellier, Nimes, France
| | - Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Laurent Muller
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Claire Roger
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Thibault Mura
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | - Thierry Boudemaghe
- Service Information Médicale, Méthodes et Recherche (SIMMER), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
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Blondonnet R, Balde A, Zhai R, Pereira B, Futier E, Bazin JE, Godet T, Constantin JM, Lambert C, Jabaudon M. Use of volatile anesthetics for sedation in the ICU during the COVID-19 pandemic: A national survey in France (VOL'ICU 2 study). PLoS One 2022; 17:e0278090. [PMID: 36580451 PMCID: PMC9799316 DOI: 10.1371/journal.pone.0278090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has increased the number of patients in ICUs leading to a worldwide shortage of the intravenous sedative agents obligating physicians to find alternatives including inhaled sedation. Inhaled sedation in French ICU has been previously explored in 2019 (VOL'ICU study). This survey was designed to explore the use of inhaled sedation two years after our first survey and to evaluate how the COVID-19 pandemic has impacted the use of inhaled sedation. METHODS We designed a national survey, contacting medical directors of French ICUs between June and October 2021. Over a 50-item questionnaire, the survey covered the characteristics of the ICU, data on inhaled sedation, and practical aspects of inhaled ICU sedation for both COVID-19 and non-COVID-19 patients. Answers were compared with the previous survey, VOL'ICU. RESULTS Among the 405 ICUs contacted, 25% of the questionnaires were recorded. Most ICU directors (87%) knew about the use of inhaled ICU sedation and 63% of them have an inhaled sedation's device in their unit. The COVID-19 pandemic increased the use of inhaled sedation in French ICUs. The main reasons said by the respondent were "need for additional sedative" (62%), "shortage of intravenous sedatives" (38%) and "involved in a clinical trial" (30%). The main reasons for not using inhaled ICU sedation were "device not available" (76%), "lack of familiarity" (60%) and "no training for the teams" (58%). More than 70% of respondents were overall satisfied with the use of inhaled sedation. Almost 80% of respondents stated that inhaled sedation was a seducing alternative to intravenous sedation for management of COVID-19 patients. CONCLUSION The use of inhaled sedation in ICU has increased fastly in the last 2 years, and is frequently associated with a good satisfaction among the users. Even if the COVID-19 pandemic could have impacted the widespread use of inhaled sedation, it represents an alternative to intravenous sedation for more and more physicians.
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Affiliation(s)
- Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
- * E-mail:
| | - Aissatou Balde
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ruoyang Zhai
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, GRC 29, AP-HP, DMU DREAM, Sorbonne University, Paris, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Cereuil A, Ronflé R, Culver A, Boucekine M, Papazian L, Lefebvre L, Leone M. Septic Shock: Phenotypes and Outcomes. Adv Ther 2022; 39:5058-5071. [PMID: 36050614 DOI: 10.1007/s12325-022-02280-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Sepsis is a heterogeneous syndrome that results in life-threatening organ dysfunction. Our goal was to determine the relevant variables and patient phenotypes to use in predicting sepsis outcomes. METHODS We performed an ancillary study concerning 119 patients with septic shock at intensive care unit (ICU) admittance (T0). We defined clinical worsening as having an increased sequential organ failure assessment (SOFA) score of ≥ 1, 48 h after admission (ΔSOFA ≥ 1). We performed univariate and multivariate analyses based on the 28-day mortality rate and ΔSOFA ≥ 1 and determined three patient phenotypes: safe, intermediate and unsafe. The persistence of the intermediate and unsafe phenotypes after T0 was defined as a poor outcome. RESULTS At T0, the multivariate analysis showed two variables associated with 28-day mortality rate: norepinephrine dose and serum lactate concentration. Regarding ΔSOFA ≥ 1, we identified three variables at T0: norepinephrine dose, lactate concentration and venous-to-arterial carbon dioxide difference (P(v-a)CO2). At T0, the three phenotypes (safe, intermediate and unsafe) were found in 28 (24%), 70 (59%) and 21 (18%) patients, respectively. We thus suggested using an algorithm featuring norepinephrine dose, lactate concentration and P(v-a)CO2 to predict patient outcomes and obtained an area under the curve (AUC) of 74% (63-85%). CONCLUSION Our findings highlight the fact that identifying relevant variables and phenotypes may help physicians predict patient outcomes.
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Affiliation(s)
- Alexandre Cereuil
- Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, APHM, Avenue des tamaris, 13100, Marseille, Aix-en-Provence, France
| | - Romain Ronflé
- Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Centre Hospitalier du Pays d'Aix, Marseille, Aix-en-Provence, France.
| | - Aurélien Culver
- Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Centre Hospitalier du Pays d'Aix, Marseille, Aix-en-Provence, France
| | - Mohamed Boucekine
- EA 3279 CEReSS, School of Medicine - La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, APHM, Marseille, France
| | - Laurent Papazian
- Hôpital Nord, Médecine Intensive - Réanimation, Aix Marseille Université, APHM, Marseille, France
| | - Laurent Lefebvre
- Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Centre Hospitalier du Pays d'Aix, Marseille, Aix-en-Provence, France
| | - Marc Leone
- Réanimation et Surveillance Continue Médico-Chirurgicales Polyvalentes, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, APHM, Avenue des tamaris, 13100, Marseille, Aix-en-Provence, France.,Centre d'Investigation Clinique, Hôpital Nord, Aix Marseille Université, APHM, Marseille, France
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Pasquier P, Danguy des Déserts M, Meaudre E, Escarment J. Les actions du service de santé des armées face à la crise COVID-19: sur mer et au-delà des mers, toujours au service des hommes ! BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022; 206:983-990. [PMID: 35975012 PMCID: PMC9372777 DOI: 10.1016/j.banm.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/29/2022] [Indexed: 11/01/2022]
Abstract
« Nous sommes en guerre ! » a déclaré le président Emmanuel Macron lors d’un discours à la nation le 16 mars 2020. Dans le cadre de cette résilience nationale, le service de santé des armées (SSA) s’est engagé dans la lutte contre le COVID-19. Cette revue générale a pour objectif de décrire et de détailler les actions que le SSA a mené dans le cadre de la lutte nationale contre la pandémie de COVID-19 en France, ainsi qu’à l’étranger. Des experts de chaque domaine ont rapporté les actions majeures menées par le SSA lors de la pandémie de COVID-19. En quelques semaines seulement, le SSA a développé des capacités médicales ad hoc pour soutenir les autorités sanitaires nationales. Il a également mis en œuvre des capacités d’évacuations médicales collectives par voie aérienne et maritime. Un hôpital militaire de campagne dédié aux soins intensifs a également été déployé en soutien de l’hôpital civil à Mulhouse. Plus tard, des modules militaires de réanimation ont aidé des centres hospitaliers débordés par l’afflux de malades COVID-19 en Guadeloupe, en Martinique, en Guyane, à Mayotte et en Nouvelle-Calédonie. Une cellule de crise COVID-19 a permis de coordonner les actions des forces armées françaises dans le cadre de la lutte contre la pandémie. Le centre d’épidémiologie et de santé publique des armées a fourni toutes les informations nécessaires pour guider les processus de prises de décisions. Les centres médicaux des armées ont organisé les soins primaires pour les patients militaires, avec un large recours à la télémédecine. Les services de secours de la Brigade des sapeurs-pompiers de Paris et du Bataillon des marins-pompiers de Marseille ont assuré la prise en charge préhospitalière des patients atteints de COVID-19. Les huit hôpitaux d’instruction militaires français ont coopéré avec les agences régionales de santé pour permettre la prise en charge hospitalière des patients les plus graves, mais aussi créer de novo des centres de vaccination. La chaîne de ravitaillement médical des armées a soutenu tous les déploiements d’unités médicales opérationnelles en France et à l’étranger, faisant face à une pénurie croissante de matériel médical. L’institut de recherche biomédicale des armées a réalisé des diagnostics, s’est engagé dans de multiples projets de recherche, a mis à jour quotidiennement la revue de la littérature scientifique sur le COVID-19 et a fourni des recommandations d’experts sur la biosécurité. Enfin, les étudiants des écoles militaires de santé de Lyon-Bron se sont portés volontaires pour participer à la lutte contre la pandémie de COVID-19. En conclusion, dans une crise médicale sans précédent, le SSA a engagé de multiples actions innovantes et adaptatives, toujours en cours, dans la lutte contre le COVID-19. La collaboration entre les systèmes de santé militaires et civils a renforcé l’objectif commun de « sauver le plus grand nombre ».
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Collange O, Lopez M, Lejay A, Pessaux P, Ouattara A, Dewitte A, Rimmele T, Girardot T, Arnaudovski D, Augustin P, Chakfe N, Tacquard C, Oulehri W, Zieleskiewicz L, Severac F, Leone M, Mertes PM. Serum lactate and acute mesenteric ischaemia: An observational, controlled multicentre study. Anaesth Crit Care Pain Med 2022; 41:101141. [DOI: 10.1016/j.accpm.2022.101141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/01/2022]
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9
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Haddam M, Kubacsi L, Hamada S, Harrois A, James A, Langeron O, Boutonnet M, Holleville M, Garrigue D, Leclercq M, Hanouz JL, Pottecher J, Audibert G, Cardinale M, Vinour H, Zieleskiewicz L, Resseguier N, Leone M. Withholding and withdrawal of life-sustaining therapy in 8569 trauma patients: A multicentre, analytical registry study. Eur J Anaesthesiol 2022; 39:418-426. [PMID: 35166244 DOI: 10.1097/eja.0000000000001671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of withholding or withdrawal of life-sustaining therapy (WLST) decisions in trauma ICU patients, using a large registry. We hypothesised that this prevalence is similar to that of the general population admitted to an ICU. As secondary aims, it sought to describe the trauma patients for whom the decision was made for WLST and the factors associated with this decision. DESIGN This observational study assessed data from 14 French centres listed in the TraumaBaseTM registry. All trauma patients hospitalised for more than 48 h were pro-spectively included. RESULTS Data from 8569 trauma patients, obtained from January 2016 to December 2018, were included in this study. A WLST decision was made in 6% of all cases. In the WLST group, 67% of the patients were older men (age: 62 versus 36, P < 0.001); more often they had a prior medical history and higher median severity scores than the patients in the no WLST decision group; SAPS II 58 (46 to 69) versus 21 (13 to 35) and ISS 26 (22 to 24) versus 12 (5 to 22), P < 0.001. Neurological status was strongly associated with WLST decisions. The geographic area of the ICUs affected the rate of the WLST decisions. The ICU mortality was 11% (n = 907) of which 47% (n = 422) were preceded by WLST decisions. Fourteen percent of WLST orders were not associated to the death. CONCLUSION Among 8569 patients, medical history, trauma severity criteria, notably neurological status and geographical areas were associated with WLST. These regional differences deserve to be investigated in future studies.
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Affiliation(s)
- Malik Haddam
- From the Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anaesthesia and Intensive Care, Hôpital Nord (MH, LK, LZ, ML), Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille - CERESS, Aix Marseille University, Marseille (NR), Kremlin Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Department of Anaesthesia and Intensive Care, Le Kremlin-Bicêtre (AH), Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital (AJ), Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou University Hospital, Paris (SH, ML), Department of Anaesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil (OL), Department of Anaesthesiology and Critical Care Medicine, DMU Parabol, Beaujon Hospital, APHP. Nord-Université de Paris, 100 Bd du General Leclerc 92110 Clichy (MHo), Department of Anaesthesia and Intensive Care, Clamart Army Training Hospital Percy, Clamart (MB), Toulon Army Training Hospital Sainte-Anne, Toulon (MC), Department of Anaesthesia and Intensive Care, Toulouse University Hospital, Toulouse (HV), Department of Anesthesia and Critical Care Medicine, Université de Lorraine, CHRU Nancy, Nancy (GA), Lille University Hospital, Pôle de l'Urgence, Pôle d'Anesthésie Réanimation, Lille (DG), Department of Anaesthesia and Intensive Care, Reims University Hospital, Reims (MLec), Department of Anaesthesia and Intensive Care, Caen University Hospital, Caen (JLH) and Department of Anaesthesia and Perioperative Medicine, Strasbourg University Hospital, Strasbourg, France (JP)
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Faivre L, Morfin R, Massard A, Huet B. [Intensive care nurse in 2021, from expertise to recognition]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2021; 66:36-39. [PMID: 34895571 DOI: 10.1016/j.soin.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The profession of intensive care nurse has been in constant evolution since the 1960s. The technical nature of medical equipment and the care of increasingly complex patients require a high level of qualification. The current health crisis has highlighted the difficulties of this profession and the lack of recognition of these carers. They are demanding a specialisation with a diploma course aimed at improving the quality of patient care.
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Affiliation(s)
- Laurent Faivre
- Hôpital Nord Franche-Comté, 100 route de Moval, 90400 Trevenans, France; Fédération nationale des infirmiers de réanimation, 31 avenue Alexandre-Dumas, 13008 Marseille, France.
| | - Raphaële Morfin
- Fédération nationale des infirmiers de réanimation, 31 avenue Alexandre-Dumas, 13008 Marseille, France; Institut de cardiologie, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Audrey Massard
- Centre hospitalier universitaire Dijon Bourgogne, 2 boulevard Maréchal-de Lattre-de-Tassigny, 21000 Dijon, France
| | - Bérengère Huet
- Fédération nationale des infirmiers de réanimation, 31 avenue Alexandre-Dumas, 13008 Marseille, France; Hôpital Henri-Mondor, AP-HP, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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11
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Reynolds HV, Von Dohren G, Tabah A. Mandated nursing ratios decrease mortality and costs in the hospital, and what about the ICU? Anaesth Crit Care Pain Med 2021; 40:100977. [PMID: 34748941 DOI: 10.1016/j.accpm.2021.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hannah Victoria Reynolds
- Intensive Care Unit, Redcliffe Hospital, ANZAC Avenue, Redcliffe, QLD 4020, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gary Von Dohren
- Intensive Care Unit, Redcliffe Hospital, ANZAC Avenue, Redcliffe, QLD 4020, Australia
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, ANZAC Avenue, Redcliffe, QLD 4020, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia..
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Leone M, Zunino C, Pauly V, Mathieu C, Antonini F, Orlean V, Cassir N, Pradel V, Bourenne J, Boussen S, Hraiech S, Lagier D, Vitte J, Wiramus S, Zieleskiewicz L, Papazian L, Boyer L. Beta-lactam allergy labeling in intensive care units: An observational, retrospective study. Medicine (Baltimore) 2021; 100:e26494. [PMID: 34232182 PMCID: PMC8270612 DOI: 10.1097/md.0000000000026494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/22/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT This retrospective study aimed to describe the association between the "β-lactam allergy" labeling (BLAL) and the outcomes of a cohort of intensive care unit (ICU) patients.Retrospective cohort study.Seven ICU of the Aix Marseille University Hospitals from Marseille in France.We collected the uses of the label "β-lactam allergy" in the electronic medical files of patients aged 18 years or more who required more than 48 hours in the ICU with mechanical ventilation and/or vasopressors admitted to 7 ICUs of a single institution.We retrospectively compared the patients with this labeling (BLAL group) with those without this labeling (control group).The primary outcome was the duration of ICU stay. Among the 7146 patients included in the analysis, 440 and 6706 patients were classified in the BLAL group and the control group, respectively. The prevalence of BLAL was 6.2%. In univariate and multivariate analyses, BLAL was weakly or not associated with the duration of ICU and hospital stays (respectively, 6 [3-14] vs 6 [3-14] days, standardized beta -0.09, P = .046; and 18 [10-29] vs 15 [8-28] days, standardized beta -0.09, P = .344). In multivariate analysis, the ICU and 28-day mortality rates were both lower in the BLAL group than in the control group (aOR 0.79 95% CI [0.64-0.98] P = .032 and 0.79 [0.63-0.99] P = .042). Antibiotic use differed between the 2 groups, but the outcomes were similar in the subgroups of septic patients in the BLAL group and the control group.In our cohort, the labeling of a β-lactam allergy was not associated with prolonged ICU and hospital stays. An association was found between the labeling of a β-lactam allergy and lower ICU and 28-day mortality rates.Trial registration: Retrospectively registered.
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Affiliation(s)
- Marc Leone
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation, Hôpital Nord
- Aix Marseille Université, IRD, AP-HM, MEPHI
| | - Claire Zunino
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation, Hôpital Nord
| | - Vanessa Pauly
- Aix Marseille Université, School of Medicine – La Timone Medical Campus, EA 3279, CEReSS – Health Service Research and Quality of Life Center
| | - Calypso Mathieu
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation, Hôpital Nord
| | - François Antonini
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation, Hôpital Nord
| | - Veronica Orlean
- Aix Marseille Université, School of Medicine – La Timone Medical Campus, EA 3279, CEReSS – Health Service Research and Quality of Life Center
| | | | - Vincent Pradel
- Aix Marseille Université, School of Medicine – La Timone Medical Campus, EA 3279, CEReSS – Health Service Research and Quality of Life Center
| | - Jérémy Bourenne
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service de Réanimation Médicale, Timone University Hospital, 13005 Marseille
| | - Salah Boussen
- LBA, UMRT 24, Aix Marseille Université-IFSTTAR, Boulevard Pierre Dramard 13916 Marseille Cedex 20
- Department of Anesthesiology and Intensive Care, Timone University Hospital, 264 Rue Saint-Pierre
| | - Sami Hraiech
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service de Réanimation des Détresses Respiratoires, Hôpital Nord
| | - David Lagier
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation 2 Adultes, Timone University Hospital
| | | | - Sandrine Wiramus
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation, Hôpital de la Conception, 13005 Marseille, France
| | - Laurent Zieleskiewicz
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service d’Anesthésie et de Réanimation, Hôpital Nord
| | - Laurent Papazian
- Aix Marseille Université, Hôpitaux Universitaires de Marseille, Service de Réanimation des Détresses Respiratoires, Hôpital Nord
| | - Laurent Boyer
- Aix Marseille Université, School of Medicine – La Timone Medical Campus, EA 3279, CEReSS – Health Service Research and Quality of Life Center
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Venous-to-Arterial Carbon Dioxide Partial Pressure Difference: Predictor of Septic Patient Prognosis Depending on Central Venous Oxygen Saturation. Shock 2021; 53:710-716. [PMID: 31490355 DOI: 10.1097/shk.0000000000001442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study aimed to assess the viability of using the venous-to-arterial carbon dioxide partial pressure difference (P(v-a)CO2) to predict clinical worsening of septic shock, depending on central venous oxygen saturation (ScvO2). The prospective, observational, multicentric study conducted in three intensive care units (ICUs) included all patients with a septic shock episode during the first 6 h, with 122 patients assessed. Clinical worsening was defined as an increase of sequential organ failure assessment (SOFA) scores ≥1 (ΔSOFA ≥1) within 2 days. To assess the ability of P(v-a)CO2 to predict clinical worsening, univariate and multivariate analyses were performed according to ΔSOFA. A receiver-operating characteristic (ROC) analysis was used to confirm model predictions. Associations between P(v-a)CO2 and mortality were explored using correlations. Using multivariate analyses, two independent factors associated with ΔSOFA at least 1 were identified: an averaged 6-h value of lactate concentration (Lac [1-6]) (odds ratios [ORs], 2.43 [95% confidence interval, CI, 1.20-4.89]; P = 0.013) and an averaged 6-h value of P(v-a)CO2 (P(v-a)CO2 [1-6]) (OR, 1.49 [95% CI, 1.04-2.15]; P = 0.029). ROC analysis confirmed that Lac [1-6] and P(v-a)CO2 [1-6] were significantly associated with ΔSOFA at least 1, whereas ScvO2 [1-6] was not. Finally, ΔSOFA at least 1 was associated with higher 28-day (76% vs. 10%, P = 0.001) and ICU (83% vs. 12%, P = 0.001) mortality rates, which were higher in patients with P(v-a)CO2 [1-6] more than 5.8 mmHg (57% vs. 33%; P = 0.012). In conclusion, P(v-a)CO2 may help predict outcomes for septic shock patients regardless of ScvO2 values.
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Godeberge C, Deneux-Tharaux C, Seco A, Rossignol M, Chantry AA, Bonnet MP. Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study. Anesth Analg 2021; 134:581-591. [PMID: 33989204 DOI: 10.1213/ane.0000000000005578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion. METHODS We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012-2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts' consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models. RESULTS Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria. CONCLUSIONS Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.
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Affiliation(s)
- Charlotte Godeberge
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Department of Anesthesia and Intensive Care, Cochin hospital
| | - Catherine Deneux-Tharaux
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France
| | - Aurélien Seco
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Clinical Research Unit of Paris Descartes Necker Cochin
| | | | - Anne Alice Chantry
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Baudelocque Midwifery School
| | - Marie-Pierre Bonnet
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Department of Anesthesia and Intensive Care, Sorbonne University, Armand Trousseau hospital, Groupe de Recherche Clinique 29 (GRC 29), Département Médico-Universitaire (DMU) DREAM, Assistance Publique des Hôpitaux de Paris, Paris, France
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15
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Widehem R, Bory P, Greco F, Pavillard F, Chalard K, Mas A, Djanikian F, Carr J, Molinari N, Jaber S, Perrigault PF, Chanques G. Transcranial sonographic assessment of the third ventricle in neuro-ICU patients to detect hydrocephalus: a diagnostic reliability pilot study. Ann Intensive Care 2021; 11:69. [PMID: 33945045 PMCID: PMC8096880 DOI: 10.1186/s13613-021-00857-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background Transcranial sonography is a point-of-care tool recommended in intensive care units (ICU) to monitor brain injured patients. Objectives of the study was to assess feasibility and reliability of the third ventricle (V3) diameter measurement using transcranial sonography (TCS) compared to brain computed-tomography (CT), the gold standard measurement, and to measure the TCS learning curve. Design: prospective study, in a 16-bed neurological ICU in an academic hospital. Every consecutive brain injured adult patient, who required a brain CT and TCS monitoring were included. The V3 diameter was blindly measured by TCS and CT. Intraclass correlation coefficient (ICC) and Bland–Altman plot were used to assess the reliability and agreement between TCS and CT V3 measurements. Diagnosis performance of the V3 diameter using TCS to detect hydrocephalus was measured. Absolute difference between V3 measurement by residents and experts was measured consecutively to assess the learning curve. Results Among the 100 patients included in the study, V3 diameter could be assessed in 87 patients (87%) from at least one side of the skull. Both temporal windows were available in 70 patients (70%). The ICC between V3 diameter measured by TCS and CT was 0.90 [95% CI 0.84–0.93] on the right side, and 0.92 [0.88–0.95] on the left side. In Bland–Altman analysis, mean difference, standard deviation, 95% limits of agreement were 0.36, 1.52, − 2.7 to 3.3 mm, respectively, on the right side; 0.25, 1.47, − 2.7 to 3.1 mm, respectively, on the left side. Among the 35 patients with hydrocephalus, V3 diameters could be measured by TCS in 31 patients (89%) from at least one side. Hydrocephalus was, respectively, excluded, confirmed, or inconclusive using TCS in 35 (40%), 25 (29%) and 27 (31%) of the 87 assessable patients. After 5 measurements, every resident reached a satisfactory measurement compared to the expert operator. Conclusion TCS allows rapid, simple and reliable V3 diameter measurement compared with the gold standard in neuro-ICU patients. Aside from sparing irradiating procedures and transfers to the radiology department, it may especially increase close patient monitoring to detect clinically occult hydrocephalus earlier. Further studies are needed to measure the potential clinical benefit of this method. Trial registration: ClinicalTrials.gov ID: NCT02830269. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00857-x.
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Affiliation(s)
- Rémy Widehem
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Paul Bory
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Frédéric Greco
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Frédérique Pavillard
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Kévin Chalard
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Alexandre Mas
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Flora Djanikian
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Julie Carr
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Saint Eloi Hospital, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, Montpellier University Hospital Center, La Colombière Hospital, and Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier, CNRS, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Saint Eloi Hospital, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Pierre-François Perrigault
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Gerald Chanques
- Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France. .,Department of Anaesthesia & Critical Care Medicine, Montpellier University Hospital Center, Saint Eloi Hospital, Montpellier, France. .,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
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16
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Oh TK, Song I. Weekend admission and mortality among patients with sepsis: A nationwide cohort study in South Korea. Acta Anaesthesiol Scand 2021; 65:639-647. [PMID: 33502007 DOI: 10.1111/aas.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate whether weekend admission was associated with a higher risk of 90-day mortality in patients with sepsis. METHODS This population-based cohort study was based on health records from the National Health Insurance Service database in South Korea. All adult patients (age ≥ 18 years) admitted for sepsis (A40, A41) or septic shock (R65.2) as diagnosed according to the International Classification of Diseases, 10th revision codes, during 2010-2018 were screened. Weekend admission was defined as admission for sepsis on weekends. RESULTS In all, 251 837 patients were enrolled, of which 43 327 (17.2%) were in the weekend admission group and 208 510 (82.8%) in the weekday admission group. After propensity score matching, 86 654 patients with sepsis (43 327 patients with sepsis in each group) were included in the analysis. The 90-day mortality rates in the weekend admission and weekday admission groups were 44.3% (19 204/43 327) and 41.9% (18 157/43 327), respectively. On Cox regression analysis, the risk of 90-day mortality in the weekend admission group was 1.09-times higher than that in the weekday admission group (hazard ratio: 1.09, 95% confidence interval: 1.07-1.12; P < .001). CONCLUSION Using the national health claims database in South Korea, we showed that weekend admission for diagnosed sepsis was associated with an increased risk of 90-day mortality, compared to that for weekday admission. This might be due to the higher severity of illness in patients with sepsis admitted during the weekend or relatively lesser hospital staff during the weekend.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - In‐Ae Song
- Department of Anesthesiology and Pain Medicine Seoul National University Bundang Hospital Seongnam Korea
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Lefrant JY, Pirracchio R, Benhamou D, Dureuil B, Pottecher J, Samain E, Joannes-Boyau O, Bouaziz H. ICU bed capacity during COVID-19 pandemic in France: From ephemeral beds to continuous and permanent adaptation. Anaesth Crit Care Pain Med 2021; 40:100873. [PMID: 33910085 PMCID: PMC8069631 DOI: 10.1016/j.accpm.2021.100873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Université de Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California San Francisco, San Francisco, California, United States
| | - Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Université Paris Saclay, Hôpital Bicêtre - 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Bertrand Dureuil
- Department of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre - Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072 Strasbourg, France
| | - Emmanuel Samain
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, EA 3920, Bourgogne Franche-Comte University, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Hervé Bouaziz
- Département d'Anesthésie Réanimation, Hôpital Central - CHRU Nancy, Nancy, France
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Blondonnet R, Quinson A, Lambert C, Audard J, Godet T, Zhai R, Pereira B, Futier E, Bazin JE, Constantin JM, Jabaudon M. Use of volatile agents for sedation in the intensive care unit: A national survey in France. PLoS One 2021; 16:e0249889. [PMID: 33857185 PMCID: PMC8049230 DOI: 10.1371/journal.pone.0249889] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background Current intensive care unit (ICU) sedation guidelines recommend strategies using non-benzodiazepine sedatives. This survey was undertaken to explore inhaled ICU sedation practice in France. Methods In this national survey, medical directors of French adult ICUs were contacted by phone or email between July and August 2019. ICU medical directors were questioned about the characteristics of their department, their knowledge on inhaled sedation, and practical aspects of inhaled sedation use in their department. Results Among the 374 ICUs contacted, 187 provided responses (50%). Most ICU directors (73%) knew about the use of inhaled ICU sedation and 21% used inhaled sedation in their unit, mostly with the Anaesthetic Conserving Device (AnaConDa, Sedana Medical). Most respondents had used volatile agents for sedation for <5 years (63%) and in <20 patients per year (75%), with their main indications being: failure of intravenous sedation, severe asthma or bronchial obstruction, and acute respiratory distress syndrome. Sevoflurane and isoflurane were mainly used (88% and 20%, respectively). The main reasons for not using inhaled ICU sedation were: “device not available” (40%), “lack of medical interest” (37%), “lack of familiarity or knowledge about the technique” (35%) and “elevated cost” (21%). Most respondents (80%) were overall satisfied with the use of inhaled sedation. Almost 75% stated that inhaled sedation was a seducing alternative to intravenous sedation. Conclusion This survey highlights the widespread knowledge about inhaled ICU sedation in France but shows its limited use to date. Differences in education and knowledge, as well as the recent and relatively scarce literature on the use of volatile agents in the ICU, might explain the diverse practices that were observed. The low rate of mild adverse effects, as perceived by respondents, and the users’ satisfaction, are promising for this potentially important tool for ICU sedation.
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Affiliation(s)
- Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- GReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
- * E-mail:
| | - Audrey Quinson
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistical and Data Management Unit, Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jules Audard
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- GReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ruoyang Zhai
- GReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistical and Data Management Unit, Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- GReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
- GReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Verdonk F, Garnier M, Bonnet F, Jabaudon M. The 'ephemeral' intensive care units that saved the French healthcare system, a new concept to be preserved. Eur J Anaesthesiol 2021; 38:441-442. [PMID: 33661828 DOI: 10.1097/eja.0000000000001320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Franck Verdonk
- From the Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (FV, MG, FB), Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (FV), Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France (MJ) and Division of Allergy, Pulmonary, and Critical Care Medicine Vanderbilt University Medical Center, Nashville (MJ)
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20
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Blondonnet R, Begard M, Jabaudon M, Godet T, Rieu B, Audard J, Lagarde K, Futier E, Pereira B, Bouzat P, Constantin JM. Blunt Chest Trauma and Regional Anesthesia for Analgesia of Multitrauma Patients in French Intensive Care Units: A National Survey. Anesth Analg 2021; 133:723-730. [PMID: 33780388 DOI: 10.1213/ane.0000000000005442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chest injuries are associated with mortality among patients admitted to the intensive care unit (ICU) and require multimodal pain management strategies, including regional anesthesia (RA). We conducted a survey to determine the current practices of physicians working in ICUs regarding RA for the management of chest trauma in patients with multiple traumas. METHODS An online questionnaire was sent to medical doctors (n = 1230) working in French ICUs, using the Société Française d'Anesthésie Réanimation (SFAR) mailing list of its members. The questionnaire addressed 3 categories: general characteristics, practical aspects of RA, and indications and contraindications. RESULTS Among the 333 respondents (response rate = 27%), 78% and 40% of 156 respondents declared that they would consider using thoracic epidural analgesia (TEA) and thoracic paravertebral blockade (TPB), respectively. The main benefits declared for performing RA were the ability to have effective analgesia, a more effective cough, and early rehabilitation. For 70% of the respondents, trauma patients with a theoretical indication of RA did not receive TEA or TPB for the following reasons: the ICU had no experience of RA (62%), no anesthesiologist-intensivist working in the ICU (46%), contraindications (27%), ignorance of the SFAR guidelines (19%), and no RA protocol available (13%). In this survey, 95% of the respondents thought the prognosis of trauma patients could be influenced by the use of RA. CONCLUSIONS While TEA and TPB are underused because of several limitations related to the patterns of injuries in multitrauma patients, lack of both experience and confidence in combination with the absence of available protocols appear to be the major restraining factors, even if physicians are aware that patients' outcomes could be improved by RA. These results suggest the need to strengthen initial training and provide continuing education about RA in the ICU.
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Affiliation(s)
- Raiko Blondonnet
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Genetics, Reproduction and Development, Centre National de la Recherche Scienctifique, Institut National de la Santé et de la Recherche Médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marc Begard
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Genetics, Reproduction and Development, Centre National de la Recherche Scienctifique, Institut National de la Santé et de la Recherche Médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Thomas Godet
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Rieu
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Jules Audard
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Genetics, Reproduction and Development, Centre National de la Recherche Scienctifique, Institut National de la Santé et de la Recherche Médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Kevin Lagarde
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- From the Department of Perioperative Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Genetics, Reproduction and Development, Centre National de la Recherche Scienctifique, Institut National de la Santé et de la Recherche Médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistical and Data Management Unit, Department of Clinical Research and Innovation (DRCI), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Bouzat
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University, Grenoble, France
| | - Jean-Michel Constantin
- Sorbonne University, Groupe de Recherche Clinique 29, Assistance Publique - Hôpitaux de Paris, Département Médico-Universitaire Diagnostic, Radiologie, Explorations fonctionnelles, Anatomopathologie, Médecine nucléaire, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
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Amino acids and vitamins status during continuous renal replacement therapy: An ancillary prospective observational study of a randomised control trial. Anaesth Crit Care Pain Med 2021; 40:100813. [PMID: 33588088 DOI: 10.1016/j.accpm.2021.100813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/23/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Continuous renal replacement therapy (CRRT) is associated with micronutrients loss. Current recommendations are to administer 1-1.5g/kg/day of proteins during CRRT. We aim to evaluate the net effect of CRRT on amino acids (AA), vitamins A and C (Vit A, Vit C) levels. METHODS This is a prospective observational study embedded within a randomised controlled trial comparing two CRRT doses in patients with septic shock. CRRT was provided in continuous veno-venous haemofiltration mode at a dose of either 35ml/kg/h or 70ml/kg/h. All patients received parenteral nutrition with standard trace elements and vitamins (protein intake 1g/kg/d). We measured serum levels of glutamine, valine and alanine as well as Vit A and Vit C upon randomisation, study day four and eight. In addition, we measured a larger panel of AA in a subset of 11 patients. RESULTS We included 30 patients (17 allocated to 70ml/kg/h and 13 to 35ml/kg/h CRRT). Before CRRT initiation, mean plasma levels of glutamine and valine, Vit A and Vit C were low. CRRT was not associated with any significant change in AA levels except for a decrease in cystein. It was associated with an increase in Vit A and a decrease in Vit C levels. CRRT dose had no impact on those nutrients blood levels. CONCLUSIONS Irrespective of dose, CRRT was associated with a decrease in cysteine and Vit C and an increase in Vit A with no significant change in other AA. Further studies should focus on lean mass wasting during CRRT.
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Risk factors for ventilator-associated pneumonia due to Staphylococcus aureus in patients with severe brain injury: A multicentre retrospective cohort study. Anaesth Crit Care Pain Med 2021; 40:100785. [DOI: 10.1016/j.accpm.2020.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
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23
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Prognostic value and time course evolution left ventricular global longitudinal strain in septic shock: an exploratory prospective study. J Clin Monit Comput 2020; 35:1501-1510. [PMID: 33216237 DOI: 10.1007/s10877-020-00620-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/13/2020] [Indexed: 01/25/2023]
Abstract
Our main objective was to describe the course of GLS during the first days of septic shock and to assess the agreement between GLS values and longitudinal strain measured in apical four chambers. A prospective observational single centre study was conducted at the Nimes University Hospital's ICU. All patients admitted for a diagnosis of septic shock without pre-existing heart disease were eligible. Echocardiography (LVEF and GLS) was performed on the first day, and repeated once between day 3 and day 5 then once between day 6 and day 8. We enrolled 40 consecutive patients. Four patients were excluded. In overall population, GLS at T1 was impaired (- 11.0%, IQR(interquartile range) [- 15; - 10]). On T2 exams, a significant improvement of the GLS (- 11% vs - 16% p = 0.02) was observed whereas LVEF remained stable over time. A good agreement between GLS and longitudinal strain measured on a four chambers view was found. Based on the Bland and Altman method, the mean of differences for T1 exams was 0.1 (95% CI [- 0.6; 0.8]) with limits of agreement ranging from - 4 to 4. Myocardial strain is depressed at the early phase of septic shock and improves over time. A single measurement of LS4C view appears sufficient at bedside.
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24
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Perin N, Roger C, Marin G, Molinari N, Evrard A, Lavigne JP, Barbar S, Claret PG, Boutin C, Muller L, Lipman J, Lefrant JY, Jaber S, Roberts JA. Vancomycin Serum Concentration after 48 h of Administration: A 3-Years Survey in an Intensive Care Unit. Antibiotics (Basel) 2020; 9:antibiotics9110793. [PMID: 33182613 PMCID: PMC7698174 DOI: 10.3390/antibiotics9110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
The present study assessed the proportion of intensive care unit (ICU) patients who had a vancomycin serum concentration between 20 and 25 mg/L after 24–48 h of intravenous vancomycin administration. From 2016 to 2018, adult ICU patients with vancomycin continuous infusion (CI) for any indication were included. The primary outcome was the proportion of patients with a first-available vancomycin serum concentration between 20–25 mg/L at 24 h (D2) or 48 h (D3). Of 3894 admitted ICU patients, 179 were included. A median loading dose of 15.6 (interquartile range (IQR) = (12.5–20.8) mg/kg) was given in 151/179 patients (84%). The median daily doses of vancomycin infusion for D1 and D2 were 2000 [(IQR (1600–2000)) and 2000 (IQR (2000–2500)) mg/d], respectively. The median duration of treatment was 4 (2–7) days. At D2 or D3, the median value of first serum vancomycin concentration was 19.8 (IQR (16.0–25.1)) with serum vancomycin concentration between 20–25 mg/L reported in 43 patients (24%). Time spent in the ICU before vancomycin initiation was the only risk factor of non-therapeutic concentration at D2 or D3. Acute kidney injury occurred significantly more when vancomycin concentration was supra therapeutic at D2 or D3. At D28, 44 (26%) patients had died. These results emphasize the need of appropriate loading dose and regular monitoring to improve vancomycin efficacy and avoid renal toxicity.
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Affiliation(s)
- Nicolas Perin
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
- Correspondence:
| | - Claire Roger
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Grégory Marin
- IMAG, CNRS, Université de Montpellier, Department of Statistics, CHU Montpellier, 34295 Montpellier, France; (G.M.); (N.M.)
| | - Nicolas Molinari
- IMAG, CNRS, Université de Montpellier, Department of Statistics, CHU Montpellier, 34295 Montpellier, France; (G.M.); (N.M.)
| | - Alexandre Evrard
- Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) de Nîmes, Hôpital Carémeau, 30029 Nîmes, France;
| | - Jean-Philippe Lavigne
- VBMI, INSERM U1047, Université de Montpellier, Laboratoire de Microbiologie, CHU de Nîmes, 30029 Nîmes, France;
| | - Saber Barbar
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Pierre Géraud Claret
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Caroline Boutin
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Laurent Muller
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Jeffrey Lipman
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
- VBMI, INSERM U1047, Université de Montpellier, Laboratoire de Microbiologie, CHU de Nîmes, 30029 Nîmes, France;
- Department of Intensive Care Medicine, Royal Brisbane and Womens’ Hospital, Brisbane 4029, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane 4029, QLD, Australia
| | - Jean-Yves Lefrant
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
| | - Samir Jaber
- Département d’Anesthésie Réanimation B, Saint Eloi ICU, Montpellier University Hospital, 34295 Montpellier, France;
| | - Jason A. Roberts
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, 30029 Nîmes, France; (C.R.); (S.B.); (P.G.C.); (C.B.); (L.M.); (J.L.); (J.-Y.L.); (J.A.R.)
- Equipe D’accueil 2992 Caractéristiques Féminines des Interfaces Vasculaires, Faculté de Médecine, Université de Montpellier, 34090 Montpellier, France
- UQ Centre for Clinical Research, The University of Queensland, Brisbane 4029, QLD, Australia
- Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane 4029, QLD, Australia
- Pharmacy Department, Royal Brisbane and Womens’ Hospital, Brisbane 4029, QLD, Australia
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Lefrant JY, Fischer MO, Potier H, Degryse C, Jaber S, Muller L, Pottecher J, Charboneau H, Meaudre E, Lanot P, Bruckert V, Plaud B, Dureuil B, Samain E, Bouaziz H, Ecoffey C, Capdevila X. A national healthcare response to intensive care bed requirements during the COVID-19 outbreak in France. Anaesth Crit Care Pain Med 2020; 39:709-715. [PMID: 33031979 PMCID: PMC7534597 DOI: 10.1016/j.accpm.2020.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Background Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. Results Among 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5054/5531 (91%) ICU beds. During the outbreak, 4806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9860, 1982 and 3089 ICU, ACU and PACU beds were made available. Before the outbreak, 3548 physicians (2224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1785 residents, 11,023 nurses and 6763 nursing auxiliaries worked in established ICUs. During the outbreak, 2524 physicians, 715 residents, 7722 nurses and 3043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3212 new ventilators were added to the 5997 initially available in ICU. Conclusion During the COVID-19 outbreak, the French Health Care system created 4806 ICU beds (+95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context.
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Affiliation(s)
- Jean-Yves Lefrant
- EA 2992 IMAGINE, Univ Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
| | - Marc-Olivier Fischer
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service d'Anesthésie Réanimation, 14000 Caen, France
| | - Hugo Potier
- Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | - Cécile Degryse
- Service d'Anesthésie Réanimation Pellegrin Tripode, CHU Bordeaux, Bordeaux, France
| | - Samir Jaber
- Department of Anaesthesia & Critical Care Medicine, University of Montpellier Saint Eloi Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Laurent Muller
- EA 2992 IMAGINE, Univ Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre - Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072, Strasbourg, France
| | | | - Eric Meaudre
- Fédération d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Sainte-Anne, Toulon; Chaire d'Anesthésie-réanimation, Médecine d'Urgence, École du Val-de-Grâce, Paris, France
| | - Pierre Lanot
- GARHPA, groupe de anesthésistes réanimateurs de l'Hôpital Privé d'Antony, 92160 Antony, France
| | - Vincent Bruckert
- Pôle d'Anesthésie-Réanimation Médecine péri-opératoire et Urgences, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Université de Nice, 06000 Nice, France
| | - Benoît Plaud
- Paris University & APHP. Nord. DMU PARABOL, Department of Anaesthesiology, Critical Care & Burn Unit, Saint-Louis hospital, 1, Avenue Claude Vellefaux, 75010 Paris, France
| | - Bertrand Dureuil
- Departement of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - Emmanuel Samain
- Département d'Anesthésie Réanimation, Hôpital Jean Minjoz - C.H.U. de Besançon, Besançon, France
| | - Hervé Bouaziz
- Département d'Anesthésie Réanimation, Hôpital Central - CHRU Nancy, Nancy, France
| | - Claude Ecoffey
- Département d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital and Montpellier University. INSERM unit 1051, Montpellier Neurosciences Institute, Montpellier, France
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Duclos G, Rivory A, Rességuier N, Hammad E, Vigne C, Meresse Z, Pastène B, D'journo XB, Jaber S, Zieleskiewicz L, Leone M. Effect of early hyperoxemia on the outcome in servere blunt chest trauma: A propensity score-based analysis of a single-center retrospective cohort. J Crit Care 2020; 63:179-186. [PMID: 32958352 DOI: 10.1016/j.jcrc.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Our study aimed to explore the association between early hyperoxemia of the first 24 h on outcomes in patients with severe blunt chest trauma. MATERIALS AND METHODS In a level I trauma center, we conducted a retrospective study of 426 consecutive patients. Hyperoxemic groups were classified in severe (average PaO2 ≥ 200 mmHg), moderate (≥150 and < 200 mmHg) or mild (≥ 100 and < 200 mmHg) and compared to control group (≥60 and < 100 mmHg) using a propensity score based analysis. The first endpoint was the incidence of a composite outcome including death and hospital-acquired pneumonia occurring from admission to day 28. The secondary endpoints were the incidence of death, the number of hospital-acquired pneumonia, mechanical ventilation-free days and intensive care unit-free day at day 28. RESULTS The incidence of the composite endpoint was lower in the severe hyperoxemia group(OR, 0.25; 95%CI, 0.09-0.73; P < 0.001) compared with control. The 28-day mortality incidence was lower in severe (OR, 0.23; 95%CI, 0.08-0.68; P < 0.001) hyperoxemia group (OR, 0.41; 95%CI, 0.17-0.97; P = 0.04). Significant association was found between hyperoxemia and secondary outcomes. CONCLUSION In our cohort early hyperoxemia during the first 24 h of admission after severe blunt chest trauma was not associated with worse outcome.
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Affiliation(s)
- Gary Duclos
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France.
| | - Adrien Rivory
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Noémie Rességuier
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille, Marseille 13385, France; Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Emmanuelle Hammad
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Coralie Vigne
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Zoé Meresse
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Bruno Pastène
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Xavier-Benoit D'journo
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Thoracic Surgery, Marseille, France
| | - Samir Jaber
- Medical-Surgical Intensive Care Unit, University Hospital of Montpellier and INSERM U1046, Montpellier, France
| | - Laurent Zieleskiewicz
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRA, Marseille, France
| | - Marc Leone
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
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Pasquier P, Luft A, Gillard J, Boutonnet M, Vallet C, Pontier JM, Duron-Martinaud S, Dia A, Puyeo L, Debrus F, Prunet B, Beaume S, de Saint Maurice G, Meaudre E, Ficko C, Merens A, Raharisson G, Conte B, Dorandeu F, Canini F, Michel R, Ausset S, Escarment J. How do we fight COVID-19? Military medical actions in the war against the COVID-19 pandemic in France. BMJ Mil Health 2020; 167:269-274. [PMID: 32759228 DOI: 10.1136/bmjmilitary-2020-001569] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 01/06/2023]
Abstract
'We are at war', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France. In just few weeks, the FMMS developed ad hoc medical capabilities to support national health authorities. It additionally developed adaptive, collective en route care via aeromedical and naval units and deployed a military intensive care field hospital. A COVID-19 crisis cell coordinated the French Armed Forces health management. The French Military Centre for Epidemiology and Public Health provided all information needed to guide the decision-making process. Medical centres of the French Armed Forces organised the primary care for military patients, with the widespread use of telemedicine. The Paris Fire Brigade and the Marseille Navy Fire Battalion emergency departments ensured prehospital management of patients with COVID-19. The eight French military training hospitals cooperated with civilian regional health agencies. The French military medical supply chain supported all military medical treatment facilities in France as well as overseas, coping with a growing shortage of medical equipment. The French Armed Forces Biomedical Research Institute performed diagnostics, engaged in multiple research projects, updated the review of the scientific literature on COVID-19 daily and provided expert recommendations on biosafety. Finally, even students of the French military medical academy volunteered to participate in the fight against the COVID-19 pandemic. In conclusion, in an unprecedented medical crisis, the FMMS engaged multiple innovative and adaptive actions, which are still ongoing, in the fight against COVID-19. The collaboration between military and civilian healthcare systems reinforced the shared objective to achieve the goal of 'saving the greatest number'.
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Affiliation(s)
- Pierre Pasquier
- Percy Military Training Hospital, French Military Health Service, Clamart, France .,Ecole du Val-de-Grâce French Military Medical Academy, Paris, France
| | - A Luft
- Direction Centrale du Service de Santé des Armées, Paris, France
| | - J Gillard
- Direction Centrale du Service de Santé des Armées, Paris, France
| | - M Boutonnet
- Percy Military Training Hospital, French Military Health Service, Clamart, France.,Ecole du Val-de-Grâce French Military Medical Academy, Paris, France
| | - C Vallet
- Service Médical de la Force d'Action Navale, French Military Health Service, Toulon, France
| | - J-M Pontier
- Cephismer, Centre d'Expertise Plongée pour la Marine Nationale, French Military Health Service, Toulon, France
| | | | - A Dia
- Centre d'épidémiologie et de Santé Publique des Armées, French Military Health Service, Marseille, France
| | - L Puyeo
- Direction de la Médecine des forces, French Military Health Service, Tours, France
| | - F Debrus
- Direction de la Médecine des forces, French Military Health Service, Tours, France
| | - B Prunet
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Emergency Department, Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - S Beaume
- Bataillon des Marins-Pompiers de Marseille, French Military Health Service, Marseille, France
| | - G de Saint Maurice
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Legouest Military Training Hospital, French Military Health Service, Metz, France
| | - E Meaudre
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Sainte-Anne Military Training Hospital, French Military Health Service, Toulon, France
| | - C Ficko
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Bégin Military Training Hospital, French Military Health Service, Saint-Mandé, France
| | - A Merens
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Bégin Military Training Hospital, French Military Health Service, Saint-Mandé, France
| | - G Raharisson
- Direction Centrale du Service de Santé des Armées, Paris, France
| | - B Conte
- Direction des approvisionnements en produits de santé des armées, French Military Health Service, Orléans, France
| | - F Dorandeu
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, French Military Health Service, Brétigny-sur-Orge, France
| | - F Canini
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, French Military Health Service, Brétigny-sur-Orge, France
| | - R Michel
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Écoles Militaires de Santé, French Military Health Service, Lyon-Bron, France
| | - S Ausset
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Écoles Militaires de Santé, French Military Health Service, Lyon-Bron, France
| | - J Escarment
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,French Military Health Service, Paris, France
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28
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Jabaudon M, Audard J, Pereira B, Jaber S, Lefrant JY, Blondonnet R, Godet T, Futier E, Lambert C, Bazin JE, Bastarache JA, Constantin JM, Ware LB. Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS. Chest 2020; 158:2394-2403. [PMID: 32659235 PMCID: PMC7768934 DOI: 10.1016/j.chest.2020.06.070] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background The Radiographic Assessment of Lung Edema (RALE) score is associated with the severity of ARDS, and treatments targeted at reducing pulmonary edema such as conservative fluid management cause a reduction in RALE score over time. Research Question Are early changes in RALE score over time associated with survival in patients with ARDS? Study Design and Methods Data from patients enrolled in three centers in the Lung Imaging for Ventilation sEtting in ARDS (LIVE) trial with available chest radiographs at baseline (day 0) and days 2 or 3 were used. The RALE was scored by two independent reviewers. The primary end point was death by day 90, considering RALE score both at baseline and as a time-varying covariate in a marginal Cox survival model. Results RALE was scored from 135, 64, and 88 radiographs on days 0, 2, and 3, respectively. Both baseline RALE (hazard ratio [HR] for each one-point increment, 1.04; 95% CI, 1.01-1.08; P = .006) and the change in RALE over time (HR for each one-point decrease per unit of time, 0.99; 95% CI, 0.99-0.99; P = .03) were associated with death by day 90, even after adjustment for age, sex, BMI, Simplified Acute Physiology Score II, vasopressor use, and total volume of fluids received since study entry. Interpretation The change in RALE during the first days after ARDS onset is independently associated with survival and may be useful as a surrogate end point in future clinical trials of new therapeutics in ARDS.
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Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
| | - Jules Audard
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Samir Jaber
- Montpellier University Hospital, Saint Eloi Intensive Care Unit and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Jean-Yves Lefrant
- Service de Recherche Clinique en Soins Critiques, Pôle Anesthésie Douleur Urgences Réanimation, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Montpellier, France
| | - Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Julie A Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Departments of Cell and Developmental Biology, Vanderbilt University, Nashville, TN; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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29
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Montmeat D, Gard C, Raux M, Constantin JM, Tilleul P. Shortage of sedatives and neuromuscular blockers during COVID-19 pandemic: The result of an overstocking procedure in French hospitals? Anaesth Crit Care Pain Med 2020; 39:585-586. [PMID: 32654910 PMCID: PMC7326429 DOI: 10.1016/j.accpm.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Déborah Montmeat
- DMU ESPRIT, pharmacy, Pitié-Salpêtrière hospital, AP-HP, Paris, France
| | - Claudine Gard
- DMU ESPRIT, pharmacy, Pitié-Salpêtrière hospital, AP-HP, Paris, France
| | - Mathieu Raux
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
| | - Patrick Tilleul
- DMU ESPRIT, pharmacy, faculté de pharmacie de Paris, Pitié-Salpêtrière hospital, AP-HP, Paris, France
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30
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Renaudier M, de Roux Q, Bougouin W, Boccara J, Dubost B, Attias A, Fiore A, de'Angelis N, Folliguet T, Mulé S, Amiot A, Langeron O, Mongardon N. Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:62–70. [PMID: 33609105 DOI: 10.1177/2048872620915655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute mesenteric ischaemia is a severe complication in critically ill patients, but has never been evaluated in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This study was designed to determine the prevalence of mesenteric ischaemia in patients supported by V-A ECMO and to evaluate its risk factors, as well as to appreciate therapeutic modalities and outcome. METHODS In a retrospective single centre study (January 2013 to January 2017), all consecutive adult patients who underwent V-A ECMO were included, with exclusion of those dying in the first 24 hours. Diagnosis of mesenteric ischaemia was performed using digestive endoscopy, computed tomography scan or first-line laparotomy. RESULTS One hundred and fifty V-A ECMOs were implanted (65 for post-cardiotomy shock, 85 for acute cardiogenic shock, including 39 patients after refractory cardiac arrest). Overall, median age was 58 (48-69) years and mortality 56%. Acute mesenteric ischaemia was suspected in 38 patients, with a delay of four (2-7) days after ECMO implantation, and confirmed in 14 patients, that is, a prevalence of 9%. Exploratory laparotomy was performed in six out of 14 patients, the others being too unstable to undergo surgery. All patients with mesenteric ischaemia died. Independent risk factors for developing mesenteric ischaemia were renal replacement therapy (odds ratio (OR) 4.5, 95% confidence interval (CI) 1.3-15.7, p=0.02) and onset of a second shock within the first five days (OR 7.8, 95% CI 1.5-41.3, p=0.02). Conversely, early initiation of enteral nutrition was negatively associated with mesenteric ischaemia (OR 0.15, 95% CI 0.03-0.69, p=0.02). CONCLUSIONS Acute mesenteric ischaemia is a relatively frequent but dramatic complication among patients on V-A ECMO.
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Affiliation(s)
- Marie Renaudier
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Quentin de Roux
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,U955-IMRB, Equipe 03 'Pharmacologie et technologies pour les maladies cardiovasculaires (PROTECT)' Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), France
| | - Wulfran Bougouin
- Réanimation polyvalente, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, France.,Paris Sudden Death Expertise Centre, Paris Cardiovascular Research Centre (PARCC), France.,AfterROSC Research Group, France
| | - Johanna Boccara
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Baptiste Dubost
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Arié Attias
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Antonio Fiore
- Service de chirurgie cardiaque, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Nicola de'Angelis
- Service de chirurgie digestive, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,Univ Paris Est Creteil, Faculté de Santé, France
| | - Thierry Folliguet
- Service de chirurgie cardiaque, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,Univ Paris Est Creteil, Faculté de Santé, France
| | - Sébastien Mulé
- Univ Paris Est Creteil, Faculté de Santé, France.,Service d'imagerie médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Aurélien Amiot
- Univ Paris Est Creteil, Faculté de Santé, France.,Service de gastro-entérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Olivier Langeron
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,Univ Paris Est Creteil, Faculté de Santé, France.,Département infection et épidémiologie, Institut Pasteur, Unité d'histopathologie et des modèles animaux, France
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,U955-IMRB, Equipe 03 'Pharmacologie et technologies pour les maladies cardiovasculaires (PROTECT)' Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), France.,AfterROSC Research Group, France.,Univ Paris Est Creteil, Faculté de Santé, France
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31
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Blanchard F, Perbet S, James A, Verdonk F, Godet T, Bazin JE, Pereira B, Lambert C, Constantin JM. Minimal alveolar concentration for deep sedation (MAC-DS) in intensive care unit patients sedated with sevoflurane: A physiological study. Anaesth Crit Care Pain Med 2020; 39:429-434. [PMID: 32376244 DOI: 10.1016/j.accpm.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Volatile anaesthetic agents, especially sevoflurane, could be an alternative for sedating ICU patients. In the operating theatre, volatile anaesthetic agents are monitored using minimal alveolar concentration (MAC). In ICU, MAC may be used to assess sedation level and may replace clinical scale especially when they are unusable. Therefore, we sought to investigate the minimal sevoflurane end-tidal concentration to achieved deep sedation in critical ill patients: MAC-deep sedation (MAC-DS). METHODS In a prospective interventional study, we included patients with a Richmond Assessment Sedation Score (RASS) of 0 without any sedation. We stepwise increased sevoflurane concentration level before assessing for deep sedation (RASS≤-3). MAC-DS was defined as the minimal sevoflurane MAC fraction or sevoflurane expiratory fraction (FeSevo) to get 90% and 95% of patients in deep sedation (MAC-DS 90 and MAC-DS 95, respectively). RESULTS Between June and November 2014, 30 patients were included (median age=60 years [interquartile range: 47-69]). Increasing sevoflurane MAC was correlated with a decrease in RASS values (r=-0.83, P<0.001). MAC-DS 90 and MAC-DS 95 were achieved at 0.42 MAC (CI 95 [0.38-0.46]) and 0.46 MAC (CI 95 [0.42-0.51]), respectively. FeSevo to achieve MAC-DS 90 and MAC-DS 95 was 0.72 (CI 95 [0.65-0.79]) and 0.80 (CI 95 [0.72-0.89]), respectively. CONCLUSION In this physiological study involving 30 ICU patients, MAC-DS, end-tidal sevoflurane concentration to get 95% of patients in deep sedation determined over more than 500 observations, is achieved at 0.8% of expired fraction of sevoflurane or at 0.5 age-adjusted MAC.
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Affiliation(s)
- Florian Blanchard
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Sébastien Perbet
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Arthur James
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Franck Verdonk
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and critical care, Saint-Antoine university Hospital, Paris, France
| | - Thomas Godet
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Clermont Université, Université d'Auvergne, Laboratoire de Biopharmacie et de Technologie Pharmaceutique, 63000 Clermont-Ferrand, France
| | - Celine Lambert
- Clermont Université, Université d'Auvergne, Laboratoire de Biopharmacie et de Technologie Pharmaceutique, 63000 Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France.
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32
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Constantin JM, Bouglé A, Salaun JP, Futier E. Non-invasive ventilation and high-flow nasal oxygenation: Looking beyond extubation failure? Anaesth Crit Care Pain Med 2020; 38:583-584. [PMID: 31785702 DOI: 10.1016/j.accpm.2019.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jean-Michel Constantin
- Sorbonne University, GRC 29, Groupe de recherche clinique ARPE, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, 75013, Paris, France.
| | - Adrien Bouglé
- Sorbonne University, GRC 29, Groupe de recherche clinique ARPE, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Jean-Philippe Salaun
- Département d'Anesthésie-Réanimation, CHU Caen, 14000, Caen, France; Groupe Jeunes de la Société française d'anesthésie et de réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Emmanuel Futier
- Department of perioperative medicine, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France
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33
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Culver A, Coiffard B, Antonini F, Duclos G, Hammad E, Vigne C, Mege JL, Baumstarck K, Boucekine M, Zieleskiewicz L, Leone M. Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study. J Intensive Care 2020; 8:4. [PMID: 31921428 PMCID: PMC6945723 DOI: 10.1186/s40560-019-0425-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/29/2019] [Indexed: 01/14/2023] Open
Abstract
Background Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9 °C (p < 0.001) and an amplitude > 0.6 °C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23–0.70], p = 0.001 and HR = 4.73, 95% CI [1.38–16.22], p = 0.01). Conclusions Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.
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Affiliation(s)
- Aurélien Culver
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Benjamin Coiffard
- Médecine Intensive - Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Marseille, France.,3CNRS, IRD, MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - François Antonini
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Gary Duclos
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Emmanuelle Hammad
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Coralie Vigne
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Jean-Louis Mege
- 3CNRS, IRD, MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Karine Baumstarck
- 4APHM, EA 3279 CEReSS, School of Medicine - La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, Marseille, France
| | - Mohamed Boucekine
- 4APHM, EA 3279 CEReSS, School of Medicine - La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, Marseille, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France.,3CNRS, IRD, MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
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Bouvet L, Zieleskiewicz L, Loubradou E, Alain A, Morel J, Argaud L, Chassard D, Leone M, Allaouchiche B. Reliability of gastric suctioning compared with ultrasound assessment of residual gastric volume: a prospective multicentre cohort study. Anaesthesia 2019; 75:323-330. [DOI: 10.1111/anae.14915] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/28/2022]
Affiliation(s)
- L. Bouvet
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
- Department of Anaesthesia and Intensive Care APCSe VetAgro Sup UPSP 2016.A101 Marcy‐l'Etoile France
| | - L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Hôpital Nord Assistance Publique –Hôpitaux de Marseille Marseille France
| | - E. Loubradou
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
| | - A. Alain
- Department of Anaesthesia and Intensive Care Hôpital Nord Assistance Publique –Hôpitaux de Marseille Marseille France
| | - J. Morel
- Department of Anaesthesia and Intensive Care Centre Hospitalier Universitaire de Saint‐Étienne Saint‐Étienne France
| | - L. Argaud
- Department of Anaesthesia and Intensive Care Civils de Lyon Groupement Hospitalier Centre Lyon France
| | - D. Chassard
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Hôpital Femme Mère Enfant Lyon France
- Department of Anaesthesia and Intensive Care APCSe VetAgro Sup UPSP 2016.A101 Marcy‐l'Etoile France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Hôpital Nord Assistance Publique –Hôpitaux de Marseille Marseille France
| | - B. Allaouchiche
- Department of Anaesthesia and Intensive Care APCSe VetAgro Sup UPSP 2016.A101 Marcy‐l'Etoile France
- Department of Anaesthesia and Intensive Care Hospices Civils de Lyon Groupement Hospitalier Sud Pierre‐Bénite Cedex France
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Guerci P, Bellut H, Mokhtari M, Gaudefroy J, Mongardon N, Charpentier C, Louis G, Tashk P, Dubost C, Ledochowski S, Kimmoun A, Godet T, Pottecher J, Lalot JM, Novy E, Hajage D, Bouglé A. Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:371. [PMID: 31752976 PMCID: PMC6873544 DOI: 10.1186/s13054-019-2649-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
Background There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy. Methods This nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy. Results Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively). Conclusions S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival. Trial registration clinicaltrials.gov, NCT03506191
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Affiliation(s)
- Philippe Guerci
- Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France.,INSERM U1116, Groupe Choc, University of Lorraine, Nancy, France
| | - Hugo Bellut
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Mokhtar Mokhtari
- Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France
| | - Julie Gaudefroy
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation, Hôpital Henri Mondor, DMU CARE, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Université Paris-Est Créteil, Créteil, France
| | - Claire Charpentier
- Réanimation Chirurgicale Polyvalente, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Guillaume Louis
- Réanimation polyvalente, Hôpital de Mercy, CHR Metz-Thionville, Metz, France
| | - Parvine Tashk
- Service d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Clément Dubost
- Réanimation polyvalente, Hôpital d'Instruction des Armées (HIA) Bégin, Saint-Mandé, France
| | - Stanislas Ledochowski
- Service de Réanimation Polyvalente, Groupement Hospitalier Nord Dauphiné- Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Antoine Kimmoun
- Réanimation Médicale, Institut Lorrain du Cœur et des Vaisseaux, CHU Nancy-Brabois, Vandoeuvre-Lès-Nancy, France
| | - Thomas Godet
- Réanimation Adultes et Soins Continus, Pôle de Médecine Péri-opératoire, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Julien Pottecher
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Faculté de Médecine, Institut de Physiologie, EA3072, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Jean-Marc Lalot
- Service d'Anesthésie-Réanimation, Réanimation polyvalente, Centre Hospitalier Emile Durkheim, Epinal, France
| | - Emmanuel Novy
- Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France
| | - David Hajage
- Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis de Santé Publique, Equipe Pharmacoépidémiologie et évaluation des soins, AP-HP, Hôpital Pitié-Salpêtrière, CIC-1421, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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Valent A, Plaud B, Mebazaa A, Gayat E. Unmet medical needs, resources allocation and issues regarding cost-effectiveness in critical care. Anaesth Crit Care Pain Med 2019; 39:111-112. [PMID: 31376578 DOI: 10.1016/j.accpm.2019.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Arnaud Valent
- Department of anaesthesiology and critical care, Saint-Louis Hospital, Public Hospitals of Paris (AP-HP), 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Benoit Plaud
- Department of anaesthesiology and critical care, Saint-Louis Hospital, Public Hospitals of Paris (AP-HP), 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Alexandre Mebazaa
- Department of anaesthesiology and critical care, Lariboisière Hospital, Public Hospitals of Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France
| | - Etienne Gayat
- Department of anaesthesiology and critical care, Lariboisière Hospital, Public Hospitals of Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France
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37
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Pastene B, Cinotti R, Gayat E, Duranteau J, Lu Q, Montravers P, Pili-Floury S, Rennuit I, Mebazaa A, Leone M. Long-term mortality and quality of life after trauma: an ancillary study from the prospective multicenter trial FROG-ICU. Eur J Trauma Emerg Surg 2019; 47:461-466. [PMID: 31214722 DOI: 10.1007/s00068-019-01176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/13/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The long-term outcomes of intensive care unit (ICU) patients are known to be worse than those of the general population, but they are poorly known in severe trauma patients. We conducted an ancillary examination of the FROG-ICU study to identify risk factors and biomarkers associated with the poorer long-term outcomes and mortality in trauma ICU patients. METHODS Mortality, quality of life (QoL) and stress level scores were obtained 1 year after discharge from ICU. Blood samples were collected at ICU admission and discharge for measurement of inflammatory and cardiovascular biomarkers. RESULTS ICU trauma patients had a significantly lower 1-year mortality than non-trauma patients (7% vs. 23%, p < 0.001), but had worse stress levels scores (19 vs. 13, p = 0.041). No difference was found regarding physical and mental QoL scores (33 vs. 31, p = 0.19 and 30 vs. 28, p = 0.42). Patients with better QoL scores had lower tracheotomy rates (11% vs. 30%, p = 0.01). Worse stress level scores are associated with poor QoL scores and vice versa. Some study biomarkers were significantly higher in those ICU trauma patients who had worse QoL scores at 1 year after discharge. DISCUSSION Our study suggests that quality of life 1 year after an ICU stay is poor and is similar in both trauma and non-trauma patients, but ICU trauma patients are at greater risk of developing post-traumatic stress disorder-related symptoms. Tracheotomy and high levels of inflammatory biomarkers could be associated with impaired quality of life.
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Affiliation(s)
- Bruno Pastene
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Raphaël Cinotti
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Jacques Duranteau
- Service de Réanimation Chirurgicale, Hôpital Bicêtre, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Qin Lu
- Service de Réanimation Chirurgicale, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Philippe Montravers
- Service de Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Sébastien Pili-Floury
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Isabelle Rennuit
- Service de Réanimation Polyvalente, Hôpital Beaujon, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
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