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Eyraud D, Creux M, Lastennet D, Lemoine L, Vaillant JC, Savier E, Vézinet C, Scatton O, Granger B, Puybasset L, Loncar Y. Restrictive intraoperative fluid intake in liver surgery and postoperative renal function: A propensity score matched study. Clin Res Hepatol Gastroenterol 2022; 46:101899. [PMID: 35257960 DOI: 10.1016/j.clinre.2022.101899] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is a common complication in hepatic surgery. In hepatic surgery, relative hypovolemia may help to limit blood loss, but the consequences of restrictive fluid intake are unknown. The goal of this study was to determine the influence of intraoperative fluid intake on the incidence of AKI and its consequences. METHODS Data from 397 consecutive patients who underwent liver resection were prospectively recorded and retrospectively analyszed. We compared the incidence of postoperative acute kidney failure in patients given restrictive (≤ 5 mL/kg/h) versus liberal (> 5 mL/kg/h) fluid therapy. We calculated a 1:1 match propensity score using logistic regression to estimate the likelihood of patients receiving restrictive or liberal intraoperative fluid intakes. The association between the intraoperative fluid intake strategy and occurrence of postoperative AKI were tested using a Cox frailty model on the database of matched patients. RESULTS Postoperative AKI was diagnosed in 133 of the 397 patients. Fluid intake strategy was restrictive for 121 patients and liberal for 276 patients. After propensity score matching to balance confounding factors, the liberal strategy was associated with a significantly lower risk for postoperative AKI compared to the restrictive strategy (Hazard Ratio 0.40 [0.29; 0.56], P<0.001). Patients with postoperative AKI had longer hospital stays and higher mortality. There were no cases of further blood loss in the liberal fluid intake group. CONCLUSIONS A restrictive fluid intake strategy is a risk factor for developing postoperative AKI, with serious consequences, without reducing blood loss in liver surgery.
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Affiliation(s)
- Daniel Eyraud
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France.
| | - Marine Creux
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Diane Lastennet
- Department of Biostatistics Public Health and Medical Informatics, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Louis Lemoine
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Jean Christophe Vaillant
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Eric Savier
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Corinne Vézinet
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Olivier Scatton
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Benjamin Granger
- Department of Biostatistics Public Health and Medical Informatics, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Louis Puybasset
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Yann Loncar
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
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Lastennet D, Mariani LL, Rascol O, Turc JD, Alfaisal H, Lapeyre-Mestre M, Corvol JC, Tubach F. Evaluation of Prescription Practices of Domperidone in Parkinson's Disease: A Cross Sectional Study Among French Neurologists. CNS Drugs 2020; 34:1267-1274. [PMID: 33278018 DOI: 10.1007/s40263-020-00774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 02/28/2023]
Abstract
BACKGROUND Domperidone is used to treat gastrointestinal symptoms in patients with Parkinson's disease. Because of an increased risk of cardiac adverse events, the European Medicines Agency has issued recommendations restricting its use mainly in terms of age, dose, and treatment duration. OBJECTIVE The aim of this study was to investigate current prescription practices of domperidone in Parkinson's disease among French neurologists. METHODS A cross-sectional study based on a questionnaire was conducted among French neurologists from Parkinson's disease expert centers from the French NS-Park/FCRIN network, general hospitals, and private practice. RESULTS Among the 253 neurologists who completed the questionnaire, 86 (34%) were physicians from expert centers and 167 (66%) were from other healthcare settings; 209 (83%) were aware of recommendations restricting domperidone use. The majority of neurologists (92%) declared prescribing domperidone regardless of the age of the patients. Sixty-one percent of neurologists prescribed domperidone beyond 7 days in newly diagnosed patients, 33% in patients with orthostatic hypotension, and 79% in patients receiving continuous apomorphine treatment. They did not follow the recommendation on posology in newly diagnosed patients (7% of neurologists), patients with orthostatic hypotension (10%), and patients receiving continuous apomorphine therapy (25%). Finally, only 58% of neurologists declared taking specific precautions before prescribing domperidone. CONCLUSIONS These findings show most French neurologists who responded to our questionnaire do not fully follow the restrictions on domperidone use, particularly in terms of treatment duration, and in patients receiving continuous apomorphine treatment. This may reflect the unmet need to prevent nausea in patients with Parkinson's disease treated with dopaminergic drugs, particularly continuous apomorphine therapy.
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Affiliation(s)
- Diane Lastennet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France
| | - Louise-Laure Mariani
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Département de Neurologie, Centre d'Investigation Clinique Neurosciences, 75013, Paris, France
| | - Olivier Rascol
- University of Toulouse 3, Clinical Investigation Center CIC1436, Parkinson Disease Expert Center, Department of Clinical Pharmacology, NS-Park/FCRIN Network, NeuroToul COEN Center, University Hospital of Toulouse, INSERM, Toulouse, France
| | - Jean-Denis Turc
- Association des Neurologues Libéraux de Langue Française (ANLLF), Fédération Française de Neurologie (FFN), Cabinet de Neurologie, Martigues, France
| | - Hala Alfaisal
- AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France
| | - Maryse Lapeyre-Mestre
- University of Toulouse 3, Clinical Investigation Center CIC1436, Parkinson Disease Expert Center, Department of Clinical Pharmacology, NS-Park/FCRIN Network, University Hospital of Toulouse, INSERM, Toulouse, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Département de Neurologie, Centre d'Investigation Clinique Neurosciences, 75013, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1422, 75013, Paris, France.
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Galezowski A, Delyon J, Le Cleach L, Guégan S, Ducroux E, Alanio A, Lastennet D, Moguelet P, Dadban A, Leccia MT, Le Pelletier F, Francès C, Lebbé C, Barete S. Deep cutaneous fungal infections in solid-organ transplant recipients. J Am Acad Dermatol 2020; 83:455-462. [PMID: 31931081 DOI: 10.1016/j.jaad.2019.12.064] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs). OBJECTIVE To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs. METHODS A 20-year retrospective observational study in France was conducted in 8 primary dermatology-dedicated centers for s-OTRs diagnosed with DCFIs. Relevant clinical data on transplants, fungal species, treatments, and outcomes were analyzed. RESULTS Overall, 46 s-OTRs developed DCFIs (median delay, 13 months after transplant) with predominant phaeohyphomycoses (46%). Distribution of nodular lesions on limbs and granulomatous findings on histopathology were helpful diagnostic clues. Treatments received were systemic antifungal therapies (48%), systemic antifungal therapies combined with surgery (28%), surgery alone (15%), and modulation of immunosuppression (61%), leading to complete response in 63% of s-OTRs. LIMITATIONS Due to the retrospective observational design of the study. CONCLUSIONS Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.
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Affiliation(s)
- Agnès Galezowski
- Unit of Dermatology, DMU3ID, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Julie Delyon
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris Paris, France
| | - Laurence Le Cleach
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Paris-Est Créteil Val de Marne-Paris 12 University, Créteil, France
| | - Sarah Guégan
- Department of Dermatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Emilie Ducroux
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Alexandre Alanio
- Department of Parasitology-Mycology, Saint-Louis Hospital, AP-HP, Université de Paris Paris, France; Unit of Molecular Mycology, Centre National de la Recherche Scientifique Unité Mixte de Recherche 2000, Institut Pasteur, Paris, France
| | - Diane Lastennet
- Unit of Public Health, Department of Biostatistics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | | | - Ali Dadban
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | | | | | - Camille Francès
- Department of Dermatology, DMU3ID, Tenon Hospital, AP-HP, Paris, France
| | - Céleste Lebbé
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris Paris, France
| | - Stéphane Barete
- Unit of Dermatology, DMU3ID, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
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