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Rambaud T, Hajage D, Dreyfuss D, Lebbah S, Martin-Lefevre L, Louis G, Moschietto S, Titeca-Beauport D, La Combe B, Pons B, De Prost N, Besset S, Combes A, Robine A, Beuzelin M, Badie J, Chevrel G, Bohe J, Coupez E, Chudeau N, Barbar S, Vinsonneau C, Forel JM, Thevenin D, Boulet E, Lakhal K, Aissaoui N, Grange S, Leone M, Lacave G, Nseir S, Poirson F, Mayaux J, Ashenoune K, Geri G, Klouche K, Thiery G, Argaud L, Rozec B, Cadoz C, Andreu P, Reignier J, Ricard JD, Quenot JP, Sonneville R, Gaudry S. Renal replacement therapy initiation strategies in comatose patients with severe acute kidney injury: a secondary analysis of a multicenter randomized controlled trial. Intensive Care Med 2024; 50:385-394. [PMID: 38407824 DOI: 10.1007/s00134-024-07339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The effect of renal replacement therapy (RRT) in comatose patients with acute kidney injury (AKI) remains unclear. We compared two RRT initiation strategies on the probability of awakening in comatose patients with severe AKI. METHODS We conducted a post hoc analysis of a trial comparing two delayed RRT initiation strategies in patients with severe AKI. Patients were monitored until they had oliguria for more than 72 h and/or blood urea nitrogen higher than 112 mg/dL and then randomized to a delayed strategy (RRT initiated after randomization) or a more-delayed one (RRT initiated if complication occurred or when blood urea nitrogen exceeded 140 mg/dL). We included only comatose patients (Richmond Agitation-Sedation scale [RASS] < - 3), irrespective of sedation, at randomization. A multi-state model was built, defining five mutually exclusive states: death, coma (RASS < - 3), incomplete awakening (RASS [- 3; - 2]), awakening (RASS [- 1; + 1] two consecutive days), and agitation (RASS > + 1). Primary outcome was the transition from coma to awakening during 28 days after randomization. RESULTS A total of 168 comatose patients (90 delayed and 78 more-delayed) underwent randomization. The transition intensity from coma to awakening was lower in the more-delayed group (hazard ratio [HR] = 0.36 [0.17-0.78]; p = 0.010). Time spent awake was 10.11 days [8.11-12.15] and 7.63 days [5.57-9.64] in the delayed and the more-delayed groups, respectively. Two sensitivity analyses were performed based on sedation status and sedation practices across centers, yielding comparable results. CONCLUSION In comatose patients with severe AKI, a more-delayed RRT initiation strategy resulted in a lower chance of transitioning from coma to awakening.
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Affiliation(s)
- Thomas Rambaud
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France
- Département de Médecine Intensive Réanimation Neuro, APHP Hôpital Pitié-Salpêtrière, Paris, France
| | - David Hajage
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France
| | - Saïd Lebbah
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | | | - Guillaume Louis
- Réanimation Polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | | | | | | | - Bertrand Pons
- Réanimation, CHU Pointe-à-Pitre/Abymes, Pointe-a-Pitre, France
| | | | - Sébastien Besset
- Médecine Intensive-Réanimation, APHP, Hôpital Louis Mourier, Colombes, France
| | - Alain Combes
- Service de Réanimation Médicale, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Adrien Robine
- Réanimation Soins Continus, CH de Bourg-en-Bresse - Fleyriat, 01012, Bourg-en-Bresse, France
| | | | - Julio Badie
- Réanimation Polyvalente, Hôpital Nord Franche-Comte CH Belfort, Belfort, France
| | - Guillaume Chevrel
- Réanimation Polyvalente, CH Sud Francilien, Corbeil Essonnes, France
| | - Julien Bohe
- Anesthésie Réanimation Médicale et Chirurgicale, CH Lyon Sud Pierre Benite, Lyon, France
| | - Elisabeth Coupez
- Réanimation Polyvalente, Hôpital G. Montpied, Clermont Ferrand, France
| | - Nicolas Chudeau
- Réanimation Médico-Chirurgicale, CH du Mans, Le Mans, France
| | | | | | | | | | - Eric Boulet
- Réanimation et USC, GH Carnelle Portes de l'Oise, 95260, Beaumont Sur Oise, France
| | - Karim Lakhal
- Réanimation Chirurgicale Polyvalente, Hôpital Nord Laennec, Nantes, France
| | - Nadia Aissaoui
- Réanimation Médicale, Hôpital Georges Pompidou, Paris, France
| | | | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, Marseille, France
| | - Guillaume Lacave
- Réanimation Médico-Chirurgicale, Hôpital André Mignot, Versailles, France
| | - Saad Nseir
- Réanimation Médicale, CHRU de Lille, Hôpital Roger Salengro, Lille, France
| | - Florent Poirson
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Julien Mayaux
- Pneumologie et Réanimation Médicale, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Guillaume Geri
- Réanimation Médico-Chirurgicale, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Kada Klouche
- Médecine Intensive Réanimation,, Hôpital Lapeyronnie, Montpellier, France
| | - Guillaume Thiery
- Réanimation Médicale, CHU Saint Etienne, Saint Priest en Jarez, France
| | - Laurent Argaud
- Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyril Cadoz
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Pascal Andreu
- Médecine Intensive Réanimation, Hôtel Dieu, Nantes, France
| | | | - Jean-Damien Ricard
- Médecine Intensive-Réanimation, APHP, Hôpital Louis Mourier, Colombes, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- NSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France
- Université Paris Cité, INSERM UMR1137, IAME, 75018, Paris, France
| | - Stéphane Gaudry
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France.
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France.
- Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.
- Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France.
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Chaïbi K, Ehooman F, Pons B, Martin-Lefevre L, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Schortgen F, Couchoud C, Dreyfuss D, Gaudry S. Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study. Ann Intensive Care 2023; 13:18. [PMID: 36907976 PMCID: PMC10008759 DOI: 10.1186/s13613-023-01108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The extent of the consequences of an episode of severe acute kidney injury (AKI) on long-term outcome of critically ill patients remain debated. We conducted a prospective follow-up of patients included in a large multicenter clinical trial of renal replacement therapy (RRT) initiation strategy during severe AKI (the Artificial Kidney Initiation in Kidney Injury, AKIKI) to investigate long-term survival, renal outcome and health related quality of life (HRQOL). We also assessed the influence of RRT initiation strategy on these outcomes. RESULTS Follow-up of patients extended from 60 days to a median of 3.35 years [interquartile range (IQR), 1.89 to 4.09] after the end of initial study. Of the 619 patients included in the AKIKI trial, 316 survived after 60 days. The overall survival rate at 3 years from inclusion was 39.4% (95% CI 35.4 to 43.4). A total of 46 patients (on the 175 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up [overall incidence of 26%, cumulative incidence at 4 years: 20.6% (CI 95% 13.0 to 28.3)]. Fifteen patients required chronic dialysis (5% of patients who survived after day 90). Among the 226 long-term survivors, 80 (35%) answered the EQ-5D questionnaire. The median index value reported was 0.67 (IQR 0.40 to 1.00) indicating a noticeable alteration of quality of life. Initiation strategy for RRT had no effect on any long-term outcome. CONCLUSION Severe AKI in critically ill patients was associated with a high proportion of death within the first 2 months but less so during long-term follow-up. A quarter of long-term survivors experienced a WRF and suffered from a noticeable impairment of quality of life. Renal replacement therapy initiation strategy was not associated with mortality outcome.
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Affiliation(s)
- Khalil Chaïbi
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France.,UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Franck Ehooman
- UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Service Anesthésie Réanimation Hôpital Privé Claude Gallien, Quincy-Sous-Sénart, France
| | - Bertrand Pons
- Service de Réanimation, CHU de Pointe à Pitre-Abymes, CHU de la Guadeloupe, France
| | | | - Eric Boulet
- Réanimation polyvalente, CH René Dubos, Pontoise, France
| | - Alexandre Boyer
- Réanimation médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Guillaume Chevrel
- Service de réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- Département de réanimation médicale et médecine hyperbare, CHU Angers, Universitéd'Angers, Angers, France
| | | | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de réanimation médicale, Créteil, France.,CARMAS research group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- Réanimation médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont- Ferrand, France
| | - Anne Bretagnol
- Réanimation médico-chirurgicale, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, 45067, Orléans Cedex, France
| | - Julien Mayaux
- Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Saad Nseir
- Centre de Réanimation, Faculté de Médecine, CHU de Lille, Université de Lille, 59000, Lille, France
| | - Bruno Megarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France
| | - Marina Thirion
- Réanimation polyvalente, CH Victor Dupouy, 95107, Argenteuil Cedex, France
| | - Jean-Marie Forel
- Service de réanimation des Détresses respiratoires aiguës et infections sévères, Hôpital Nord Marseille, Marseille, France
| | - Julien Maizel
- Service de réanimation médicale INSERM U1088, Centre hospitalier universitaire de picardie, Amiens, France
| | - Hodane Yonis
- Réanimation médicale, Hôpital de la Croix Rousse, Lyon, France
| | | | - Guillaume Thiery
- Réanimation médicale, CHU Saint Etienne, 42270, Saint Priest en Jarez, France
| | - Frédérique Schortgen
- Centre Hospitalier Intercommunal, Service de Réanimation Polyvalente Adulte, Créteil, France
| | - Cécile Couchoud
- REIN registry, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Didier Dreyfuss
- UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Cité, Paris, France
| | - Stephane Gaudry
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France. .,UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
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Gaudry S, Grolleau F, Barbar S, Martin-Lefevre L, Pons B, Boulet É, Boyer A, Chevrel G, Montini F, Bohe J, Badie J, Rigaud JP, Vinsonneau C, Porcher R, Quenot JP, Dreyfuss D. Continuous renal replacement therapy versus intermittent hemodialysis as first modality for renal replacement therapy in severe acute kidney injury: a secondary analysis of AKIKI and IDEAL-ICU studies. Crit Care 2022; 26:93. [PMID: 35379300 PMCID: PMC8981658 DOI: 10.1186/s13054-022-03955-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 01/05/2023] Open
Abstract
Background Intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) are the two main RRT modalities in patients with severe acute kidney injury (AKI). Meta-analyses conducted more than 10 years ago did not show survival difference between these two modalities. As the quality of RRT delivery has improved since then, we aimed to reassess whether the choice of IHD or CRRT as first modality affects survival of patients with severe AKI. Methods This is a secondary analysis of two multicenter randomized controlled trials (AKIKI and IDEAL-ICU) that compared an early RRT initiation strategy with a delayed one. We included patients allocated to the early strategy in order to emulate a trial where patients would have been randomized to receive either IHD or CRRT within twelve hours after the documentation of severe AKI. We determined each patient’s modality group as the first RRT modality they received. The primary outcome was 60-day overall survival. We used two propensity score methods to balance the differences in baseline characteristics between groups and the primary analysis relied on inverse probability of treatment weighting. Results A total of 543 patients were included. Continuous RRT was the first modality in 269 patients and IHD in 274. Patients receiving CRRT had higher cardiovascular and total-SOFA scores. Inverse probability weighting allowed to adequately balance groups on all predefined confounders. The weighted Kaplan–Meier death rate at day 60 was 54·4% in the CRRT group and 46·5% in the IHD group (weighted HR 1·26, 95% CI 1·01–1·60). In a complementary analysis of less severely ill patients (SOFA score: 3–10), receiving IHD was associated with better day 60 survival compared to CRRT (weighted HR 1.82, 95% CI 1·01–3·28; p < 0.01). We found no evidence of a survival difference between the two RRT modalities in more severe patients. Conclusion Compared to IHD, CRRT as first modality seemed to convey no benefit in terms of survival or of kidney recovery and might even have been associated with less favorable outcome in patients with lesser severity of disease. A prospective randomized non-inferiority trial should be implemented to solve the persistent conundrum of the optimal RRT technique. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03955-9.
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Affiliation(s)
- Stéphane Gaudry
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France. .,Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France. .,Common and Rare Kidney Diseases, INSERM, UMR-S 1155, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. .,Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France.
| | - François Grolleau
- Centre of Research in Epidemiology and Statistics (CRESS), Université de Paris, French Institute of Health and Medical Research (INSERM), National Institute of Agricultural Research (INRA), Paris, France
| | | | | | | | - Éric Boulet
- Réanimation Et USC, GH Carnelle Portes de L'Oise, 95260, Beaumont sur Oise, France
| | - Alexandre Boyer
- CHU de Bordeaux, Service de Réanimation Médicale, 33000, Bordeaux, France
| | | | - Florent Montini
- Réanimation Polyvalente, Centre Hospitalier d'Avignon, Avignon, France
| | - Julien Bohe
- Anesthésie Réanimation Médicale et Chirurgicale, CH Lyon Sud, Pierre Benite, France
| | - Julio Badie
- Réanimation Polyvalente, Hôpital Nord Franche-Comte CH Belfort, Belfort, France
| | | | - Christophe Vinsonneau
- Médecine Intensive Réanimation, CH Bethune Beuvry - Germont et Gauthier, Bethune, France
| | - Raphaël Porcher
- Centre of Research in Epidemiology and Statistics (CRESS), Université de Paris, French Institute of Health and Medical Research (INSERM), National Institute of Agricultural Research (INRA), Paris, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, INSERM, UMR-S 1155, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,Médecine Intensive-Réanimation, APHP, Hôpital Louis Mourier, Université de Paris, Colombes, France
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4
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Le Terrier C, Vinetti M, Bonjean P, Richard R, Jarrige B, Pons B, Madeux B, Piednoir P, Ardisson F, Elie E, Martino F, Valette M, Ollier E, Breurec S, Carles M, Thiéry G. Impact of a restrictive antibiotic policy on the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an endemic region: a before-and-after, propensity-matched cohort study in a Caribbean intensive care unit. Crit Care 2021; 25:261. [PMID: 34311760 PMCID: PMC8311634 DOI: 10.1186/s13054-021-03660-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-level antibiotic consumption plays a critical role in the selection and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in the ICU. Implementation of a stewardship program including a restrictive antibiotic policy was evaluated with respect to ESBL-E acquisition (carriage and infection). METHODS We implemented a 2-year, before-and-after intervention study including all consecutive adult patients admitted for > 48 h in the medical-surgical 26-bed ICU of Guadeloupe University Hospital (French West Indies). A conventional strategy period (CSP) including a broad-spectrum antibiotic as initial empirical treatment, followed by de-escalation (period before), was compared to a restrictive strategy period (RSP) limiting broad-spectrum antibiotics and shortening their duration. Antibiotic therapy was delayed and initiated only after microbiological identification, except for septic shock, severe acute respiratory distress syndrome and meningitis (period after). A multivariate Cox proportional hazard regression model adjusted on propensity score values was performed. The main outcome was the median time of being ESBL-E-free in the ICU. Secondary outcome included all-cause ICU mortality. RESULTS The study included 1541 patients: 738 in the CSP and 803 in the RSP. During the RSP, less patients were treated with antibiotics (46.8% vs. 57.9%; p < 0.01), treatment duration was shorter (5 vs. 6 days; p < 0.01), and administration of antibiotics targeting anaerobic pathogens significantly decreased (65.3% vs. 33.5%; p < 0.01) compared to the CSP. The incidence of ICU-acquired ESBL-E was lower (12.1% vs. 19%; p < 0.01) during the RSP. The median time of being ESBL-E-free was 22 days (95% CI 16-NA) in the RSP and 18 days (95% CI 16-21) in the CSP. After propensity score weighting and adjusted analysis, the median time of being ESBL-E-free was independently associated with the RSP (hazard ratio, 0.746 [95% CI 0.575-0.968]; p = 0.02, and hazard ratio 0.751 [95% CI 0.578-0.977]; p = 0.03, respectively). All-cause ICU mortality was lower in the RSP than in the CSP (22.5% vs. 28.6%; p < 0.01). CONCLUSIONS Implementation of a program including a restrictive antibiotic strategy is feasible and is associated with less ESBL-E acquisition in the ICU without any worsening of patient outcome.
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Affiliation(s)
- Christophe Le Terrier
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France. .,Division of Intensive Care, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.
| | - Marco Vinetti
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Division of Intensive Care, Saint-Pierre Clinic, Ottignies, Belgium
| | - Paul Bonjean
- Division of Clinical Epidemiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Régine Richard
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Bruno Jarrige
- Division of Hospital Infection Control, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Bertrand Pons
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Benjamin Madeux
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Pascale Piednoir
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Fanny Ardisson
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Elain Elie
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Frédéric Martino
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Marc Valette
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France
| | - Edouard Ollier
- Division of Clinical Epidemiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sébastien Breurec
- Laboratory of Clinical Microbiology, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Faculty of Medecine Hyacinthe Bastaraud, University of Antilles, Pointe-à-Pitre, French West Indies, France.,INSERM Center for Clinical Investigation 1424, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de Guadeloupe, Pointe-à-Pitre, French West Indies, France
| | - Michel Carles
- Division of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, Les Abymes, French West Indies, France.,Faculty of Medecine Hyacinthe Bastaraud, University of Antilles, Pointe-à-Pitre, French West Indies, France
| | - Guillaume Thiéry
- Division of Intensive Care, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France. .,University Jean Monnet, Saint-Etienne, France.
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5
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Rodriguez M, Ragot S, Coudroy R, Quenot JP, Vignon P, Forel JM, Demoule A, Mira JP, Ricard JD, Nseir S, Colin G, Pons B, Danin PE, Devaquet J, Prat G, Merdji H, Petitpas F, Vivier E, Mekontso-Dessap A, Nay MA, Asfar P, Dellamonica J, Argaud L, Ehrmann S, Fartoukh M, Girault C, Robert R, Thille AW, Frat JP. Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial. Ann Intensive Care 2021; 11:114. [PMID: 34292408 PMCID: PMC8295638 DOI: 10.1186/s13613-021-00892-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. METHODS Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m-2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure. RESULTS Among the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m-2. Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI - 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77-93] with noninvasive ventilation and 86% [78-92] with high-flow nasal oxygen (P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission. CONCLUSIONS Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ventilation may not reduce this risk compared with high-flow nasal oxygen. Trial registration Clinical trial number: NCT02668458 ( http://www.clinicaltrials.gov ).
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Affiliation(s)
- Maeva Rodriguez
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Stéphanie Ragot
- INSERM, CIC-1402, Biostatistics, Université de Poitiers, Faculté de Médecine Et de Pharmacie de Poitiers, Poitiers, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, CHU Dijon Bourgogne, Dijon, France.,Université Bourgogne Franche-Comté Lipness Team UMR 1231 Et INSERM CIC 1432 Epidémiologie Clinique, Dijon, France
| | - Philippe Vignon
- Réanimation Polyvalente, CHU Dupuytren, 87042, Limoges, France.,Clinical Investigation Centre INSERM 1435, 87042, Limoges, France
| | - Jean-Marie Forel
- Médecine Intensive Réanimation Détresses Respiratoires Et Infection Sévères, AP-HM, CHU Nord and CEReSS - Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Alexandre Demoule
- AP-HP 6, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie Et Réanimation Médicale du Département R3S, Paris, France.,INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France
| | - Jean-Paul Mira
- Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire de Paris Centre, Hôpital Cochin, Réanimation médicale, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Jean-Damien Ricard
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 92700, Colombes, France.,UMR IAME 1137, Université Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.,INSERM, IAME 1137, 75018, Paris, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, Inserm U1285, Univ. Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale Et Fonctionnelle, 59000, Lille, France
| | - Gwenhael Colin
- Centre Hospitalier Départemental de La Roche Sur Yon, Service de Réanimation Polyvalente, La Roche sur Yon, France
| | - Bertrand Pons
- Service de Réanimation, CHU Point-À-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Pierre-Eric Danin
- Réanimation Chirurgicale, CHU de Nice, Nice, France.,INSERM U1065, team 8, C3M, Nice, France
| | | | - Gwenael Prat
- Service de Réanimation Médicale, CHU de La Cavale Blanche, Brest, France
| | - Hamid Merdji
- Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | | | - Emmanuel Vivier
- Service de Réanimation Polyvalente, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
| | - Armand Mekontso-Dessap
- Assistance Publique des Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service Médecine Intensive Réanimation Médicale, 94010, Créteil, France.,Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, 94010, Créteil, France.,INSERM, Unité UMR 955, IMRB, 94010, Créteil, France
| | - Mai-Anh Nay
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional D'Orléans, Orléans, France
| | - Pierre Asfar
- Département de Médecine Intensive-Réanimation, CHU D'Angers, Angers, France
| | - Jean Dellamonica
- Médecine Intensive Réanimation, CHU de Nice, Nice, France.,UR2CA, Université Cote D'Azur, Nice, France
| | - Laurent Argaud
- Service de Réanimation Médicale, Hospices Civils de Lyon, Groupement Hospitalier Universitaire Edouard Herriot, 69003, Lyon, France
| | - Stephan Ehrmann
- CHRU de Tours, Médecine Intensive Réanimation, CIC1415,, CRICS-TriggerSEP Research Network, Tours, France.,Centre D'Etudes Des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Muriel Fartoukh
- Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, 75020, Paris, France
| | - Christophe Girault
- CHU de Rouen, Normandie Univ, UNIROUEN, Department of Medical Intensive Care, Charles Nicolle University, Hospital, Rouen, France.,EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, 76000, Rouen, France
| | - René Robert
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France. .,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France.
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6
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Benichou N, Lebbah S, Hajage D, Martin-Lefèvre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Schortgen F, Tubach F, Ricard JD, Dreyfuss D, Gaudry S. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial. Ann Intensive Care 2021; 11:56. [PMID: 33830370 PMCID: PMC8032839 DOI: 10.1186/s13613-021-00843-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury. PATIENTS AND METHODS We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected. RESULTS Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34-4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98-1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64-1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred. CONCLUSION Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.
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Affiliation(s)
- Nicolas Benichou
- AP-HP, Hôpital Européen Georges Pompidou, Service de Néphrologie, 75015, Paris, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Saïd Lebbah
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - David Hajage
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Faculté de Médecine Sorbonne, Sorbonne Université, Université, Paris, France
| | | | - Bertrand Pons
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Eric Boulet
- Réanimation Polyvalente, CH René Dubos, 95301, Pontoise, France
| | - Alexandre Boyer
- Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, 33000, Bordeaux, France
| | - Guillaume Chevrel
- Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale Et Médecine Hyperbare, CHU Angers, Université D'Angers, Angers, France
| | | | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.,CARMAS Research Group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Bretagnol
- Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional D'Orléans, BP 6709, 45067, Orléans Cedex, France
| | - Julien Mayaux
- Service de Pneumologie Et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, Faculté de Médecine, Université de Lille, 59000, Lille, France
| | - Bruno Megarbane
- Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France
| | - Marina Thirion
- Réanimation Polyvalente, CH Victor Dupouy, 95107, Argenteuil Cedex, France
| | - Jean-Marie Forel
- Service de Réanimation Des Détresses Respiratoires Aiguës Et Infections Sévères, Hôpital Nord Marseille, 13015, Marseille, France
| | - Julien Maizel
- Service de Réanimation Médicale INSERM U1088, Centre Hospitalier Universitaire de Picardie, Amiens, France
| | - Hodane Yonis
- Réanimation Médicale, Hôpital de La Croix Rousse, 69004, Lyon, France
| | | | - Guillaume Thiery
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Frederique Schortgen
- Centre Hospitalier Inter-Communal, Service de Réanimation Polyvalente Adulte, Créteil, France
| | - Florence Tubach
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Univ Pierre Et Marie Curie, Sorbonne Universités, 75013, Paris, France
| | - Jean-Damien Ricard
- Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, 75018, Paris, France.,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France
| | - Didier Dreyfuss
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Stéphane Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 93008, Bobigny, France. .,Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France.
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7
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Gaudry S, Hajage D, Martin-Lefevre L, Lebbah S, Louis G, Moschietto S, Titeca-Beauport D, Combe BL, Pons B, de Prost N, Besset S, Combes A, Robine A, Beuzelin M, Badie J, Chevrel G, Bohé J, Coupez E, Chudeau N, Barbar S, Vinsonneau C, Forel JM, Thevenin D, Boulet E, Lakhal K, Aissaoui N, Grange S, Leone M, Lacave G, Nseir S, Poirson F, Mayaux J, Asehnoune K, Geri G, Klouche K, Thiery G, Argaud L, Rozec B, Cadoz C, Andreu P, Reignier J, Ricard JD, Quenot JP, Dreyfuss D. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet 2021; 397:1293-1300. [PMID: 33812488 DOI: 10.1016/s0140-6736(21)00350-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Delaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury and no severe complication is safe and allows optimisation of the use of medical devices. Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy. METHODS This was an unmasked, multicentre, prospective, open-label, randomised, controlled trial done in 39 intensive care units in France. We monitored critically ill patients with severe acute kidney injury (defined as Kidney Disease: Improving Global Outcomes stage 3) until they had oliguria for more than 72 h or a blood urea nitrogen concentration higher than 112 mg/dL. Patients were then randomly assigned (1:1) to either a strategy (delayed strategy) in which RRT was started just after randomisation or to a more-delayed strategy. With the more-delayed strategy, RRT initiation was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen concentration reached 140 mg/dL. The primary outcome was the number of days alive and free of RRT between randomisation and day 28 and was done in the intention-to-treat population. The study is registered with ClinicalTrial.gov, NCT03396757 and is completed. FINDINGS Between May 7, 2018, and Oct 11, 2019, of 5336 patients assessed, 278 patients underwent randomisation; 137 were assigned to the delayed strategy and 141 to the more-delayed strategy. The number of complications potentially related to acute kidney injury or to RRT were similar between groups. The median number of RRT-free days was 12 days (IQR 0-25) in the delayed strategy and 10 days (IQR 0-24) in the more-delayed strategy (p=0·93). In a multivariable analysis, the hazard ratio for death at 60 days was 1·65 (95% CI 1·09-2·50, p=0·018) with the more-delayed versus the delayed strategy. The number of complications potentially related to acute kidney injury or renal replacement therapy did not differ between groups. INTERPRETATION In severe acute kidney injury patients with oliguria for more than 72 h or blood urea nitrogen concentration higher than 112 mg/dL and no severe complication that would mandate immediate RRT, longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm. FUNDING Programme Hospitalier de Recherche Clinique.
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Affiliation(s)
- Stéphane Gaudry
- Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France; Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France; Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France
| | - David Hajage
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Saïd Lebbah
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Guillaume Louis
- Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | | | | | | | - Bertrand Pons
- Réanimation, CHU Pointe-à-Pitre-Abymes, Pointe-a-Pitre, France
| | | | - Sébastien Besset
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive-Réanimation, Colombes, France
| | - Alain Combes
- Service de Réanimation Médicale, Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Adrien Robine
- Réanimation Soins continus, CH de Bourg-en-Bresse-Fleyriat, 01012 Bourg-en-Bresse, France
| | | | - Julio Badie
- Réanimation polyvalente, Hôpital Nord Franche-Comte CH Belfort, Belfort, France
| | | | - Julien Bohé
- Anesthésie réanimation médicale et chirurgicale, CH Lyon Sud, Pierre Benite
| | - Elisabeth Coupez
- Réanimation polyvalente, Hôpital G. Montpied, Clermont Ferrand, France
| | - Nicolas Chudeau
- Réanimation médico-chirurgicale, CH du Mans, Le Mans, France
| | | | | | | | | | - Eric Boulet
- Réanimation et USC, GH Carnelle Portes de l'Oise, Beaumont sur Oise, France
| | - Karim Lakhal
- Réanimation chirurgicale polyvalente, Hôpital Nord laennec, Nantes, France
| | - Nadia Aissaoui
- Réanimation médicale, Hôpital Georges Pompidou, Paris, France
| | | | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, Marseille, France
| | - Guillaume Lacave
- Réanimation médico-chirurgicale, Hôpital André Mignot, Versailles, France
| | - Saad Nseir
- Réanimation médicale, CHRU de Lille, Hôpital Roger Salengro, Lille, France
| | - Florent Poirson
- Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Julien Mayaux
- Pneumologie et Réanimation médicale, Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Guillaume Geri
- Réanimation médico-chirurgicale, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Kada Klouche
- Médecine Intensive Réanimation, Hôpital Lapeyronnie, Montpellier, France
| | - Guillaume Thiery
- Réanimation médicale, CHU Saint Etienne, Saint Priest en Jarez, France
| | - Laurent Argaud
- Réanimation médicale, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyril Cadoz
- Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | - Pascal Andreu
- Médecine intensive réanimation, Hôtel Dieu, Nantes, France
| | - Jean Reignier
- Médecine intensive réanimation, Hôtel Dieu, Nantes, France
| | - Jean-Damien Ricard
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive-Réanimation, Colombes, France; INSERM, IAME, U1137, Paris, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France; Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France; Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive-Réanimation, Colombes, France.
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8
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Gaudry S, Hajage D, Martin-Lefevre L, Louis G, Moschietto S, Titeca-Beauport D, La Combe B, Pons B, de Prost N, Besset S, Combes A, Robine A, Beuzelin M, Badie J, Chevrel G, Reignier J, Bohé J, Coupez E, Chudeau N, Barbar S, Vinsonneau C, Forel JM, Thevenin D, Boulet E, Lakhal K, Aissaoui N, Grange S, Leone M, Lacave G, Nseir S, Poirson F, Mayaux J, Asehnoune K, Geri G, Klouche K, Thiery G, Argaud L, Ricard JD, Quenot JP, Dreyfuss D. The Artificial Kidney Initiation in Kidney Injury 2 (AKIKI2): study protocol for a randomized controlled trial. Trials 2019; 20:726. [PMID: 31843007 PMCID: PMC6915917 DOI: 10.1186/s13063-019-3774-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Artificial Kidney Initiation in Kidney Injury (AKIKI) trial showed that a delayed renal replacement therapy (RRT) strategy for severe acute kidney injury (AKI) in critically ill patients was safe and associated with major reduction in RRT initiation compared with an early strategy. The five criteria which mandated RRT initiation in the delayed arm were: severe hyperkalemia, severe acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia, serum urea concentration > 40 mmol/l and oliguria/anuria > 72 h. However, duration of anuria/oliguria and level of blood urea are still criteria open to debate. The objective of the study is to compare the delayed strategy used in AKIKI (now termed "standard") with another in which RRT is further delayed for a longer period (termed "delayed strategy"). METHODS/DESIGN This is a prospective, multicenter, open-label, two-arm randomized trial. The study is composed of two stages (observational and randomization stages). At any time, the occurrence of a potentially severe condition (severe hyperkalemia, severe metabolic or mixed acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia) suggests immediate RRT initiation. Patients receiving (or who have received) intravenously administered catecholamines and/or invasive mechanical ventilation and presenting with AKI stage 3 of the KDIGO classification and with no potentially severe condition are included in the observational stage. Patients presenting a serum urea concentration > 40 mmol/l and/or an oliguria/anuria for more than 72 h are randomly allocated to a standard (RRT is initiated within 12 h) or a delayed RRT strategy (RRT is initiated only if an above-mentioned potentially severe condition occurs or if the serum urea concentration reaches 50 mmol/l). The primary outcome will be the number of RRT-free days at day 28. One interim analysis is planned. It is expected to include 810 patients in the observational stage and to randomize 270 subjects. DISCUSSION The AKIKI2 study should improve the knowledge of RRT initiation criteria in critically ill patients. The potential reduction in RRT use allowed by a delayed RRT strategy might be associated with less invasive care and decreased costs. Enrollment is ongoing. Inclusions are expected to be completed by November 2019. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03396757. Registered on 11 January 2018.
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Affiliation(s)
- Stéphane Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France
- AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, 125 Rue de Stalingrad, 93000 Bobigny, France
- Health Care Simulation Center, UFR SMBH, Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - David Hajage
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, CIC-1421, F75013 Paris, France
| | - Laurent Martin-Lefevre
- Réanimation polyvalente, CHR départementale La Roche Sur Yon, 85025 La Roche Sur Yon, France
| | - Guillaume Louis
- Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, 57085 Metz, France
| | | | | | | | - Bertrand Pons
- Réanimation, CHU Pointe-a-Pitre/Abymes, 97159 Pointe-a-Pitre, France
| | - Nicolas de Prost
- Réanimation médicale, Hôpital Henri Mondor, 94010 Créteil, France
| | - Sébastien Besset
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700 Colombes, France
| | - Alain Combes
- Service de Réanimation Médicale, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Adrien Robine
- Réanimation Soins continus, CH de Bourg-en-Bresse – Fleyriat, 01012 Bourg-en-Bresse, France
| | | | - Julio Badie
- Réanimation polyvalente, Hôpital Nord Franche-Comte CH Belfort, 90016 Belfort, France
| | - Guillaume Chevrel
- Réanimation polyvalente, CH Sud Francilien, 91106 Corbeil Essones, France
| | - Jean Reignier
- Réanimation médicale, Hôtel Dieu, 44035 Nantes, France
| | - Julien Bohé
- Anesthésie réanimation médicale et chirurgicale, CH Lyon Sud, 69495 Pierre Benite,, France
| | - Elisabeth Coupez
- Réanimation polyvalente, Hôpital G. Montpied, 63003 Clermont Ferrand, France
| | - Nicolas Chudeau
- Réanimation médico-chirurgicale, CH du Mans, 72037 Le Mans, France
| | - Saber Barbar
- Réanimation, Hôpital Caremeau, 30029 Nimes, France
| | | | | | | | - Eric Boulet
- Réanimation et USC, GH Carnelle Portes de l’Oise, 95260 Beaumont sur Oise, France
| | - Karim Lakhal
- Anesthésie Réanimation, hôpital Nord laennec, 44093 Nantes, France
| | - Nadia Aissaoui
- Réanimation médicale, Hôpital Georges Pompidou, 75014 Paris, France
| | - Steven Grange
- Réanimation médicale, CHU Rouen, 76031 Rouen, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015 Marseille, France
| | - Guillaume Lacave
- Réanimation médico-chirurgicale, Hôpital André Mignot, 78000 Versailles, France
| | - Saad Nseir
- Réanimation médicale, CHRU de Lille, Hôpital Roger Salengro, 59037 Lille, France
| | - Florent Poirson
- AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Julien Mayaux
- Pneumologie et Réanimation médicale, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | | | - Guillaume Geri
- Réanimation médico-chirurgicale, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - Kada Klouche
- Médecine Intensive Réanimation, Hôpital lapeyronnie, 34295 Montpellier, France
| | - Guillaume Thiery
- Réanimation médicale, CHU Saint Etienne, 42270 Saint Priest en Jarez, France
| | - Laurent Argaud
- Réanimation médicale, Hôpital Edouard Herriot, 69437 Lyon, France
| | - Jean-Damien Ricard
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700 Colombes, France
- Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France
- INSERM, IAME, U1137, F-75018 Paris, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Didier Dreyfuss
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700 Colombes, France
- Sorbonne Paris-Cité, Paris, France
- Present address: Intensive Care Unit, Hôpital Louis Mourier, 178 rue des Renouillers, 92110 Colombes, France
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Abstract
BACKGROUND Data on outcomes of critically ill patients requiring mechanical ventilation at the onset of stroke are limited. OBJECTIVE To assess the hospital and long-term functional outcomes of patients with stroke who require mechanical ventilation. METHODS This retrospective single-center cohort study performed from 1994 to 2008 involved adult patients within 7 days of stroke onset and who required intensive care unit admission and mechanical ventilation. RESULTS A total of 274 patients requiring mechanical ventilation at the onset of stroke were analyzed. Indications for intubation included coma in 195 patients (71%). The median (interquartile range) score on the Glasgow Coma Scale at admission to the intensive care unit was 6 (3-9). Forty-four patients (16%) had sepsis at intensive care unit admission. The overall hospital mortality rate was 53%. After adjustment for confounders, severity of illness at admission as assessed by the Simplified Acute Physiology Score II (odds ratio, 1.07; 95% CI, 1.05-1.10), anisocoria (odds ratio, 5.26; 95% CI, 1.76-15.80), and sepsis at intensive care unit admission (odds ratio, 0.40; 95% CI, 0.19-0.85) were associated with outcome. At 1 year, median (interquartile range) modified Rankin Scale score was 6 (2-6). Only 89 patients (32%) exhibited mild to moderate neurologic impairment. CONCLUSION In this study, adult patients requiring mechanical ventilation at the onset of stroke experienced high 1-year mortality, with survivors having poor functional status.
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Affiliation(s)
- Perrine Bouvet
- Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
| | - Martin Murgier
- Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
| | - Bertrand Pons
- Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France
| | - Michael Darmon
- Perrine Bouvet is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France, and Department of Anesthesiology, Montelimar Hospital, Montelimar, France. Martin Murgier is a physician, medical-surgical intensive care unit, Saint-Etienne University Hospital. Bertrand Pons is a physician, medical-surgical intensive care unit, Pointe à Pitre University Hospital, Guadeloupe, France. Michael Darmon is a physician, medical intensive care unit, Saint-Louis University Hospital, AP-HP, Paris, France; a professor of intensive care medicine, Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France; and a researcher on the ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.
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10
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Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Verney C, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Tubach F, Ricard JD, Dreyfuss D. Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial. Am J Respir Crit Care Med 2019; 198:58-66. [PMID: 29351007 DOI: 10.1164/rccm.201706-1255oc] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown. OBJECTIVES To examine the effect of an early compared with a delayed RRT initiation strategy on 60-day mortality according to baseline sepsis status, ARDS status, and severity. METHODS Post hoc analysis of the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial. MEASUREMENTS AND MAIN RESULTS Subgroups were defined according to baseline characteristics: sepsis status (Sepsis-3 definition), ARDS status (Berlin definition), Simplified Acute Physiology Score 3 (SAPS 3), and Sepsis-related Organ Failure Assessment (SOFA). Of 619 patients, 348 (56%) had septic shock and 207 (33%) had ARDS. We found no significant influence of the baseline sepsis status (P = 0.28), baseline ARDS status (P = 0.94), and baseline severity scores (P = 0.77 and P = 0.46 for SAPS 3 and SOFA, respectively) on the comparison of 60-day mortality according to RRT initiation strategy. A delayed RRT initiation strategy allowed 45% of patients with septic shock and 46% of patients with ARDS to escape RRT. Urine output was higher in the delayed group. Renal function recovery occurred earlier with the delayed RRT strategy in patients with septic shock or ARDS (P < 0.001 and P = 0.003, respectively). Time to successful extubation in patients with ARDS was not affected by RRT strategy (P = 0.43). CONCLUSIONS Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or ARDS. Unnecessary and potentially risky procedures might often be avoided in these fragile populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01932190).
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Affiliation(s)
- Stéphane Gaudry
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France.,2 Unité Mixte de Recherche (UMR) S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, French National Institute of Health and Medical Research (INSERM), Paris, France
| | - David Hajage
- 3 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Centre d'Investigation Clinique 1421, INSERM, Paris, France.,4 Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France.,5 Département de Biostatistiques, Santé Publique, et Information Médicale, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Frédérique Schortgen
- 6 Service de Réanimation Polyvalente Adulte, Centre Hospitalier Inter-communal, Créteil, France
| | | | - Charles Verney
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - Bertrand Pons
- 8 Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Pointe à Pitre-Abymes, France.,9 CHU de la Guadeloupe, Pointe-à-Pitre, France
| | - Eric Boulet
- 10 Réanimation Polyvalente, Centre Hospitalier René Dubos, Pontoise, France
| | - Alexandre Boyer
- 11 Réanimation Médicale, CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Guillaume Chevrel
- 12 Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- 13 Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers, Angers, France
| | | | - Nicolas de Prost
- 15 Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, AP-HP, Créteil, France.,16 Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- 17 Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Bretagnol
- 18 Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, Orléans, France
| | - Julien Mayaux
- 19 Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris France
| | - Saad Nseir
- 20 Centre de Réanimation, CHU de Lille, Lille, France.,21 Faculté de Médecine, Université de Lille, Lille, France
| | - Bruno Megarbane
- 22 Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Université Paris-Diderot, INSERM U1144, Paris, France
| | - Marina Thirion
- 23 Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Jean-Marie Forel
- 24 Service de Réanimation des Détresses Respiratoires Aiguës et Infections Sévères, Hôpital Nord Marseille, Marseille, France
| | - Julien Maizel
- 25 Service de Réanimation Médicale CHU de Picardie, INSERM U1088, Amiens, France
| | - Hodane Yonis
- 26 Réanimation Médicale, Hôpital de la Croix Rousse, Lyon, France
| | | | - Guillaume Thiery
- 8 Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Pointe à Pitre-Abymes, France.,9 CHU de la Guadeloupe, Pointe-à-Pitre, France
| | - Florence Tubach
- 3 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Centre d'Investigation Clinique 1421, INSERM, Paris, France.,5 Département de Biostatistiques, Santé Publique, et Information Médicale, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.,28 Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Jean-Damien Ricard
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France.,29 Université Paris Diderot, Sorbonne Paris Cité, Infection, Antimicrobials, Modelling, Evolution (IAME), UMRS 1137, Paris, France; and.,30 INSERM, IAME, U1137, Paris, France
| | - Didier Dreyfuss
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France.,29 Université Paris Diderot, Sorbonne Paris Cité, Infection, Antimicrobials, Modelling, Evolution (IAME), UMRS 1137, Paris, France; and.,30 INSERM, IAME, U1137, Paris, France
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11
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Kallel H, Rozé B, Pons B, Mayence C, Mathien C, Resiere D, Melot B, Hommel D, Mehdaoui H, Carles M. Infections tropicales graves dans les départements français d’Amérique, Antilles françaises et Guyane. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies infectieuses. Ces territoires sont de plus l’objet de mouvements importants de populations, voyageurs ou migrants, ce qui joue un rôle significatif dans le développement d’épidémies et/ou de pathologies émergentes. Ces pathologies infectieuses dites « tropicales » peuvent nécessiter une prise en charge en réanimation. Nous rapportons ici les principales données récentes concernant ces pathologies (hors infection liée au VIH) ainsi que les stratégies diagnostiques et thérapeutiques, à l’usage des réanimateurs amenés à exercer en zone tropicale AG ou recevant en métropole des patients issus de cette région.
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12
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Frat JP, Ricard JD, Quenot JP, Pichon N, Demoule A, Forel JM, Mira JP, Coudroy R, Berquier G, Voisin B, Colin G, Pons B, Danin PE, Devaquet J, Prat G, Clere-Jehl R, Petitpas F, Vivier E, Razazi K, Nay MA, Souday V, Dellamonica J, Argaud L, Ehrmann S, Gibelin A, Girault C, Andreu P, Vignon P, Dangers L, Ragot S, Thille AW, Chatellier D, Boissier F, Veinstein A, Robert R, Deletage-Métreau C, Olivry M, Dahyot-Fizelier C, Dargent A, Large A, Begot E, Mancia C, Decavele M, Dres M, Lehingue S, Papazian L, Paul M, Marin N, Le Meur M, Laissy M, Rouzé A, Nseir S, Henry-Lagarrigue M, Yehia A, Martino F, Cerf C, Bailly P, Helms J, Putegnat JB, Mekontso-Dessap A, Boulain T, Asfar P, Cabasson S, Wallet F, Klouche K, Bellec F, Chatellier D, Boissier F, Veinstein A, Robert R, Deletage-Métreau C, Olivry M, Decavele M, Dres M, Lehingue S, Papazian L, Le Meur M, Laissy M, Rouzé A, Nseir S, Henry-Lagarrigue M, Yehia A, Cerf C, Mekontso-Dessap A, Boulain T, Asfar P. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial. The Lancet Respiratory Medicine 2019; 7:303-312. [DOI: 10.1016/s2213-2600(19)30048-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
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13
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Ichai P, Laurent-Bellue A, Camus C, Moreau D, Boutonnet M, Saliba F, Peron JM, Ichai C, Gregoire E, Aigle L, Cousty J, Quinart A, Pons B, Boudon M, André S, Coilly A, Antonini T, Guettier C, Samuel D. Liver transplantation in patients with liver failure related to exertional heatstroke. J Hepatol 2019; 70:431-439. [PMID: 30521841 DOI: 10.1016/j.jhep.2018.11.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Severe acute liver injury is a grave complication of exertional heatstroke. Liver transplantation (LT) may be a therapeutic option, but the criteria for LT and the optimal timing of LT have not been clearly established. The aim of this study was to define the profile of patients who require transplantation in this context. METHODS This was a multicentre, retrospective study of patients admitted with a diagnosis of exertional heatstroke-related severe acute liver injury with a prothrombin time (PT) of less than 50%. A total of 24 male patients were studied. RESULTS Fifteen of the 24 patients (median nadir PT: 35% [29.5-40.5]) improved under medical therapy alone and survived. Nine of the 24 were listed for emergency LT. At the time of registration, the median PT was 10% (5-12) and all had numerous dysfunctional organs. Five patients (nadir PT: 12% [9-12]) were withdrawn from the list because of an elevation of PT values that mainly occurred between day 2 and day 3. Ultimately, 4 patients underwent transplantation as their PT persisted at <10%, 3 days (2.75-3.25) after the onset of exertional heatstroke, and they had more than 3 organ dysfunctions. Of these 4 patients, 3 were still alive 1 year later. Histological analysis of the 4 explanted livers demonstrated massive or sub-massive necrosis, and little potential for effective mitoses, characterised by a "mitonecrotic" appearance. CONCLUSION The first-line treatment for exertional heatstroke-related severe acute liver injury is medical therapy. LT is only a rare alternative and such a decision should not be taken too hastily. A persistence of PT <10%, without any signs of elevation after a median period of 3 days following the onset of heatstroke, was the trigger that prompted LT, was the trigger adopted in order to decide upon LT. LAY SUMMARY Acute liver injury due to heatstroke can progress to acute liver failure with organ dysfunction despite medical treatment; in such situations, liver transplantation (LT) may offer a therapeutic option. The classic criteria for LT appear to be poorly adapted to heatstroke-related acute liver failure. We confirmed thatmedication is the first-line therapy acute liver injury caused by heatstroke, with LT only rarely necessary. A decision to perform LT should not be made hastily. Fluctuations in prothrombin time and the patient's clinical status should be considered even in the event of severe liver failure.
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Affiliation(s)
- Philippe Ichai
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France; INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France.
| | | | - Christophe Camus
- CHU de Rennes, Department of Infectious Disease and Intensive Care Unit, Hôpital Pontchaillou, Rennes, France
| | | | - Mathieu Boutonnet
- Percy Military Teaching Hospital, French Ministry of Defence, Intensive Care Unit, Clamart 92000, France
| | - Faouzi Saliba
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France; INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Jean Marie Peron
- Hôpital Purpan, Department of Hepato-Gastro-Enterology, Université Paul Sabatier III, Toulouse 31059, France
| | - Carole Ichai
- Hôpital Saint Roch, Liver Intensive Care Unit, Nice 06006, France
| | - Emilie Gregoire
- AP-HM Hôpital La Timone, Département de chirurgie digestive, Marseille 13005, France
| | - Luc Aigle
- 154(e) Antenne Médicale du 10(e) Centre Médical des Armées, France
| | - Julien Cousty
- CHU de La Réunion, Intensive Care Unit, La Réunion, France
| | - Alice Quinart
- CHU de Bordeaux, Hôpital Pellegrin, Bordeaux 33 076, France
| | - Bertrand Pons
- CHU Pointe à Pitre, Intensive Care Unit, 97159 Pointe à Pitre, France
| | - Marc Boudon
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France; INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Stephane André
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France; INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Teresa Antonini
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France; INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Catherine Guettier
- INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France; APHP Hôpital Bicêtre, Department of Pathology, Le Kremlin-Bicêtre, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Liver Intensive Care Unit, Villejuif F-94800, France; INSERM, Unité 1193, Université Paris-Saclay, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
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Rodríguez-Vida A, Pérez-Gracia J, Taus A, Bonfill T, Vázquez-Mazón F, Galtes S, Pons B, Cano L, Macia S, Maroto P, Bellmunt J. Phase II study of paclitaxel and TAK-228 in metastatic urothelial carcinoma and the impact of PI3K-mTOR pathway genomic alterations. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Beaulieu S, Comby A, Clergerie A, Caillat J, Descamps D, Dudovich N, Fabre B, Géneaux R, Légaré F, Petit S, Pons B, Porat G, Ruchon T, Taïeb R, Blanchet V, Mairesse Y. Attosecond-resolved photoionization of chiral molecules. Science 2017; 358:1288-1294. [DOI: 10.1126/science.aao5624] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/10/2017] [Indexed: 11/02/2022]
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Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer D, Jost D, Lamhaut L, Beganton F, Cariou A, Meyer G, Jouven X, Bureau C, Charpentier J, Salem OBH, Guillemet L, Arnaout M, Ferre A, Geri G, Mongardon N, Pène F, Chiche JD, Mira JP, Labro G, Belon F, Luu VP, Chenet J, Besch G, Puyraveau M, Piton G, Capellier G, Martin M, Lascarrou JB, Le Thuaut A, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Henry-Laguarrigue M, Colin G, Reignier J, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Robert-Edan V, Lakhal K, Quartin A, Hobbs B, Cely C, Bell C, Pham T, Schein R, Geng Y, Ng C, Ehrmann S, Gandonnière CS, Boisramé-Helms J, Le Tilly O, De Bretagne IB, Mercier E, Mankikian J, Bretagnol A, Meziani F, Halimi JM, Le Guellec CB, Gaudry S, Hajage D, Tubach F, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Mayaux J, Nseir S, Ricard JD, Dreyfuss D, Robert R, Garzotto F, Kipnis E, Tetta C, Ronco C, Schnell D, Aurelie B, Reynaud M, Clec’h C, Benyamina M, Vincent F, Mariat C, Bornstain C, Gloulou O, Boussarsar M, Zelmat SA, Batouche DD, Chaffi B, Mazour F, Benatta N, Fathallah I, Aloui R, Zoubli A, Rouleau S, Kouraichi N, Fathallah I, Kouraichi N, Salem S, Vicaut E, Megarbane B, Ambroise D, Loriot AM, Bourgogne E, Megarbane B, Leroy C, Ghadhoune H, Jihene G, Trabelsi I, Allouche H, Brahmi H, Samet M, Ghord HE, Lebeau R, Laplanche JL, Benturquia N, Cohen Y, Megarbane B, Blel Y, M’rad A, Essafi F, Benabderrahim A, Jouffroy R, Resiere D, Sanchez B, Inamo J, Megarbane B, Morel J, Batouche DD, Zerhouni A, Tabeliouna K, Negadi A, Mentouri Z, Le Gall F, Hanouz JL, Normand H, Khoury A, Sall FS, Legrand M, De Luca A, Pugin A, Pazart L, Vidal C, Leroux F, Khoury A, L’Her E, Marjanovic N, Khoury A, Desmettre T, Terreaux J, Lambert C, Ragey SP, Baboi L, Bazin JE, Koffel C, Dhonneur G, Bouzit Z, Bradai L, Ayed IB, Aissa F, Darmon M, Haouache H, Marechal Y, Biston P, Piagnerelli M, 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L, Hermetet C, Regaieg K, Khemakhem R, Sonneville R, Chelly H, Cheikh CM, Mountij H, Rghioui K, Haddad W, Cherkab R, Barrou H, Naima A, bennani OM, Regaieg K, Fayssoil A, Douib A, Samet A, Cungi PJ, Nguyen C, Cotte J, D’aranda E, Meaudre E, Avaro JP, Slaoui MT, Mokline A, Stojkovic T, Rahmani I, Laajili A, Amri H, Gharsallah L, Gasri B, Tlaili S, Hammouda R, Messadi AA, Behin A, Ogna A, Lofaso F, Laforet P, Wahbi K, Prigent H, Duboc D, Orlikowski D, Eymard B, Annane D, Le Guennec L, Cholet C, Bréchot N, Hekimian G, Besset S, Lebreton G, Nieszkowska A, Trouillet JL, Leprince P, Combes A, Luyt CE, Griton M, Sesay M, De Panthou NS, Bienvenu T, Biais M, Nouette-Gaulain K, Fossat G, Baudin F, Coulanges C, Bobet S, Dupont A, Courtes L, Benzekri D, Kamel T, Muller G, Bercault N, Barbier F, Runge I, Skarzynski M, Mathonnet A, Boulain T, Jouan Y, Teixera N, Hassen-Khodja C, Guillon A, Gaborit C, Grammatico-Guillon L, Rebière C, Azoulay E, Misset B, Ruckly S, Garrouste-Orgeas M, Kentish-Barnes N, Duranteau J, Thuong M, Joseph L, Renault A, Lesieur O, Larbi AGS, Viquesnel G, Zuber B, Marque S, Kandelman S, Pichon N, Floccard B, Galon M, Chevret S, Kentish-Barnes N, Seegers V, Legriel S, Jaber S, Lefrant JY, Reuter D, Guisset O, Cracco C, Seguin A, Durand-Gasselin J, Thirion M, Cohen-Solal Z, Foulgoc H, Rogier J, Delobbe E, Schortgen F, Asfar P, Julie BH, Grimaldi D, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Radermacher P, Kentish-Barnes N, Makunza JN, Nathalie MK, Pierre A, Adolphe KM, Mahieu R, Reydel T, Jamet A, Chudeau N, Huntzinger J, Grange S, Courte A, Lemarie J, Gibot S, Champey J, Dellamonica J, Du Cheyron D, Contou D, Tadié JM, Cour M, Beduneau G, Marchalot A, Guérin L, Jochmans S, Terzi N, Preau S, Brun-Buisson C, Dessap AM, Vedrenne-Cloquet M, Breinig S, Jung C, Brussieux M, Marcoux MO, Durrmeyer X, Blondé R, Angoulvant F, Grasset J, Naudin J, Dauger S, Remy S, Kolev-Descamp K, Demaret J, Monneret G, Javouhey E, Chomton M, Sauthier M, Vallieres E, Jouvet P, Geslain G, Guellec I, Rambaud J, Schmidt M, Schellongowski P, Dorget A, Patroniti N, Taccone FS, Miranda DR, Reuter J, Prodanovic H, Pierrot M, Balik M, Park S, Guérin C, Papazian L, Jean R, Ayzac L, Loundou A, Forel JM, Mezidi M, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Yonis H, Coudroy R, Frat JP, Boissier F, Thille AW, Richard F, Le Gullou-Guillemette H, Fahri J, Kouatchet A, Bodet-Contentin L, Garot D, Le Pennec D, Vecellio L, Tavernier E, Dequin PF, Messika J, Martin Y, Maquigneau N, Puechberty C, Stoclin A, Villard S, Dechanet A, De Jong A, Monnin M, Girard M, Chanques G, Molinari N, Decavèle M, Campion S, Ainsouya R, Niérat MC, Raux M, Similowski T, Demoule A, Razazi K, Tchir M, May F, Carteaux G, Pauline RB, Marc A, Bedos JP, Mehrsa K, Mauger-Briche C, Mijon F, Trouiller P, Sztrymf B, Cretallaz P, Mermillod-Blondin R, Savary D, Sedghiani I, Doghri H, Jendoubi A, Hamdi D, Cherif MA, Hechmi YZE, Zouheir J, Persico N, Maltese F, Ferrigno C, Bablon A, Marmillot C, Roch A, Sedghiani I, Papin G, Gainnier M, Argaud L, Christophe A, Souweine B, Goldgran-Toledano D, Marcotte G, Dumenil AS, Carole S, Cecchini J, Tuffet S, Fartoukh M, Roux D, Thyrault M, Armand MD, Chauveau S, Wesner N, Monnier-Cholley L, Bigé N, Ait-Oufella H, Guidet B, Dubée V, Labroca P, Lemarié J, Chiesa G, Laroyenne I, Borrini L, Klotz R, Sy QP, Cristina MC, Paysant J, Fillâtre P, Gacouin A, Revest M, Tattevin P, Flecher E, Le Tulzo Y, Jamme M, Daviaud F, Marin N, Thy M, Duceau B, Ardisson F, Sandrine V, Venot M, Schlemmer B, Zafrani L, Pons S, Styfalova L, Bouadma L, Radjou A, Lebut J, Mourvillier B, Dorent R, Dilly MP, Nataf P, Wolff M, Le Gall A, Bourcier S, Tandjaoui-Lambiotte Y, Das V, Alves M, Bigé N, Kamilia C, Rania A, Baccouch N, Turki O, Ben HC, Bahloul M, Bouaziz M, Dupuis C, Perozziello A, Letheulle J, Valette M, Herrmann-Storck C, Crosby L, Elkoun K, Madeux B, Martino F, Migueres H, Piednoir P, Posch M, Thiery G, Huynh-Ky MT, Bouchard PA, Sarrazin JF, Lellouche F, Nay MA, Lortat-Jacob B, Rozec B, Colnot M, Belin N, Barrot L, Navellou JC, Patry C, Chaignat C, Claveau M, Claude F, Aubron C, Mcquilten Z, Bailey M, Board J, Buhr H, Cartwright B, Dennis M, Forrest P, Hodgson C, Mcilroy D, Murphy D, Murray L, Pellegrino V, Pilcher D, Sheldrake J, Tran H, Vallance S, Cooper J, Bombled C, Vidal C, Margetis D, Amour J, Coart D, Dubois J, Van Herpe T, Mesotten D, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Tudesq JJ, Valade S, Galicier L, De Bazelaire C, Munoz-Bongrand N, Mignard X, Biard L, Mokart D, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Mariotte E, Ehooman F, Hamidfar-Roy R, Hourmant Y, Mailloux A, Beurton A, Teboul JL, Girroto V, Laura G, Richard C, Monnet X, Dubée V, Merdji H, Dang J, Preda G, Baudel JL, Desnos C, Zeitouni M, Belaroussi I, Parrot A, Blayau C, Fulgencio JP, Quesnel C, Labbe V, De Chambrun MP, Beloncle F, Merceron S, Fedun Y, Lecomte B, Devaquet J, Puidupin M, Verdière B, Amoura Z, Vuillard C, Xavier J, Bourlier D, David A, Caroline S, David M, Gerald S, Olivier S, Humbert M, Laurent S, Dujardin O, Bouglé A, Ait HN, Salem JE, El-Helali N, Coppere Z, Gibelin A, Taconet C, Djibre M, Maamar A, Colobert E, Fillatre P, Uhel F, Camus C, Moraly J, Dahoumane R, Maury E, Tan BK, Emmanuel V, Pauline M, Laurence P, Philippe P, Zahar JR, Catherine H, Christian P, Karim AB, Mounia H, Laura T, Rasoldier VH, Mager G, Eraldi JP, Gelinotte S, Bougerol F, Dehay J, Rigaud JP, Declercq PL, Michel J, Aissa N, Henard S, Guerci P, Latar I, Levy B, Girerd N, Kimmoun A, Abdallah SB, Nakaa S, Hraiech K, Braiek DB, Adhieb A, M’ghirbi A, Ousji A, Hammouda Z, Abroug F, Sellami W, Hajjej Z, Samoud W, Labbene I, Ferjani M, Medhioub FK, Allela R, Algia NB, Cherif S, Attia D, Herinjatovo A, Francois XL, Bouhouri MA, Slaoui MT, Soufi A, Khaleq K, Hamoudi D, Nsiri A, Harrar R, Maury E, Goursaud S, Gauberti M, Labeyrie PE, Gaberel T, Agin V, Maubert E, Vivien D, Gakuba C, Armel A, Abdou R, Kalouch S, Yaqini K, Chlilek A, Sellami W, Yedder SB, Tonnelier A, Hervé F, Halley G, Frances JL, Moriconi M, Saoli M, Garnero A, Demory D, Arnal JM, Canoville B, Daubin C, Brunet J, Ghezala HB, Snouda S, Ben CI, Kaddour M, Ouanes I, Marzouk M, Haniez F, Jaillet H, Maas H, Andrivet P, Darné C, Viau F, Ghezala HB, Ouanes I, Dangers L, Montlahuc C, Perbet S, Ouanes I, Hamouda Z, Nakee S, Ouanes-Besbes L, Meddeb K, Khedher A, Sma N, Ayachi J, Khelfa M, Fraj N, Lakhal HB, Hammed H, Boukadida R, Hafsa H, Chouchene I, Boussarsar M, Ben BD, Ouanes-Besbes L, Benatti K, Dafir A, Aissaoui W, Elallame W, Haddad W, Cherkab R, Elkettani C, Barrou L, Hamou ZA, Repessé X, Charron C, Aubry A, Paternot A, Maizel J, Slama M, Vieillard-Baron A, Trifi A, Abdellatif S, Fatnassi M, Daly F, Nasri R, Ismail KB, Lakhal SB, Bazalgette F, Daurat A, Roger C, Muller L, Doyen D, Plattier R, Robert A, Hyvernat H, Bernardin G, Jozwiak M, Gimenez J, Mercado P, Depret F, Tilouch N, Mater H, Habiba BSA, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Pasquier P, Vuillemin Q, Schaal JV, Martinez T, Duron S, Trousselard M, Schwartzbrod PE, Baugnon T, Dupic L, Gout CD, De Saint Blanquat L, Séguret S, Le Ficher G, Orliaguet G, Hubert P, Bigé N, Leblanc G, Briand R, Brousse L, Brunet V, Chatelain L, Prat D, Jacobs F, Demars N, Hamzaoui O, Moneger G, Sztrymf B, Duburcq-Gury E, Satre-Buisson L, Duburcq T, Poissy J, Robriquet L, Jourdain M, Sécheresse T, Miquet M, Simond A, Usseglio P, Hamdaoui Y, Boussarsar M, Desailly V, Brun P, Iglesias P, Huet J, Masseran C, Claudon A, Ebeyer C, Truong T, Tesnière A, Mignon A, Gaudry S, Resiere D, Valentino R, Fabre J, Roze B, Ferge JL, Charbatier C, Marie S, Scholsser M, Aitsatou S, Raad M, Cabie A, Mehdaoui H, Cousin C, Rousseau C, Llitjos JF, Alby-Laurent F, Toubiana J, Belaidouni N, Cherruault M, Tamburini J, Bouscary D, Fert S, Delile E, Besnier E, Coquerel D, Nevière R, Richard V, Tamion F, Wei C, Louis H, Margaux S, Eliane A, Sophie O, Kimmoun A, Riad Z, Coroir M, Rémy B, Camille B, Joffre J, Aegerter P, Ilic D, Ginet M, Pignard C, Nguyen P, Mourey G, Samain E, Pili-Floury S, Jouffroy R, Nicolas C, Alvarez JC, Tomasso M, Philippe P, Raphalen JH, Frédéric JB, Vivien B, Pierre C, Baud F, Fredj H, Blel Y, Brahmi N, Ghezala HB, Hanak AS, Malissin I, Poupon J, Risede P, Chevillard L, Megarbane B, Barghouth M, M’rad A, Hmida MB, Thabet H, Liang H, Callebert J, Lagard C, Megarbane B, Habacha S, Chatbri B, Camillerapp C, Labat L, Soichot M, Garçon P, Goury A, Kerdjana L, Voicu S, Deye N, Megarbane B, Armel A, Anas B, Othman M, Moumine S, Kalouch S, Yakini KK, Chlilek A, Hajji A, Louati A, Khaldi A, Borgi A, Ghali N, Bouziri A, Menif K, Ben JN, Armel A, Brochon J, Dumitrescu M, Thévenot S, Saulnier JP, Husseini K, Laland C, Cremniter J, Bousseau A, Castel O, Brémaud-Csizmadia C, Diss M, Portefaix A, Berthiller J, Gillet Y, Aoul NT, Douah A, Addou Z, Youbi H, Moussati M, Belhabiche K, Mir S, Abada S, Amel Z, Aouffen N, Bouzit Z, Grati AH, Dhonneur GF, Boussarsar M, Lau N, Mezhari I, Roucaud N, Le Meur M, Paulet R, Coudray JM, Ghomari WI, Boumlik R, Peigne V, Daban JL, Boutonnet M, Lenoir B, Yassine H, Mohamed CC, Khalid A, Ihssan M, Said E, Said S, Jazia AB, Fatima J, Wafa S, Maha B, Khaoula BA, Sami T, Abdallah Taeib B, Medhioub FK, Rollet-Cohen V, Sachs P, Merchaoui Z, Renolleau S, Oualha M, Eloi M, Jean S, Demoulin M, Valentin C, Guilbert J, Walti H, Carbajal R, Leger PL, Karaca-Altintas Y, Botte A, Labreuche J, Drumez E, Devos P, Bour F, Leclerc F, Ahmed A, khaled M, Louati A, Aida B, Ammar K, Narjess G, Ahmed H, Asma B, Jaballah NB, Leger PL, Pansiot J, Besson V, Palmier B, Baud O, Cauli B, Charriaut-Marlangue C, Mansuy A, Michel F, Le Bel S, Boubnova J, Ughetto F, Ovaert C, Fouilloux V, Paut O, Jacquet-Lagrèze M, Tiebergien N, Hanna N, Evain JN, Baudin F, Courtil-Teyssedre S, Bompard D, Lilot M, Chardonal L, Fellahi JL, Claverie C, Pouessel G, Dorkenoo A, Renaudin JM, Eb M, Deschildre A, Leteurtre S, Yassine H, Kamal B, Adil O, Ouafa A, Mouhamed M, Rachid C, Lahoucine B, Dachraoui F, Nakkaa S, Zaineb H, Mlika D. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225387 DOI: 10.1186/s13613-016-0223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Tubach F, Ricard JD, Dreyfuss D. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med 2016; 375:122-33. [PMID: 27181456 DOI: 10.1056/nejmoa1603017] [Citation(s) in RCA: 625] [Impact Index Per Article: 78.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The timing of renal-replacement therapy in critically ill patients who have acute kidney injury but no potentially life-threatening complication directly related to renal failure is a subject of debate. METHODS In this multicenter randomized trial, we assigned patients with severe acute kidney injury (Kidney Disease: Improving Global Outcomes [KDIGO] classification, stage 3 [stages range from 1 to 3, with higher stages indicating more severe kidney injury]) who required mechanical ventilation, catecholamine infusion, or both and did not have a potentially life-threatening complication directly related to renal failure to either an early or a delayed strategy of renal-replacement therapy. With the early strategy, renal-replacement therapy was started immediately after randomization. With the delayed strategy, renal-replacement therapy was initiated if at least one of the following criteria was met: severe hyperkalemia, metabolic acidosis, pulmonary edema, blood urea nitrogen level higher than 112 mg per deciliter, or oliguria for more than 72 hours after randomization. The primary outcome was overall survival at day 60. RESULTS A total of 620 patients underwent randomization. The Kaplan-Meier estimates of mortality at day 60 did not differ significantly between the early and delayed strategies; 150 deaths occurred among 311 patients in the early-strategy group (48.5%; 95% confidence interval [CI], 42.6 to 53.8), and 153 deaths occurred among 308 patients in the delayed-strategy group (49.7%, 95% CI, 43.8 to 55.0; P=0.79). A total of 151 patients (49%) in the delayed-strategy group did not receive renal-replacement therapy. The rate of catheter-related bloodstream infections was higher in the early-strategy group than in the delayed-strategy group (10% vs. 5%, P=0.03). Diuresis, a marker of improved kidney function, occurred earlier in the delayed-strategy group (P<0.001). CONCLUSIONS In a trial involving critically ill patients with severe acute kidney injury, we found no significant difference with regard to mortality between an early and a delayed strategy for the initiation of renal-replacement therapy. A delayed strategy averted the need for renal-replacement therapy in an appreciable number of patients. (Funded by the French Ministry of Health; ClinicalTrials.gov number, NCT01932190.).
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Affiliation(s)
- Stéphane Gaudry
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - David Hajage
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Fréderique Schortgen
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Laurent Martin-Lefevre
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Bertrand Pons
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Eric Boulet
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Alexandre Boyer
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Guillaume Chevrel
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Nicolas Lerolle
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Dorothée Carpentier
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Nicolas de Prost
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Alexandre Lautrette
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Anne Bretagnol
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Julien Mayaux
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Saad Nseir
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Bruno Megarbane
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Marina Thirion
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Jean-Marie Forel
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Julien Maizel
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Hodane Yonis
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Philippe Markowicz
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Guillaume Thiery
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Florence Tubach
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Jean-Damien Ricard
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Didier Dreyfuss
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
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Madeux B, Pons B, Elkoun K, Thiery G. Uraemic frost: a clinical manifestation of severe uraemia. Postgrad Med J 2016; 92:491. [PMID: 27083208 DOI: 10.1136/postgradmedj-2015-133932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/31/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Benjamin Madeux
- Service de réanimation, Centre Hospitalier Universitaire de la Guadeloupe, Pointe à Pitre, Guadeloupe, France
| | - Bertrand Pons
- Service de réanimation, Centre Hospitalier Universitaire de la Guadeloupe, Pointe à Pitre, Guadeloupe, France
| | - Khalid Elkoun
- Service de réanimation, Centre Hospitalier Universitaire de la Guadeloupe, Pointe à Pitre, Guadeloupe, France
| | - Guillaume Thiery
- Service de réanimation, Centre Hospitalier Universitaire de la Guadeloupe, Pointe à Pitre, Guadeloupe, France Faculté de Médecine, Université des Antilles, Pointe à Pitre, Guadeloupe, France
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Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Tubach F, Pons B, Boulet E, Boyer A, Lerolle N, Chevrel G, Carpentier D, Lautrette A, Bretagnol A, Mayaux J, Thirion M, Markowicz P, Thomas G, Dellamonica J, Richecoeur J, Darmon M, de Prost N, Yonis H, Megarbane B, Loubières Y, Blayau C, Maizel J, Zuber B, Nseir S, Bigé N, Hoffmann I, Ricard JD, Dreyfuss D. Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (AKIKI). Trials 2015; 16:170. [PMID: 25902813 PMCID: PMC4407416 DOI: 10.1186/s13063-015-0718-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/10/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is currently no validated strategy for the timing of renal replacement therapy (RRT) for acute kidney injury (AKI) in the intensive care unit (ICU) when short-term life-threatening metabolic abnormalities are absent. No adequately powered prospective randomized study has addressed this issue to date. As a result, significant practice heterogeneity exists and may expose patients to either unnecessary hazardous procedures or undue delay in RRT. METHODS/DESIGN This is a multicenter, prospective, randomized, open-label parallel-group clinical trial that compares the effect of two RRT initiation strategies on overall survival of critically ill patients receiving intravenous catecholamines or invasive mechanical ventilation and presenting with AKI classification stage 3 (KDIGO 2012). In the 'early' strategy, RRT is initiated immediately. In the 'delayed' strategy, clinical and metabolic conditions are closely monitored and RRT is initiated only when one or more events (severity criteria) occur, including: oliguria or anuria for more than 72 hours after randomization, serum urea concentration >40 mmol/l, serum potassium concentration >6 mmol/l, serum potassium concentration >5.5 mmol/l persisting despite medical treatment, arterial blood pH <7.15 in a context of pure metabolic acidosis (PaCO2 < 35 mmHg) or in a context of mixed acidosis with a PaCO2 ≥ 50 mmHg without possibility of increasing alveolar ventilation, acute pulmonary edema due to fluid overload despite diuretic therapy leading to severe hypoxemia requiring oxygen flow rate >5 l/min to maintain SpO2 > 95% or FiO2 > 50% under invasive or noninvasive mechanical ventilation. The primary outcome measure is overall survival, measured from randomization (D0) until death, regardless of the cause. The minimum follow-up duration for each patient will be 60 days. Two interim analyses are planned, blinded to group allocation. It is expected that there will be 620 subjects in all. DISCUSSION The AKIKI study will be one of the very few large randomized controlled trials evaluating mortality according to the timing of RRT in critically ill patients with AKI classification stage 3 (KDIGO 2012). Results should help clinicians decide when to initiate RRT. TRIAL REGISTRATION ClinicalTrials.gov NCT01932190.
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Affiliation(s)
- Stéphane Gaudry
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010, Paris, France. .,INSERM, ECEVE, U1123, F-75010, Paris, France.
| | - David Hajage
- INSERM, CIC-EC 1425, UMR 1123, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, Paris, France. .,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, Paris, France.
| | - Fréderique Schortgen
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.
| | - Laurent Martin-Lefevre
- Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
| | - Florence Tubach
- INSERM, CIC-EC 1425, UMR 1123, Paris, France. .,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France.
| | - Bertrand Pons
- Service de Réanimation, CHU de Pointe à Pitre - Abymes, CHU de la Guadeloupe, Basse-Terre, France.
| | - Eric Boulet
- Réanimation polyvalente, CH René Dubos, 95301, Pontoise, France.
| | | | - Nicolas Lerolle
- Département de réanimation médicale et médecine hyperbare, CHU Angers, Université d'Angers, Angers, France.
| | - Guillaume Chevrel
- Intensive Care Unit, Centre Hospitalier Sud Francilien, Corbeil Essonnes, France.
| | | | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel Montpied Teaching Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Anne Bretagnol
- Medical-Surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, , 45067, Orleans Cedex, France.
| | - Julien Mayaux
- Service de Pneumologie et Réanimation médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
| | - Marina Thirion
- Réanimation polyvalente, CH Victor Dupouy, 95107, Argenteil Cedex, France.
| | | | - Guillemette Thomas
- Service de Réanimation Détresses respiratoires aiguës et infections sévères, Hôpital Nord, Marseille, 13015, France.
| | - Jean Dellamonica
- Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200, Nice, France.
| | | | - Michael Darmon
- Medical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, Saint-Priest en Jarez, France.
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France. .,CARMAS research group, UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France.
| | - Hodane Yonis
- Réanimation médicale, Hôpital de la Croix Rousse, 69000, Lyon, France.
| | - Bruno Megarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris Diderot, Paris, France.
| | - Yann Loubières
- Réanimation, CH Poissy Saint Germain en laye, 78300, Poissy, France.
| | - Clarisse Blayau
- Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020, Paris, France.
| | - Julien Maizel
- Medical intensive care unit, University medical center and INSERM U-1088, University of Picardie, Amiens, France.
| | - Benjamin Zuber
- Réanimation médico-chirurgicale, CH Versailles, 78000, Versailles, France.
| | - Saad Nseir
- Centre de Réanimation, Hôpital R. Salengro, CHRU de Lill, Rue E. Laine, 59037, Lille Cedex, France.
| | - Naïke Bigé
- AP-HP, Hôpital Saint Antoine, Service de Réanimation Médicale, Paris, F-75012, France.
| | - Isabelle Hoffmann
- INSERM, CIC-EC 1425, UMR 1123, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France.
| | - Jean-Damien Ricard
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France. .,INSERM, IAME, U1137, F-75018, Paris, France.
| | - Didier Dreyfuss
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France. .,INSERM, IAME, U1137, F-75018, Paris, France. .,Present address: Intensive care unit, Hôpital Louis Mourier, 178 rue des Renouillers, 92110, Colombes, France.
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Dusacre JA, Pons B, Piednoir P, Soubirou JF, Thiery G. [Acute respiratory distress syndrome complicating an acute chest syndrome: potential benefit of early combination of exchange transfusion and prone positioning]. ACTA ACUST UNITED AC 2014; 33:700-3. [PMID: 25458459 DOI: 10.1016/j.annfar.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
We report the case of an 8-year-old sickle cell anemia child admitted for acute respiratory failure complicating acute chest syndrome. Because of threatening respiratory failure, tracheal intubation was performed immediately after ICU admission. The patient met the criteria for ARDS with a PaO2/FiO2 ratio of 94mmHg. An exchange transfusion was performed immediately after admission. HbS fraction failed from 69 % to 30 %. Fluid resuscitation with crystalloids and continuous norepinephrine infusion was needed because of arterial hypotension. Due to persistent severe hypoxemia with PaO2/FiO2 ratio below 100, the patient was placed in prone positioning 16hours after admission, for a total duration of 14hours. A second 12-hour session of prone positioning was performed 41h after admission and PaO2/FiO2 ratio reached 300mmHg after. Treatment also included transfusion of two red-cell pack on day 1 and 2 after admission in order to maintain hemoglobin level above 8g/dL, and a daily folic acid supplementation. The control of hyperthermia was achieved by a systematic parenteral administration of paracetamol. Cefotaxime and erythromycine were continued until day 7 despite the negative results of all bacteriological samples. The outcome was favorable from day 3 and the patient met the criteria for extubation on day 5. A first attempt of extubation was performed on day 5, but re-intubation was required because of laryngeal edema. Steroids were given for 48h and the patient was successfully extubated on day 7. She was discharged from the ICU on day 8, and from the hospital on day 12. We discuss the various treatments available for the management of acute chest syndrome and their actual relevance in acute respiratory distress syndrome in the absence of strong evidence-based guidelines in pediatric ARDS.
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Affiliation(s)
- J-A Dusacre
- Réanimation et Grands Brûlés, CHU Pointe-à-Pitre, CHU de Guadeloupe, route de Chauvel, 97159 Pointe-à-Pitre cedex, France
| | - B Pons
- Réanimation et Grands Brûlés, CHU Pointe-à-Pitre, CHU de Guadeloupe, route de Chauvel, 97159 Pointe-à-Pitre cedex, France.
| | - P Piednoir
- Réanimation et Grands Brûlés, CHU Pointe-à-Pitre, CHU de Guadeloupe, route de Chauvel, 97159 Pointe-à-Pitre cedex, France
| | - J-F Soubirou
- Réanimation et Grands Brûlés, CHU Pointe-à-Pitre, CHU de Guadeloupe, route de Chauvel, 97159 Pointe-à-Pitre cedex, France
| | - G Thiery
- Réanimation et Grands Brûlés, CHU Pointe-à-Pitre, CHU de Guadeloupe, route de Chauvel, 97159 Pointe-à-Pitre cedex, France
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Briffaz A, Bohuon P, Méot J, Pons B, Matencio F, Dornier M, Mestres C. Modelling of brown rice and limited-water cooking modes and its potential use for texture prediction. J FOOD ENG 2014. [DOI: 10.1016/j.jfoodeng.2014.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Caballero-Ruiz E, García-Sáez G, Rigla M, Balsells M, Pons B, Morillo M, Gómez EJ, Hernando ME. Automatic Blood Glucose Classification for Gestational Diabetes with Feature Selection: Decision Trees vs. Neural Networks. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-00846-2_339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Urbain X, de Ruette N, Andrianarijaona VM, Martin MF, Menchero LF, Errea LF, Méndez L, Rabadán I, Pons B. New light shed on charge transfer in fundamental H+ + H2 collisions. Phys Rev Lett 2013; 111:203201. [PMID: 24289684 DOI: 10.1103/physrevlett.111.203201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Indexed: 06/02/2023]
Abstract
There is no consensus on the magnitude and shape of the charge transfer cross section in low-energy H+ + H2 collisions, in spite of the fundamental importance of these collisions. Experiments have thus been carried out in the energy range 15≤E≤5000 eV. The measurements invalidate previous recommended data for E≤200 eV and confirm the existence of a local maximum around 45 eV, which was predicted theoretically. Additionally, vibrationally resolved cross sections allow us to investigate the evolution of the underlying charge transfer mechanism as a function of E.
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Affiliation(s)
- X Urbain
- IMCN, Université Catholique de Louvain, Chemin du Cyclotron 2, 1348 Louvain-la-Neuve, Belgium
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Briffaz A, Mestres C, Matencio F, Pons B, Dornier M. Modelling starch phase transitions and water uptake of rice kernels during cooking. J Cereal Sci 2013. [DOI: 10.1016/j.jcs.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Leredde A, Fléchard X, Cassimi A, Hennecart D, Pons B. High-resolution probe of coherence in low-energy charge exchange collisions with oriented targets. Phys Rev Lett 2013; 111:133201. [PMID: 24116777 DOI: 10.1103/physrevlett.111.133201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/09/2013] [Indexed: 06/02/2023]
Abstract
The trapping lasers of a magneto-optical trap have been used to bring Rb atoms into well defined oriented states. Coupled to recoil-ion-momentum spectroscopy, this provided a unique MOTRIMS setup which was able to probe scattering dynamics, including the coherence features, with unprecedented resolution. The technique was applied to the low-energy charge exchange reactions Na+ + Rb(5p±1)→Na(3p,4s)+Rb+. The measurements revealed detailed features of the collisional interaction which were employed to improve the theoretical description. As such, it was possible to ascertain the validity of the intuitive models used to predict the most likely capture transitions.
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Affiliation(s)
- A Leredde
- LPC Caen, ENSICAEN, Université de Caen, CNRS/IN2P3, F-14070 Caen, France
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Degardin J, Pons B, Ardisson F, Gallego JP, Thiery G. [Multiple organ failure complicating a severe acute necrotising pancreatitis secondary of a severe hypertriglyceridemia: a case report]. ACTA ACUST UNITED AC 2013; 32:611-4. [PMID: 23948029 DOI: 10.1016/j.annfar.2013.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
We report the case of a 42-year-old man admitted for a multi-organ failure with a coma, a hemodynamic instability, a respiratory distress syndrome, an acute renal failure and a thrombocytopenia. The blood samples highlighted a milky serum and allowed to diagnose an acute pancreatitis associated with a major dyslipidemia: hypertriglyceridemia 11,800 mg/dL and hypercholesterolemia 1195 mg/dL. The CT-scans do not reveal any cerebral abnormalities but highlighted pancreatic lesions without biliary obstruction. A multi-organ failure complicating a severe acute pancreatitis secondary of a major hypertriglyceridemia was mentioned. Despite the absence of clear guidelines, a session of plasma exchange was started in emergency. Symptomatic treatment with protective ventilation, vasopressors, continuous heparin and insulin was continued. The clinical and biological course was good in parallel of the normalization of lipid abnormalities. The patient was discharged at day 17 with a lipid-lowering therapy. We discuss the various treatments available for the management of acute pancreatitis complicating a severe hypertriglyceridemia and their actual relevance in the absence of clear recommendations.
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Affiliation(s)
- J Degardin
- Service de réanimation et grands brûlés, CHU de Pointe-à-Pitre-Guadeloupe, route de Chauvel, 97159 Pointe-à-Pitre cedex, France
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Pons B, Lautrette A, Oziel J, Dellamonica J, Vermesch R, Ezingeard E, Mariat C, Bernardin G, Zeni F, Cohen Y, Tardy B, Souweine B, Vincent F, Darmon M. Diagnostic accuracy of early urinary index changes in differentiating transient from persistent acute kidney injury in critically ill patients: multicenter cohort study. Crit Care 2013; 17:R56. [PMID: 23531299 PMCID: PMC3733426 DOI: 10.1186/cc12582] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/21/2013] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Urinary indices have limited effectiveness in separating transient acute kidney injury (AKI) from persistent AKI in ICU patients. Their time-course may vary with the mechanism of AKI. The primary objective of this study was to evaluate the diagnostic value of changes over time of the usual urinary indices in separating transient AKI from persistent AKI. METHODS An observational prospective multicenter study was performed in six ICUs involving 244 consecutive patients, including 97 without AKI, 54 with transient AKI, and 93 with persistent AKI. Urinary sodium, urea and creatinine were measured at ICU admission (H0) and on 6-hour urine samples during the first 24 ICU hours (H6, H12, H18, and H24). Transient AKI was defined as AKI with a cause for renal hypoperfusion and reversal within 3 days. RESULTS Significant increases from H0 to H24 were noted in fractional excretion of urea (median, 31% (22 to 41%) and 39% (29 to 48%) at H24, P<0.0001), urinary urea/plasma urea ratio (15 (7 to 28) and 20 (9 to 40), P<0.0001), and urinary creatinine/plasma creatinine ratio (50 (24 to 101) and 57 (29 to 104), P=0.01). Fractional excretion of sodium did not change significantly during the first 24 hours in the ICU (P=0.13). Neither urinary index values at ICU admission nor changes in urinary indices between H0 and H24 performed sufficiently well to recommend their use in clinical setting (area under the receiver-operating characteristic curve≤0.65). CONCLUSION Although urinary indices at H24 performed slightly better than those at H0 in differentiating transient AKI from persistent AKI, they remain insufficiently reliable to be clinically relevant.
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Ruf H, Handschin C, Ferré A, Thiré N, Bertrand JB, Bonnet L, Cireasa R, Constant E, Corkum PB, Descamps D, Fabre B, Larregaray P, Mével E, Petit S, Pons B, Staedter D, Wörner HJ, Villeneuve DM, Mairesse Y, Halvick P, Blanchet V. High-harmonic transient grating spectroscopy of NO2 electronic relaxation. J Chem Phys 2012; 137:224303. [DOI: 10.1063/1.4768810] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Ruf
- Université de Bordeaux-CNRS-CEA, CELIA, UMR5107, F-33400 Talence, France
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Mounier B, Pons B, Delavenne X, Beyens MN, Rémy C, Zeni F, Mismetti P, Basset T. [Severe meprobamate poisoning: description of 146 cases in a French department]. Therapie 2012; 67:183-9. [PMID: 22850107 DOI: 10.2515/therapie/2012019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 02/29/2012] [Indexed: 11/20/2022]
Abstract
Meprobamate poisoning are serious and sometimes fatal. Faced with a potential stop of marketing, we conducted a multicenter retrospective study to assess the severity criteria presented by patients admitted to the ICU for severe meprobamate poisoning, whether with alone form or in combination with aceprometazine. One hundred fourty-six patients have been enrolled between January 2005 and June 2011: 38 had a single meprobamate poisoning, 104 to meprobamate and aceprometazine and 4 to both forms. At admission, 88% of patients exhibited coma (Glasgow ≤ 7) and half of them a systolic blood pressure ≤ 90 mmHg. Mortality rate was 3%. Our results did not find any significant between-group difference, either in regard of clinical or biological severity criteria. These data argue for a cessation of marketing of all meprobamate-based specialities.
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Affiliation(s)
- Bérenger Mounier
- Urgences Médico-chirurgicales, Hôpital Nord, CHU, Saint-Étienne, France
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Shafir D, Fabre B, Higuet J, Soifer H, Dagan M, Descamps D, Mével E, Petit S, Wörner HJ, Pons B, Dudovich N, Mairesse Y. Role of the ionic potential in high harmonic generation. Phys Rev Lett 2012; 108:203001. [PMID: 23003145 DOI: 10.1103/physrevlett.108.203001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Indexed: 06/01/2023]
Abstract
Recollision processes provide direct insight into the structure and dynamics of electronic wave functions. However, the strength of the process sets its basic limitations--the interaction couples numerous degrees of freedom. In this Letter we decouple the basic steps of the process and resolve the role of the ionic potential which is at the heart of a broad range of strong field phenomena. Specifically, we measure high harmonic generation from argon atoms. By manipulating the polarization of the laser field we resolve the vectorial properties of the interaction. Our study shows that the ionic core plays a significant role in all steps of the interaction. In particular, Coulomb focusing induces an angular deflection of the electrons before recombination. A complete spatiospectral analysis reveals the influence of the potential on the spatiotemporal properties of the emitted light.
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Affiliation(s)
- D Shafir
- Department of Physics of Complex Systems, Weizmann Institute of Science, Rehovot 76100, Israel
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Errea LF, Illescas C, Macías A, Méndez L, Pons B, Rabadán I, Riera A. Influence of nuclear exchange on nonadiabatic electron processes in H(+)+H2 collisions. J Chem Phys 2010; 133:244307. [PMID: 21197993 DOI: 10.1063/1.3518417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
H(+)+H(2) collisions are studied by means of a semiclassical approach that explicitly accounts for nuclear rearrangement channels in nonadiabatic electron processes. A set of classical trajectories is used to describe the nuclear motion, while the electronic degrees of freedom are treated quantum mechanically in terms of a three-state expansion of the collision wavefunction. We describe electron capture and vibrational excitation, which can also involve nuclear exchange and dissociation, in the E = 2-1000 eV impact energy range. We compare dynamical results obtained with two parametrizations of the potential energy surface of H(3)(+) ground electronic state. Total cross sections for E > 10 eV agree with previous results using a vibronic close-coupling expansion, and with experimental data for E < 10 eV. Additionally, some prototypical features of both nuclear and electron dynamics at low E are discussed.
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Affiliation(s)
- L F Errea
- Laboratorio Asociado al CIEMAT de Física Atómica y Molecular en Plasmas de Fusión, Departamento de Química, Universidad Autónoma de Madrid, Madrid-28049, Spain
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Candéias S, Pons B, Viau M, Caillat S, Sauvaigo S. Direct inhibition of excision/synthesis DNA repair activities by cadmium: analysis on dedicated biochips. Mutat Res 2010; 694:53-9. [PMID: 20969882 DOI: 10.1016/j.mrfmmm.2010.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 09/02/2010] [Accepted: 10/12/2010] [Indexed: 10/18/2022]
Abstract
The well established toxicity of cadmium and cadmium compounds results from their additive effects on several key cellular processes, including DNA repair. Mammalian cells have evolved several biochemical pathways to repair DNA lesions and maintain genomic integrity. By interfering with the homeostasis of redox metals and antioxidant systems, cadmium promotes the development of an intracellular environment that results in oxidative DNA damage which can be mutagenic if unrepaired. Small base lesions are recognised by specialized glycosylases and excised from the DNA molecule. The resulting abasic sites are incised, and the correct sequences restored by DNA polymerases using the opposite strands as template. Bulky lesions are recognised by a different set of proteins and excised from DNA as part of an oligonucleotide. As in base repair, the resulting gaps are filled by DNA polymerases using the opposite strands as template. Thus, these two repair pathways consist in excision of the lesion followed by DNA synthesis. In this study, we analysed in vitro the direct effects of cadmium exposure on the functionality of base and nucleotide DNA repair pathways. To this end, we used recently described dedicated microarrays that allow the parallel monitoring in cell extracts of the repair activities directed against several model base and/or nucleotide lesions. Both base and nucleotide excision/repair pathways are inhibited by CdCl₂, with different sensitivities. The inhibitory effects of cadmium affect mainly the recognition and excision stages of these processes. Furthermore, our data indicate that the repair activities directed against different damaged bases also exhibit distinct sensitivities, and the direct comparison of cadmium effects on the excision of uracile in different sequences even allows us to propose a hierarchy of cadmium sensibility within the glycosylases removing U from DNA. These results indicate that, in our experimental conditions, cadmium is a very potent DNA repair poison.
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Affiliation(s)
- S Candéias
- CEA, INAC, SCIB, UJF & CNRS, LCIB (UMR_E 3 CEA-UJF and FRE 3200), Laboratoire Lésions des Acides Nucléiques, 17 Rue des Martyrs, F-38054 Grenoble Cedex 9, France.
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Delavenne X, Juthier L, Pons B, Mariat C, Basset T. UPLC MS/MS method for quantification of mycophenolic acid and metabolites in human plasma: Application to pharmacokinetic study. Clin Chim Acta 2010; 412:59-65. [PMID: 20937266 DOI: 10.1016/j.cca.2010.09.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/10/2010] [Accepted: 09/10/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND We described the development and full validation of a rapid, high throughput sensible and accurate UPLC method using tandem mass spectrometry detection for mycophenolate acid (MPA) and its metabolites, MPA glucuronide (MPAG) and acyl MPA glucuronide (AcMPAG) concentration determination with MPA-D3 as internal standard in human plasma. METHODS Plasma pretreatment involved a one-step protein precipitation with acetonitrile. The separation was performed by reverse-phase chromatography on a Waters BEH HSST3 100 mm*2.1 mm*1.8 μm column. The multiple reaction monitoring transitions used for quantification were m/z 321.04→303.02 for MPA, 524.09→303.02 for AcMPAG and MPAG and 324.03→306.04 for MPA-D3 in the electrospray positive ionization mode. RESULTS The method was linear over the concentration range of 0.1-20mg/L for MPA and AcMPAG and 1-200mg/L for MPAG respectively. The intra- and inter-day precision values were below 14% and accuracy was from 94.0 to 103.3% at all quality control levels. The lower LOQ was 0.1 mg/L for MPA and AcMPAG, 1 mg/L for MPAG. CONCLUSION Sample analysis time was reduced to 7 min including sample preparation. The present method was successfully applied to a pharmacokinetic study following oral administration of enterocoated sodium mycophenolate in de novo renal transplantation.
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Affiliation(s)
- Xavier Delavenne
- Laboratory of Pharmacology and Toxicology, University Hospital, F-42055 Saint-Etienne, France.
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Soifer H, Botheron P, Shafir D, Diner A, Raz O, Bruner BD, Mairesse Y, Pons B, Dudovich N. Near-threshold high-order harmonic spectroscopy with aligned molecules. Phys Rev Lett 2010; 105:143904. [PMID: 21230832 DOI: 10.1103/physrevlett.105.143904] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/16/2010] [Indexed: 05/30/2023]
Abstract
We study high-order harmonic generation in aligned molecules close to the ionization threshold. Two distinct contributions to the harmonic signal are observed, which show very different responses to molecular alignment and ellipticity of the driving field. We perform a classical electron trajectory analysis, taking into account the significant influence of the Coulomb potential on the strong-field-driven electron dynamics. The two contributions are related to primary ionization and excitation processes, offering a deeper understanding of the origin of high harmonics near the ionization threshold. This Letter shows that high-harmonic spectroscopy can be extended to the near-threshold spectral range, which is in general spectroscopically rich.
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Affiliation(s)
- H Soifer
- Department of Physics of Complex Systems, Weizmann Institute of Science, 76100 Rehovot, Israel
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35
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Leray V, Nesme P, Landry G, Pons B, Pignat JC, Guerin C. A successful new method for removal of a large foreign body from the airways of an ARDS patient. Intensive Care Med 2009; 36:719-20. [PMID: 19921149 DOI: 10.1007/s00134-009-1716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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de Leiva A, Hernando ME, Rigla M, Capel I, Brugués E, Pons B, Erdozain L, Prados A, Corcoy R, Gómez EJ, García-Sáez G, Martínez-Sarriegui I, Rodríguez-Herrero A, Pérez-Gandía C, del Pozo F. Telemedical artificial pancreas: PARIS (Pancreas Artificial Telemedico Inteligente) research project. Diabetes Care 2009; 32 Suppl 2:S211-6. [PMID: 19875554 PMCID: PMC2811476 DOI: 10.2337/dc09-s313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alberto de Leiva
- EDUAB-HSP: Research Group, Department of Endocrinology, Diabetes and Nutrition, Universitat Autònoma de Barcelona - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Alberto de Leiva,
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Alzola R, Pons B, Bravo D, Arranz A. Determination of polynuclear aromatic hydrocarbons (PAHs) in sewage sludge by micellar electrokinetic capillary chromatography and HPLC-fluorescence detection: a comparative study. Environ Technol 2008; 29:1219-1228. [PMID: 18975854 DOI: 10.1080/09593330802270673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Two different methods, based on micellar electrokinetic capillary chromatography (MECC-DA) and high performance liquid chromatography (HPLC)-fluorescence detection, were studied to separate and determine 12 polynuclear aromatic hydrocarbons (PAHs) of 16 PAHs recommended by the Environmental Protection Agency (EPA) in sewage sludge. beta-cyclodextrin was used as a micelle precursor in a sodium borate buffer solution which included the surfactant sodium dodecyl sulphate (SDS) and the acetonitrile dissolvent. The following parameters: temperature, voltage, pH, concentrations of buffer solution and injection time, were optimized by an experimental design (Nemrodw programme). Furthermore, HPLC-fluorescence detection and separation conditions are reported. The mobile phase was acetonitrile-water in different percentages. Precision, accuracy, linearity and detection and quantification limits were determined. This method was applied in the analysis of sewage sludge from a wastewater depuration station in Crispijana (Alava, Spain). In this case, it is necessary to carry out a solid phase extraction step for its determination. The method was validated by the analysis of a certificated sample of LGC 6182, and finally samples of sewage sludge were analysed weekly for two years, obtaining in all cases results under the legal limits for the use of sewage sludge in agriculture.
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Affiliation(s)
- R Alzola
- Department of Analytical Chemistry, Pharmacy Faculty, University of the Basque Country, C/ Paseo de la Universidad 7, 01006-Vitoria-Gasteiz, Alava, Spain
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Chanet V, Amarger S, Pons B, Déchelotte P, Ruivard M, Philippe P. [Nodular thrombophlebitis and granulomatous systemic disease]. Rev Med Interne 2007; 28:416-9. [PMID: 17349722 DOI: 10.1016/j.revmed.2007.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2006] [Revised: 01/28/2007] [Accepted: 01/31/2007] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nodular thrombophlebitis is septal hypodermitis characterised by vasculitis with vein thrombosis. It may indicate serious underlying disorders. EXEGESIS We present two cases of nodular superficial phlebitis, which revealed tuberculosis and sarcoidosis. CONCLUSION Nodular thrombophlebitis are classic during evolution of Behçet disease or Buerger vasculitis. In sarcoidosis, erythema nodosum and granulomatous involvement are the most common cutaneous manifestation. Nodular thrombophlebitis has never been described. Panniculitis are classical in tuberculosis. But most cases are erythema nodosum and cases of erythema induratum of Bazin. Nodular thrombophlebitis could reveal thrombophilic abnormalities, and even more neoplasms especially when they are recurrent and migratory.
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Affiliation(s)
- V Chanet
- Service de Médecine Interne, Pôle Santé République, 105, avenue de la République, 63000 Clermont-Ferrand, France.
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Dorchies F, Caillaud T, Blasco F, Bonté C, Jouin H, Micheau S, Pons B, Stevefelt J. Investigation of laser-irradiated Ar cluster dynamics from K-shell x-ray emission measurements. Phys Rev E Stat Nonlin Soft Matter Phys 2005; 71:066410. [PMID: 16089883 DOI: 10.1103/physreve.71.066410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 03/09/2005] [Indexed: 05/03/2023]
Abstract
Intense (up to a few 10(17) W/ cm2) femtosecond (down to 40 fs) laser pulses are focused onto a partially clusterized argon gas jet. The target was previously characterized and optimized in order to get a homogeneous and dense jet of clusters with a well controlled size. The interaction leads to x-ray emission that is absolutely calibrated and spectrally resolved using a high resolution time-integrated spectrometer in the K-shell range (from 2.9 to 4.3 keV). X-ray spectra are investigated as a function of different laser temporal parameters such as the nanosecond prepulse contrast, the laser pulse duration, and the femtosecond delay between two different laser pulses. The cluster size ranges from 180 to 350 angstroms and irradiation by laser pulses with both linear and circular polarization is investigated. The experimental results are discussed in terms of the laser-cluster interaction dynamics. They are compared with the predictions of collision-dominated nanoplasma models. However, further interaction processes are required in order to explain the observed characteristic lines demonstrating highly charged ions up to Ar16+.
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Affiliation(s)
- F Dorchies
- CELIA, UMR 5107, CNRS, CEA, Université Bordeaux I, 33405 Talence, France.
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Chanet V, Fournioux J, Hermier M, Gavet E, Pons B, Ruivard M, Philippe P. [Gastroparesis on a gastric ulcer]. Presse Med 2004; 33:1264-6. [PMID: 15611706 DOI: 10.1016/s0755-4982(04)98903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Gastroparesis is the failure of the stomach to empty because of decreased gastric motility. It's a fairly frequent medical problem. Diabetes is the most common known cause. OBSERVATION The first case report is that of an 82 year-old woman, in whom acute gastric distension occurred, evoking a gastric volvulus on the scan. Upper endoscopy revealed gastric ulcers. All symptoms disappeared with medical treatment. The second case report concerns a 37 year-old man who was admitted with signs of occlusion. CT scans revealed acute gastric distension. Emergency surgery revealed no gastric volvulus. Upper endoscopy revealed gastritis and numerous ulcers. The signs regressed with medical treatment. DISCUSSION Our observations are original in their -pseudo-surgical discovery. Acute gastric distension is rare, but must be recognised because of the risk of perforation and rupture of the stomach walls. These case reports are also original in their aetiology. Gastric ulcers are rarely described in this situation. CONCLUSION; Gastroparesis is a frequent situation but potentially severe. A review of the principle signs, aetiology and treatment is made.
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Affiliation(s)
- V Chanet
- Service de médecine interne, boulevard Léon Malfreyt, Hôtel-Dieu, 63000 Clermont-Ferrand.
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Ruivard M, Pailles J, Pons B, Bommelear G, Philippe P. Étiologie des anémies ferriprives en médecine interne. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ruivard M, Coindon A, Fouassier M, Pons B, Philippe P. Thrombophilie familiale combinée : étude rétrospective monocentrique de 20 patients. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Pons B, Ruivard M, Philippe P. Lésions granulomateuses du sein : six observations. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Errea LF, Macı́as A, Méndez L, Pons B, Riera A. Quantum chemistry calculation of excited three center systems: Theoretical study of He2++H2 collisions. J Chem Phys 2003. [DOI: 10.1063/1.1571821] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pons B, Ruivard M, Gerbaud L, Cluzel J, Philippe P. Impact de la carence en fer sur la qualité de vie. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Alonso A, Fernández-Torroba MA, Tena MT, Pons B. Development and validation of a solid-phase microextraction method for the analysis of volatile organic compounds in groundwater samples. Chromatographia 2003. [DOI: 10.1007/bf02492410] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Philippe P, Pellissier G, Ruivard M, Gallot D, Laurichesse H, Pons B, Lemery D. Analyse de la prise en charge de la thrombopénie chez la femme enceinte. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pons B, Abergel A, Ruivard M, Rieu V, Fouilhoux A, Philippe P. Sclérodermie généralisée au cours d'une hépatite chronique C traitée par interféron pégylé alpha et ribavirine. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Philippe P, Ruivard M, Lagrange D, Lemery D, Rieu V, Pons B, Mage G. Prise en charge des grossesses dans une population de 40 femmes suspectes de thrombophilie. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Ruivard M, Pages D, Dauphin C, Fouassier M, Pons B, Philippe P. Récidives de maladie thromboembolique veineuse après un premier épisodesurvenu sous contraception œstroprogestative. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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