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Zweerink A, Zubarev S, Bakelants E, Potyagaylo D, Stettler C, Chmelevsky M, Lozeron ED, Hachulla AL, Vallée JP, Burri H. His-Optimized Cardiac Resynchronization Therapy With Ventricular Fusion Pacing for Electrical Resynchronization in Heart Failure. JACC Clin Electrophysiol 2021; 7:881-892. [PMID: 33640346 DOI: 10.1016/j.jacep.2020.11.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to evaluate the effectiveness of His-optimized cardiac resynchronization therapy (HOT-CRT) for reducing left ventricular activation time (LVAT) compared to His bundle pacing (HBP) and biventricular (BiV) pacing (including multipoint pacing [MPP]), using electrocardiographic (ECG) imaging. BACKGROUND HBP may correct bundle branch block (BBB) and has shown encouraging results for providing CRT. However, HBP does not correct BBB in all patients and may be combined with univentricular or BiV fusion pacing to deliver HOT-CRT to maximize resynchronization. METHODS Nineteen patients with a standard indication for CRT, implanted with HBP without correction of BBB and BiV (n = 14) or right ventricular (n = 5) leads, were prospectively enrolled. Patients underwent ECG imaging while pacing in different configurations using different LV electrodes and at different HBP ventricular pacing (VP) delays. The primary endpoint was reduction in LVAT with HOT-CRT, and the secondary endpoints included various other dys-synchrony measurements including right ventricular activation time (RVAT). RESULTS Compared to HBP, HOT-CRT reduced LVAT by 21% (-17 ms [95% confidence interval [CI]: -25 to -9 ms]; p < 0.001) and outperformed BiV by 24% (-22 ms [95% CI: -33 to -10 ms]; p = 0.002) and MPP by 13% (-11 ms [95% CI: -21 to -1 ms]; p = 0.035). Relative to HBP, HOT-CRT also reduced RVAT by 7% (-5 ms [95% CI: -9 to -1 ms; p = 0.035) in patients with right BBB, whereas RVAT was increased by BiV. The other electrical dyssynchrony measurements also improved with HOT-CRT. CONCLUSIONS HOT-CRT acutely improves ventricular electrical synchrony beyond BiV and MPP. The impact of this finding needs to be evaluated further in studies with clinical follow-up. (Electrical Resynchronization and Acute Hemodynamic Effects of Direct His Bundle Pacing Compared to Biventricular Pacing; NCT03452462).
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Stepan Zubarev
- Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Elise Bakelants
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Carine Stettler
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland
| | - Anne-Lise Hachulla
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Jean-Paul Vallée
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland.
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Prieur G, Medrinal C, Combret Y, Dupuis Lozeron E, Bonnevie T, Gravier F, Quieffin J, Lamia B, Borel J, Reychler G. Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study. Respirology 2019; 24:1088-1094. [DOI: 10.1111/resp.13664] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/16/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Guillaume Prieur
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Groupe de Recherche en Kinésithérapie RespiratoireUniversité Catholique de Louvain Brussels Belgium
- Institute for Research and Innovation in Biomedicine (IRIB)Normandie University, UNIROUEN Rouen France
- Pulmonology DepartmentGroupe Hospitalier du Havre Montivilliers France
- Pulmonary Rehabilitation DepartmentGroupe Hospitalier du Havre Montivilliers France
| | - Clement Medrinal
- Institute for Research and Innovation in Biomedicine (IRIB)Normandie University, UNIROUEN Rouen France
- Pulmonology DepartmentGroupe Hospitalier du Havre Montivilliers France
- Pulmonary Rehabilitation DepartmentGroupe Hospitalier du Havre Montivilliers France
| | - Yann Combret
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Groupe de Recherche en Kinésithérapie RespiratoireUniversité Catholique de Louvain Brussels Belgium
- Physiotherapy DepartmentGroupe Hospitalier du Havre Montivilliers France
| | | | - Tristan Bonnevie
- Institute for Research and Innovation in Biomedicine (IRIB)Normandie University, UNIROUEN Rouen France
- ADIR AssociationRouen University Hospital Rouen France
| | - Francis‐Edouard Gravier
- Institute for Research and Innovation in Biomedicine (IRIB)Normandie University, UNIROUEN Rouen France
- ADIR AssociationRouen University Hospital Rouen France
| | - Jean Quieffin
- Pulmonology DepartmentGroupe Hospitalier du Havre Montivilliers France
- Pulmonary Rehabilitation DepartmentGroupe Hospitalier du Havre Montivilliers France
| | - Bouchra Lamia
- Institute for Research and Innovation in Biomedicine (IRIB)Normandie University, UNIROUEN Rouen France
- Pulmonology DepartmentGroupe Hospitalier du Havre Montivilliers France
- Pulmonary Rehabilitation DepartmentGroupe Hospitalier du Havre Montivilliers France
| | - Jean‐Christian Borel
- Association AGIR à dom, Research and Development Meylan France
- HP2 INSERMU 1042 Grenoble France
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Groupe de Recherche en Kinésithérapie RespiratoireUniversité Catholique de Louvain Brussels Belgium
- Service de PneumologieCliniques Universitaires Saint‐Luc Brussels Belgium
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Blanc AL, Fumeaux T, Stirnemann J, Dupuis Lozeron E, Ourhamoune A, Desmeules J, Chopard P, Perrier A, Schaad N, Bonnabry P. Development of a predictive score for potentially avoidable hospital readmissions for general internal medicine patients. PLoS One 2019; 14:e0219348. [PMID: 31306461 PMCID: PMC6629067 DOI: 10.1371/journal.pone.0219348] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Identifying patients at high risk of hospital preventable readmission is an essential step towards selecting those who might benefit from specific transitional interventions. Objective Derive and validate a predictive risk score for potentially avoidable readmission (PAR) based on analysis of readmissions, with a focus on medication. Design/Setting/Participants Retrospective analysis of all hospital admissions to internal medicine wards between 2011 and 2014. Comparison between patients readmitted within 30 days and non-readmitted patients, as identified using a specially designed algorithm. Univariate and multivariate regression analyses of demographic data, clinical diagnoses, laboratory results, and the medication data of patients admitted during the first period (2011–2013), to identify factors associated with PAR. Using these, derive a predictive score with a regression coefficient-based scoring method. Subsequently, validate this score with a second cohort of patients admitted in 2013–2014. Variables were identified at hospital discharge. Results The derivation cohort included 7,317 hospital stays. Multivariate logistic regressions found significant associations with PAR for: [adjusted OR (95% CI)] hospital length of stay > 4 days [1.3 (1.1–1.7)], admission in previous 6 months [2.3 (1.9–2.8)], heart failure [1.3 (1.0–1.7)], chronic ischemic heart disease [1.7 (1.2–2.3)], diabetes with organ damage [2.2 (1.3–3.8)], cancer [1.4 (1.0–1.9)], metastatic carcinoma [1.9 (1.3–3.0)], anemia [1.2 (1.0–1.5)], hypertension [1.3 (1.1–1.7)], arrhythmia [1.3 (1.0–1.6)], hyperkalemia [1.4 (1.0–1.7)], opioid drug prescription [1.3 (1.1–1.6)], and acute myocardial infarction [0.6 (0.4–0.9)]. The PAR-Risk Score, derived from these results, demonstrated fair discriminatory and calibration power (C-statistic = 0.699; Brier Score = 0.069). The results for the validation cohort’s operating characteristics were similar (C-statistic = 0.687; Brier Score = 0.064). Conclusion This study identified routinely-available factors that were significantly associated with PAR. A predictive score was derived and internally validated.
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Affiliation(s)
- Anne-Laure Blanc
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- * E-mail:
| | - Thierry Fumeaux
- Groupement hospitalier de l’ouest lémanique (GHOL), Nyon, Switzerland
| | - Jérôme Stirnemann
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Aimad Ourhamoune
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Quality of Care, Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Chopard
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Quality of Care, Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud Perrier
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Schaad
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Emonet S, Lazarevic V, Leemann Refondini C, Gaïa N, Leo S, Girard M, Nocquet Boyer V, Wozniak H, Després L, Renzi G, Mostaguir K, Dupuis Lozeron E, Schrenzel J, Pugin J. Identification of respiratory microbiota markers in ventilator-associated pneumonia. Intensive Care Med 2019; 45:1082-1092. [PMID: 31209523 PMCID: PMC6667422 DOI: 10.1007/s00134-019-05660-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare bacteria recovered by standard cultures and metataxonomics, particularly with regard to ventilator-associated pneumonia (VAP) pathogens, and to determine if the presence of particular bacteria or microbiota in tracheal and oropharyngeal secretions during the course of intubation was associated with the development of VAP. METHODS In this case-control study, oropharyngeal secretions and endotracheal aspirate were collected daily in mechanically ventilated patients. Culture and metataxonomics (16S rRNA gene-based taxonomic profiling of bacterial communities) were performed on serial upper respiratory samples from patients with late-onset definite VAP and their respective controls. RESULTS Metataxonomic analyses showed that a low relative abundance of Bacilli at the time of intubation in the oropharyngeal secretions was strongly associated with the subsequent development of VAP. On the day of VAP, the quantity of human and bacterial DNA in both tracheal and oropharyngeal secretions was significantly higher in patients with VAP than in matched controls with similar ventilation times. Molecular techniques identified the pathogen(s) of VAP found by culture, but also many more bacteria, classically difficult to culture, such as Mycoplasma spp. and anaerobes. CONCLUSIONS Molecular analyses of respiratory specimens identified markers associated with the development of VAP, as well as important differences in the taxa abundance between VAP and controls. Further prospective trials are needed to test the predictive value of these markers, as well as the relevance of uncultured bacteria in the pathogenesis of VAP.
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Affiliation(s)
- Stéphane Emonet
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
- Bacteriology Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Corinne Leemann Refondini
- Division of Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Gaïa
- Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stefano Leo
- Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Myriam Girard
- Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valérie Nocquet Boyer
- Division of Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Hannah Wozniak
- Division of Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lena Després
- Division of Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gesuele Renzi
- Bacteriology Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Khaled Mostaguir
- Clinical Research Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elise Dupuis Lozeron
- Clinical Research Centre and Division of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
- Bacteriology Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Toso S, Laurent M, Lozeron ED, Brindel P, Lacalamita MC, Hanquinet S. Iterative algorithms for metal artifact reduction in children with orthopedic prostheses: preliminary results. Pediatr Radiol 2018; 48:1884-1890. [PMID: 30056564 DOI: 10.1007/s00247-018-4217-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/08/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increased computational power allows computed tomography (CT) software to process very advanced mathematical algorithms to generate better quality images at lower doses. One such algorithm, iterative metal artifact reduction (iMAR) has proven to decrease metal artifacts seen in CT images of adults with orthopedic implants. OBJECTIVES To evaluate artifact reduction capability of the algorithm in lower-dose pediatric CT compared to our routine third-generation advanced modeled iterative reconstruction (ADMIRE) algorithm. MATERIALS AND METHODS Thirteen children (11-17 years old) with metal implants underwent routine clinically indicated CT. Data sets were reconstructed with an iMAR algorithm. Hounsfield units and image noise were measured in bone, muscle and fat in the streak artifact (near the implant) and at the greatest distance from the artifact (far from the implant). A regression model compared the effects of the algorithm (standard ADMIRE vs. iMAR) near and far from the implant. RESULTS Near the implant, Hounsfield units with iMAR were significantly different in our standard ADMIRE vs. iMAR for bone, muscle and fat (P<0.001). Noise was significantly different in standard ADMIRE vs. iMAR in bone (P<0.003). Far from the implant, Hounsfield units and noise were not significantly different for ADMIRE vs. iMAR, for the three tissue types. CONCLUSION These preliminary results demonstrate that iMAR algorithms improves Hounsfield units near the implant and decreases image noise in bone in low-dose pediatric CT. It does this without changing baseline tissue density or noise far from the implant.
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Affiliation(s)
- Seema Toso
- Paediatric Radiology Unit, Division of Radiology, Geneva Children's Hospitals, Rue Willy-Donzé 6, 1211, Geneva, Switzerland.
| | - Meryle Laurent
- Paediatric Radiology Unit, Division of Radiology, Geneva Children's Hospitals, Rue Willy-Donzé 6, 1211, Geneva, Switzerland
| | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Brindel
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Marirosa Cristallo Lacalamita
- Paediatric Radiology Unit, Division of Radiology, Geneva Children's Hospitals, Rue Willy-Donzé 6, 1211, Geneva, Switzerland
| | - Sylviane Hanquinet
- Paediatric Radiology Unit, Division of Radiology, Geneva Children's Hospitals, Rue Willy-Donzé 6, 1211, Geneva, Switzerland
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Medrinal C, Combret Y, Prieur G, Robledo Quesada A, Bonnevie T, Gravier FE, Dupuis Lozeron E, Frenoy E, Contal O, Lamia B. Comparison of exercise intensity during four early rehabilitation techniques in sedated and ventilated patients in ICU: a randomised cross-over trial. Crit Care 2018; 22:110. [PMID: 29703223 PMCID: PMC5923017 DOI: 10.1186/s13054-018-2030-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/06/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the ICU, out-of-bed rehabilitation is often delayed and in-bed exercises are generally low-intensity. Since the majority of rehabilitation is carried out in bed, it is essential to carry out the exercises that have the highest intensity. The aim of this study was to compare the physiological effects of four common types of bed exercise in intubated, sedated patients confined to bed in the ICU, in order to determine which was the most intensive. METHODS A randomised, single-blind, placebo-controlled crossover trial was carried out to evaluate the effects of four bed exercises (passive range of movements (PROM), passive cycle-ergometry, quadriceps electrical stimulation and functional electrical stimulation (FES) cycling) on cardiac output. Each exercise was carried out for ten minutes in ventilated, sedated patients. Cardiac output was recorded using cardiac Doppler ultrasound. The secondary aims were to evaluate right heart function and pulmonary and systemic artery pressures during the exercises, and the microcirculation of the vastus lateralis muscle. RESULTS The results were analysed in 19 patients. FES cycling was the only exercise that increased cardiac output, with a mean increase of 1 L/min (15%). There was a concomitant increase in muscle oxygen uptake, suggesting that muscle work occurred. FES cycling thus constitutes an effective early rehabilitation intervention. No muscle or systemic effects were induced by the passive techniques. CONCLUSION Most bed exercises were low-intensity and induced low levels of muscle work. FES cycling was the only exercise that increased cardiac output and produced sufficient intensity of muscle work. Longer-term studies of the effect of FES cycling on functional outcomes should be carried out. TRIAL REGISTRATION ClinicalTrials.gov, NCT02920684 . Registered on 30 September 2016. Prospectively registered.
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Affiliation(s)
- Clément Medrinal
- Normandie Univ, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France. .,Intensive Care Unit Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Pierre Mendes France, 76290, Montivilliers, France.
| | - Yann Combret
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, 1200, Brussels, Belgium.,Physiotherapy Department, Groupe Hospitalier du Havre, avenue Pierre Mendes France, 76290, Montivilliers, France
| | - Guillaume Prieur
- Intensive Care Unit Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Pierre Mendes France, 76290, Montivilliers, France
| | - Aurora Robledo Quesada
- Intensive Care Unit Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, Pierre Mendes France, 76290, Montivilliers, France
| | - Tristan Bonnevie
- Normandie Univ, UNIROUEN, EA3830 - GRHV, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France.,ADIR Association, Bois Guillaume, France
| | | | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Eric Frenoy
- Intensive Care Unit Department Department, Groupe Hospitalier du Havre, Hôpital Jacques Monod, 76290, Montivilliers, France
| | - Olivier Contal
- University of Applied Sciences and Arts Western Switzerland (HES-SO), avenue de Beaumont, 1011, Lausanne, Switzerland
| | - Bouchra Lamia
- Normandie Univ, UNIROUEN, EA3830 - GRHV, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), 76000, Rouen, France.,Intensive Care Unit, Respiratory Department, Rouen University Hospital, Rouen, France.,Pulmonology Department, Groupe Hospitalier du Havre, avenue Pierre Mendes France, 76290, Montivilliers, France
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Medrinal C, Prieur G, Combret Y, Quesada AR, Debeaumont D, Bonnevie T, Gravier FE, Dupuis Lozeron E, Quieffin J, Contal O, Lamia B. Functional Electrical Stimulation-A New Therapeutic Approach to Enhance Exercise Intensity in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Crossover Trial. Arch Phys Med Rehabil 2018. [PMID: 29524398 DOI: 10.1016/j.apmr.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake (V˙o2) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD). DESIGN A randomized, single-blind, placebo-controlled crossover trial. SETTING Pulmonary rehabilitation department. PARTICIPANTS Consecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program. INTERVENTION Two consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling. MAIN OUTCOME MEASURES The primary outcome was mean V˙o2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions. RESULTS FES-cycling increased the physiological response more than the placebo, with a greater V˙o2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9-64.3mL/min) (P=.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05-2.9mmol/L]; P=.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition. CONCLUSIONS FES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.
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Affiliation(s)
- Clément Medrinal
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France.
| | - Guillaume Prieur
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Yann Combret
- Institute for Experimental Research, Pulmonology, ORL & Dermatology, Catholic University of Louvain, Brussels, Belgium; Physiotherapy Department, Le Havre Hospital, Montivilliers, France
| | | | - David Debeaumont
- Exercise and Respiratory Physiology Department, Bois Guillaume Hospital, Rouen University Hospital, Rouen Cedex, France
| | - Tristan Bonnevie
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; ADIR Association, Bois Guillaume, France
| | | | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Quieffin
- Pulmonology Department, Le Havre Hospital, Montivilliers, France
| | - Olivier Contal
- University of Applied Sciences and Arts of Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Bouchra Lamia
- Normandy University, UNIROUEN, and the Institute for Research and Innovation in Biomedicine, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France; Intensive Care Unit, Respiratory Department, Rouen University Hospital, Rouen, France
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Gonzalez AI, Bartolone P, Lubbeke A, Dupuis Lozeron E, Peter R, Hoffmeyer P, Christofilopoulos P. Comparison of dual-mobility cup and unipolar cup for prevention of dislocation after revision total hip arthroplasty. Acta Orthop 2017; 88:18-23. [PMID: 27841712 PMCID: PMC5251258 DOI: 10.1080/17453674.2016.1255482] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Revision total hip arthroplasty (THA) is associated with higher dislocation rates than primary THA. We compared the risk of dislocation within 6 months and all-cause re-revision during the whole study period using either the dual-mobility cup or the unipolar cup. Methods - We used a prospective hospital registry-based cohort including all total and cup-only revision THAs performed between 2003 and 2013. The cups used were either dual-mobility or unipolar; the choice was made according to the preference of the surgeon. 316 revision THAs were included. The mean age of the cohort was 69 (25-98) years and 160 THAs (51%) were performed in women. The dual-mobility group (group 1) included 150 THAs (48%) and the mean length of follow-up was 31 (0-128) months. The unipolar group (group 2) included 166 THAs (53%) and the mean length of follow-up was 52 (0-136) months. Results - The incidence of dislocation within 6 months was significantly lower with the dual-mobility cup than with the unipolar cup (2.7% vs. 7.8%). The unadjusted risk ratio (RR) was 0.34 (95% CI: 0.11-1.02) and the adjusted RR was 0.28 (95% CI: 0.09-0.87). The number of patients needed to treat with a dual-mobility cup in order to prevent 1 case of dislocation was 19. The unadjusted incidence rate ratio for all-cause re-revision in the dual-mobility group compared to the unipolar group was 0.6 (95% CI: 0.3-1.4). Interpretation - Use of a dual-mobility rather than a unipolar cup in revision THA reduced the risk of dislocation within 6 months.
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Que YA, Virgini V, Lozeron ED, Paratte G, Prod'hom G, Revelly JP, Pagani JL, Charbonney E, Eggimann P. Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumoniae that require intensive care management. Infection 2015; 43:193-9. [PMID: 25732200 PMCID: PMC7101553 DOI: 10.1007/s15010-015-0755-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
Abstract
Purpose To identify risk factors associated with mortality in patients with severe community-acquired pneumonia (CAP) caused by S. pneumoniae who require intensive care unit (ICU) management, and to assess the prognostic values of these risk factors at the time of admission. Methods Retrospective analysis of all consecutive patients with CAP caused by S. pneumoniae who were admitted to the 32-bed medico-surgical ICU of a community and referral university hospital between 2002 and 2011. Univariate and multivariate analyses were performed on variables available at admission. Results Among the 77 adult patients with severe CAP caused by S. pneumoniae who required ICU management, 12 patients died (observed mortality rate 15.6 %). Univariate analysis indicated that septic shock and low C-reactive protein (CRP) values at admission were associated with an increased risk of death. In a multivariate model, after adjustment for age and gender, septic shock [odds ratio (OR), confidence interval 95 %; 4.96, 1.11–22.25; p = 0.036], and CRP (OR 0.99, 0.98–0.99 p = 0.034) remained significantly associated with death. Finally, we assessed the discriminative ability of CRP to predict mortality by computing its receiver operating characteristic curve. The CRP value cut-off for the best sensitivity and specificity was 169.5 mg/L to predict hospital mortality with an area under the curve of 0.72 (0.55–0.89). Conclusions The mortality of patients with S. pneumoniae CAP requiring ICU management was much lower than predicted by severity scores. The presence of septic shock and a CRP value at admission <169.5 mg/L predicted a fatal outcome.
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Affiliation(s)
- Yok-Ai Que
- Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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