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Imbert S, Revers M, Enaud R, Orieux A, Camino A, Massri A, Villeneuve L, Carrié C, Petit L, Boyer A, Berger P, Gruson D, Delhaes L, Prével R. Lower airway microbiota compositions differ between influenza, COVID-19 and bacteria-related acute respiratory distress syndromes. Crit Care 2024; 28:133. [PMID: 38649970 PMCID: PMC11036773 DOI: 10.1186/s13054-024-04922-2] [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: 12/07/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is responsible for 400,000 deaths annually worldwide. Few improvements have been made despite five decades of research, partially because ARDS is a highly heterogeneous syndrome including various types of aetiologies. Lower airway microbiota is involved in chronic inflammatory diseases and recent data suggest that it could also play a role in ARDS. Nevertheless, whether the lower airway microbiota composition varies between the aetiologies of ARDS remain unknown. The aim of this study is to compare lower airway microbiota composition between ARDS aetiologies, i.e. pulmonary ARDS due to influenza, SARS-CoV-2 or bacterial infection. METHODS Consecutive ARDS patients according to Berlin's classification requiring invasive ventilation with PCR-confirmed influenza or SARS-CoV-2 infections and bacterial infections (> 105 CFU/mL on endotracheal aspirate) were included. Endotracheal aspirate was collected at admission, V3-V4 and ITS2 regions amplified by PCR, deep-sequencing performed on MiSeq sequencer (Illumina®) and data analysed using DADA2 pipeline. RESULTS Fifty-three patients were included, 24 COVID-19, 18 influenza, and 11 bacterial CAP-related ARDS. The lower airway bacteriobiota and mycobiota compositions (β-diversity) were dissimilar between the three groups (p = 0.05 and p = 0.01, respectively). The bacterial α-diversity was significantly lower in the bacterial CAP-related ARDS group compared to the COVID-19 ARDS group (p = 0.04). In contrast, influenza-related ARDS patients had higher lung mycobiota α-diversity than the COVID-19-related ARDS (p = 0 < 01). CONCLUSION Composition of lower airway microbiota (both microbiota and mycobiota) differs between influenza, COVID-19 and bacterial CAP-related ARDS. Future studies investigating the role of lung microbiota in ARDS pathophysiology should take aetiology into account.
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Affiliation(s)
- Sébastien Imbert
- HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Mathilde Revers
- HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Raphaël Enaud
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
- CHU Bordeaux, CRCM Pédiatrique, CIC 1401, 33000, Bordeaux, France
| | - Arthur Orieux
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France
| | - Adrian Camino
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | | | | | - Cédric Carrié
- d CHU Bordeaux, Surgical Intensive Care Unit, 33000, Bordeaux, France
| | - Laurent Petit
- d CHU Bordeaux, Surgical Intensive Care Unit, 33000, Bordeaux, France
| | - Alexandre Boyer
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France
| | - Patrick Berger
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Didier Gruson
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France
| | - Laurence Delhaes
- HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France
| | - Renaud Prével
- Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France.
- CHU Bordeaux, Medical Intensive Care Unit, 33000, Bordeaux, France.
- Medical Intensive Care Unit, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France.
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Gonzalez-Anton D, Gallice T, Borges Da Silva A, Carrié C. Extubation failure: Upper airway obstruction by chewing gum. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00026-X. [PMID: 38342303 DOI: 10.1016/j.redare.2024.02.006] [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] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/22/2023] [Indexed: 02/13/2024]
Abstract
Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.
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Affiliation(s)
- D Gonzalez-Anton
- Trauma and Surgical Intensive Care Unit, Emergency Unit, Bordeaux Universitary Hospital, Bordeaux, France.
| | - T Gallice
- Neurologic Intensive Care Unit and Neurosurgery Unit, Bordeaux Universitary Hospital, Bordeaux, France
| | - A Borges Da Silva
- Trauma and Surgical Intensive Care Unit, Emergency Unit, Bordeaux Universitary Hospital, Bordeaux, France
| | - C Carrié
- Trauma and Surgical Intensive Care Unit, Emergency Unit, Bordeaux Universitary Hospital, Bordeaux, France
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Carrié C, Rieu B, Benard A, Trin K, Petit L, Massri A, Jurcison I, Rousseau G, Tran Van D, Reynaud Salard M, Bourenne J, Levrat A, Muller L, Marie D, Dahyot-Fizelier C, Pottecher J, David JS, Godet T, Biais M. Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial. Crit Care 2023; 27:163. [PMID: 37101272 PMCID: PMC10131545 DOI: 10.1186/s13054-023-04429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The benefit-risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O2) during the early stage of blunt chest trauma remains controversial because of limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients. METHODS The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO2/FiO2 ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O2 and "early" NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and "late" NIV, indicated in patients with respiratory deterioration and/or PaO2/FiO2 ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS). RESULTS Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20-2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73-5.89], p = 0.18, 0.85 [95%IC: 0.33-2.20], p = 0.74 and 2.14 [95%IC: 0.36-20.77], p = 0.41, respectively). CONCLUSION A prompt association of HFNC-O2 with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure. CLINICAL TRIAL REGISTRATION NCT03943914, Registered 7 May 2019.
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Affiliation(s)
- Cédric Carrié
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.
| | - Benjamin Rieu
- Anesthesiology and Critical Care Department, Clermont - Ferrand University Hospital, Clermont - Ferrand, France
| | - Antoine Benard
- Pôle de Santé Publique, Service d'information Médicale, Clinical Epidemiology Unit (USMR), CHU Bordeaux, Bordeaux, France
| | - Kilian Trin
- Pôle de Santé Publique, Service d'information Médicale, Clinical Epidemiology Unit (USMR), CHU Bordeaux, Bordeaux, France
| | - Laurent Petit
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Alexandre Massri
- Anesthesiology and Critical Care Department, Pau Hospital, Pau, France
| | - Igor Jurcison
- Anesthesiology and Critical Care Department, Beaujon University Hospital, Paris, France
| | - Guillaume Rousseau
- Anesthesiology and Critical Care Department, Beaujon University Hospital, Paris, France
| | - David Tran Van
- Anesthesiology and Critical Care Department, Robert Picqué Hospital, Bordeaux, France
| | - Marie Reynaud Salard
- Anesthesiology and Critical Care Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Jeremy Bourenne
- Emergency and Critical Care Department, Hôpital de La Timone, Marseille University Hospital, Marseille, France
| | - Albrice Levrat
- Anesthesiology and Critical Care Department, Annecy Hospital, Annecy, France
| | - Laurent Muller
- Anesthesiology and Critical Care Department, Nimes University Hospital, Nimes, France
| | - Damien Marie
- Anesthesiology and Critical Care Department, Poitiers University Hospital, Poitiers, France
| | - Claire Dahyot-Fizelier
- Anesthesiology and Critical Care Department, Poitiers University Hospital, Poitiers, France
| | - Julien Pottecher
- Anesthesiology and Critical Care Department, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Stéphane David
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Lyon, France
- Research On Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | - Thomas Godet
- Anesthesiology and Critical Care Department, Clermont - Ferrand University Hospital, Clermont - Ferrand, France
| | - Matthieu Biais
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
- INSERM U1034, Biology of Cardiovascular Diseases, Bordeaux University, Pessac, France
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Dreydemy G, Coussy A, Lannou A, Petit L, Biais M, Carrié C. Augmented Renal Clearance, Muscle Catabolism and Urinary Nitrogen Loss: Implications for Nutritional Support in Critically Ill Trauma Patients. Nutrients 2021; 13:nu13103554. [PMID: 34684555 PMCID: PMC8540369 DOI: 10.3390/nu13103554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/03/2021] [Accepted: 10/09/2021] [Indexed: 02/07/2023] Open
Abstract
The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CLCR) > 130 mL/min/1.73 m2. The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CLCR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm2/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.
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Affiliation(s)
- Guilhem Dreydemy
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; (A.L.); (L.P.); (M.B.); (C.C.)
- Correspondence:
| | - Alexis Coussy
- Radiology Department, CHU Pellegrin, 33000 Bordeaux, France;
| | - Alexandre Lannou
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; (A.L.); (L.P.); (M.B.); (C.C.)
| | - Laurent Petit
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; (A.L.); (L.P.); (M.B.); (C.C.)
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; (A.L.); (L.P.); (M.B.); (C.C.)
- Health Department, University Bordeaux Segalen, 33000 Bordeaux, France
| | - Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; (A.L.); (L.P.); (M.B.); (C.C.)
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desrousseaux J, Chaltiel L, Claude L, Padovani L, Ducassou A, Bolle S, Habrand J, Carrié C, Muracciole X, Escande A, Alapetite C, Supiot S, Bernier-Chastagner V, Huchet A, Lesueur J, Kerr C, Truc G, Servagi-Vernat S, Leblond P, Bertozzi A, Boetto S, Sevely A, Tensaouti F, Laprie A. PH-0326 Treatment for recurrent Ependymoma : A retrospective and multicentric French study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07299-6] [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: 11/16/2022]
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Carrié C, Sauvage N, Biais M. Optimisation du traitement par β-Lactamines chez le patient de réanimation en hyperclairance rénale. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
L'optimisation du traitement par β-Lactamines représente toujours un défi complexe chez le patient de soins critiques, compte tenu de la large variabilité des concentrations d'antibiotiques en relation avec d’importantes interactions pharmacocinétiques et pharmacodynamiques (PK/PD). D’une part, il est communément admis que les patients présentant une insuffisance rénale justifient une diminution des posologies afin de limiter le risque de toxicité. D’autre part, certains patients peuvent également présenter une hyperclairance rénale (HCR), désormais reconnue comme un des principaux facteurs de risque de sous-dosage et d’échec thérapeutique des agents anti-infectieux à élimination urinaire. L’hyperclairance est une entité fréquente en réanimation chirurgicale, probablement sous-diagnostiquée en l’absence de mesure de clairance urinaire de la créatinine (CLCR). Pour certaines β-lactamines prescrites en probabiliste, plusieurs études de pharmacocinétique suggèrent une augmentation des posologies recommandées afin d’atteindre les objectifs PK/PD chez les patients atteints d'HCR. En cas d’impossibilité de monitorer les concentrations plasmatiques dans des délais brefs, l'optimisation des posologies de β-lactamines selon le monitorage quotidien de la CLCR est une stratégie sûre et efficace pour améliorer les taux de succès thérapeutique. L’HCR étant un phénomène fluctuant, cette stratégie impose un monitorage quotidien de la CLCR afin d’adapter les posologies et limiter le risque de surdosage.
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Favre PA, de Molliens L, Petit L, Biais M, Carrié C. May the neutrophil-to-lymphocyte ratio at admission predict the occurrence and the severity of ARDS after blunt chest trauma patients? A retrospective study. Am J Emerg Med 2020; 39:137-142. [PMID: 33039232 DOI: 10.1016/j.ajem.2020.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In blunt chest trauma patients, the activation of inflammatory response is thought to be one of the pathophysiological pathways leading to delayed acute respiratory distress syndrome(ARDS). The main objective of the study was to assess the performance of the neutrophil-lymphocyte ratio(NLR) for prediction of delayed ARDS. The secondary objective was to compare NLR in patients with traumarelated focal and non-focal ARDS. METHODS Over a 2-year period, every adult patient triaged to our level 1 trauma center with multiple rib fractures and PaO 2 /FiO 2 ratio > 200 at admission were retrospectively included. The NLR was recorded at admission in the Emergency Department(ED). The main study outcome was the occurrence of moderate to severe ARDS within 5 days after admission according to Berlin criteria. Two phenotypes (focal and non-focal ARDS) were determined based on the closest chest CT regarding the ARDS onset. RESULTS 216 patients were included and 42(19%) underwent moderate to severe ARDS within 5 days after ED admission (focal, N = 26 [12%] and non-focal, N = 16 [7%]). The NLR at ED admission was not statistically different between patients who developed or not a delayed ARDS (14 ± 13 vs. 11 ± 8,p = 0.095), although patients with non-focal ARDS presented higher NLR ratio than focal ARDS (21 ± 18 p < 0.0001). The AUC for NLR at ED in predicting delayed ARDS was 0.53. CONCLUSION In blunt chest trauma patients, the NLR at ED admission was unable to predict delayed ARDS over the five first days post-injury. Although not clinically relevant, the NLR was higher in patients with non focal ARDS.
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Affiliation(s)
| | - Louis de Molliens
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France
| | - Laurent Petit
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France
| | - Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France.
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Carré S, Carrié C, Petit L, Biais M. Rib fracture displacement is a strong predictor for long-term opioid requirement in blunt chest trauma patients. Injury 2020; 51:1686-1688. [PMID: 32409185 DOI: 10.1016/j.injury.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Simon Carré
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France
| | - Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France.
| | - Laurent Petit
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France
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Rubin S, Orieux A, Prevel R, Garric A, Bats ML, Dabernat S, Camou F, Guisset O, Issa N, Mourissoux G, Dewitte A, Joannes-Boyau O, Fleureau C, Rozé H, Carrié C, Petit L, Clouzeau B, Sazio C, Bui HN, Pillet O, Rigothier C, Vargas F, Combe C, Gruson D, Boyer A. Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019. Clin Kidney J 2020; 13:354-361. [PMID: 32695326 PMCID: PMC7314187 DOI: 10.1093/ckj/sfaa099] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported. METHODS Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated. RESULTS Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12-23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54-140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively. CONCLUSION Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.
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Affiliation(s)
- Sébastien Rubin
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Antoine Garric
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Marie-Lise Bats
- Service de Biochimie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Sandrine Dabernat
- Service de Biochimie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Fabrice Camou
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Nahema Issa
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Gaelle Mourissoux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Antoine Dewitte
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Catherine Fleureau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Hadrien Rozé
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Cédric Carrié
- Service d’Anesthésie-Réanimation, Pellegrin CHU de Bordeaux, Bordeaux, France
| | - Laurent Petit
- Service d’Anesthésie-Réanimation, Pellegrin CHU de Bordeaux, Bordeaux, France
| | - Benjamin Clouzeau
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Charline Sazio
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Odile Pillet
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Claire Rigothier
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Frederic Vargas
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
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10
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Gonzalez G, Robert C, Petit L, Biais M, Carrié C. May the initial CT scan predict the occurrence of delayed hemothorax in blunt chest trauma patients? Eur J Trauma Emerg Surg 2020; 47:71-78. [PMID: 32435842 DOI: 10.1007/s00068-020-01391-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the impact of delayed hemothorax on outcomes in blunt chest trauma patients without life-threatening condition at admission and characterize the predictive value of predefined anatomical factors for delayed hemothorax. METHODS In a single-centre retrospective study, every spontaneous breathing patient admitted for a blunt chest trauma without significant pleural effusion at ICU admission was included. A multivariable regression model was used to determine the covariate-adjusted odd of secondary respiratory complications in patients with delayed hemothorax ≥ 500 ml. The characteristics of rib fractures (number, location and displacement) were integrated into a logistic regression model to determine variables associated with delayed hemothorax in multivariate analysis. RESULTS Over the study period, 109 patients were included and the rate of delayed hemothorax ≥ 500 ml was 36%. Patients with delayed hemothorax had higher rates of pulmonary infections (OR 4.8 [1.6-16.4]) but no statistical association between delayed hemothorax and secondary respiratory failure (OR 2.0 [0.4-9.4]). A posterior location and a displaced rib fracture were independent predictors of delayed hemothorax (OR 3.4 [1.3-8.6] and OR 2.3 [1.1-5.1], respectively). At least one displaced rib fracture was more specific of delayed hemothorax than the commonly used threshold of three or more rib fractures (81.3 vs. 51.5%). CONCLUSION Delayed hemothorax is a frequent complication associated with increased risk of pulmonary infection. The posterior location and the displacement of at least one rib fracture in the initial CT scan were independent risk factors for predicting the occurrence of delayed hemothorax.
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Affiliation(s)
- Geoffrey Gonzalez
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.
| | - Charlotte Robert
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Laurent Petit
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Matthieu Biais
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.,University of Bordeaux, Segalen, 33000, Bordeaux, France
| | - Cédric Carrié
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
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11
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Naudin J, Petit L, Mesli S, Carrié C, Cottenceau V, Biais M. Évaluation du déficit en vitamines et éléments traces sous épuration extra-rénale après mise en place d’un protocole de supplémentation en micronutriments. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.380] [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: 10/24/2022]
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12
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Carrié C, Chadefaux G, Sauvage N, de Courson H, Petit L, Nouette-Gaulain K, Pereira B, Biais M. Increased β-Lactams dosing regimens improve clinical outcome in critically ill patients with augmented renal clearance treated for a first episode of hospital or ventilator-acquired pneumonia: a before and after study. Crit Care 2019; 23:379. [PMID: 31775840 PMCID: PMC6881978 DOI: 10.1186/s13054-019-2621-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/23/2019] [Indexed: 01/18/2023]
Abstract
Background Augmented renal clearance (ARC) is recognized as a leading cause of β-lactam subexposure when conventional dosing regimens are used. The main objective was to compare the clinical outcome of ARC patients treated by conventional or increased β-lactam dosing regimens for a first episode of hospital or ventilator-acquired pneumonia (HAP-VAP). Methods In this single-center, retrospective study, every ARC patient treated by β-lactam for a first episode of HAP-VAP was included during two 15-month periods, before (Control period) and after (Treatment period) the modification of a local antibiotic therapy protocol. ARC was defined by a 24-h measured creatinine clearance ≥ 150 ml/min. The primary endpoint was defined as a therapeutic failure of the antimicrobial therapy or a HAP-VAP relapse within 28 days. Inverse probability of treatment weight (IPTW) was derived from a propensity score model. Cox proportional hazard models were used to evaluate the association between treatment period and clinical outcome. Results During the study period, 177 patients were included (control period, N = 88; treatment period, N = 89). Therapeutic failure or HAP-VAP relapse was significantly lower in the treatment period (10 vs. 23%, p = 0.019). The IPTW-adjusted hazard ratio of poor clinical outcome in the treatment period was 0.35 (95% CI 0.15–0.81), p = 0.014. No antibiotic side effect was reported during the treatment period. Conclusions Higher than licensed dosing regimens of β-lactams may be safe and effective in reducing the rate of therapeutic failure and HAP-VAP recurrence in critically ill augmented renal clearance (ARC) patients.
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Affiliation(s)
- Cédric Carrié
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France.
| | - Grégoire Chadefaux
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France
| | - Noémie Sauvage
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France
| | - Hugues de Courson
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France
| | - Laurent Petit
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France
| | - Karine Nouette-Gaulain
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France.,University Bordeaux Segalen, 33000, Bordeaux, France
| | - Bruno Pereira
- Biostatistics Unit, Délégation Recherche Clinique & Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, 33000, Bordeaux, France.,University Bordeaux Segalen, 33000, Bordeaux, France
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13
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Carrié C, Bardonneau G, Petit L, Ouattara A, Gruson D, Pereira B, Biais M. Piperacillin-tazobactam should be preferred to third-generation cephalosporins to treat wild-type inducible AmpC-producing Enterobacterales in critically ill patients with hospital or ventilator-acquired pneumonia. J Crit Care 2019; 56:6-11. [PMID: 31765910 DOI: 10.1016/j.jcrc.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/04/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the rate of therapeutic failure in critically ill patients treated by third-generation cephalosporins (3GCs) or piperacillin-tazobactam (PTZ) for wild-type AmpC-producing Enterobacterales pulmonary infections. METHODS Over a 4-year period, all adult patients treated for a wild-type AmpC-producing Enterobacterales pulmonary infection were retrospectively included. Two groups of patients were compared according to the definitive antibiotic therapy (3GCs or PTZ) considered after <48 h of empirical antibiotic therapy. The main outcome was the rate of therapeutic failure (impaired clinical response under treatment and/or a relapse of pulmonary infection). The secondary outcome was a secondary acquisition of 3GCs resistance. RESULTS Over the study period, 244 patients were included; 56 (23%) experienced therapeutic failure. In the non-adjusted cohort, the rate of therapeutic failure and emergence of resistance were significantly higher in the 3GCs group (32 vs. 18%, p = .011 and 13 vs. 5%, p = .035, respectively). In the propensity score-matched population, the use of 3GCs was associated with higher rates of therapeutic failure (HR = 1.61 [1.27-2.07]). The secondary de-escalation to 3GCs after 48 h of PTZ as a first-line antibiotic therapy was not associated with increased rate of emergence of resistance. CONCLUSION Our study confirms that 3GCs should be avoided as first-line antibiotic therapy in wild-type AmpC-producing Enterobacterales pulmonary infections.
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Affiliation(s)
- Cédric Carrié
- Anesthesiology and Critical Care Department I, CHU Pellegrin, 33000 Bordeaux, France.
| | - Guillaume Bardonneau
- Anesthesiology and Critical Care Department I, CHU Pellegrin, 33000 Bordeaux, France
| | - Laurent Petit
- Anesthesiology and Critical Care Department I, CHU Pellegrin, 33000 Bordeaux, France
| | - Alexandre Ouattara
- Anesthesiology and Critical Care Department II, CHU Magellan, 33600 Pessac, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France
| | - Didier Gruson
- Medical Intensive Care Unit, CHU Pellegrin, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France
| | - Bruno Pereira
- Biostatistics Unit, Délégation Recherche Clinique & Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Matthieu Biais
- Anesthesiology and Critical Care Department I, CHU Pellegrin, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France
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Besnard T, Carrié C, Petit L, Biais M. Increased dosing regimens of piperacillin-tazobactam are needed to avoid subtherapeutic exposure in critically ill patients with augmented renal clearance. Crit Care 2019; 23:13. [PMID: 30651133 PMCID: PMC6335799 DOI: 10.1186/s13054-019-2308-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/03/2019] [Indexed: 02/27/2023] Open
Affiliation(s)
- Thibaud Besnard
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France. .,Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.
| | - Laurent Petit
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France.,Université Bordeaux Segalen, 33000, Bordeaux, France
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15
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Carrié C, Legeron R, Petit L, Ollivier J, Cottenceau V, d'Houdain N, Boyer P, Lafitte M, Xuereb F, Sztark F, Breilh D, Biais M. Higher than standard dosing regimen are needed to achieve optimal antibiotic exposure in critically ill patients with augmented renal clearance receiving piperacillin-tazobactam administered by continuous infusion. J Crit Care 2018; 48:66-71. [PMID: 30172963 DOI: 10.1016/j.jcrc.2018.08.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 04/18/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine whether augmented renal clearance (ARC) impacts negatively on piperacillin-tazobactam unbound concentrations in critically ill patients receiving 16 g/2 g/day administered continuously. MATERIAL AND METHODS Fifty nine critically ill patients without renal impairment underwent 24-h creatinine clearance (CrCL) measurement and therapeutic drug monitoring during the first three days of antimicrobial therapy by piperacillin-tazobactam. The main outcome was the rate of piperacillin underexposure, defined by at least one of three samples under 16 mg/L. Monte Carlo simulation was performed to predict the distribution of piperacillin concentrations for various CrCL and minimal inhibitory concentration (MIC) values. RESULTS The rate of piperacillin underexposure was 19%, significantly higher in ARC patients (0 vs. 31%, p = .003). A threshold of CrCL ≥ 170 mL/min had a sensitivity and specificity of 1 (95%CI: 0.79-1) and 0.69 (95%CI: 0.61-0.76) to predict piperacillin underexposure. In ARC patients, a 20 g/2.5 g/24 h PTZ dosing regimen was associated with the highest probability to reach the 16 mg/L empirical target, without risk of excessive dosing. CONCLUSIONS When targeting a theoretical MIC at the upper limit of the susceptibility range, the desirable target (100%fT>16) may not be achieved in patients with CrCL ≥ 170 mL/min receiving PTZ 16 g/2 g/day administered continuously.
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Affiliation(s)
- Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France.
| | - Rachel Legeron
- Pharmacy and Clinical Pharmacy Department, CHU Bordeaux, 33000 Bordeaux, France; Pharmacokinetics and PK/PD Group INSERM 1034, Univ. Bordeaux, 33000 Bordeaux, France.
| | - Laurent Petit
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France.
| | - Julien Ollivier
- Pharmacy and Clinical Pharmacy Department, CHU Bordeaux, 33000 Bordeaux, France.
| | - Vincent Cottenceau
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France.
| | - Nicolas d'Houdain
- Pharmacy and Clinical Pharmacy Department, CHU Bordeaux, 33000 Bordeaux, France. nicolas.d'
| | - Philippe Boyer
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France
| | - Mélanie Lafitte
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France.
| | - Fabien Xuereb
- Pharmacy and Clinical Pharmacy Department, CHU Bordeaux, 33000 Bordeaux, France; Pharmacokinetics and PK/PD Group INSERM 1034, Univ. Bordeaux, 33000 Bordeaux, France.
| | - François Sztark
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France.
| | - Dominique Breilh
- Pharmacy and Clinical Pharmacy Department, CHU Bordeaux, 33000 Bordeaux, France; Pharmacokinetics and PK/PD Group INSERM 1034, Univ. Bordeaux, 33000 Bordeaux, France.
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France.
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16
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Carrié C, Rubin S, Sioniac P, Breilh D, Biais M. The kinetic glomerular filtration rate is not interchangeable with measured creatinine clearance for prediction of piperacillin underexposure in critically ill patients with augmented renal clearance. Crit Care 2018; 22:177. [PMID: 30037335 PMCID: PMC6056989 DOI: 10.1186/s13054-018-2117-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France. .,Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.
| | - Sébastien Rubin
- Nephrology Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Pierre Sioniac
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Dominique Breilh
- Pharmacy and Clinical Pharmacy Department, CHU Bordeaux, 33000, Bordeaux, France.,Pharmacokinetics and PK/PD Group INSERM 1034, University Bordeaux, 33000, Bordeaux, France
| | - Matthieu Biais
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France.,University Bordeaux Segalen, 33000, Bordeaux, France
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17
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Carrié C, Petit L, d'Houdain N, Sauvage N, Cottenceau V, Lafitte M, Foumenteze C, Hisz Q, Menu D, Legeron R, Breilh D, Sztark F. Association between augmented renal clearance, antibiotic exposure and clinical outcome in critically ill septic patients receiving high doses of β-lactams administered by continuous infusion: a prospective observational study. Int J Antimicrob Agents 2017; 51:443-449. [PMID: 29180280 DOI: 10.1016/j.ijantimicag.2017.11.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/07/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022]
Abstract
This study assessed whether augmented renal clearance (ARC) impacts negatively on antibiotic concentrations and clinical outcomes in patients treated by high-dose β-lactams administered continuously. Over a 9-month period, all critically ill patients without renal impairment treated by one of the monitored β-lactams for a documented infection were eligible. During the first 3 days of antibiotic therapy, every patient underwent 24-h CLCr measurements and therapeutic drug monitoring. The main outcome was the rate of β-lactam underdosing, defined as a free drug concentration <4 × MIC of the known pathogen. Secondary outcomes were rates of subexposure for β-lactams and therapeutic failure. The performance of CLCr in predicting underdosing was assessed by a ROC curve, and multivariable logistic regression was performed to determine risk factors for subexposure and therapeutic failure. A total of 79 patients were included and 235 samples were analysed. The rate of underdosing<4×MIC was 12%, with a significant association with CLCr (P <0.0001). A threshold of CLCr ≥ 170 mL/min had a sensitivity and specificity of 0.93 (95% CI 0.77-0.99) and 0.65 (95% CI 0.58-0.71) for predicting β-lactam underdosing<4×MIC. Mean CLCr values ≥170 mL/min were significantly associated with subexposure<4xMIC [OR = 10.1 (2.4-41.6); P = 0.001]. Patients with subexposure<4×MIC presented higher rates of therapeutic failure [OR = 6.3 (1.2-33.2); P = 0.03]. Mean CLCr values ≥170 mL/min remain a risk factor for subexposure to β-lactams despite high doses of β-lactams administered continuously. β-Lactam subexposure was associated with higher rates of therapeutic failure in septic critically ill patients.
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Affiliation(s)
- Cédric Carrié
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France.
| | - Laurent Petit
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Noemie Sauvage
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Vincent Cottenceau
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Melanie Lafitte
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Cecile Foumenteze
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Quentin Hisz
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Deborah Menu
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Rachel Legeron
- Pharmacology Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Dominique Breilh
- Pharmacology Department, CHU Bordeaux, 33000, Bordeaux, France; Université Bordeaux Segalen, 33000 Bordeaux, France
| | - Francois Sztark
- Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France; Université Bordeaux Segalen, 33000 Bordeaux, France
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18
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Carrié C, Bonnardel E, Vally R, Revel P, Marthan R, Marthan R. Vital Capacity Impairment due to Neuromuscular Disease and its Correlation with Diaphragmatic Ultrasound: A Preliminary Study. Ultrasound Med Biol 2016; 42:143-149. [PMID: 26620221 DOI: 10.1016/j.ultrasmedbio.2015.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this pilot study was to evaluate the correlation between diaphragmatic excursion measured by a right sub-costal ultrasound approach and forced vital capacity in patients with amyotrophic lateral sclerosis (ALS) or myotonic dystrophy (MD). All patients referred for pulmonary function testing underwent ultrasonic measurement of diaphragmatic excursion during quiet breathing, voluntary sniffing (Esniff) and forced breathing (EDEmax). Forty-five patients were included, mainly for amyotrophic lateral sclerosis or myotonic dystrophy. There was a significant correlation between EDEmax values and forced vital capacity (FVC) values (r = 0.68 [0.46–0.90], p < 0.0001) and between EDEmax values and percentage of predicted FVC values (r = 0.75 [0.55–0.95], p < 0.0001). At a threshold of EDEmax < 5.5 cm, the sensitivity and specificity of ultrasonic diaphragmatic excursion in predicting FVC ≤ 50% of theoretical values were 100% [66%–100%] and 69% [52%–84%] respectively, without any significant difference between males and females. There was no statistical correlation between maximal inspiratory pressure and Esniff.
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Affiliation(s)
- Cédric Carrié
- Emergency Department, CHU de Bordeaux, Bordeaux, France
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Affiliation(s)
- C. Carrié
- Centre Hospitalier Universitaire de Bordeaux Pellegrin; Bordeaux France
| | - M. Biais
- Centre Hospitalier Universitaire de Bordeaux Pellegrin; Bordeaux France
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20
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Soulat M, Carrié C, Cassone O, Thicoïpé MM, Revel P. [Prehospital ultrasound: time for a widespread use!]. Ann Fr Anesth Reanim 2014; 33:448-449. [PMID: 24907189 DOI: 10.1016/j.annfar.2014.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 06/03/2023]
Affiliation(s)
- M Soulat
- Samu/Smur, pôle des urgences adultes, groupe hospitalier Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France
| | - C Carrié
- Samu/Smur, pôle des urgences adultes, groupe hospitalier Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France.
| | - O Cassone
- Samu/Smur, pôle des urgences adultes, groupe hospitalier Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France
| | - M-M Thicoïpé
- Samu/Smur, pôle des urgences adultes, groupe hospitalier Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France
| | - P Revel
- Samu/Smur, pôle des urgences adultes, groupe hospitalier Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France
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21
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Carrié C, Morel N, Delaunay F, Revel P, Biais M. Noninvasive ventilation in blunt chest trauma: beware of missed esophageal injuries! Intensive Care Med 2014; 40:1055-6. [DOI: 10.1007/s00134-014-3300-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
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22
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Carrié C, Biais M. Authors' response. Crit Care 2013; 17:448. [PMID: 25152953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Biais M, Carrié C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. Crit Care 2012; 16:R82. [PMID: 22583539 PMCID: PMC3580625 DOI: 10.1186/cc11340] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/14/2012] [Indexed: 11/14/2022]
Abstract
Introduction In the emergency setting, focused cardiac ultrasound has become a fundamental tool for diagnostic, initial emergency treatment and triage decisions. A new ultra-miniaturized pocket ultrasound device (PUD) may be suited to this specific setting. Therefore, we aimed to compare the diagnostic ability of an ultra-miniaturized ultrasound device (Vscan™, GE Healthcare, Wauwatosa, WI) and of a conventional high-quality echocardiography system (Vivid S5™, GE Healthcare) for a cardiac focused ultrasonography in patients admitted to the emergency department. Methods During 4 months, patients admitted to our emergency department and requiring transthoracic echocardiography (TTE) were included in this single-center, prospective and observational study. Patients underwent TTE using a PUD and a conventional echocardiography system. Each examination was performed independently by a physician experienced in echocardiography, unaware of the results found by the alternative device. During the focused cardiac echocardiography, the following parameters were assessed: global cardiac systolic function, identification of ventricular enlargement or hypertrophy, assessment for pericardial effusion and estimation of the size and the respiratory changes of the inferior vena cava (IVC) diameter. Results One hundred fifty-one (151) patients were analyzed. With the tested PUD, the image quality was sufficient to perform focused cardiac ultrasonography in all patients. Examination using PUD adequately qualified with a very good agreement global left ventricular systolic dysfunction (κ = 0.87; 95%CI: 0.76-0.97), severe right ventricular dilation (κ = 0.87; 95%CI: 0.71-1.00), inferior vena cava dilation (κ = 0.90; 95%CI: 0.80-1.00), respiratory-induced variations in inferior vena cava size in spontaneous breathing (κ = 0.84; 95%CI: 0.71-0.98), pericardial effusion (κ = 0.75; 95%CI: 0.55-0.95) and compressive pericardial effusion (κ = 1.00; 95%CI: 1.00-1.00). Conclusions In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
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Carrié C, Quinart A, Gille O, Merville P, Sztark F. [Postoperative diaphragmatic paralysis after kidney transplantation]. Ann Fr Anesth Reanim 2011; 30:939-941. [PMID: 22040864 DOI: 10.1016/j.annfar.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Carrié C, Gisbert-Mora C, Delaunay F, Revel P, Janvier G, Biais M. Angiœdème non histaminique lié aux inhibiteurs de l’enzyme de conversion : le plus difficile est d’y penser ! Ann Fr Med Urgence 2011. [DOI: 10.1007/s13341-011-0092-6] [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: 11/28/2022]
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Carrié C, Bui HN, Gerbaud E, Vargas F, Hilbert G. Myocardial ischaemia and weaning failure: is angioplasty the heart of the problem? Intensive Care Med 2011; 37:1223-4. [DOI: 10.1007/s00134-011-2186-4] [Citation(s) in RCA: 5] [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] [Accepted: 12/29/2010] [Indexed: 11/29/2022]
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Carrié C. Zur Frage der Seltenheit der von Fernmetastasen ausgehenden gonorrhoischen Lymphangitiden. Dermatology 2009. [DOI: 10.1159/000253008] [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: 11/19/2022] Open
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Affiliation(s)
- C. Carrié
- Städtische Krankenanstalten, Dortmund
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Abstract
The importance of the quality of radiotherapy for Hodgkin's disease has been stressed, particularly in specific American and German studies. A quality control program for verification of technical files for each patient was implemented during the EORTC H8 protocol for patients with a supra-diaphragmatic stage I & II Hodgkin's disease. Today, 161 technical files have been reviewed. While the definition of the target volumes were in accordance with the protocol for most of the patients, we observed 13.6% of major deviations in terms of treated volumes, and 39.7% of major deviations in terms of dose (for volumes, a number of deviations were in the cervical areas, where the upper limit of the field was lowered in view of protecting the parotids, but the others were due to inadequate margins around the mediastinum and the hilum). Some of the dose deviations were due, in some cases, to the addition of a sub-carinal block after 30 Gy, but also, in cervical areas, in misinterpretation of the protocol. In conclusion, such a quality control program is justified by the number of major deviations which have been observed; it seems justified to carry out this program in the future H9 protocol.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, Paris, France
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Oberlin O, Habrand JL, Zucker JM, Brunat-Mentigny M, Terrier-Lacombe MJ, Dubousset J, Gentet JC, Schmitt C, Ponvert D, Carrié C. No benefit of ifosfamide in Ewing's sarcoma: a nonrandomized study of the French Society of Pediatric Oncology. J Clin Oncol 1992; 10:1407-12. [PMID: 1517783 DOI: 10.1200/jco.1992.10.9.1407] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To undertake a new protocol with the goals of improving the chemotherapeutic treatment of pediatric Ewing's sarcoma by introducing ifosfamide, and to widen the indications for surgical resection of Ewing's tumor to obtain better local control and to reduce radiation doses. PATIENTS AND METHODS The French Society of Pediatric Oncology initiated its first cooperative Ewing's sarcoma study in 1978, using a four-drug regimen (cyclophosphamide, dactinomycin, Adriamycin [doxorubicin; Farmitalia Carlo Erba, Rueil-Malmaison, France], and vincristine). Ninety-five patients were included, and, at 5 years, the disease-free survival reached a plateau of 51%. After encouraging responses of recurrent soft tissue or bone sarcomas to ifosfamide, a second study began in 1984 using a new chemotherapy regimen in which cyclophosphamide was replaced by ifosfamide. Sixty-five patients were treated. RESULTS By February 1992, the median follow-up was 5.8 years. The estimated 5-year disease-free survival was 52%. We observed unexpected cardiac toxicity. Three patients experienced acute cardiac failure that was lethal in two cases. The acute toxicity of ifosfamide prompted us to stop the protocol. Retrospectively, the lack of efficacy reinforced our decision. CONCLUSION We conclude that ifosfamide did not improve the outcome of the patients despite the fact that these two treatment regimens were not randomized.
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Affiliation(s)
- O Oberlin
- Institut Gustave Roussy, Villejuif, France
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Cailliez M, Poupin F, Carrié C, Petithory JC, Savel J. [Comparative value of immunofluorescence and immunoenzymology on figured antigen in the immunological diagnosis of African trypanosomiasis]. Bull Soc Pathol Exot Filiales 1977; 70:391-8. [PMID: 352560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Indirect immunoperoxydase method is compared with indirect immunofluorescence using immunized animal and human sera, and negative control sera. The obtained results show a good statisticly established concord and allow to propose the indirect immunoperoxydase method being used in the biological diagnostic of african Trypanosomiasis because its easy carrying out and its examin with an ordinary microscope.
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Carrié C. [In memoriam of H. Th. Schreus (1892-1970)]. Hautarzt 1970; 21:560-1. [PMID: 4928099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Carrié C, Brocker R. Zur Behandlung der Epidermophytie. Dermatology 1957. [DOI: 10.1159/000256005] [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: 11/19/2022] Open
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Carrié C. Zur Behebung der Röntgenstrahlen-Leukopenie. J Mol Med (Berl) 1938. [DOI: 10.1007/bf01776130] [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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Schreus HT, Carrié C. Untersuchungen zum Gallenfarbstoffwechsel. J Mol Med (Berl) 1934. [DOI: 10.1007/bf01778933] [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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