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Housset M, Fayad Kazour A, Paugam C, Le Corre Y, Croue A, Martin L, Lechevalier D, Berthin C. Pruriginous vesicular eruption associated with nivolumab immunotherapy: A case of dermatitis herpetiformis. Ann Dermatol Venereol 2024; 151:103269. [PMID: 38678772 DOI: 10.1016/j.annder.2024.103269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/05/2023] [Accepted: 02/15/2024] [Indexed: 05/01/2024]
Affiliation(s)
- M Housset
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France.
| | - A Fayad Kazour
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France
| | - C Paugam
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France
| | - Y Le Corre
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France
| | - A Croue
- Department of Pathology, 4 rue Larrey, 49100 Angers, France
| | - L Martin
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France
| | - D Lechevalier
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France
| | - C Berthin
- Department of Dermatology, 4 rue Larrey, 49100 Angers, France
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Rigourd V, Benoit L, Paugam C, Driessen M, Charlier C, Bille E, Pommeret B, Leroy E, Murmu MS, Guyonnet A, Baumot N, Seror JY. Management of lactating breast abscesses by ultrasound-guided needle aspiration and continuation of breastfeeding: A pilot study. J Gynecol Obstet Hum Reprod 2021; 51:102214. [PMID: 34469779 DOI: 10.1016/j.jogoh.2021.102214] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/21/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Needle aspiration of breast abscesses during lactation are currently recommended as an alternative to surgery only for moderate forms. In case of breast abscess, many patients stop breastfeeding on the advice of a health professional. We reviewed our experience of treatment of lactating breast abscesses by ultrasound-guided aspiration and suggest an algorithm of their management. We also analyzed the continuation of breastfeeding of these patients after advices from trained teams. MATERIEL AND METHODS We conducted a retrospective study from April 2016 to April 2017, including 28 patients referred for a breast abscess during lactation at the Duroc Breast Imaging Center. A management by ultrasound-guided aspiration was proposed to each patient. We collected data about the breastfeeding between October 2018 and January 2019. RESULTS A single aspiration was sufficient in 64.3% of cases. The delay between the occurrence of the abscess and the indication for drainage was significantly higher for patients who have needed finally surgical drainage (p = 0,0031). There were no difference of size of abscesses between patients receiving needle aspiration alone and those who have undergone surgery (p = 0,97). All patients who had been managed by needle aspiration continued breastfeeding after the treatment and 40% of the patients were still breastfeeding at 6 months. CONCLUSION The management of lactating breast abscess by ultrasound-guided needle aspiration is an effective alternative to surgery. It appears to be effective regardless of the size of the abscess and is compatible with the continuation of breastfeeding. Our study has indeed shown that if they are well advised, the majority of patients continue breastfeeding so that it is essential that health professionals be better trained regarding the management of breastfeeding complications.
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Affiliation(s)
- V Rigourd
- Lactarium Régional d'Ile-de-France, Necker Hôpital Enfants malades, 149 rue de Sèvres, Paris 75015, France; Réseau de Santé Périnatal Parisien, Paris, France.
| | - L Benoit
- Department of Obstetrics and Gynecology, Necker Hôpital Enfants malades, Paris, France
| | - C Paugam
- Réseau de Santé Périnatal Parisien, Paris, France
| | - M Driessen
- Department of Obstetrics and Gynecology, Necker Hôpital Enfants malades, Paris, France
| | - C Charlier
- Department of Obstetrics and Gynecology, Necker Hôpital Enfants malades, Paris, France
| | - E Bille
- Department of Microbiology, Necker Hôpital Enfants malades, Paris, France
| | - B Pommeret
- Department of Obstetrics and Gynecology, Lille, France
| | - E Leroy
- Department of Neonatology, Necker Hôpital Enfants malades, Paris, France
| | - M S Murmu
- Lactarium Régional d'Ile-de-France, Necker Hôpital Enfants malades, 149 rue de Sèvres, Paris 75015, France
| | - A Guyonnet
- Lactarium Régional d'Ile-de-France, Necker Hôpital Enfants malades, 149 rue de Sèvres, Paris 75015, France
| | - N Baumot
- Réseau de Santé Périnatal Parisien, Paris, France
| | - J Y Seror
- Department of Radiology, Duroc Breast Imaging Department, Paris, France
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Khonsari RH, Bernaux M, Vie JJ, Diallo A, Paris N, Luong LB, Assouad J, Paugam C, Simon T, Vicaut E, Nizard R, Vibert E. Risks of early mortality and pulmonary complications following surgery in patients with COVID-19. Br J Surg 2021; 108:e158-e159. [PMID: 33793755 PMCID: PMC7929121 DOI: 10.1093/bjs/znab007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/01/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R H Khonsari
- Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - M Bernaux
- Direction de la Stratégie et de la Transformation, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-J Vie
- Université de Lille, Inria, CNRS, UMR 9189 - CRIStAL, Lille, France
| | - A Diallo
- Unité de Recherche Clinique (URC) Saint-Louis Lariboisière Fernand-Widal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Paris
- Direction des Systèmes d'Information, Web INnovations Données (WIND), Assistance Publique - Hôpitaux de Paris, Paris, France
| | - L B Luong
- CIC Cochin Pasteur, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - J Assouad
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris; Sorbonne Université, Paris, France
| | - C Paugam
- Direction Générale, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - T Simon
- Service de Pharmacologie Clinique, Plateforme de Recherche Clinique de l'Est Parisien (URCEST-CRB-CRCEST), AP-HP.SU, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E Vicaut
- Unité de Recherche Clinique (URC) Saint-Louis Lariboisière Fernand-Widal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - R Nizard
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Centre Hépato-biliaire, Hôpital Paul-Brousse, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
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Paugam C, Dréno B. Is nicotinamide a sustainable therapy for resistant actinic keratoses? J Eur Acad Dermatol Venereol 2020; 34:e624-e626. [DOI: 10.1111/jdv.16501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Paugam
- Department of Dermatology University Hospital Nantes Nantes France
| | - B. Dréno
- Department of Dermatology University Hospital Nantes Nantes France
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Camus C, Locher C, Saliba F, Goubaux B, Bonadona A, Lavayssiere L, Paugam C, Quinart A, Barbot O, Dharancy S, Delafosse B, Pichon N, Barraud H, Galbois A, Veber B, Cayot S, Souche B. Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study. JGH Open 2020; 4:757-763. [PMID: 32782967 PMCID: PMC7411551 DOI: 10.1002/jgh3.12359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/09/2019] [Revised: 03/11/2020] [Accepted: 05/02/2020] [Indexed: 12/22/2022]
Abstract
Background and Aim The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real‐life use are lacking. Methods This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injury–hepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44–54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1‐year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P < 0.001). Among nonbiliary cirrhotic patients, hospital mortality was associated with the severity of liver disease (HE and severe cholestasis) and not being listed for transplant. In ALF, paracetamol etiology and ≥3 MARS sessions were associated with better transplant‐free survival. Conclusion Our study suggests that MARS should be mainly used as a bridge to liver transplantation. Survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF.
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Affiliation(s)
- Christophe Camus
- Service de Reanimation medicale, Hôpital Pontchaillou Rennes France
| | - Clara Locher
- Laboratoire de Pharmacologie, Centre d'Investigation Clinique INSERM 1414 Rennes France
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse Centre Hépato-biliaire Villejuif France
| | - Bernard Goubaux
- Service d'Anesthesie Reanimation, Hôpital de l'Archet II Nice France
| | - Agnès Bonadona
- Service de Reanimation medicale, Hôpital La Tronche Grenoble France
| | | | - Catherine Paugam
- Service d'Anesthesie Reanimation chirurgicale, Hôpital Beaujon Clichy France
| | - Alice Quinart
- Service d'Anesthesie Reanimation, Hôpital Pellegrin Bordeaux France
| | - Olivier Barbot
- Service de Reanimation medicale, Hôpital Jean Minjoz Besançon France
| | | | - Bertrand Delafosse
- Service d' Anesthesie Reanimation chirurgicale, Hôpital Edouard Herriot Lyon France
| | - Nicolas Pichon
- Service de Reanimation medicale, Hôpital Dupuytren Limoges France
| | - Hélène Barraud
- Service d'Hepato-gastroenterologie, Hôpital de Brabois Vandoeuvre-les-Nancy France
| | - Arnaud Galbois
- Service de Reanimation medicale, Hôpital Saint-Antoine Paris France
| | - Benoit Veber
- Service de Reanimation chirurgicale, Hôpital Charles Nicolle Rouen France
| | - Sophie Cayot
- Service de Reanimation, CHU Estaing Clermont-Ferrand France
| | - Bruno Souche
- Service d'Anesthesie reanimation, Hôpital Saint-Eloi Montpellier France
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Montravers P, Kantor E, Constantin JM, Lefrant JY, Lescot T, Nesseler N, Paugam C, Jabaudon M, Dupont H. Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study. Crit Care 2019; 23:393. [PMID: 31805988 PMCID: PMC6896276 DOI: 10.1186/s13054-019-2681-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
Background Recent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP. Methods Using a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model. Results In this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057). Conclusions High proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.
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Affiliation(s)
- Philippe Montravers
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, 48 rue Henri Huchard, F-75018, Paris, France. .,Université de Paris, Paris, France. .,INSERM UMR 1152 - Université de Paris, Paris, France.
| | - Elie Kantor
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, 48 rue Henri Huchard, F-75018, Paris, France.,Université de Paris, Paris, France
| | - Jean-Michel Constantin
- Département de Médecine Post-opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Jean-Yves Lefrant
- Division of Anaesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, and EA 2992, Université Montpellier, Nîmes, France
| | - Thomas Lescot
- Department of Anaesthesia and Critical Care, Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Nicolas Nesseler
- Surgical Intensive Care Unit, Hôpital Pontchaillou, and Inserm U 991, Université de Rennes 1, Rennes, France
| | - Catherine Paugam
- Université de Paris, Paris, France.,Department of Anaesthesiology and Critical Care Medicine, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Jabaudon
- Département de Médecine Post-opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France
| | - Hervé Dupont
- Medical and Surgical ICU, Amiens University Hospital and INSERM U1088, University of Picardy Jules Verne, Amiens, France
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Jacob N, JeddiI F, Gueno LM, Giral M, Paugam C. Mycétome à cœliomycète chez un greffé rénal. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.459] [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: 11/30/2022]
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Bekel L, Paugam C, Mallet S, Leclerc-Mercier S, Fraitag S, Macagno N, Bodemer C, Barbarot S, Alby C, Hadj-Rabia S. L’hamartome dyskérato-acantholytique hémicorporel est aussi associé à une dysfonction de la connexine 26. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.396] [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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Navez J, Cauchy F, Dokmak S, Goumard C, Faivre E, Weiss E, Paugam C, Scatton O, Soubrane O. Complex liver resection under hepatic vascular exclusion and hypothermic perfusion with versus without veno-venous bypass: a comparative study. HPB (Oxford) 2019; 21:1131-1138. [PMID: 30723061 DOI: 10.1016/j.hpb.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/14/2018] [Accepted: 12/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND While hypothermic liver perfusion has been shown to improve parenchymal tolerance to complex resections in patients requiring prolonged hepatic vascular exclusion (HVE), the benefit of associated veno-venous bypass (VVB) in this setting remains poorly evaluated. METHODS All patients undergoing liver resection requiring HVE and hypothermic liver perfusion for at least 55 min between 2006 and 2017 were retrospectively reviewed. Perioperative outcomes were compared between patients with (VVB+) or without VVB (VVB-). RESULTS Twenty-seven patients were analyzed, including 13 VVB+ and 14 VVB-. Median HVE duration was similar in VVB+ and VVB- patients (96 vs. 75 min, respectively). VVB+patients had longer operative time (460 vs. 375 min, p = 0.023) but less blood loss (p = 0.010). Five (19%) patients died postoperatively from liver failure or sepsis, without difference between groups. Postoperative major morbidity rate was similar between VVB+ and VVB- patients (30% vs. 50%, respectively) such as rates of liver failure, haemorrhage, renal insufficiency and sepsis, but VVB- patients experienced more respiratory complications (64% vs. 15%, p = 0.012). CONCLUSION During liver resection under HVE and hypothermic liver perfusion, use of VVB allows for reducing blood loss and postoperative respiratory complications. VVB should be recommended in case of liver resection with prolonged HVE.
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Affiliation(s)
- Julie Navez
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - François Cauchy
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Safi Dokmak
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Claire Goumard
- Department of Hepatobiliary Surgery and Liver transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France(5)
| | - Evelyne Faivre
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Catherine Paugam
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France(5)
| | - Olivier Soubrane
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4).
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Paugam C, Dréno B. Actualités sur la prise en charge des kératoses actiniques chez les patients transplantés d’organes. Ann Dermatol Venereol 2019; 146 Suppl 2:IIS31-IIS35. [PMID: 31133228 DOI: 10.1016/s0151-9638(19)30203-0] [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] [Indexed: 11/29/2022]
Abstract
Transplant recipients are at high risk of developing actinic keratosis (AK) and skin cancer. For this reason, initiating treatment at an early stage is crucial. Topical and systemic therapeutic options for AK have widely been described in studies of immunocompetent patients. However, little is known about AK management in organ transplant recipients (OTR). Photodynamic therapy (PDT), along with imiquimod, topical NSAIDs and topical 5-fluorouracil have been used on ORT patients in small non randomized studies. Although these studies seem to suggest that PDT offers best results, solid evidence is lacking. Nicotinamide and oral retinoids have also been described as reasonably effective preventive treatments in ORT patients. Management of immunosuppressive drugs is also considered as a key point for reducing the number of AK in ORT patients; an early switch for m-tor inhibitors has been shown to be protective while azathioprine, ciclosporin and tacrolimus have been shown to heighten the risk of developing AKs and skin cancer in this population. © 2019 Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Kératoses actiniques : comprendre et traiter réalisé avec le soutien institutionnel de Galderma International.
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Affiliation(s)
- C Paugam
- Clinique dermatologique, Hôtel-Dieu CHU de Nantes, 1 place Alexis-Ricordeau, 44035 Nantes Cedex 01, France
| | - B Dréno
- Clinique dermatologique, Hôtel-Dieu CHU de Nantes, 1 place Alexis-Ricordeau, 44035 Nantes Cedex 01, France.
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Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, Pottecher J, Demoule A, Ferrandière M, Asehnoune K, Dellamonica J, Velly L, Abback PS, de Jong A, Brunot V, Belafia F, Roquilly A, Chanques G, Muller L, Constantin JM, Bertet H, Klouche K, Molinari N, Jung B. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 2018; 392:31-40. [PMID: 29910040 DOI: 10.1016/s0140-6736(18)31080-8] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute acidaemia is frequently observed during critical illness. Sodium bicarbonate infusion for the treatment of severe metabolic acidaemia is a possible treatment option but remains controversial, as no studies to date have examined its effect on clinical outcomes. Therefore, we aimed to evaluate whether sodium bicarbonate infusion would improve these outcomes in critically ill patients. METHODS We did a multicentre, open-label, randomised controlled, phase 3 trial. Local investigators screened eligible patients from 26 intensive care units (ICUs) in France. We included adult patients (aged ≥18 years) who were admitted within 48 h to the ICU with severe acidaemia (pH ≤7·20, PaCO2 ≤45 mm Hg, and sodium bicarbonate concentration ≤20 mmol/L) and with a total Sequential Organ Failure Assessment score of 4 or more or an arterial lactate concentration of 2 mmol/L or more. We randomly assigned patients (1:1), by stratified randomisation with minimisation via a restricted web platform, to receive either no sodium bicarbonate (control group) or 4·2% of intravenous sodium bicarbonate infusion (bicarbonate group) to maintain the arterial pH above 7·30. Our protocol recommended that the volume of each infusion should be within the range of 125-250 mL in 30 min, with a maximum of 1000 mL within 24 h after inclusion. Randomisation criteria were stratified among three prespecified strata: age, sepsis status, and the Acute Kidney Injury Network (AKIN) score. The primary outcome was a composite of death from any cause by day 28 and the presence of at least one organ failure at day 7. All analyses were done on data from the intention-to-treat population, which included all patients who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02476253. FINDINGS Between May 5, 2015, and May 7, 2017, we enrolled 389 patients into the intention-to-treat analysis in the overall population (194 in the control group and 195 in the bicarbonate group). The primary outcome occurred in 138 (71%) of 194 patients in the control group and 128 (66%) of 195 in the bicarbonate group (absolute difference estimate -5·5%, 95% CI -15·2 to 4·2; p=0·24). The Kaplan-Meier method estimate of the probability of survival at day 28 between the control group and bicarbonate group was not significant (46% [95% CI 40-54] vs 55% [49-63]; p=0·09. In the prespecified AKIN stratum of patients with a score of 2 or 3, the Kaplan-Meier method estimate of survival by day 28 between the control group and bicarbonate group was significant (37% [95% CI 28-48] vs 54% [45-65]; p=0·0283). [corrected] Metabolic alkalosis, hypernatraemia, and hypocalcaemia were observed more frequently in the bicarbonate group than in the control group, with no life-threatening complications reported. INTERPRETATION In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined stratum of patients with acute kidney injury. FUNDING French Ministry of Health and the Société Française d'Anesthésie Réanimation.
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Affiliation(s)
- Samir Jaber
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France.
| | - Catherine Paugam
- AP-HP, Département Anesthésie et Réanimation, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Emmanuel Futier
- CHU de Clermont-Ferrand, Department of Perioperative Medicine, GReD, UMR/CNRS6293, University Clermont Auvergne, INSERM U1103, Clermont-Ferrand, France
| | - Jean-Yves Lefrant
- CHU de Nîmes, Département Anesthésie et Réanimation, University of Montpellier-Nîmes, Nîmes, France
| | | | - Thomas Lescot
- AP-HP, Département Anesthésie et Réanimation, Hôpital Saint Antoine, Paris, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Service d'Anesthésie-Réanimation Chirurgicale-Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Alexandre Demoule
- Service de Pneumologie, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | | | - Karim Asehnoune
- CHU de Nantes, Département Anesthésie et Réanimation Chirurgicale, Nantes, France
| | - Jean Dellamonica
- CHU de Nice, Département de Réanimation Médicale, INSERM-C3M-Université Cote d'Azur, Nice, France
| | - Lionel Velly
- Aix-Marseille Université, AP-HM, Département Anesthésie et Réanimation Chirurgicale, Groupe Hospitalier Timone, UMR 7289, CNRS, Marseille, France
| | - Paër-Sélim Abback
- AP-HP, Département Anesthésie et Réanimation, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Audrey de Jong
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Vincent Brunot
- Département de Médecine Intensive et Réanimation, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Fouad Belafia
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Antoine Roquilly
- CHU de Nantes, Département Anesthésie et Réanimation Chirurgicale, Nantes, France
| | - Gérald Chanques
- Saint Eloi ICU, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Laurent Muller
- CHU de Nîmes, Département Anesthésie et Réanimation, University of Montpellier-Nîmes, Nîmes, France
| | - Jean-Michel Constantin
- CHU de Clermont-Ferrand, Department of Perioperative Medicine, GReD, UMR/CNRS6293, University Clermont Auvergne, INSERM U1103, Clermont-Ferrand, France
| | - Helena Bertet
- CHU de Montpellier, Department of Statistics, Montpellier University, Montpellier, France
| | - Kada Klouche
- Département de Médecine Intensive et Réanimation, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Nicolas Molinari
- CHU de Montpellier, Department of Statistics, Montpellier University, Montpellier, France
| | - Boris Jung
- Département de Médecine Intensive et Réanimation, Montpellier University Hospital, PhyMedExp, INSERM, CNRS, Montpellier, France
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Paugam C, Saint-Jean M, Colas L, Bernier C, Dréno B. Isotretinoin treatment and peanut allergy: a new case report and review of the literature. J Eur Acad Dermatol Venereol 2018; 32:e341-e343. [PMID: 29512201 DOI: 10.1111/jdv.14916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Paugam
- Dermatology Department, Hôtel-Dieu University hospital, Nantes Cedex 1, France
| | - M Saint-Jean
- Dermatology Department, Hôtel-Dieu University hospital, Nantes Cedex 1, France
| | - L Colas
- Allergology and Clinical Immunology Department, Hôtel-Dieu University hospital, Nantes Cedex 1, France
| | - C Bernier
- Dermatology Department, Hôtel-Dieu University hospital, Nantes Cedex 1, France
| | - B Dréno
- Dermatology Department, Hôtel-Dieu University hospital, Nantes Cedex 1, France
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13
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Montravers P, Tubach F, Lescot T, Veber B, Esposito-Farèse M, Seguin P, Paugam C, Lepape A, Meistelman C, Cousson J, Tesniere A, Plantefeve G, Blasco G, Asehnoune K, Jaber S, Lasocki S, Dupont H. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Med 2018; 44:300-310. [PMID: 29484469 DOI: 10.1007/s00134-018-5088-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown. METHODS A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomisation (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multidrug-resistant (MDR) bacteria and reoperation rate, with 45-day follow-up. RESULTS Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6-20] vs 12 [6-13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99-6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI - 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or reoperation rate, while subsequent drainages between day 8 and day 45 were observed following short-course ABT (P = 0.041). CONCLUSION Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit. CLINICALTRIALS. GOV IDENTIFIER NCT01311765.
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Affiliation(s)
- Philippe Montravers
- Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, INSERM, UMR 1152, Paris Diderot Sorbonne Cite University, Paris, France.
- Département d'Anesthésie-Réanimation, CHU Bichat Claude Bernard, 48 rue Henri Huchard, 75018, Paris, France.
| | - Florence Tubach
- Département de Biostatistique, Santé Publique et Information Médicale (BIOSPIM), Hôpital Pitié-Salpêtrière, AP-HP, INSERM, UMR 1123, ECEVE, CIC-EC 1425, Sorbonne Universités, UPMC Univ Paris 06, 75013, Paris, France
| | - Thomas Lescot
- Department of Anaesthesiology and Critical Care Medicine, St Antoine Hospital, APHP, Sorbonne Universites, UPMC Univ Paris 06, Paris, France
| | - Benoit Veber
- Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France
| | - Marina Esposito-Farèse
- INSERM CIC-EC 1425, Unité de Recherche Clinique, HUPNVS, CHU Bichat-Claude Bernard, APHP, Paris, France
| | - Philippe Seguin
- Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Rennes, Rennes, France
| | - Catherine Paugam
- Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Beaujon, Clichy, Paris Diderot Sorbonne Cite University, Paris, France
| | - Alain Lepape
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | | | - Joel Cousson
- Pôle Anesthésie-Réanimation, CHU Reims, Reims, France
| | - Antoine Tesniere
- Surgical Intensive Care Unit, CHU Cochin, Paris Descartes University, Paris, France
| | | | - Gilles Blasco
- Service d'Anesthésie Réanimation Chirurgicale, CHU Besancon, Besançon, France
| | - Karim Asehnoune
- Service d'Anesthésie et Réanimation Chirurgicale, Hotel Dieu, CHU Nantes, Nantes, France
| | - Samir Jaber
- Service d'Anesthésie Réanimation, Hopital St Eloi, CHU Montpellier, Montpellier, France
| | - Sigismond Lasocki
- Département d'Anesthésie Réanimation, CHU Angers, L'UBL, Université d'Angers, Angers, France
| | - Herve Dupont
- Critical Care Medicine Department, Amiens University Hospital, INSERM U1088, University of Picardy Jules Verne, Amiens, France
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Peoc’h K, Nuzzo A, Guedj K, Paugam C, Corcos O. Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far. ACTA ACUST UNITED AC 2017; 56:373-385. [DOI: 10.1515/cclm-2017-0291] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/21/2017] [Indexed: 12/20/2022]
Abstract
Abstract
Acute intestinal ischemic injury (i3) is a life-threatening condition with disastrous prognosis, which is currently difficult to diagnose at the early stages of the disease; a rapid diagnosis is mandatory to avoid irreversible ischemia, extensive bowel resection, sepsis and death. The overlapping protein expression of liver and gut related to the complex physiopathology of the disease, the heterogeneity of the disease and its relative rarity could explain the lack of a useful early biochemical marker of i3. Apart from non-specific biological markers of thrombosis, hypoxia inflammation, and infection, several more specific biomarkers in relation with the gut barrier dysfunction, the villi injury and the enterocyte mass have been used in the diagnosis of acute i3. It includes particularly D-lactate, intestinal fatty acid-binding protein (FABP) and citrulline. Herein, we will discuss leading publications concerning these historical markers that point out the main limitations reagrding their use in routine clinical practice. We will also introduce the first and limited results arising from omic studies, underlying the remaining effort that needs to be done in the field of acute i3 biological diagnosis, which remains a challenge.
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Affiliation(s)
- Katell Peoc’h
- Biochimie Clinique, Hôpital Beaujon , Université Paris Diderot, UFR de Médecine Xavier Bichat and APHP, HUPNVS, DHU Unity , Clichy , France
- INSERM, UMRs 1149, CRI , Université Paris Diderot , Paris , France , Phone: +33 (0)1 40 87 54 36
| | - Alexandre Nuzzo
- SURVI, Hôpital Beaujon, APHP, HUPNVS, DHU Unity , Clichy , France
- Gastroenterologie, Hôpital Beaujon, APHP, HUPNVS , Clichy , France
| | - Kevin Guedj
- SURVI, Hôpital Beaujon, APHP, HUPNVS, DHU Unity , Clichy , France
- INSERM, UMRs 1148, LVTS , Paris , France
| | - Catherine Paugam
- Anesthésie Réanimation, Hôpital Beaujon , Université Paris Diderot, UFR de Médecine Xavier Bichat and APHP, HUPNVS , Clichy , France
| | - Olivier Corcos
- SURVI, Hôpital Beaujon, APHP, HUPNVS, DHU Unity , Clichy , France
- Gastroenterologie, Hôpital Beaujon, APHP, HUPNVS , Clichy , France
- INSERM, UMRs 1148, LVTS , Paris , France
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15
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Marjanovic N, Frasca D, Asehnoune K, Paugam C, Lasocki S, Ichai C, Lefrant JY, Leone M, Dahyot-Fizelier C, Pottecher J, Falcon D, Veber B, Constantin JM, Seguin S, Guénézan J, Mimoz O. Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol. BMJ Open 2017; 7:e017003. [PMID: 28790042 PMCID: PMC5724199 DOI: 10.1136/bmjopen-2017-017003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/17/2017] [Accepted: 06/14/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Severe trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspiration, which plays a major role in the pathogenesis of VAP. Automatic devices facilitate the regulation of tracheal cuff pressure, and their implementation has the potential to reduce VAP. The objective of this work is to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device reduces the incidence of VAP compared with intermittent control in severe trauma patients. METHODS AND ANALYSIS This multicentre randomised controlled and open-label trial will include patients suffering from severe trauma who are admitted within the first 24 hours, who require invasive mechanical ventilation to longer than 48 hours. Their tracheal cuff pressure will be monitored either once every 8 hours (control group) or continuously using a pneumatic device (intervention group). The primary end point is the proportion of patients that develop VAP in the intensive care unit (ICU) at day 28. The secondary end points include the proportion of patients that develop VAP in the ICU, early (≤7 days) or late (>7 days) VAP, time until the first VAP diagnosis, the number of ventilator-free days and antibiotic-free days, the length of stay in the ICU, the proportion of patients with ventilator-associated events and that die during their ICU stay. ETHICS AND DISSEMINATION This protocol has been approved by the ethics committee of Poitiers University Hospital, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION Clinical Trials NCT02534974.
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Affiliation(s)
- Nicolas Marjanovic
- Department of Emergency and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Denis Frasca
- INSERM UMR1246—Methods in Patient-Centered Outcomes and Health Research, Poitiers, France
| | - Karim Asehnoune
- Centre Hospitalier Universitaire de Nantes, Anaesthesia and Intensive Care Unit, Nantes, France
| | - Catherine Paugam
- Assistance Publique des Hôpitaux de Paris, Intensive Care Unit, Hôpital Beaujon, Clichy, France
| | - Sigismond Lasocki
- Centre Hospitalier Universitaire d’Angers, Intensive Care Unit, Angers, France
| | - Carole Ichai
- Centre Hospitalier Universitaire de Nice, Intensive Care Unit, Nice, France
| | - Jean-Yves Lefrant
- Division Anaesthesia Critical Care, Emergency and Pain Medicine, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Marc Leone
- Assistance Publique Hopitaux de Marseille, Intensive Care Unit, Hôpital Nord, Marseille, France
| | - Claire Dahyot-Fizelier
- Centre Hospitalier Universitaire de Poitiers, Neuro-Intensive Care Unit, Poitiers, France
| | - Julien Pottecher
- Hopitaux Universitaires de Strasbourg, Intensive Care Unit, Strasbourg, France
| | - Dominique Falcon
- Centre Hospitalier Universitaire de Grenoble, Intensive Care Unit, Grenoble, France
| | - Benoit Veber
- Centre Hospitalier Universitaire de Rouen, Intensive Care Unit, Rouen, France
| | - Jean-Michel Constantin
- Centre Hospitalier Universitaire de Clermont-Ferrand, Intensive Care Unit, Clermont-Ferrand, France
| | - Sabrina Seguin
- Department of Emergency and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Intensive Care Unit, Poitiers, France
| | - Jérémy Guénézan
- Department of Emergency and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Mimoz
- Department of Emergency and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM U1070, Université de Poitiers, Poitiers, France
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Paugam C, Corvec S, Saint-Jean M, Le Moigne M, Khammari A, Boisrobert A, Nguyen J, Gaultier A, Dréno B. Propionibacterium acnesphylotypes and acne severity: an observational prospective study. J Eur Acad Dermatol Venereol 2017; 31:e398-e399. [DOI: 10.1111/jdv.14206] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- C. Paugam
- Dermato-Oncology Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
| | - S. Corvec
- Bacteriological Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
| | - M. Saint-Jean
- Dermato-Oncology Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
| | - M. Le Moigne
- Dermato-Oncology Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
| | - A. Khammari
- Dermato-Oncology Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
| | - A. Boisrobert
- Dermato-Oncology Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
| | - J.M. Nguyen
- Biostatistic Department; PIMES- Hôpital St Jacques; CHU Nantes; 44093 Nantes France
| | - A. Gaultier
- Biostatistic Department; PIMES- Hôpital St Jacques; CHU Nantes; 44093 Nantes France
| | - B. Dréno
- Dermato-Oncology Department; Nantes Hospital; 1 Place Alexis Ricordeau 44093 Nantes France
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Nuzzo A, Maggiori L, Ronot M, Becq A, Plessier A, Gault N, Joly F, Castier Y, Vilgrain V, Paugam C, Panis Y, Bouhnik Y, Cazals-Hatem D, Corcos O. Predictive Factors of Intestinal Necrosis in Acute Mesenteric Ischemia: Prospective Study from an Intestinal Stroke Center. Am J Gastroenterol 2017; 112:597-605. [PMID: 28266590 DOI: 10.1038/ajg.2017.38] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/02/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To identify predictive factors for irreversible transmural intestinal necrosis (ITIN) in acute mesenteric ischemia (AMI) and establish a risk score for ITIN. METHODS This single-center prospective cohort study was performed between 2009 and 2015 in patients with AMI. The primary outcome was the occurrence of ITIN, confirmed by specimen analysis in patients who underwent surgery. Patients who recovered from AMI with no need for intestinal resection were considered not to have ITIN. Clinical, biological and radiological data were compared in a Cox regression model. RESULTS A total of 67 patients were included. The origin of AMI was arterial, venous, or non-occlusive in 61%, 37%, 2% of cases, respectively. Intestinal resection and ITIN concerned 42% and 34% of patients, respectively. Factors associated with ITIN in multivariate analysis were: organ failure (hazard ratio (HR): 3.1 (95% confidence interval (CI): 1.1-8.5); P=0.03), serum lactate levels >2 mmol/l (HR: 4.1 (95% CI: 1.4-11.5); P=0.01), and bowel loop dilation on computerized tomography scan (HR: 2.6 (95% CI: 1.2-5.7); P=0.02). ITIN rate increased from 3% to 38%, 89%, and 100% in patients with 0, 1, 2, and 3 factors, respectively. Area under the receiver operating characteristics curve for the diagnosis of ITIN was 0.936 (95% CI: 0.866-0.997) depending on the number of predictive factors. CONCLUSIONS We identified three predictive factors for irreversible intestinal ischemic injury requiring resection in the setting of AMI. Close monitoring of these factors could help avoid unnecessary laparotomy, prevent resection, as well as complications due to unresected necrosis, and possibly lower the overall mortality.
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Affiliation(s)
- Alexandre Nuzzo
- Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.,Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Leon Maggiori
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Colorectal Surgery, Beaujon Hospital, Clichy, APHP, France
| | - Maxime Ronot
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Radiology, Beaujon Hospital, Clichy, APHP, France
| | - Aymeric Becq
- Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France
| | - Aurelie Plessier
- Department of Hepatology, Beaujon Hospital, Clichy, APHP, France
| | - Nathalie Gault
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Epidemiology, Biostatistics and Clinical Research, APHP, Beaujon Hospital, Clichy, APHP, France.,INSERM CIC-EC 1425 Bichat Hospital, Paris, France
| | - Francisca Joly
- Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.,Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Yves Castier
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Vascular Surgery, Bichat Hospital, Paris, APHP, France
| | - Valerie Vilgrain
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Radiology, Beaujon Hospital, Clichy, APHP, France
| | - Catherine Paugam
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Intensive Care Unit and Anesthesiology, Beaujon Hospital, Clichy, APHP, France
| | - Yves Panis
- Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.,Department of Colorectal Surgery, Beaujon Hospital, Clichy, APHP, France
| | - Yoram Bouhnik
- Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.,Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
| | | | - Olivier Corcos
- Structure d'URgences Vasculaires Intestinales (SURVI), Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, APHP, France.,Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
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Le Moigne M, Corvec S, Aubin G, Paugam C, Jean MS, Khammari A, Dréno B. Acné fulminans et phylotype de Propionibacterium acnes. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.188] [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: 11/25/2022]
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Paugam C, Colas L, Saint-Jean M, Bernier C, Dréno B. Traitement par isotrétinoïne : quid des allergiques au soja et à l’arachide ? Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.371] [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: 10/20/2022]
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Duclos A, Peix JL, Piriou V, Occelli P, Denis A, Bourdy S, Carty MJ, Gawande AA, Debouck F, Vacca C, Lifante JC, Colin C, Aegerter P, Aouifi A, Arickx D, Aubart F, Baudrin D, Berry WR, Beuvry C, Bonnet F, Bouveret L, Cabarrot P, Cames E, Carty MJ, Caton J, Chenitz MC, Clergues F, Colin C, Coudray JM, Damiens M, Dauzac C, Debono B, Debouck F, De Germay B, Deleforterie AC, Denis A, Desrousseaux JF, Didelot MP, Doat B, Domingo-Saidji NY, Duclos A, Durieux P, Fessy M, Hardy P, Cariven P, Fontas N, Ganansia P, Gawande AA, Giraud F, Gostiaux G, Habi S, Haga S, Houlgatte A, Jaffe M, Jourdan J, Kaczmarek N, Lamblin S, Level C, Liaras E, Lifante JC, Lipsitz SR, Majchrzak C, Malavaud B, Serres TM, Martin X, Martinet C, Maupetit B, Michel P, Movondo A, Naamani B, Nacry R, Occelli P, Olousouzian S, Papin P, Paquet JC, Parfaite A, Pattou F, Paugam C, Pavy E, Peix JL, Petit H, Pierre S, Piriou V, Poupon Bourdy S, Pradere B, Quesne M, Radola Y, Raould A, Rongieras F, Rouquette I, Sanders V, Sanz F, Sens F, Surmont S, Sicre C, Tabur D, Targosz P, Thery D, Toppan N, Usandizaga G, Vacca C, Verheyde I, Zadegan F. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Br J Surg 2016; 103:1804-1814. [DOI: 10.1002/bjs.10295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/07/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation.
Methods
A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals.
Results
Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.
Conclusion
Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A Duclos
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - J L Peix
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - V Piriou
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service d'Anesthésie Réanimation Médicale et Chirurgicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | - A Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - S Bourdy
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - M J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - A A Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
- Ariadne Labs and Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - F Debouck
- Air France Consulting, AFM42, Chambourcy, France
| | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes, Lyon, France
| | - J C Lifante
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - C Colin
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | | | | | | | | | - D Baudrin
- Agence Régional de Santé de Toulouse
| | | | | | - F Bonnet
- Assistance Publique-Hôpitaux de Paris
| | | | | | - E Cames
- Centre Hospitalier Universitaire de Toulouse
| | - M J Carty
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Caton
- Clinique Emile Vialar de Lyon
| | | | | | | | | | | | - C Dauzac
- Assistance Publique-Hôpitaux de Paris
| | - B Debono
- Clinique des Cèdres de Cornebarrieu
| | | | | | | | | | | | | | | | | | | | - P Durieux
- Assistance Publique-Hôpitaux de Paris
| | | | - P Hardy
- Assistance Publique-Hôpitaux de Paris
| | | | - N Fontas
- Centre Hospitalier Universitaire de Toulouse
| | | | - A A Gawande
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - S Habi
- Centre Hospitalier de Vienne
| | - S Haga
- Infirmerie Protestante de Lyon
| | - A Houlgatte
- Hôpital d'Instruction des Armées du Val de Grâce
| | - M Jaffe
- Clinique Ambroise Paré de Toulouse
| | | | | | | | - C Level
- Assistance Publique-Hôpitaux de Paris
| | - E Liaras
- Hôpital Privé de Natécia de Lyon
| | | | - S R Lipsitz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - B Malavaud
- Centre Hospitalier Régional Universitaire de Toulouse
| | | | | | | | | | | | | | | | | | | | | | - P Papin
- Centre Hospitalier de Villefranche sur Saône
| | | | | | - F Pattou
- Centre Hospitalier Régional Universitaire de Lille
| | - C Paugam
- Assistance Publique-Hôpitaux de Paris
| | - E Pavy
- Hôpital Simone Veil d'Eaubonne
| | | | | | - S Pierre
- Institut Claudius Régaud de Toulouse
| | | | | | - B Pradere
- Centre Hospitalier Régional Universitaire de Lille
| | | | - Y Radola
- Centre Hospitalier Régional Universitaire de Lille
| | - A Raould
- Assistance Publique-Hôpitaux de Paris
| | - F Rongieras
- Hôpital d'Instruction des Armées Desgenettes de Lyon
| | | | - V Sanders
- Centre Hospitalier Régional Universitaire de Lille
| | - F Sanz
- Centre Hospitalier Régional Universitaire de Lille
| | | | | | | | | | | | - D Thery
- Institut Catholique de Lille
| | - N Toppan
- Clinique de l'Union de Saint Jean
| | | | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes de Lyon
| | | | - F Zadegan
- Assistance Publique-Hôpitaux de Paris
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Idri S, Gauss T, Mortelecque-Baglioni R, Morin F, Paugam C, Bierling P. Retour d’expérience sur une procédure d’urgence transfusionnelle pour les patients traumatisés graves à l’hôpital Beaujon. Transfus Clin Biol 2015. [DOI: 10.1016/j.tracli.2015.06.258] [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: 10/22/2022]
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Lukaszewicz AC, Faivre V, Bout H, Gayat E, Lagergren T, Damoisel C, Bresson D, Paugam C, Mantz J, Payen D. Multicenter testing of the rapid quantification of radical oxygen species in cerebrospinal fluid to diagnose bacterial meningitis. PLoS One 2015; 10:e0128286. [PMID: 26011286 PMCID: PMC4444193 DOI: 10.1371/journal.pone.0128286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/27/2015] [Indexed: 01/26/2023] Open
Abstract
Purpose Meningitis is a serious concern after traumatic brain injury (TBI) or neurosurgery. This study tested the level of reactive oxygen species (ROS) in cerebrospinal fluid (CSF) to diagnose meningitis in febrile patients several days after trauma or surgery. Methods Febrile patients (temperature > 38°C) after TBI or neurosurgery were included prospectively. ROS were measured in CSF within 4 hours after sampling using luminescence in the basal state and after cell stimulation with phorbol 12-myristate 13-acetate (PMA). The study was conducted in a single-center cohort 1 (n = 54, training cohort) and then in a multicenter cohort 2 (n = 136, testing cohort) in the Intensive Care and Neurosurgery departments of two teaching hospitals. The performance of the ROS test was compared with classical CSF criteria, and a diagnostic decision for meningitis was made by two blinded experts. Results The production of ROS was higher in the CSF of meningitis patients than in non-infected CSF, both in the basal state and after PMA stimulation. In cohort 1, ROS production was associated with a diagnosis of meningitis with an AUC of 0.814 (95% confidence interval (CI) [0.684–0.820]) for steady-state and 0.818 (95% CI [0.655–0.821]) for PMA-activated conditions. The best threshold value obtained in cohort 1 was tested in cohort 2 and showed high negative predictive values and low negative likelihood ratios of 0.94 and 0.36 in the basal state, respectively, and 0.96 and 0.24 after PMA stimulation, respectively. Conclusion The ROS test in CSF appeared suitable for eliminating a diagnosis of bacterial meningitis.
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Affiliation(s)
- Anne-Claire Lukaszewicz
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Valérie Faivre
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Hélène Bout
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Tina Lagergren
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Charles Damoisel
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Damien Bresson
- Department of Neurosurgery, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Catherine Paugam
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean Mantz
- Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Didier Payen
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
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Paugam C, Aubert H, Malard O, Derkinderen P. Atrophie narinaire unilatérale post-syndrome de Wallenberg, observation originale d’un cas. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.520] [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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Kuteifan K, Mertes PM, Bretonnière C, Eon B, Dupic L, Capellier G, Leone M, Jars-Guincestre MC, Paugam C, Cariou A, Piriou V. [Implementation of morbidity and mortality conferences in French intensive care units: a survey]. ACTA ACUST UNITED AC 2013; 32:602-6. [PMID: 23953832 DOI: 10.1016/j.annfar.2013.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A national survey was conducted by the "Collège français d'anesthésie et de réanimation (CFAR)" and the "Collège des bonnes pratiques en réanimation (CBPR)", to analyze the implementation of morbidity and mortality conferences (MMCs) in French intensive care units (ICUs). STUDY DESIGN An electronic questionnaire was set up. We directed the survey at French ICUs physicians registered in the two Colleges directories, only one form was filled in by each participating unit. RESULTS From December 2009 to February 2010, Among the 170 replies, 120 ICUs (71%) practiced MMC. No difference in the typology of the two groups was found. The median annual number of MMCs was 4 per year (1-15). The perimeter of the MMCs concerned only the ICU unit in 70 cases (58%), more than one ICU unit in the same department in 11 cases (9.8%), more than one department of ICU in 16 cases (13%) and other departments in 57 cases (48%). The events analyzed were: all deaths in 45 cases (37.5%), unexpected deaths in 50 cases (41.7%), severe adverse events in 67 cases (55.8%) and other events in 19 cases (15.8%). At least one adverse event defined by the two colleges in the process of "accreditation" was analyzed in 86 cases (72%). Participation of a physician of at least one other unit was reported in 56 cases (47%) and of medical students in 62 cases (52%). The low rate of participation of ICU nurses was reported in 62 cases (69.2%) and their absence in 35 cases (29%). MMCs consequences were drafting of new procedure in 99 cases (83%), changes in procedures in 75 cases (63%), conducting training programs in 60 cases (50%), organizational changes in 86 cases (72%), adverse event declaration in 21 cases (18%) and monitoring indicators in 40 cases (33%). Among units which did not practice MMCs, Identified obstacles were organizational causes in 25 cases (50%), inexperience in seven cases (14%), lack of methodology in 4 cases (8%), realization of other methods of formative assessment in 4 cases (8%) and physician's refusal in three cases (6%). The fear of medico-legal problem was never reported as a barrier to MMCs practice. Forty-five units (90%) projected to practice MMR. CONCLUSION This survey showed that the practice of MMR is common in French ICUs, allowing the identification of organizational problems, but also of training needs, joining one of the initial concerns that have led to their implementation. Expanding the participation to non-physician members of the units should be encouraged, without underestimating the difficulties particularly in the organizational domains that represent an obstacle to development of MMCs.
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Affiliation(s)
- K Kuteifan
- Service de réanimation médicale, hôpital Émile-Muller, 20, avenue du Docteur-Laennec, 68100 Mulhouse cedex, France.
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Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F, Paugam C, Bretagnol F, Abdel-Rehim M, Francis F, Bondjemah V, Ferron M, Zappa M, Amiot A, Stefanescu C, Leseche G, Marmuse JP, Belghiti J, Ruszniewski P, Vilgrain V, Panis Y, Mantz J, Bouhnik Y. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol 2013; 11:158-65.e2. [PMID: 23103820 DOI: 10.1016/j.cgh.2012.10.027] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/10/2012] [Accepted: 10/12/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability. METHODS In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease. RESULTS Patients were followed up for a mean of 497 days (range, 7-2085 d); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18% and 71%, respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02). CONCLUSIONS A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.
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Affiliation(s)
- Olivier Corcos
- Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support and Intestinal Transplantation, Beaujon Hospital Clichy, Paris VII University, Clichy, France.
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Aussilhou B, Douflé G, Hubert C, Francoz C, Paugam C, Paradis V, Farges O, Vilgrain V, Durand F, Belghiti J. Extended Liver Resection for Polycystic Liver Disease Can Challenge Liver Transplantation. Ann Surg 2010; 252:735-43. [DOI: 10.1097/sla.0b013e3181fb8dc4] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Balzan S, Nagarajan G, Farges O, Galleano CZ, Dokmak S, Paugam C, Belghiti J. Safety of Liver Resections in Obese and Overweight Patients. World J Surg 2010; 34:2960-8. [DOI: 10.1007/s00268-010-0756-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Stern JB, Paugam C, Validire P, Adle-Biassette H, Jaffré S, Dehoux M, Crestani B. Cytokeratin 19 fragments in patients with acute lung injury: a preliminary observation. Intensive Care Med 2006; 32:910-4. [PMID: 16570150 DOI: 10.1007/s00134-006-0124-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 01/04/2006] [Accepted: 02/20/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cytokeratin 19 (CK19) is a specific cytoskeletal structure for alveolar epithelium. We hypothesized that the levels of CK19 fragments in bronchoalveolar lavage (BAL) fluid could serve as an index of epithelial injury and as a prognosis marker in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The aims of our study were, in patients with ALI/ARDS: (1) to measure CK19 fragments concentrations in BAL fluid, (2) to assess its prognostic value, and (3) to identify the cellular source of CK19 in the alveolar space. DESIGN Prospective preliminary study. SETTING University hospital surgical ICU. PATIENTS Twenty-two mechanically ventilated patients with ALI/ARDS and 10 non-ventilated control patients. Plasma samples were obtained for 11 ALI/ARDS patients. MEASUREMENTS AND RESULTS The concentration of BAL CK19 fragments was higher in patients (median 4916 pg/ml, 25th-75th percentile 2717-10533) than in controls (2208 pg/ml. 767-3923; p =0.05), and higher in 10 non-survivors (7051 pg/ml, 4372-13371) than in 12 survivors (2888 pg/ml, 1315-5639; p =0.03 among ALI/ARDS patients). BAL CK19 fragment concentration did not correlate with simplified acute physiologic score, lung injury score or PaO(2)/FIO(2) ratio, but correlated positively with BAL albumin concentration (p =0.002) and with number of BAL macrophages (p=0.0001). Plasma CK19 fragment concentrations were 10 times lower than those in BAL. Immunohistochemical staining for CK19 showed a strong labelling of injured detached epithelial cells and hyperplastic epithelium in ALI/ARDS lung samples. CONCLUSION CK19 fragment concentrations were found to be elevated in BAL fluid in ALI/ARDS patients compared with control subjects. High BAL CK19 fragment levels were associated with a poor prognosis.
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Affiliation(s)
- Jean-Baptiste Stern
- Institut Mutualiste Montsouris, Département Thoracique, 42 bd Jourdan, 75014 Paris, France.
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Beaussier M, Weickmans H, Paugam C, Lavazais S, Baechle JP, Goater P, Buffin A, Loriferne JF, Perier JF, Didelot JP, Mosbah A, Said R, Lienhart A. A Randomized, Double-Blind Comparison Between Parecoxib Sodium and Propacetamol for Parenteral Postoperative Analgesia After Inguinal Hernia Repair in Adult Patients. Anesth Analg 2005; 100:1309-1315. [PMID: 15845675 DOI: 10.1213/01.ane.0000150972.88708.13] [Citation(s) in RCA: 28] [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: 11/05/2022]
Abstract
The newly injectable cyclooxygenase-2 selective nonsteroidal antiinflammatory drug, parecoxib, has never been compared with propacetamol, a parenteral formulation of acetaminophen. In this prospective, randomized, double-blind, double-dummy study, we randomly assigned 182 patients scheduled for initial inguinal hernia repair under general anesthesia to receive a single injection of 40 mg parecoxib or 2 injections of 2 g propacetamol within the first 12 h after surgery. The study variables were morphine consumption, pain at rest and while coughing, and patient satisfaction throughout the first 12 h postoperatively. For statistical analysis, we used the Student's t-test, chi(2), and covariance analysis. Total morphine consumption did not differ between the two groups. Pain was less intense in the parecoxib group at rest (P = 0.035) but did not differ for pain while coughing. The incidence of side effects was similar. Significantly more patients in the parecoxib group rated their pain management as good or excellent (87% versus 70% in the propacetamol group, P = 0.001). Within the first 12 h after inguinal hernia repair in adult patients, a single injection of parecoxib 40 mg compares favorably with 2 injections of propacetamol 2 g.
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Affiliation(s)
- M Beaussier
- *CHU St. Antoine, Paris, France; †CHU Poitiers, France; ‡Clinique de la Sauvegarde, Lyon, France; §HIA Val de Grâce, Paris, France; ∥CHU Annecy, France; ¶Hôpital Ste Camille, Bry sur Marne, France; #CHU Tenon, Paris, France; **CHU Brabois, Vandoeuvre, les Nancy, France; and ††CHU Sahloul, Sousse, Tunisie
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Stern JB, Bernard O, Paugam C, Silve C, Mantz J, Aubier M, Crestani B. Parathyroid hormone-related protein in epithelial lining fluid in humans negatively correlates with the severity of lung injury. Chest 2002; 121:852-7. [PMID: 11888972 DOI: 10.1378/chest.121.3.852] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To determine the concentration of parathyroid hormone-related protein (PTHrP; an autocrine/paracrine regulator of type-2 alveolar epithelial cells proliferation and apoptosis) in the epithelial lining fluid (ELF) from patients without pulmonary disease and from patients with acute lung injury (ALI), and to evaluate whether PTHrP concentrations correlated with the intensity of lung injury. DESIGN Prospective study. SETTING An adult trauma/surgical ICU in an urban teaching hospital. PATIENTS A total of 20 patients with ALI receiving mechanical ventilation (patients), and 10 patients without pulmonary disease not receiving mechanical ventilation (control subjects). INTERVENTIONS None. MEASUREMENTS AND RESULTS PTHrP was detected in all BAL fluids, and ELF PTHrP concentrations (median; 25% to 75% percentiles) tended to be higher in patients (52.2 nmol/mL; 20.8 to 65.6 nmol/mL) than in control subjects (25.4 nmol/mL; 20.5 to 35.4 nmol/mL; p = 0.18). In patients, ELF PTHrP concentration correlated positively with the PaO(2)/fraction of inspired oxygen ratio (r = 0.53; p = 0.005), and negatively with lung injury score (r = - 0.44; p = 0.02), radiologic score (r = - 0.40; p = 0.04), and BAL albumin concentration (r = - 0.42; p = 0.02). CONCLUSION PTHrP is present in biologically significant concentrations in the alveolar milieu in humans. In patients with ALI, the PTHrP concentration correlates negatively with the degree of lung injury.
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Affiliation(s)
- Jean-Baptiste Stern
- INSERM U408, Hôpital Lariboisière (Assistance Publique - Hôpitaux de Paris), Paris, France
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Jaffré S, Dehoux M, Paugam C, Grenier A, Chollet-Martin S, Stern JB, Mantz J, Aubier M, Crestani B. Hepatocyte growth factor is produced by blood and alveolar neutrophils in acute respiratory failure. Am J Physiol Lung Cell Mol Physiol 2002; 282:L310-5. [PMID: 11792636 DOI: 10.1152/ajplung.00121.2001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We tested the novel hypothesis that neutrophils in the lung or the airspaces may produce hepatocyte growth factor (HGF) in ventilated patients with acute respiratory failure. Neutrophils were purified from blood and bronchoalveolar lavage (BAL) fluid samples from 16 mechanically ventilated patients who underwent BAL for a diagnostic workup of ventilator-acquired pneumonia. Most of the patients had pneumonia (n = 11). Ten nonventilated patients served as controls. Both blood and BAL neutrophils released HGF in vitro. Basal HGF secretion by blood neutrophils from controls was 823 (666) pg x ml(-1) x 10(-7) neutrophils (median, 25th-75th percentile) and doubled to 1,730 (1,684-2,316) pg x ml(-1) x 10(-7) neutrophils (P = 0.001) with lipopolysaccharide (LPS) stimulation. Basal HGF secretion by blood neutrophils from patients was similar [956 (655-2,140) pg x ml(-1) x 10(-7) neutrophils, P = 0.4] and doubled with LPS stimulation [2,767 (2,165-3,688) pg x ml(-1) x 10(-7) neutrophils, P < 0.0001 vs. controls]. Alveolar neutrophils released HGF in vitro [653 (397-1,209) pg x ml(-1) x 10(-7) neutrophils]. LPS stimulation did not significantly increase the HGF release from alveolar neutrophils [762 (434-1,305) pg x ml(-1) x 10(-7) neutrophils]. BAL HGF positively correlated with the BAL neutrophil count (P = 0.01, R = 0.58). We conclude that blood and alveolar neutrophils from patients with acute respiratory failure can produce HGF, a mitogenic factor that may enhance the alveolar repair process.
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Affiliation(s)
- Sandrine Jaffré
- Institut National de la Santé et de la Recherche Médicale Unité 408, Faculté Xavier Bichat, Département d'Anesthésie-Réanimation, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75877 Paris, France
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Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, Thuong M, Paugam C, Apperre C, De Cagny B, Brun F, Bornstain C, Parrot A, Thamion F, Lacherade JC, Bouffard Y, Le Gall JR, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF. Compliance with triage to intensive care recommendations. Crit Care Med 2001; 29:2132-6. [PMID: 11700409 DOI: 10.1097/00003246-200111000-00014] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [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: 11/26/2022]
Abstract
DESIGN Recommendations for triage to intensive care units (ICUs) have been issued but not evaluated. SETTING In this prospective, multicenter study, all patients granted or refused admission to 26 ICUs affiliated with the French Society for Critical Care were included during a 1-month period. Characteristics of participating ICUs and patients, circumstances of triage, and description of the triage decision with particular attention to compliance with published recommendations were recorded. RESULTS During the study period, 1,009 patients were and 283 were not admitted to the participating ICUs. Refused patients were more likely to be older than 65 yrs (odds ratio [OR], 3.53; confidence interval [CI], 1.98-5.32) and to have a poor chronic health status (OR, 3.09; CI, 2.05-4.67). An admission diagnosis of acute respiratory or renal failure, shock, or coma was associated with admission, whereas chronic severe respiratory and heart failure or metastatic disease without hope of remission were associated with refusal (OR, 2.24; CI, 1.38-3.64). Only four (range, 0-8) of the 20 recommendations for triage to ICU were observed; a full unit and triage over the phone were associated with significantly poorer compliance with recommendations (0 [0-2] vs. 6 [2-9], p =.0003; and 1 [0-6] vs. 6 [1-9], p <.0001; respectively). CONCLUSION Recommendations for triage to intensive care are rarely observed, particularly when the unit is full or triage is done over the phone. These recommendations may need to be redesigned to improve their practicability under real-life conditions, with special attention to phone triage and triaging to a full unit.
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Affiliation(s)
- E Azoulay
- Intensive Care and Biostatistics Departments, Saint-Louis Teaching Hospital and Paris VII Teaching, Paris, France
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Beaussier M, Paugam C, Deriaz H, Mestari M, Chandon M, Sautet A, Lienhart A. Haemodynamic stability during moderate hypotensive anaesthesia for spinal surgery. A comparison between desflurane and isoflurane. Acta Anaesthesiol Scand 2000; 44:1154-9. [PMID: 11028740 DOI: 10.1034/j.1399-6576.2000.440921.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to compare desflurane and isoflurane for spinal procedures requiring moderate levels of controlled arterial hypotension, when these agents were administered via a semi-closed circuit at 1 l x min(-1) fresh gas flow. METHODS After ethics committee approval and written informed consent, 20 ASA I or II patients were randomly allocated to receive either desflurane (n=10) or isoflurane (n=10), in O2/ N2O (1:1) for maintenance of anaesthesia. Induction of anaesthesia, fentanyl dosing and volume loading were standardized. Blood pressure was invasively monitored and maintained within a target systolic blood pressure (SBP) range of 80 to 100 mmHg during the study period. Results were presented as medians and interquartiles, and non-parametric statistical methods were used. RESULTS Patient demographic data, SBP and heart rate prior to surgery, and duration of the procedure were similar between the two groups. During the study period, tighter arterial blood pressure control was maintained with desflurane as compared with isoflurane. SBP was 21.2% (9.5-41.7) of time outside the range 80-100 mmHg with isoflurane and 5.1% (0.6-10.3) with desflurane (P<0.01). CONCLUSIONS Desflurane, administered via a semi-closed circuit at 1 l x min(-1) fresh gas flow, maintained better haemodynamic stability in spinal surgery requiring moderate arterial hypotension than isoflurane.
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Affiliation(s)
- M Beaussier
- Department of Anaesthesia and Intensive Care , St Antoine University Hospital, Paris, France.
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Stern JB, Fierobe L, Paugam C, Rolland C, Dehoux M, Petiet A, Dombret MC, Mantz J, Aubier M, Crestani B. Keratinocyte growth factor and hepatocyte growth factor in bronchoalveolar lavage fluid in acute respiratory distress syndrome patients. Crit Care Med 2000; 28:2326-33. [PMID: 10921560 DOI: 10.1097/00003246-200007000-00024] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [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: 11/25/2022]
Abstract
OBJECTIVES To determine bronchoalveolar lavage (BAL) fluid concentrations of keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF), two potent growth factors for alveolar type II epithelial cells, in patients with acute respiratory distress syndrome (ARDS). DESIGN Prospective study. SETTING An adult trauma/surgical intensive care unit in an urban teaching hospital. PATIENTS A total of 32 ventilated patients with pulmonary infiltrates prospectively identified with ARDS (n = 17) or without ARDS (n = 15), including eight patients with hydrostatic edema (HE), and ten nonventilated patients serving as controls. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS BAL was performed 2.88 days +/- 2.4, 3.5 days +/- 2.4, and 2.3 days +/- 2.2 after the lung insult in ARDS, HE, and other non-ARDS patients respectively (p = .32). KGF was detected in BAL fluid in 13 of the 17 ARDS patients (median, 31.6 pg/mL), in one patient with HE, and in none of other non-ARDS patients. In ARDS patients, detection of KGF in BAL was associated in BAL fluid with the detection of type III procollagen peptide (PIIIP), a biological marker of fibroproliferation. In ARDS patients, detection of KGF in BAL was associated with death (p = .02). HGF was detected in 15 ARDS patients (median, 855 pg/mL), in seven patients with HE (median, 294 pg/mL; p = .05 for the comparison with ARDS group), in six of other non-ARDS patients (median, 849 pg/mL; p = .32 with ARDS group). HGF concentrations were higher in nonsurvivors than in survivors (p = .01). None of the ten BAL of controls contained either KGF or HGF. CONCLUSION KGF was detected almost exclusively in BAL fluid from ARDS patients and correlated with a poor prognosis in this group. In contrast, HGF was detected in the BAL fluid from a majority of patients with or without ARDS. Elevated HGF concentrations were associated with a poor prognosis in the overall group.
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Affiliation(s)
- J B Stern
- Laboratoire de Biophysique, Centre Hospitalier Universitaire et Faculté de Médecine, Xavier Bichat, Assistance Publique-Hôpitaux de Paris, and Inserm Unit 408, France
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Chosidow D, Lesurtel M, Sauvat F, Paugam C, Johanet H, Marmuse JP, Benhamou G. [Interest in several surgeries for serious abdominal trauma]. Ann Chir 2000; 125:62-5. [PMID: 10921187] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathy and hypothermia. The aim of an abbreviated laparotomy is to control hemorrhage, prevent digestive contamination and close the abdominal wall without tension. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis.
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Affiliation(s)
- D Chosidow
- Service de chirurgie digestive, hôpital Bichat, Paris, France
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Paugam C, Chollet-Martin S, Dehoux M, Chatel D, Brient N, Desmonts JM, Philip I. Neutrophil expression of CD11b/CD18 and IL-8 secretion during normothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11:575-9. [PMID: 9263088 DOI: 10.1016/s1053-0770(97)90007-0] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess blood polymorphonuclear neutrophil (PMN) activation status during normothermic cardiopulmonary bypass (CPB), the expression of the PMN adhesion molecule CD11b/CD18 was measured. Basal state as well as ex vivo capacity of PMN to be stimulated by a bacterial peptide (FMLP) were investigated. Because interleukin-8 (IL-8) is known to induce CD11b/CD18 expression in vitro in PMN, IL-8 plasma levels were concomitantly measured. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Thirteen patients scheduled for cardiac surgery. INTERVENTIONS Systemic arterial and pulmonary arterial blood samples were withdrawn at the same moment during the first 4 hours after the onset of CPB. MEASUREMENTS AND MAIN RESULTS Twenty minutes after the onset of CPB, basal expression of PMN CD11b/CD18 was upregulated, whereas IL-8 plasma levels remained unchanged. The increase in PMN CD11b expression was maintained until the fourth hour after the onset of CPB. At this time, elevation of IL-8 plasma levels was maximal. No differences were found between pulmonary and systemic arterial IL-8 plasma levels, even after aortic unclamping. The capacity of PMN to be stimulated ex vivo by FMLP remained normal. CONCLUSIONS Normothermic CPB induced a fast increase in CD11b expression, which appeared to be similar to that observed during hypothermia. IL-8 was probably not related to the very early CD11b upregulation, but could be involved in pulmonary PMN sequestration during pulmonary reperfusion and contribute to the maintained expression of PMN CD11b. Although partially activated, PMNs maintain a normal capacity to respond to a further FMLP stimulation and thus to bacterial infection.
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Affiliation(s)
- C Paugam
- Département d'Anesthésie et de Réanimation Chirurgicale et INSERM U408, Centre hospitalo-universitaire Bichat, Paris, France
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Gentil B, Paugam C, Wolf C, Lienhart A, Augereau B. Methylmethacrylate plasma levels during total hip arthroplasty. Clin Orthop Relat Res 1993:112-6. [PMID: 8448927] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Methylmethacrylate (MMA) plasma concentrations were measured in 11 patients scheduled for total hip arthroplasty. After acetabular and after femoral cement implantation, sequential blood samples were withdrawn from pulmonary and radial artery catheters. The peak concentration of MMA (mean +/- standard error of the mean) in pulmonary artery blood occurred two minutes after cement implantation and was significantly higher after acetabulum (5.0 +/- 1.3 micrograms/ml) than after femoral cement insertion (1.9 +/- 0.6 micrograms/ml). The MMA peak in plasma was above 1 micrograms/ml in 13 cases, and the decrease fit a biexponential decay (r = 0.91). The initial half-life was 0.3 +/- 0.1 minutes, and the terminal half-life was 3 +/- 0.7 minutes. The areas under the curve (AUC) were determined for pulmonary (AUCpa) and radial (AUCra) plasma samples, and the ratio (AUCpa - AUCra)/AUCpa was computed: 55.1 +/- 7.8% of MMA was cleared during the transpulmonary passage. These results demonstrate that: (1) MMA could be determined after each cement implantation, (2) MMA plasma concentrations were higher after acetabulum than after femoral cement implantation, and (3) the half-life is short and the total pulmonary clearance is high.
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Affiliation(s)
- B Gentil
- Saint Antoine Hospital, Paris, France
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Paugam C, Servin F, Desmonts J. Propofol itversus Étomidate pour l’Induction et l’Entretien de l’Anesthésie chez le Sujet de Plus de 80 Ans: Déroulement Opératoire et Réveil. ACTA ACUST UNITED AC 1993. [DOI: 10.1016/s0750-7658(16)30009-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Delva E, Camus Y, Paugam C, Parc R, Huguet C, Lienhart A. Hemodynamic effects of portal triad clamping in humans. Anesth Analg 1987; 66:864-8. [PMID: 3619092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The hemodynamic effects of portal triad clamping (PTC) were studied in 48 adult patients scheduled for elective liver resection. Prior to hepatic resection the effects of a short period of PTC (3-5 min) were evaluated in all 48 patients: mean arterial pressure increased 21%, whereas pulmonary capillary wedge pressure and cardiac index decreased 10 and 17%, respectively. Systemic vascular resistance increased 48%. In 34 patients a liver resection was performed during PTC and hemodynamic measurements were repeated throughout the duration of liver ischemia, which ranged from 14 to 68 min. Hemodynamic changes occurred in the first 3 min and persisted thereafter. After releasing the clamp, hemodynamic parameters returned to initial values in 3 min. These results confirm that PTC does not induce the cardiovascular collapse in humans that it does in common laboratory animals and demonstrate that humans tolerate PTC for periods up to 1 hr.
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Bahnini A, Tiret E, Levy E, Parc R, Paugam C, Loygue J. [Instrumental peritonitis]. Ann Chir 1985; 39:592-6. [PMID: 3833054] [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: 01/07/2023]
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