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Kriege M, Hilt JA, Dette F, Wittenmeier E, Meuser R, Staubitz JI, Musholt TJ. Impact of direct laryngoscopy vs. videolaryngoscopy on signal quality of recurrent laryngeal nerve monitoring in thyroid surgery: a randomised parallel group trial. Anaesthesia 2023; 78:55-63. [PMID: 36166515 DOI: 10.1111/anae.15865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/24/2022]
Abstract
In thyroid surgery, intra-operative neuromonitoring signals of the recurrent laryngeal nerve can be detected by surface electrodes on a tracheal tube positioned at the vocal fold level. The incidence of difficult tracheal intubation in patients undergoing thyroidectomy for nodular goitre ranges from 5.3% to 20.5%. The aim of this study was to compare videolaryngoscopy with conventional direct laryngoscopy as methods for proper placement of the surface electrode to prevent insufficient intra-operative nerve signal quality. In this prospective randomised trial, adult patients requiring tracheal intubation during thyroid surgery were randomly allocated to two groups of C-MAC® (Macintosh style blade) videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. Primary outcome was the incidence of insufficient signal electromyogram amplitude level (< 500 μV) after successful tracheal intubation. A total of 260 (130 per group) participants were analysed. An insufficient signal was more frequent with direct laryngoscopy (35/130, 27%), compared with C-MAC (12/130, 9%, p < 0.001). First-pass tracheal intubation success rate was lower with direct laryngoscopy (86/130 (66%)) compared with the C-MAC (125/130 (96%)) (p < 0.0001). Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (16/130 (12%)), compared with the C-MAC (0/130, (0%)) (p < 0.0001). The results suggest that videolaryngoscopy has an impact on the quality of the initial intra-operative neuromonitoring signal in patients undergoing thyroid surgery, and this technique can provide optimised surface electrode positioning.
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Affiliation(s)
- M Kriege
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - J A Hilt
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - F Dette
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - E Wittenmeier
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - R Meuser
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - J I Staubitz
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - T J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
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Fu D, Li W, Li W, Han Y. Improved skill for tracheal intubation using optical stylets through remote training model: a before and after interventional study. BMC MEDICAL EDUCATION 2022; 22:668. [PMID: 36085051 PMCID: PMC9462891 DOI: 10.1186/s12909-022-03715-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Conducting on-site, hands-on training during the Coronavirus disease 2019 (COVID-19) pandemic has been challenging. We conducted a before and after interventional study to estimate the efficacy of a new remote hands-on training model for improving the trainees' tracheal intubation competency using optical stylets. METHODS Residents or physicians in anesthesiology apartment who have not received the nominated training in tracheal intubation using optical stylets were enrolled. The 4-week training course contains theoretical knowledge along with preclinical and clinical training of optical stylets techniques. Competency of intubation using optical stylets on patients with normal airways was evaluated according to an assessment tool with a maximum score of 29 points based on video recording pre-post training performance. Pre-post questionnaires measured theoretical knowledge and self-efficacy. RESULTS Twenty-two participants were included (8 females, 14 men, mean age of 33.5 years). The total score of intubation competency was significantly improved after training from 14.6±3.7 to 25.3±2.6 (P < 0.0001). The scores of three subitems (anatomical identification, hand-eye coordination, and optimized intubation condition) were all significantly increased after training (P < 0.0001). The total percentage of correct answers in the multiple-choice questionnaire increased from 58.2%±8.2% before training to 85.2%±7.2% shortly after training (P < 0.0001). In addition, the self-efficacy score was significantly increased from 2.5±1.2 to 4.4±0.6 (P < 0.0001). CONCLUSIONS The new remote and progressively advanced hands-on training model improved the competency of intubation using optical stylets under the COVID-19 pandemic.
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Affiliation(s)
- Danyun Fu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
| | - Weixing Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
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Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report. Healthcare (Basel) 2022; 10:healthcare10040741. [PMID: 35455918 PMCID: PMC9027904 DOI: 10.3390/healthcare10040741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult airways because of an improved laryngeal view, higher frequency of successful intubations, higher frequency of first-attempt intubation, and fewer intubation attempts. In this case series report, we describe the video-assisted intubating stylet technique in five patients with difficult airways. We believe that the intubating stylet is a feasible and safe airway technique for anesthetized tracheal intubation in patients with an anticipated difficult airway.
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Optimization of Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery. Medicina (B Aires) 2022; 58:medicina58040495. [PMID: 35454334 PMCID: PMC9028259 DOI: 10.3390/medicina58040495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
The application of intraoperative neural monitoring (IONM) has been widely accepted to improve surgical outcomes after thyroid surgery. The malfunction of an IONM system might interfere with surgical procedures. Thus, the development of anesthesia modalities aimed at ensuring functional neuromonitoring is essential. Two key issues should be taken into consideration for anesthetic management. Firstly, most patients undergo recurrent laryngeal nerve monitoring via surface electrodes embedded in an endotracheal tube. Thus, advanced video-assisted devices might optimize surface electrode positioning for improved neuromonitoring signaling accuracy. Secondly, neuromuscular blocking agents are routinely used during thyroid surgery. The ideal neuromuscular block should be deep enough for surgical relaxation at excision and recovered enough for an adequate signal f nerve stimulation. Proper neuromuscular block management could be achieved by titration doses of muscle relaxants and reversal agents.
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The Use of a Video-Assisted Intubating Stylet Technique in a Critically Ill and Contagious COVID-19 Patient. Healthcare (Basel) 2022; 10:healthcare10020388. [PMID: 35207001 PMCID: PMC8871715 DOI: 10.3390/healthcare10020388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 01/03/2023] Open
Abstract
Tracheal intubation and ventilatory support are among the important treatments in patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) and severe hypoxia. The intubating team often uses video-assisted intubation equipment to ensure a safe and successful tracheal intubation. In this case report, we demonstrate for the first time, the use of the Shikani video-assisted intubating stylet and the Shikani intubating technique as a safe, speedy, and effective way to intubate a critically ill and highly contagious COVID-19 patient. In addition to the conventional consensus guidelines that are currently available for good practice (such as the proper use of personal protection equipment, etc.), we demonstrated that using the Shikani video-assisted intubating stylet is a reliable and proficient technique that is easy to learn while minimizing the risk of COVID-19 exposure of the airway personnel.
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 359] [Impact Index Per Article: 179.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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De Cassai A, Boscolo A, Rose K, Carron M, Navalesi P. Predictive parameters of difficult intubation in thyroid surgery: a meta-analysis. Minerva Anestesiol 2020; 86:317-326. [DOI: 10.23736/s0375-9393.19.14127-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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The Shikani Optical Stylet as an Alternative to Awake Fiberoptic Intubation in Patients at Risk of Secondary Cervical Spine Injury: A Randomized Controlled Trial. J Neurosurg Anesthesiol 2018; 30:354-358. [DOI: 10.1097/ana.0000000000000454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ÇAĞLAR TORUN AYSUN, SARI MUSTAFAERHAN, KÖKSAL ERSİN, İBİŞ SEVGİN. Comparing the intubation effectiveness of two different laryngoscopes in patients with cerebral palsy. CUMHURIYET DENTAL JOURNAL 2018. [DOI: 10.7126/cumudj.397203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pieters BMA, Maas EHA, Knape JTA, van Zundert AAJ. Videolaryngoscopy vs. direct laryngoscopy use by experienced anaesthetists in patients with known difficult airways: a systematic review and meta-analysis. Anaesthesia 2017; 72:1532-1541. [DOI: 10.1111/anae.14057] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- B. M. A. Pieters
- Department of Anaesthesia; University Medical Centre Utrecht; Utrecht the Netherlands
| | - E. H. A. Maas
- Department of Anesthesia; Erasmus University Medical Center; Rotterdam the Netherlands
| | - J. T. A. Knape
- Department of Anaesthesia; University Medical Centre Utrecht; Utrecht the Netherlands
| | - A. A. J. van Zundert
- Department of Anaesthesia and Perioperative Medicine; Royal Brisbane and Women's Hospital; University of Queensland; Brisbane Qld Australia
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Xu M, Li XX, Guo XY, Wang J. Reply to "Comparing Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal Intubation". Chin Med J (Engl) 2017. [PMID: 28639587 PMCID: PMC5494935 DOI: 10.4103/0366-6999.208266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mao Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Xi Li
- Department of Anesthesiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Jun Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
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Xu M, Li XX, Guo XY, Wang J. Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis: A Randomized Controlled Trial. Chin Med J (Engl) 2017; 130:297-302. [PMID: 28139512 PMCID: PMC5308011 DOI: 10.4103/0366-6999.198926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis. Methods: A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III–IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test. Results: The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P < 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034). Conclusions: SOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway. Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IOR-16007821; http://www.chictr.org.cn/showproj.aspx?proj=13203.
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Affiliation(s)
- Mao Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Xiao-Xi Li
- Department of Anesthesiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Jun Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
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Van Oeveren L, Donner J, Fantegrossi A, Mohr NM, Brown CA. Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry Study. Telemed J E Health 2016; 23:290-297. [PMID: 27673565 DOI: 10.1089/tmj.2016.0140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance. INTRODUCTION We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network. MATERIALS AND METHODS Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015. We report demographic information, indication, methods, number of attempts, operator characteristics, telemedicine involvement/intervention, adverse events, and clinical outcome by using descriptive statistics. RESULTS Included were 206 intubations. The most common indication for intubation was respiratory failure. First-pass success rate (postactivation) was 71%, and 96% were eventually intubated. Most attempts (66%) used rapid-sequence intubation. Fifty-four percent of first attempts used video laryngoscopy (VL). Telemedicine providers intervened in 24%, 43%, and 55% of first-third attempts, respectively. First-pass success with VL and direct laryngoscopy was equivalent (70% vs. 71%, p = 0.802). Adverse events were reported in 49 cases (24%), which were most frequently hypoxemia. DISCUSSION The impact of telemedicine during emergency intubation is not defined. We showed a 71% first-pass rate post-telemedicine linkage (70% of cases had a previous attempt). Our ultimate success rate was 96%, similar to that in large-center studies. Telemedicine support may contribute to success. CONCLUSIONS Telemedicine-supported endotracheal intubation performed in rural hospitals is feasible, with good success rates. Future research is required to better define the impact of telemedicine providers on emergency airway management.
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Affiliation(s)
- Lucas Van Oeveren
- 1 Section of Emergency Medicine, Avera McKennan Hospital , Sioux Falls, South Dakota.,2 Avera eCARE, Avera Health System , Sioux Falls, South Dakota
| | - Julie Donner
- 2 Avera eCARE, Avera Health System , Sioux Falls, South Dakota
| | - Andrea Fantegrossi
- 3 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Nicholas M Mohr
- 4 Department of Emergency Medicine, Division of Critical Care, University of Iowa Carver College of Medicine , Iowa City, Iowa.,5 Department of Anesthesia, University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Calvin A Brown
- 3 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,6 Harvard Medical School , Boston, Massachusetts
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Bailly A, Lascarrou JB, Le Thuaut A, Boisrame-Helms J, Kamel T, Mercier E, Ricard JD, Lemiale V, Champigneulle B, Reignier J. McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol. BMJ Open 2015; 5:e009855. [PMID: 26700287 PMCID: PMC4691786 DOI: 10.1136/bmjopen-2015-009855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the most similar to the Macintosh laryngoscope. The primary goal of this trial was to determine whether videolaryngoscopy increased the frequency of successful first-pass intubation in critically ill patients, compared to direct view Macintosh laryngoscopy. METHODS AND ANALYSIS MACMAN is a multicentre, open-label, randomised controlled superiority trial. Consecutive patients requiring intubation are randomly allocated to either the McGRATH MAC videolaryngoscope or the Macintosh laryngoscope, with stratification by centre and operator experience. The expected frequency of successful first-pass intubation is 65% in the Macintosh group and 80% in the videolaryngoscope group. With α set at 5%, to achieve 90% power for detecting this difference, 185 patients are needed in each group (370 in all). The primary outcome is the proportion of patients with successful first-pass orotracheal intubation, compared between the two groups using a generalised mixed model to take the stratification factors into account. ETHICS AND DISSEMINATION The study project has been approved by the appropriate ethics committee (CPP Ouest 2, # 2014-A00674-43). Informed consent is not required, as both laryngoscopy methods are considered standard care in France; information is provided before study inclusion. If videolaryngoscopy proves superior to Macintosh laryngoscopy, its use will become standard practice, thereby decreasing first-pass intubation failure rates and, potentially, the frequency of intubation-related complications. Thus, patient safety should benefit. Further studies would be warranted to determine whether videolaryngoscopy is also beneficial in the emergency room and for prehospital emergency care. TRIAL REGISTRATION NUMBER NCT02413723; Pre-results.
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Affiliation(s)
- Arthur Bailly
- Medical-Surgical Intensive Care Unit, District Hospital Centre, La Roche-sur-Yon, France
| | | | - Aurelie Le Thuaut
- Clinical Research Unit, District Hospital Centre, La Roche-sur-Yon, France
- Delegation a la Recherche Clinique et a l'Innovation-CHU Hotel Dieu, Nantes, France
| | - Julie Boisrame-Helms
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France
| | - Toufik Kamel
- Medical Intensive Care Unit, Regional Hospital Centre, Orleans, France
| | | | - Jean Damien Ricard
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France
- Univ Paris Diderot, IAME 1137, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint Louis University Hospital Centre, Paris, France
| | | | - Jean Reignier
- Medical Intensive Care Unit, Nantes university Hospital Center, Nantes, France
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