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Hariri G, Urbina T, Ait-Oufella H. Authors' reply: "Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit". J Crit Care 2024; 81:154526. [PMID: 38272770 DOI: 10.1016/j.jcrc.2024.154526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Geoffroy Hariri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France.
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Hariri G, Luxey X, Wenger S, Dureau P, Hariri S, Charfeddine A, Lebreton G, Djavidi N, Lancelot A, Duceau B, Bouglé A. Capillary refill time assessment after fluid challenge in patients on venoarterial extracorporeal membrane oxygenation: A retrospective study. J Crit Care 2024; 82:154770. [PMID: 38461658 DOI: 10.1016/j.jcrc.2024.154770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Monitoring fluid therapy is challenging in patients assisted with Veno-arterial ECMO. The aim of our study was to evaluate the usefulness of capillary refill time to assess the response to fluid challenge in patients assisted with VA-ECMO. METHODS Retrospective monocentric study in a cardiac surgery ICU. We assess fluid responsiveness after a fluid challenge in patients on VA-ECMO. We recorded capillary refill time before and after fluid challenge and the evolution of global hemodynamic parameters. RESULTS A total of 27 patients were included. The main indications for VA-ECMO were post-cardiotomy cardiogenic shock (44%). Thirteen patients (42%) were responders and 14 non-responders (58%). In the responder group, the index CRT decreased significantly (1.7 [1.5; 2.1] vs. 1.2 [1; 1.3] s; p = 0.01), whereas it remained stable in the non-responder group (1.4 [1.1; 2.5] vs. 1.6 [0.9; 1.9] s; p = 0.22). Diagnosis performance of CRT variation to assess response after fluid challenge shows an AUC of 0.68 (p = 0.10) with a sensitivity of 79% [95% CI, 52-92] and a specificity of 69% [95% CI, 42-87], with a threshold at 23%. CONCLUSION In patients treated with VA-ECMO index capillary refill time is a reliable tool to assesses fluid responsiveness. SPECIALTY Critical care, Cardiac surgery, ECMO.
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Affiliation(s)
- Geoffroy Hariri
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France..
| | - Xavier Luxey
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France
| | - Stefanie Wenger
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
| | - Pauline Dureau
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
| | - Sarah Hariri
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France
| | - Ahmed Charfeddine
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France
| | - Guillaume Lebreton
- Sorbonne Université, AP-HP, Service de Chirurgie Cardiaque, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
| | - Nima Djavidi
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
| | - Aymeric Lancelot
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
| | - Baptiste Duceau
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
| | - Adrien Bouglé
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France.
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Urbina T, Gabarre P, Bonny V, Lavillegrand JR, Garnier M, Joffre J, Mario N, Dumas G, Hariri G, Turpin M, Pardo E, Fartoukh M, Guidet B, Maury E, Chantran Y, Boelle PY, Voiriot G, Ait-Oufella H. Corticosteroids induce an early but limited decrease in IL-6 dependent pro-inflammatory responses in critically ill COVID-19 patients. Minerva Anestesiol 2024; 90:172-180. [PMID: 38287776 DOI: 10.23736/s0375-9393.23.17765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Corticosteroids have become standard of care for COVID-19 but their effect on the systemic immune-inflammatory response has been little investigated. METHODS Multicenter prospective cohort, including critically ill COVID-19 patients between March and November 2020. C-reactive protein (CRP), lymphocyte count and fibrinogen levels were collected upon hospital admission before initiation of steroid treatment and at ICU admission, three days and seven days later, along with interleukin (IL)-6, IL-10 and tumor necrosis factor-alpha (TNF-α) plasma levels. RESULTS A hundred and fifty patients were included, 47 received corticosteroids, 103 did not. Median age was 62 [53-70], and 96 (65%) patients were mechanically ventilated. Propensity score matching rendered 45 well-balanced pairs of treated and non-treated patients, particularly on pre-treatment CRP levels. Using a mixed model, CRP (P=0.019), fibrinogen (P=0.003) and lymphocyte counts (P=0.006) remained lower in treated patients over ICU stay. Conversely, there was no significant difference over the ICU stay for Il-6 (P=0.146) and IL-10 (0.301), while TNF- α levels were higher in the treated group (P=0.013). Among corticosteroid-treated patients, CRP (P=0.012), fibrinogen (P=0.041) and lymphocyte count (P=0.004) over time were associated with outcome, whereas plasma cytokine levels were not. CONCLUSIONS Steroid treatment was associated with an early and sustained decrease in the downstream IL-6-dependent inflammatory signature but an increase in TNF-α levels. In corticosteroid-treated patients, CRP and lymphocyte count were associated with outcome, conversely to plasma cytokine levels. Further research on using these biomarker's kinetics to individualize immunomodulatory treatments is warranted.
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Affiliation(s)
- Tomas Urbina
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France -
| | - Paul Gabarre
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Jean-Rémi Lavillegrand
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Marc Garnier
- Sorbonne University, Faculty of Medicine, Paris, France
- Anesthesiology and Critical Care Medicine Department, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Jérémie Joffre
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Nathalie Mario
- Department of Biochemistry, Hormonology and Therapeutic Follow-Up, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Geoffroy Hariri
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Matthieu Turpin
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Emmanuel Pardo
- Anesthesiology and Critical Care Medicine Department, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Yannick Chantran
- Department of Biological Immunology, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Pierre-Yves Boelle
- INSERM, Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Guillaume Voiriot
- Sorbonne University, Faculty of Medicine, Paris, France
- Intensive Care Unit, Tenon Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine Hospital, Public Assistance-Hospitals of Paris, Paris, France
- Sorbonne University, Faculty of Medicine, Paris, France
- Inserm U970, Cardiovascular Research Center, University of Paris, Paris, France
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Hariri G, Belossi V, Perol L, Missri L, Gabarre P, Bonny V, Urbina T, Baudel JL, Guidet B, Joffre J, Maury E, Dumas G, Ait-Oufella H. Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit. J Crit Care 2024; 79:154405. [PMID: 37659243 DOI: 10.1016/j.jcrc.2023.154405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE Bleeding risk evaluation of thrombocytopenic patients admitted in ICU has been poorly investigated. METHODS A prospective observational study conducted in an 18-bed medical ICU. Consecutive patients with thrombocytopenia (<150 Giga/L) and no bleeding at admission were included. RESULTS Over one year, 91 patients were included, mainly men (63%), with an age of 61 [46-68] years and a SOFA score of 6 [3-8]. Twenty-three patients (25%) had an hemorrhagic event during ICU stay, mainly digestive (n = 9; 39%) and urological (n = 6; 26%). The time between ICU admission and bleeding was 8 [2-19] days. Almost half of bleeding events required vasopressor infusion and a hemostatic procedure. At admission, two variables were significantly different between the Bleeding and No-Bleeding groups: plasma urea level was significantly higher in the Bleeding group (9 [5.1; 13] vs. 13 [8.9; 31] mmol/L; p < 0.001) and the presence of skin purpura was associated with a 3-fold higher risk for bleeding during ICU stay (HR: 3.4 [1.3-8.3]; p < 0.05). In contrast, admission platelet count was not significantly different between the 2 groups (90 [32; 128] vs 62 [36; 103] G/L; p = 0.26). CONCLUSION Plasma urea levels and the presence of skin purpura are helpful in identifying thrombocytopenic patients at high-risk of bleeding during ICU stay.
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Affiliation(s)
- Geoffroy Hariri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Vincent Belossi
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Louis Perol
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Louai Missri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Paul Gabarre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Vincent Bonny
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Bertrand Guidet
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Jeremie Joffre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Guillaume Dumas
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Inserm U970, Paris Research Cardiovascular Center, Paris, France.
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Roué M, Guédon AF, Lapidus N, Razazi K, Hariri G, Morawiec E, Desnos C, Ederhy S, Cohen A, Mekontso Dessap A, Fartoukh M, Labbé V. In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease. Ann Intensive Care 2023; 13:87. [PMID: 37725298 PMCID: PMC10509106 DOI: 10.1186/s13613-023-01188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is one of the major cardiac complications in patients hospitalized in the intensive care unit (ICU) for non-cardiac disease. A better knowledge of ischemic and bleeding risks in these patients is needed to identify those most likely to benefit from specific cardiac management. We therefore assessed the incidence and predictors of a composite outcome of severe ischemic event (AMI recurrence, ischemic stroke), major bleeding, or all-cause death in this setting. METHODS In this multicenter retrospective study, all consecutive adult patients admitted for non-cardiac disease to four French university hospital ICUs between January 2012 and December 2018 who had an AMI with obstructive coronary artery disease (OCAD) during the ICU stay were considered for inclusion. AMI with OCAD was defined as an elevated cardiac troponin value associated with at least one sign (clinical, electrocardiographic, or echocardiographic) suggestive of myocardial ischemia and presence of OCAD on coronary angiography. The primary endpoint was in-hospital occurrence of the composite outcome. RESULTS Ninety-six patients [median age 69 years, 22 women (23%), 59 with sepsis (61%), 35 with ST elevation (37%), median sequential organ failure assessment (SOFA) of 8 on the day of AMI] were included. The median peak cardiac troponin value was 131 (IQR 44-303) times the upper reference limit. Dual antiplatelet, therapeutic anticoagulation, and early mechanical reperfusion therapies were administered in 61 (64%), 68 (71%), and 47 (49%) patients, respectively. The composite outcome occurred in 48 (50%) patients. Severe ischemic events occurred in 17 (18%) patients and major bleeding in 26 (27%) patients; 26 patients (27%) died in the hospital. AMI management was not significantly different in patients with and without the composite outcome. A history of arterial hypertension (HR 2.05, 95% CI 1.01-4.16) and high SOFA score at the time of AMI (HR 1.07, 95% CI 1.00-1.15) were independent risk factors for the composite outcome. CONCLUSIONS Patients who have an AMI with OCAD during an ICU stay for non-cardiac disease are at risk of a composite outcome of severe ischemia, major bleeding, and death. A history of arterial hypertension and high SOFA scores were independent hazards for poor prognosis.
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Affiliation(s)
- Morgan Roué
- Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Alexis F Guédon
- Sorbonne Université, Public Health Department, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Paris, France
| | - Nathanaël Lapidus
- Sorbonne Université, Public Health Department, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Paris, France
| | - Keyvan Razazi
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, AP-HP, Créteil, France
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France
| | - Geoffroy Hariri
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Elise Morawiec
- Service de Médecine Intensive Réanimation, Hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Cyrielle Desnos
- Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Stéphane Ederhy
- Department of Cardiology, UNICO Cardio-Oncology Program, Hôpital Saint-Antoine, AP-HP, Paris, France
- INSERM U 856, Paris, France
| | - Ariel Cohen
- Department of Cardiology, UNICO Cardio-Oncology Program, Hôpital Saint-Antoine, AP-HP, Paris, France
- INSERM U 856, Paris, France
- Sorbonne Université, UMR-S ICAN 1166, Paris, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, AP-HP, Créteil, France
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France
| | - Muriel Fartoukh
- Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France
| | - Vincent Labbé
- Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France.
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de Recherche Biomédicale, INSERM, Créteil, France.
- Service des Soins Intensifs, Hôpital Universitaire Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
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Hariri G, Collet L, Duarte L, Martin GL, Resche-Rigon M, Lebreton G, Bouglé A, Dechartres A. Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions. Crit Care 2023; 27:354. [PMID: 37700297 PMCID: PMC10498585 DOI: 10.1186/s13054-023-04640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury (CSA-AKI) is frequent. While two network meta-analyses assessed the impact of pharmacological interventions to prevent CSA-AKI, none focused on non-pharmacological interventions. We aim to assess the effectiveness of non-pharmacological interventions to reduce the incidence of CSA-AKI. METHODS We searched PubMed, Embase, Central and clinical trial registries from January 1, 2004 (first consensus definition of AKI) to July 1, 2023. Additionally, we conducted manual screening of abstracts of major anesthesia and intensive care conferences over the last 5 years and reference lists of relevant studies. We selected all randomized controlled trials (RCTs) assessing a non-pharmacological intervention to reduce the incidence of CSA-AKI, without language restriction. We excluded RCTs of heart transplantation or involving a pediatric population. The primary outcome variable was CSA-AKI. Two reviewers independently identified trials, extracted data and assessed risk of bias. Random-effects meta-analyses were conducted to calculate risk ratios (RRs) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of evidence. RESULTS We included 86 trials (25,855 patients) evaluating 10 non-pharmacological interventions to reduce the incidence of CSA-AKI. No intervention had high-quality evidence to reduce CSA-AKI. Two interventions were associated with a significant reduction in CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion (RR, 0.55 [95% CI 0.40-0.76], I2 = 0%; Phet = 0.44) and remote ischemic preconditioning (RR, 0.86 [0.78-0.95]; I2 = 23%; Phet = 0.07). Pulsatile flow during cardiopulmonary bypass was associated with a significant reduction in CSA-AKI incidence but with very low quality of evidence (RR = 0.69 [0.48; 0.99]; I2 = 53%; Phet < 0.01). We found high quality of evidence for lack of effect of restrictive transfusion strategy (RR, 1.02 [95% CI 0.92; 1.12; Phet = 0.67; I2 = 3%) and tight glycemic control (RR, 0.86 [95% CI 0.55; 1.35]; Phet = 0.25; I2 = 26%). CONCLUSIONS Two non-pharmacological interventions are likely to reduce CSA-AKI incidence, with moderate quality of evidence: goal-directed perfusion and remote ischemic preconditioning.
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Affiliation(s)
- Geoffroy Hariri
- Département de Santé Publique, UMR-S 1136, AP-HP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.
- Département d'anesthésie et réanimation, GRC 29, DMU DREAM, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France.
| | - Lucie Collet
- Département de Santé Publique, UMR-S 1136, AP-HP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Lucie Duarte
- Département d'anesthésie et réanimation, GRC 29, DMU DREAM, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France
| | - Guillaume L Martin
- Département de Santé Publique, UMR-S 1136, AP-HP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Matthieu Resche-Rigon
- ECSTRRA - CRESS UMR1153, INSERM and SBIM, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Guillaume Lebreton
- AP-HP, Service de Chirurgie Cardiaque, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France
| | - Adrien Bouglé
- Département d'anesthésie et réanimation, GRC 29, DMU DREAM, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France
| | - Agnès Dechartres
- Département de Santé Publique, UMR-S 1136, AP-HP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Vandestienne M, Braik R, Lavillegrand JR, Hariri G, Demailly Z, Ben Hamouda N, Tamion F, Clavier T, Ait-Oufella H. Soluble TREM-1 plasma levels are associated with acute kidney injury, acute atrial fibrillation and prolonged ICU stay after cardiac surgery- a proof-concept study. Front Cardiovasc Med 2023; 10:1098914. [PMID: 37522081 PMCID: PMC10373879 DOI: 10.3389/fcvm.2023.1098914] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cardiopulmonary bypass (CPB) during cardiac surgery leads to deleterious systemic inflammation. We hypothesized that TREM-1, a myeloid receptor shed after activation, drives systemic inflammation during CPB. Methods Prospective observational bi-centric study. Blood analysis (flow cytometry and ELISA) before and at H2 and H24 after CPB. Inclusion of adult patients who underwent elective cardiac surgery with CPB. Results TREM-1 expression on neutrophils decreased between H0 and H2 while soluble (s)TREM-1 plasma levels increased. sTREM-1 levels increased at H2 and at H24 (p < 0.001). IL-6, IL-8, G-CSF and TNF-α, but not IL-1β, significantly increased at H2 compared to H0 (p < 0.001), but dropped at H24. Principal component analysis showed a close relationship between sTREM-1 and IL-8. Three patterns of patients were identified: Profile 1 with high baseline sTREM-1 levels and high increase and profile 2/3 with low/moderate baseline sTREM-1 levels and no/moderate increase overtime. Profile 1 patients developed more severe organ failure after CPB, with higher norepinephrine dose, higher SOFA score and more frequently acute kidney injury at both H24 and H48. Acute atrial fibrillation was also more frequent in profile 1 patients at H24 (80% vs. 19.4%, p = 0.001). After adjustment on age and duration of CPB, H0, H2 and H24 sTREM-1 levels remained associated with prolonged ICU and hospital length of stay. Conclusions Baseline sTREM-1 levels as well as early kinetics after cardiac surgery identified patients at high risk of post-operative complications and prolonged length of stay.
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Affiliation(s)
- Marie Vandestienne
- Centre de Recherche Cardiovasculaire de Paris (PARCC), Université de Paris, Inserm U970, Paris, France
| | - Rayan Braik
- Centre de Recherche Cardiovasculaire de Paris (PARCC), Université de Paris, Inserm U970, Paris, France
| | - Jean-Rémi Lavillegrand
- Centre de Recherche Cardiovasculaire de Paris (PARCC), Université de Paris, Inserm U970, Paris, France
| | - Geoffroy Hariri
- Service de Réanimation Chirurgicale, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpétrière, Institut du Coeur, Paris, France
| | - Zoe Demailly
- Université de Normandie, UNIROUEN, Inserm U1096, FHU REMOD-VHF, Rouen, France
- Service D’anesthésie-Réanimation Chirurgicale, CHU De Rouen, Rouen, France
| | - Nadine Ben Hamouda
- Service D’Immunologie, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Fabienne Tamion
- Université de Normandie, UNIROUEN, Inserm U1096, FHU REMOD-VHF, Rouen, France
- Service de Médecine Intensive-Réanimation, CHU De Rouen, Rouen, France
| | - Thomas Clavier
- Université de Normandie, UNIROUEN, Inserm U1096, FHU REMOD-VHF, Rouen, France
- Service D’anesthésie-Réanimation Chirurgicale, CHU De Rouen, Rouen, France
| | - Hafid Ait-Oufella
- Centre de Recherche Cardiovasculaire de Paris (PARCC), Université de Paris, Inserm U970, Paris, France
- Service de Médecine Intensive-Réanimation, Assistance Publique – Hôpitaux de Paris, Sorbonne Université, Paris, France
- Hôpital Saint-Antoine, Sorbonne Université, Paris, France
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8
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Marquet Y, Omar E, Hariri G, Bouglé A. Major Aeroportia Detected on Bedside Ultrasound in a Critically Ill Cardiac Surgery Patient. Am J Respir Crit Care Med 2023; 208:e1-e2. [PMID: 36753054 DOI: 10.1164/rccm.202205-0881im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Yann Marquet
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France
| | - Edris Omar
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France
| | - Geoffroy Hariri
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France
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9
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Massol J, Simon-Tillaux N, Tohme J, Hariri G, Dureau P, Duceau B, Belin L, Hajage D, De Rycke Y, Charfeddine A, Lebreton G, Combes A, Bouglé A. Levosimendan in patients undergoing extracorporeal membrane oxygenation after cardiac surgery: an emulated target trial using observational data. Crit Care 2023; 27:51. [PMID: 36750852 PMCID: PMC9906922 DOI: 10.1186/s13054-023-04328-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Retrospective cohorts have suggested that levosimendan may facilitate the weaning of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We therefore studied this clinical question by emulating a randomized trial with observational data. METHODS All patients with refractory postcardiotomy cardiogenic shock and assisted with VA-ECMO, admitted to a surgical intensive care unit at La Pitié-Salpêtrière Hospital between 2016 and 2019, were eligible. To avoid immortal-time bias, we emulated a target trial sequentially comparing levosimendan administration versus no levosimendan administration in patients treated with VA-ECMO. The primary outcome was time to successful ECMO weaning. The secondary outcomes were 30-day and 1-year mortality. We performed a multivariable analysis to adjust for confounding at baseline. RESULTS Two hundred and thirty-nine patients were included in the study allowing building a nested trials cohort of 1434 copies of patients. No association of levosimendan treatment and VA-ECMO weaning was found (HR = 0.91, [0.57; 1.45], p = 0.659 in multivariable analysis), or 30-day mortality (OR = 1.03, [0.52; 2.03], p = 0.940) and 1-year mortality (OR = 1.00, [0.53; 1.89], p = 0.999). CONCLUSIONS Using the emulated target trial framework, this study did not find any association of levosimendan treatment and ECMO weaning success after postcardiotomy cardiogenic shock. However, the population of interest remains heterogeneous and subgroups might benefit from levosimendan.
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Affiliation(s)
- Julien Massol
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Noémie Simon-Tillaux
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Joanna Tohme
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Geoffroy Hariri
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Pauline Dureau
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Baptiste Duceau
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Lisa Belin
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - David Hajage
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Yann De Rycke
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Ahmed Charfeddine
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Guillaume Lebreton
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Alain Combes
- grid.411439.a0000 0001 2150 9058Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
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10
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Morisson L, Duceau B, Do Rego H, Lancelot A, Hariri G, Charfeddine A, Laferrière-Langlois P, Richebé P, Lebreton G, Provenchère S, Bouglé A. A new machine learning algorithm to predict veno-arterial ECMO implantation after post-cardiotomy low cardiac output syndrome. Anaesth Crit Care Pain Med 2023; 42:101172. [PMID: 36375781 DOI: 10.1016/j.accpm.2022.101172] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Post-cardiotomy low cardiac output syndrome (PC-LCOS) is a life-threatening complication after cardiac surgery involving a cardiopulmonary bypass (CPB). Mechanical circulatory support with veno-arterial membrane oxygenation (VA-ECMO) may be necessary in the case of refractory shock. The objective of the study was to develop a machine-learning algorithm to predict the need for VA-ECMO implantation in patients with PC-LCOS. PATIENTS AND METHODS Patients were included in the study with moderate to severe PC-LCOS (defined by a vasoactive inotropic score (VIS) > 10 with clinical or biological markers of impaired organ perfusion or need for mechanical circulatory support after cardiac surgery) from two university hospitals in Paris, France. The Deep Super Learner, an ensemble machine learning algorithm, was trained to predict VA-ECMO implantation using features readily available at the end of a CPB. Feature importance was estimated using Shapley values. RESULTS Between January 2016 and December 2019, 285 patients were included in the development dataset and 190 patients in the external validation dataset. The primary outcome, the need for VA-ECMO implantation, occurred respectively, in 16% (n = 46) and 10% (n = 19) in the development and the external validation datasets. The Deep Super Learner algorithm achieved a 0.863 (0.793-0.928) ROC AUC to predict the primary outcome in the external validation dataset. The most important features were the first postoperative arterial lactate value, intraoperative VIS, the absence of angiotensin-converting enzyme treatment, body mass index, and EuroSCORE II. CONCLUSIONS We developed an explainable ensemble machine learning algorithm that could help clinicians predict the risk of deterioration and the need for VA-ECMO implantation in moderate to severe PC-LCOS patients.
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Affiliation(s)
- Louis Morisson
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM.
| | - Baptiste Duceau
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Hermann Do Rego
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Aymeric Lancelot
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Geoffroy Hariri
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Ahmed Charfeddine
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de L'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montreal, Montréal, Québec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de L'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montreal, Montréal, Québec, Canada
| | - Guillaume Lebreton
- Department of Cardiac and Thoracic Surgery, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Sophie Provenchère
- Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
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11
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Hariri G, Genoud M, Bruckert V, Chosidow S, Guérot E, Kimmoun A, Nesseler N, Besnier E, Daviaud F, Lagier D, Imbault J, Grimaldi D, Bouglé A, Mongardon N. Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome. Crit Care 2023; 27:6. [PMID: 36609390 PMCID: PMC9817255 DOI: 10.1186/s13054-022-04277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. METHODS Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009-2019). RESULTS Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17-61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43-65] vs. 65 [61-73] yo; p = 0.013), had lower body mass index (24 [20-26] vs. 30 [24-32] kg/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28-40] vs. 54 [34-61]; p = 0.012). CONCLUSION Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.
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Affiliation(s)
- Geoffroy Hariri
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.462844.80000 0001 2308 1657Institut Pierre Louis d’épidémiologie et de santé publique, Inserm U1136, Sorbonne Université, 75013 Paris, France
| | - Mathieu Genoud
- grid.150338.c0000 0001 0721 9812Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland
| | - Vincent Bruckert
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.410528.a0000 0001 2322 4179Service d’anesthésie-réanimation, CHU de Nice, 06000 Nice, France
| | - Samuel Chosidow
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Emmanuel Guérot
- grid.414093.b0000 0001 2183 5849Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000 Nancy, France
| | - Nicolas Nesseler
- grid.411154.40000 0001 2175 0984Service d’anesthésie-réanimation, CHU de Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284CHU de Rennes, Inra, Inserm, Institut NUMECAN – UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d’Investigation Clinique de Rennes), Univ Rennes, 35000 Rennes, France
| | - Emmanuel Besnier
- grid.41724.340000 0001 2296 5231Département d’anesthésie-réanimation, CHU de Rouen, 76000 Rouen, France ,grid.412043.00000 0001 2186 4076UNIROUEN, Inserm U1096, Normandie Univ, 76000 Rouen, France
| | - Fabrice Daviaud
- grid.417818.30000 0001 2204 4950Service de réanimation, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - David Lagier
- grid.411266.60000 0001 0404 1115Service d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13000 Marseille, France
| | - Julien Imbault
- grid.42399.350000 0004 0593 7118Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France ,grid.412041.20000 0001 2106 639XInserm, UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, 33000 Bordeaux, France
| | - David Grimaldi
- Service de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de Bruxelles, 1070 Brussels, Belgium
| | - Adrien Bouglé
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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12
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Dubée V, Hariri G, Joffre J, Hagry J, Raia L, Bonny V, Gabarre P, Ehrminger S, Bigé N, Baudel JL, Guidet B, Maury E, Dumas G, Ait-Oufella H. Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability. Ann Intensive Care 2022; 12:68. [PMID: 35843960 PMCID: PMC9288942 DOI: 10.1186/s13613-022-01043-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic instability (PIHI). Methods Prospective observational monocenter study conducted in an 18-bed medical ICU. Consecutive patients requiring tracheal intubation were eligible for the study. Global hemodynamic parameters (blood pressure, heart rate, cardiac function) and tissue perfusion parameters (arterial lactate, mottling score, capillary refill time [CRT], toe-to-room gradient temperature) were recorded before, 5 min and 2 h after tracheal intubation (TI). Post intubation hemodynamic instability (PIHI) was defined as any hemodynamic event requiring therapeutic intervention. Results During 1 year, 120 patients were included, mainly male (59%) with a median age of 68 [57–77]. The median SOFA score and SAPS II were 6 [4–9] and 47 [37–63], respectively. The main indications for tracheal intubation were hypoxemia (51%), hypercapnia (13%), and coma (29%). In addition, 48% of patients had sepsis and 16% septic shock. Fifty-one (42%) patients develop PIHI. Univariate analysis identified several baseline factors associated with PIHI, including norepinephrine prior to TI, sepsis, tachycardia, fever, higher SOFA and high SAPSII score, mottling score ≥ 3, high lactate level and prolonged knee CRT. By contrast, mean arterial pressure, baseline cardiac index, and ejection fraction were not different between PIHI and No-PIHI groups. After adjustment on potential confounders, the mottling score was associated with a higher risk for PIHI (adjusted OR: 1.84 [1.21–2.82] per 1 point increased; p = 0.005). Among both global haemodynamics and tissue perfusion parameters, baseline mottling score was the best predictor of PIHI (AUC: 0.72 (CI 95% [0.62–0.81]). Conclusions In non-selected critically ill patients requiring invasive mechanical ventilation, tissue hypoperfusion parameters, especially the mottling score, could be helpful to predict PIHI. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01043-3.
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Affiliation(s)
- Vincent Dubée
- Service de Maladies Infectieuses et Tropicales, CHU Angers, Angers, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Geoffroy Hariri
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Jérémie Joffre
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France
| | - Julien Hagry
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Lisa Raia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Vincent Bonny
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Paul Gabarre
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Sebastien Ehrminger
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Naike Bigé
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Luc Baudel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Bertrand Guidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Eric Maury
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France
| | - Guillaume Dumas
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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13
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Raia L, Urbina T, Gabarre P, Bonny V, Hariri G, Ehrminger S, Bigé N, Baudel JL, Guidet B, Maury E, Joffre J, Ait-Oufella H. Impaired skin microvascular endothelial reactivity in critically ill COVID-19 patients. Ann Intensive Care 2022; 12:51. [PMID: 35696007 PMCID: PMC9188908 DOI: 10.1186/s13613-022-01027-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Some clinical and histological studies have reported that SARS-CoV-2 infection may damage the endothelium. However, the impact of this virus on endothelial function in vivo remains poorly characterized. In this single-center pilot observational study, we performed iontophoresis of acetylcholine coupled with Laser doppler to investigate microvascular endothelial reactivity in COVID-19 patients compared to patients with non-COVID-19 bacterial pneumonia (NCBP) patients. Results During three consecutive months, 32 COVID-19 patients and 11 control NCBP patients with acute respiratory failure were included. The median age was 59 [50–68] and 69 [57–75] years in COVID-19 and NCBP groups, respectively (P = 0.11). There was no significant difference in comorbidities or medications between the two groups, except for body mass index, which was higher in COVID-19 patients. NCBP patients had a higher SAPS II score compared to COVID-19 patients (P < 0.0001), but SOFA score was not different between groups (P = 0.51). Global hemodynamic and peripheral tissue perfusion parameters were not different between groups. COVID-19 patients had significantly lower skin microvascular basal blood flow than NCBP patients (P = 0.02). In addition, endothelium-dependent microvascular reactivity was threefold lower in COVID-19 patients than NCBP patients (P = 0.008). Conclusions Both baseline skin microvascular blood flow and skin endothelial-dependent microvascular reactivity were impaired in critically ill COVID-19 patients compared to NCBP patients, despite a lower disease severity score supporting a specific pathogenic role of SARS-CoV-2 on the endothelium. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01027-3.
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Affiliation(s)
- Lisa Raia
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Geoffroy Hariri
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Sebastien Ehrminger
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Naïke Bigé
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Inserm U1136, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, Inserm U1136, Paris, France.,Centre de Recherche Saint-Antoine, Sorbonne University, Inserm U938, 75012, Paris, France
| | - Jeremie Joffre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Centre de Recherche Saint-Antoine, Sorbonne University, Inserm U938, 75012, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France. .,Paris Cardiovascular Research Center, Paris University, Inserm U970, Paris, France.
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14
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Hariri G, Joffre J, Maury E, Guidet B, Ait-Oufella H. Ten myths about albumin: do not forget the endothelium. Intensive Care Med 2022; 48:1097-1098. [PMID: 35618923 DOI: 10.1007/s00134-022-06740-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Geoffroy Hariri
- Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Sorbonne University, Centre de Recherche Saint-Antoine Inserm U938, 75012, Paris, France.,Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Paris, France
| | - Jeremie Joffre
- Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Sorbonne University, Centre de Recherche Saint-Antoine Inserm U938, 75012, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Sorbonne University, Centre de Recherche Saint-Antoine Inserm U938, 75012, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.,Sorbonne University, Centre de Recherche Saint-Antoine Inserm U938, 75012, Paris, France.,Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France. .,Sorbonne University, Centre de Recherche Saint-Antoine Inserm U938, 75012, Paris, France. .,Paris University, Paris Cardiovascular Research Center, Inserm U970, Paris, France. .,Service de reanimation médicale, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France.
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15
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Pasqueron J, Dureau P, Arcile G, Duceau B, Hariri G, Lepère V, Lebreton G, Rouby JJ, Bouglé A. Usefulness of lung ultrasound for early detection of hospital-acquired pneumonia in cardiac critically ill patients on venoarterial extracorporeal membrane oxygenation. Ann Intensive Care 2022; 12:43. [PMID: 35596817 PMCID: PMC9124275 DOI: 10.1186/s13613-022-01013-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 12/20/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is the most common and severe complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO) and its diagnosis remains challenging. Nothing is known about the usefulness of lung ultrasound (LUS) in early detection of HAP in patients treated with VA ECMO. Also, LUS and chest radiography were performed when HAP was suspected in cardiac critically ill adult VA ECMO presenting with acute respiratory failure. The sonographic features of HAP in VA ECMO patients were determined and we assessed the performance of the lung ultrasound simplified clinical pulmonary score (LUS-sCPIS), the sCPIS and bioclinical parameters or chest radiography alone for early diagnosis of HAP. Results We included 70 patients, of which 44 (63%) were independently diagnosed with HAP. LUS examination revealed that color Doppler intrapulmonary flow (P = 0.0000043) and dynamic air bronchogram (P = 0.00024) were the most frequent HAP-related signs. The LUS-sCPIS (area under the curve = 0.77) yielded significantly better results than the sCPIS (area under the curve = 0.65; P = 0.004), while leukocyte count, temperature and chest radiography were not discriminating for HAP diagnosis. Discussion Diagnosis of HAP is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Color Doppler intrapulmonary flow and dynamic air bronchogram appear to be particularly insightful for the diagnosis of HAP. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01013-9.
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Affiliation(s)
- Jean Pasqueron
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Pauline Dureau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Gauthier Arcile
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Baptiste Duceau
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Geoffroy Hariri
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Victoria Lepère
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Guillaume Lebreton
- Sorbonne Université, Department of Cardiac Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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16
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Urbina T, Elabbadi A, Gabarre P, Bigé N, Turpin M, Bonny V, Desnos C, Baudel JL, Lavillegrand JR, Hariri G, Fartoukh M, Guidet B, Maury E, Dumas G, Voiriot G, Ait-Oufella H. Endotracheal intubation rate is lower in critically-ill SARS-CoV-2 patients requiring high-flow nasal oxygen receiving additional face-mask noninvasive ventilation: a retrospective bicentric cohort with propensity score analysis. Minerva Anestesiol 2022; 88:580-587. [PMID: 35191641 DOI: 10.23736/s0375-9393.22.16094-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). This work aimed to assess whether adding face-mask noninvasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation. METHODS This retrospective cohort study was conducted from July 2020 to January 2021 in two tertiary care intensive care units (ICUs) in Paris, France. Patients admitted for laboratory confirmed SARS-CoV-2 infection with acute hypoxemic respiratory failure requiring HFNO with or without NIV were included. The primary outcome was the rate of endotracheal intubation. Secondary outcomes included day-28 mortality, day-28 respiratory support and IMV free days, ICU and hospital length-of-stay. Sensitivity analyses with both propensity score matching and overlap weighting were used. RESULTS 128 patients were included, 88 (69%) received HFNO alone and 40 (31%) received additional NIV. Additional NIV was associated with a reduced rate of endotracheal intubation in multivariate analysis (53 (60%) vs 15 (38%), HR=0.46 (95%CI, 0.23-0.95), p=0.04). Sensitivity analyses by propensity score matching (HR=0.45 (95%IC, 0.24-0.84), p=0.01) and overlap weighting (HR=0.52 (95% CI, 0.28-0.94), p=0.03) were consistent. Day-28 mortality was 25 (28%) in the HFNO group and 8 (20%) in the NIV group (HR=0.75 (95%CI, 0.15-3.82), p=0.72). NIV was associated with higher IMV free days (20 (0-28) vs 28 (14-28), p=0.015). All sensitivity analyses were consistent regarding secondary outcomes. CONCLUSION Need for endotracheal intubation was lower in critically-ill SARS-CoV-2 patients receiving face-mask noninvasive mechanical ventilation in addition to high-flow oxygen therapy.
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Affiliation(s)
- Tomas Urbina
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France - .,Sorbonne Université, Pierre et Marie-Curie university, Paris, France -
| | - Alexandre Elabbadi
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Paul Gabarre
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Naike Bigé
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Turpin
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cyrielle Desnos
- Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Baudel
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Remi Lavillegrand
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Geoffroy Hariri
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Intensive Care Unit, Tenon hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Pierre et Marie-Curie university, Paris, France.,Inserm U970, Cardiovascular research center, Université de Paris, Paris, France
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17
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Urbina T, Lavillegrand JR, Garnier M, Mekinian A, Pacanowski J, Mario N, Dumas G, Hariri G, Pilon A, Darrivère L, Fartoukh M, Guidet B, Maury E, Leblanc J, Chantran Y, Fain O, Lacombe K, Voiriot G, Ait-Oufella H. Delayed inflammation decrease is associated with mortality in Tocilizumab-treated critically ill SARS-CoV-2 patients: A retrospective matched-cohort analysis. Innate Immun 2022; 28:3-10. [PMID: 35089113 PMCID: PMC8841634 DOI: 10.1177/17534259211064602] [Citation(s) in RCA: 1] [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] [Indexed: 01/08/2023] Open
Abstract
Little is known about the immuno-inflammatory response to Tocilizumab and its association with outcome in critically-ill SARS-CoV2 pneumonia. In this multicenter retrospective cohort of SARS-CoV-2 patients admitted to three intensive care units between March and April 2020, we matched on gender and SAPS II 21 Tocilizumab-treated patients to 42 non-treated patients. Need for mechanical ventilation was 76% versus 79%. IL-6, C-reactive protein, and fibrinogen had been collected within the first days of admission (T1), 3 d (T2) and 7 d (T3) later. Tocilizumab-treated patients had persistently higher IL-6 plasma levels and persistently lower C-Reactive protein and fibrinogen levels. Among Tocilizumab-treated patients, baseline levels of inflammatory biomarkers were not different according to outcome. Conversely, C-reactive protein and fibrinogen decrease was delayed in non-survivors. C-Reactive protein decreased at T1 in survivors (45 [30–98] vs 170 [69–204] mg/l, P < 0.001) but only at T2 in non-survivors (37 [13–74] vs 277 [235–288], P = 0.03). Fibrinogen decreased at T2 in survivors (4.11 [3.58–4.69] vs 614 [5.61–7.85] g/l, P = 0.005) but not in non-survivors (4.79 [4.12–7.58] vs 7.24 [6.22–9.24] g/l, P = 0.125). Tocilizumab treatment was thus associated with a persistent both increase in plasma IL-6, and decrease in C-reactive protein and fibrinogen. Among Tocilizumab-treated patients, the decrease in inflammatory biomarkers was delayed in non-survivors.
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Affiliation(s)
- Tomas Urbina
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Marc Garnier
- 27063Sorbonne Université, France.,Service d'Anesthésie-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Arsene Mekinian
- 27063Sorbonne Université, France.,Service de médecine interne, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Jerome Pacanowski
- Service de maladies infectieuses, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Nathalie Mario
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Guillaume Dumas
- Service de Médecine Intensive-Réanimation, 55663Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Antoine Pilon
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Lucie Darrivère
- Service d'Anesthésie-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Muriel Fartoukh
- 27063Sorbonne Université, France.,Service de Médecine Intensive-Réanimation, 55705Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France
| | - Judith Leblanc
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, France
| | - Yannick Chantran
- Département d'Immunologie Biologique, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Olivier Fain
- 27063Sorbonne Université, France.,Service de médecine interne, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Karine Lacombe
- 27063Sorbonne Université, France.,Service de maladies infectieuses, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - Guillaume Voiriot
- 27063Sorbonne Université, France.,Service de Médecine Intensive-Réanimation, 55705Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, 37117Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, France.,27063Sorbonne Université, France.,Inserm U970, Cardiovascular research center, Université de Paris, France
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Lavillegrand JR, Raia L, Urbina T, Hariri G, Gabarre P, Bonny V, Bigé N, Baudel JL, Bruneel A, Dupre T, Guidet B, Maury E, Ait-Oufella H. Vitamin C improves microvascular reactivity and peripheral tissue perfusion in septic shock patients. Crit Care 2022; 26:25. [PMID: 35062987 PMCID: PMC8781452 DOI: 10.1186/s13054-022-03891-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/08/2022] [Indexed: 12/29/2022]
Abstract
Background Vitamin C has potential protective effects through antioxidant and anti-inflammatory properties. However, the effect of vitamin C supplementation on microvascular function and peripheral tissue perfusion in human sepsis remains unknown. We aimed to determine vitamin C effect on microvascular endothelial dysfunction and peripheral tissue perfusion in septic shock patients. Methods Patients with septic shock were prospectively included after initial resuscitation. Bedside peripheral tissue perfusion and skin microvascular reactivity in response to acetylcholine iontophoresis in the forearm area were measured before and 1 h after intravenous vitamin C supplementation (40 mg/kg). Norepinephrine dose was not modified during the studied period. Results We included 30 patients with septic shock. SOFA score was 11 [8–14], SAPS II was 66 [54–79], and in-hospital mortality was 33%. Half of these patients had vitamin C deficiency at inclusion. Vitamin C supplementation strongly improved microvascular reactivity (AUC 2263 [430–4246] vs 5362 [1744–10585] UI, p = 0.0004). In addition, vitamin C supplementation improved mottling score (p = 0.06), finger-tip (p = 0.0003) and knee capillary refill time (3.7 [2.6–5.5] vs 2.9 [1.9–4.7] s, p < 0.0001), as well as and central-to-periphery temperature gradient (6.1 [4.9–7.4] vs 4.6 [3.4–7.0] °C, p < 0.0001). The beneficial effects of vitamin C were observed both in patients with or without vitamin C deficiency. Conclusion In septic shock patients being resuscitated, vitamin C supplementation improved peripheral tissue perfusion and microvascular reactivity whatever plasma levels of vitamin C. ClinicalTrials.gov Identifier: NCT04778605 registered 26 January 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03891-8.
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19
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gournay V, Dumas G, Lavillegrand JR, Hariri G, Urbina T, Baudel JL, Ait-Oufella H, Maury E, Brissot E, Legrand O, Malard F, Mohty M, Guidet B, Duléry R, Bigé N. Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study. Ann Hematol 2021; 100:2787-2797. [PMID: 34476574 DOI: 10.1007/s00277-021-04640-7] [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: 04/28/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients-median age 55 (36-64) years-were admitted to ICU in a median time of 58.5 (14-245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6-11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30-23.19], p<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31-2.05], p<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14-12.92], p=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05-3.31], p=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10-2.84], p=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14-3.10], p=0.01), MV (HR=2.37 [95% CI 1.38-4.07, p=0.002), and vasopressors (HR=2.21 [95% CI 1.38-3.54], p=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.
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Affiliation(s)
- Viviane Gournay
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France
| | - Guillaume Dumas
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Inserm U970, Paris Research Cardiovascular Center, Paris, France
| | - Eric Maury
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Eolia Brissot
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Ollivier Legrand
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Florent Malard
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Mohamad Mohty
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Inserm U1136, Paris, France
| | - Rémy Duléry
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Naïke Bigé
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.
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Hariri G, Urbina T, Mazerand S, Bige N, Baudel JL, Ait-Oufella H. Rate control in atrial fibrillation using Landiolol is safe in critically ill Covid-19 patients. Crit Care 2021; 25:33. [PMID: 33482867 PMCID: PMC7820818 DOI: 10.1186/s13054-021-03470-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Geoffroy Hariri
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Paris, France
| | - Sandie Mazerand
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Naike Bige
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Luc Baudel
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Service de réanimation médicale, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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Lavillegrand JR, Garnier M, Spaeth A, Mario N, Hariri G, Pilon A, Berti E, Fieux F, Thietart S, Urbina T, Turpin M, Darrivere L, Fartoukh M, Verdonk F, Dumas G, Tedgui A, Guidet B, Maury E, Chantran Y, Voiriot G, Ait-Oufella H. Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients. Ann Intensive Care 2021; 11:9. [PMID: 33439360 PMCID: PMC7804215 DOI: 10.1186/s13613-020-00798-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 10/16/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023] Open
Abstract
Background SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. Methods Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3–4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. Results 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111–251] mmHg), SAPS II of 37 [31–45] and SOFA score of 4 [3–7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70–622] vs. 71 [29–153] pg/mL, P < 0.01; and 178 [100–295] vs. 100 [37–213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3–4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. Conclusions In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality.
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Affiliation(s)
- Jean-Rémi Lavillegrand
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Marc Garnier
- Sorbonne Université, Paris, France.,Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agathe Spaeth
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Mario
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Antoine Pilon
- Département de Biochimie, Hormonologie et Suivi Thérapeutique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Enora Berti
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabienne Fieux
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sara Thietart
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Matthieu Turpin
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Darrivere
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Franck Verdonk
- Service D'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Dumas
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France
| | - Alain Tedgui
- Inserm U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France.,Sorbonne Université, Paris, France
| | - Yannick Chantran
- Département D'Immunologie Biologique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris cedex 12, France. .,Sorbonne Université, Paris, France. .,Inserm U970, Cardiovascular Research Center, Université de Paris, Paris, France.
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Hariri G, Hodjat Panah K, Beneteau-Burnat B, Chaquin M, Mekinian A, Ait-Oufella H. Carboxyhemoglobin, a reliable diagnosis biomarker for hemolysis in intensive care unit: a retrospective study. Crit Care 2021; 25:7. [PMID: 33402152 PMCID: PMC7786981 DOI: 10.1186/s13054-020-03437-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Geoffroy Hariri
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de réanimation médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France
| | - Kyann Hodjat Panah
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de réanimation médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Bénédicte Beneteau-Burnat
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de biochimie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Michael Chaquin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'hématologie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Arsene Mekinian
- Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Service de médecine interne, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de réanimation médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Université Pierre-et-Marie Curie, Paris 6, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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Hariri G, Ferre A, Legriel S. Tiagabine-related status epilepticus: a case report and systematic literature review. Acta Neurol Belg 2020; 120:1283-1288. [PMID: 32789647 DOI: 10.1007/s13760-020-01464-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/03/2020] [Indexed: 12/01/2022]
Abstract
Tiagabine-related status epilepticus (SE) is an uncommon complication of tiagabine use. We aimed to detail the features and outcomes in a patient with tiagabine poisoning and review the relevant literature. We describe a case of tiagabine-related SE and literature review based on a 1995-2019 PubMed search. We report the case of a 30-year-old man with super-refractory SE after tiagabine poisoning. He fully recovered after 72 h of general anesthesia and was discharged from the ICU on day 16. A literature review showed distinct features among patients with tiagabine-related SE. Tiagabine side effects were characterized by non-convulsive SE after a slight increase in tiagabine dose and a rapid favorable evolution after benzodiazepine and early tiagabine withdrawal. Generalized convulsive SE was a complication of voluntary or involuntary tiagabine poisoning and was particularly refractory. Both presentations are characterized by a return to baseline after prompt and adequate management. Tiagabine-related SE electroclinical features vary according to the underlying pathophysiological mechanism and can be life threatening. Recovery is the rule after tiagabine withdrawal and SE management with progressive therapeutic escalation guided by response to prior anticonvulsant treatments.
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Affiliation(s)
- Geoffroy Hariri
- Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, 78150, Le Chesnay, France.
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
- Medical Intensive Care Unit, Centre Hospitalier Universitaire Saint-Antoine, Assistance Publique Hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Alexis Ferre
- Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, 78150, Le Chesnay, France
| | - Stephane Legriel
- Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, 78150, Le Chesnay, France
- IctalGroup, Le Chesnay, France
- University Paris-Saclay, UVSQ, INSERM, CESP, Team « PsyDev », Villejuif, France
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25
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Bigé N, Lavillegrand JR, Dang J, Attias P, Deryckere S, Joffre J, Dubée V, Preda G, Dumas G, Hariri G, Pichereau C, Baudel JL, Guidet B, Maury E, Boelle PY, Ait-Oufella H. Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study. Ann Intensive Care 2020; 10:47. [PMID: 32323060 PMCID: PMC7176798 DOI: 10.1186/s13613-020-00663-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/01/2019] [Accepted: 04/11/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite improvements in intermittent hemodialysis management, intradialytic hemodynamic instability (IHI) remains a common issue that could account for increased mortality and delayed renal recovery. However, predictive factors of IHI remain poorly explored. The objective of this study was to evaluate the relationship between baseline macrohemodynamic, tissue hypoperfusion parameters and IHI occurrence. METHODS Prospective observational study conducted in a 18-bed medical ICU of a tertiary teaching hospital. Cardiovascular SOFA score, index capillary refill time (CRT) and lactate level were measured just before (T0) consecutive intermittent hemodialysis sessions performed for AKI. The occurrence of IHI requiring a therapeutic intervention was recorded. RESULTS Two hundred eleven sessions, corresponding to 72 (34%) first sessions and 139 (66%) later sessions, were included. As IHI mostly occurred during first sessions (43% vs 12%, P < 0.0001), following analyses were performed on the 72 first sessions. At T0, cardiovascular SOFA score ≥1 (87% vs 51%, P = 0.0021) was more frequent before IHI sessions, as well as index CRT ≥ 3 s (55% vs 15%, P = 0.0004), and hyperlactatemia > 2 mmol/L (68% vs 29%, P = 0.0018). Moreover, the occurrence of IHI increased with the number of macrohemodynamic and tissue perfusion impaired parameters, named SOCRATE score (cardiovascular SOFA, index CRT and lactATE): 10% (95% CI [3%, 30%]), 33% (95% CI [15%, 58%]), 55% (95% CI [35%, 73%]) and 80% (95% CI [55%, 93%]) for 0, 1, 2 and 3 parameters, respectively (AUC = 0.79 [0.69-0.89], P < 0.0001). These results were confirmed by analyzing the 139 later sessions included in the study. CONCLUSIONS The SOCRATE score based on 3 easy-to-use bedside parameters correlates with the risk of IHI. By improving risk stratification of IHI, this score could help clinicians to manage intermittent hemodialysis initiation in critically ill AKI patients.
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Affiliation(s)
- Naïke Bigé
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Julien Dang
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France
| | - Philippe Attias
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France
| | - Stéphanie Deryckere
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France
| | - Jérémie Joffre
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Vincent Dubée
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Gabriel Preda
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France
| | - Guillaume Dumas
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Geoffroy Hariri
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Claire Pichereau
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France
| | - Bertrand Guidet
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France.,Inserm U1136, Paris, France
| | - Eric Maury
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France
| | - Pierre-Yves Boelle
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France.,Inserm U1136, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris, 75006, France.,Inserm U970, Paris Research Cardiovascular Center, Paris, France
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26
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Gabarre P, Boelle PY, Bigé N, Fartoukh M, Guitton C, Dumas G, Lavillegrand JR, Hariri G, Baudel JL, Zafimahazo D, Ait-Oufella H, Maury E. French ICU's health care workers have a poor knowledge of the cost of the devices they use for patient care: A prospective multicentric study. J Crit Care 2019; 56:37-41. [PMID: 31837599 DOI: 10.1016/j.jcrc.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE ICU patient's care may require the use of onerous devices, which contributes to make this department one of the most expensive in the hospital. It seemed us relevant to assess healthcare workers' (HCWs) knowledge of the cost of the devices daily used in ICU. MATERIALS AND METHODS An anonymous questionnaire was administered on a voluntary basis to HCWs of 3 ICUs. MEASUREMENTS AND MAIN RESULTS Cost estimations were expressed as percentage of the real cost; an estimation was considered correct if it was ±50% of the true price. 107 HCWs (66 physicians and 41 nurses and nurse aids) answered the survey. Only 29% of estimations were within 50% of the real cost. The prices of the cheapest devices were overestimated, while the costs of the most expensive ones were underestimated. In multivariate analysis, cost less than50 euros [OR = 3.2; CI 95%(1.6-6.3)], professional experience <10 years [OR = 1.5; CI 95%(1.1-2.1)], being a medical student [OR = 2.0; CI 95%(1.3-3.0)], and working in a university affiliated hospital [OR = 0.6; CI 95%(0.4-0.9)] were associated with an incorrect estimation. CONCLUSIONS ICU's HCWs have a poor knowledge of the price of devices they regularly use for the care of their patients.
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Affiliation(s)
- Paul Gabarre
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France
| | - Pierre-Yves Boelle
- Université Pierre-et-Marie Curie-Paris 6, Paris 6, France; Inserm U1136, 75012 Paris, France
| | - Naike Bigé
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France
| | - Muriel Fartoukh
- Université Pierre-et-Marie Curie-Paris 6, Paris 6, France; Service de Médecine Intensive - Réanimation, Hôpital Tenon, 75020 Paris, France
| | - Christophe Guitton
- Service de Médecine Intensive - Réanimation, Centre Hospitalier, 72037 Le Mans, France
| | - Guillaume Dumas
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France; Université Pierre-et-Marie Curie-Paris 6, Paris 6, France
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France; Université Pierre-et-Marie Curie-Paris 6, Paris 6, France
| | - Geoffroy Hariri
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France; Université Pierre-et-Marie Curie-Paris 6, Paris 6, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France
| | - Daniel Zafimahazo
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France; Université Pierre-et-Marie Curie-Paris 6, Paris 6, France
| | - Eric Maury
- Service de Médecine Intensive - Réanimation, Hôpital Saint-Antoine, 75571 Paris Cedex 12, France; Université Pierre-et-Marie Curie-Paris 6, Paris 6, France; Inserm U1136, 75012 Paris, France.
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27
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Hariri G, Bourcier S, Marjanovic Z, Joffre J, Lemarié J, Lavillegrand JR, Charue D, Duflot T, Bigé N, Baudel JL, Maury E, Mohty M, Guidet B, Bellien J, Blanc-Brude O, Ait-Oufella H. Exploring the microvascular impact of red blood cell transfusion in intensive care unit patients. Crit Care 2019; 23:292. [PMID: 31470888 PMCID: PMC6717366 DOI: 10.1186/s13054-019-2572-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Red blood cell (RBC) transfusion is a common treatment for hospitalized patients. However, the effects of RBC transfusion on microvascular function remain controversial. METHODS In a medical ICU in a tertiary teaching hospital, we prospectively included anemic patients requiring RBC transfusion. Skin microvascular reactivity was measured before and 30 min after RBC transfusion. Plasma was collected to analyze intravascular hemolysis and draw the lipidomic and cytokine profiles. RESULTS In a cohort of 59 patients, the median age was 66 [55-81] years and SAPS II was 38 [24-48]. After RBC transfusion, endothelium-dependent microvascular reactivity improved in 35 (59%) patients, but worsened in 24 others (41%). Comparing clinical and biological markers revealed that baseline blood leucokyte counts distinguished improving from worsening patients (10.3 [5.7; 19.7] vs. 4.6 [2.1; 7.3] × 109/L; p = 0.001) and correlated with variations of microvascular reactivity (r = 0.36, p = 0.005). Blood platelet count was also higher in improving patients (200 [97; 280] vs 160 [40; 199] × 103/mL, p = 0.03) but did not correlate with variations of microvascular reactivity. We observed no intravascular hemolysis (HbCO, heme, bilirubin, LDH), but recorded a significant increase in RBC microparticle levels specific to improving patients after transfusion (292 [108; 531] vs. 53 [34; 99] MP/μL; p = 0.03). The improvement in microvascular dilation was positively correlated with RBC microparticle levels (R = 0.83, p < 0.001) and conversion of arachidonic acid into vasodilating eicosanoids. CONCLUSIONS Patients displaying an improved microvascular reactivity after RBC transfusion had high blood leukocyte counts, increased RBC microparticle formation, and enhanced metabolism of arachidonic acid into vasodilating lipids. Our data suggested a contribution of recipient leukocytes to the vascular impact of RBC transfusion.
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Affiliation(s)
- Geoffroy Hariri
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Simon Bourcier
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
| | - Zora Marjanovic
- Assistance Publique, Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service d’hématologie, 75571 Paris Cedex 12, France
| | - Jérémie Joffre
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Jérémie Lemarié
- Service de Réanimation Médicale, Hôpital Central, Nancy, France
| | - Jean-Rémi Lavillegrand
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Dominique Charue
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
| | - Thomas Duflot
- Normandie University, UNIROUEN, INSERM U1096, FHU REMOD-VHF, 76000 Rouen, France
- Laboratory of Pharmacokinetics, Toxicology and Pharmacogenomics, Rouen University Hospital, 76000 Rouen, France
| | - Naïke Bigé
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
| | - Jean-Luc Baudel
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
| | - Eric Maury
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Mohamad Mohty
- Assistance Publique, Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service d’hématologie, 75571 Paris Cedex 12, France
| | - Bertrand Guidet
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
- Inserm U1136, F-75012 Paris, France
| | - Jeremy Bellien
- Normandie University, UNIROUEN, INSERM U1096, FHU REMOD-VHF, 76000 Rouen, France
- Department of Pharmacology, Rouen University Hospital, 76000 Rouen, France
| | - Olivier Blanc-Brude
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
| | - Hafid Ait-Oufella
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
- Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France
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Hariri G, Joffre J, Leblanc G, Bonsey M, Lavillegrand JR, Urbina T, Guidet B, Maury E, Bakker J, Ait-Oufella H. Narrative review: clinical assessment of peripheral tissue perfusion in septic shock. Ann Intensive Care 2019; 9:37. [PMID: 30868286 PMCID: PMC6419794 DOI: 10.1186/s13613-019-0511-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/01/2019] [Indexed: 12/21/2022] Open
Abstract
Sepsis is one of the main reasons for intensive care unit admission and is responsible for high morbidity and mortality. The usual hemodynamic targets for resuscitation of patients with septic shock use macro-hemodynamic parameters (hearth rate, mean arterial pressure, central venous pressure). However, persistent alterations of microcirculatory blood flow despite restoration of macro-hemodynamic parameters can lead to organ failure. This dissociation between macro- and microcirculatory compartments brings a need to assess end organs tissue perfusion in patients with septic shock. Traditional markers of tissue perfusion may not be readily available (lactate) or may take time to assess (urine output). The skin, an easily accessible organ, allows clinicians to quickly evaluate the peripheral tissue perfusion with noninvasive bedside parameters such as the skin temperatures gradient, the capillary refill time, the extent of mottling and the peripheral perfusion index.
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Affiliation(s)
- Geoffroy Hariri
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Jérémie Joffre
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Guillaume Leblanc
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de recherche du CHU de Québec - Université Laval, Université Laval, Québec City, QC, Canada
| | - Michael Bonsey
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Remi Lavillegrand
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Tomas Urbina
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Bertrand Guidet
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France.,Inserm U1136, Paris, 75012, France
| | - Eric Maury
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France.,Inserm U1136, Paris, 75012, France
| | - Jan Bakker
- Department Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA.,Department of Pulmonology and Critical Care, New York University Medical Center - Bellevue Hospital, New York, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hafid Ait-Oufella
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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29
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Hariri G, Joffre J, Dumas G, Lavillegrand JR, Bigé N, Baudel JL, Guidet B, Maury E, Ait-Oufella H. Exploration de la perfusion tissulaire microcirculatoire au cours du choc septique. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2018-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Au cours des infections graves, les travaux chez l’animal et chez l’homme ont mis en évidence une altération de la perfusion microcirculatoire à l’origine des défaillances viscérales et potentiellement du décès. La sévérité des anomalies microcirculatoires ainsi que leur persistance sont des facteurs prédictifs de mortalité indépendamment du débit cardiaque ou de la pression artérielle. Il est donc indispensable de développer des outils permettant d’évaluer la perfusion microcirculatoire au lit du malade. De nombreux travaux au cours du sepsis suggèrent que l’analyse de la perfusion cutanée au travers de sa température (et/ou du gradient), du temps de recoloration cutané, de l’étendue des marbrures et de l’indice de perfusion périphérique constitue un outil simple qui permet au réanimateur une évaluation rapide des anomalies microcirculatoires.
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30
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Hariri G, Baudel JL, Dubee V, Dumas G, Joffre J, Bourcier S, Bige N, Ait Oufella H, Maury E. Nasotracheal intubation in ICU: an unfairly forgotten procedure. Minerva Anestesiol 2018; 84:997-998. [PMID: 29589421 DOI: 10.23736/s0375-9393.18.12655-1] [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: 11/08/2022]
Affiliation(s)
- Geoffroy Hariri
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France
| | - Vincent Dubee
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France.,INSERM, UMR S 1136, Institut Pierre Louis Epidemiology and Public Health, Paris, France
| | - Guillaume Dumas
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France.,INSERM, UMR S 1136, Institut Pierre Louis Epidemiology and Public Health, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France.,INSERM, UMR S 1136, Institut Pierre Louis Epidemiology and Public Health, Paris, France
| | - Simon Bourcier
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France.,INSERM, UMR S 1136, Institut Pierre Louis Epidemiology and Public Health, Paris, France
| | - Naïke Bige
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France
| | - Hafid Ait Oufella
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France.,INSERM, UMR S 1136, Institut Pierre Louis Epidemiology and Public Health, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France: 2 Sorbonne Universities, Pierre et Marie Curie University, Paris, France - .,INSERM, UMR S 1136, Institut Pierre Louis Epidemiology and Public Health, Paris, France
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Hariri G, Joffre J, Deryckere S, Bigé N, Dumas G, Baudel JL, Maury E, Guidet B, Ait-Oufella H. Albumin infusion improves endothelial function in septic shock patients: a pilot study. Intensive Care Med 2018; 44:669-671. [PMID: 29392345 DOI: 10.1007/s00134-018-5075-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Geoffroy Hariri
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jérémie Joffre
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Stephanie Deryckere
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Naïke Bigé
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Guillaume Dumas
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Luc Baudel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Eric Maury
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Université Pierre-et-Marie Curie-Paris 6, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Bertrand Guidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Université Pierre-et-Marie Curie-Paris 6, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Hafid Ait-Oufella
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Université Pierre-et-Marie Curie-Paris 6, Paris, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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Hariri G, Tankovic J, Boëlle PY, Dubée V, Leblanc G, Pichereau C, Bourcier S, Bigé N, Baudel JL, Galbois A, Ait-Oufella H, Maury E. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study. Ann Intensive Care 2017; 7:35. [PMID: 28341979 PMCID: PMC5366988 DOI: 10.1186/s13613-017-0259-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Third-generation cephalosporins (3GCs) are recommended for empirical antibiotic therapy of community-acquired pneumonia (CAP) in patients requiring ICU admission. However, their extensive use could promote the emergence of extended-spectrum beta-lactamases-producing Enterobacteriaceae. Our aim was to assess whether the use of 3GCs in patients with CAP requiring ICU admission was justified. METHODS We assessed all patients with CAP who required ICU admission during a 7-year period. We recorded empirical and definitive antibiotic therapies and susceptibility of causative pathogens. Amoxicillin, amoxicillin/clavulanate (A/C) susceptibilities as well as amikacin susceptibility of A/C-resistant strains were recorded. RESULTS From January 2007 to March 2014, 391 patients were included in the study. Empirical 3GCs were used in 215 patients (55%). Among 267 patients with microbiologically documented CAP (68%), 241 received a beta-lactam as definitive therapy, and of those, 3CGs were chosen for 43 patients (18%). Amoxicillin or A/C was active against isolated pathogens in 159 patients (66%), while 39 patients (16%) required a beta-lactam with a broader spectrum than 3GCs. Ninety-four per cent of A/C-resistant strains were amikacin susceptible. CONCLUSIONS In ICU patients with CAP, 3GCs given on an empirical basis are changed, according to microbiological documentation, for another beta-lactam in 82% of cases especially to A/C in the absence of resistance risk factor. In patients evidencing risk factors for A/C-resistant strains infection, 3GCs or antipseudomonal beta-lactams including carbapenem associated with amikacin in the most severe patients seem a relevant empirical antibiotic therapy. This strategy could decrease 3GCs' use.
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Affiliation(s)
- Geoffroy Hariri
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Jacques Tankovic
- Microbiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Yves Boëlle
- Institut Pierre-Louis d'Epidémiologie et de Santé Publique, U 1136, Inserm, 75012, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Vincent Dubée
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Guillaume Leblanc
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Claire Pichereau
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Simon Bourcier
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Naike Bigé
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Jean-Luc Baudel
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Arnaud Galbois
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France.,Réanimation Polyvalente, HP Claude Galien, 91480, Quincy-sous-Sénart, France
| | - Hafid Ait-Oufella
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France. .,Institut Pierre-Louis d'Epidémiologie et de Santé Publique, U 1136, Inserm, 75012, Paris, France. .,UPMC Univ Paris 06, Sorbonne Universités, Paris, France.
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, Rodriguez J, Taddei M, Di Bari M, Hickmann C, Castanares-Zapatero D, Sayed FE, Deldicque L, Van Den Bergh P, Caty G, Roeseler J, Francaux M, Laterre PF, Dupuis B, Machayeckhi S, Sarfati C, Moore A, Dinh A, Mendialdua P, Rodet E, Pilorge C, Stephan F, Rezaiguia-Delclaux S, Dugernier J, Hesse M, Jumetz T, Bialais E, Depoortere V, Charron C, Michotte JB, Wittebole X, Jamar F, Geri G, Vieillard-Baron A, Repessé X, Kallel H, Mayence C, Houcke S, Guegueniat P, Hommel D, Dhifaoui K, Hajjej Z, Fatnassi A, Sellami W, Labbene I, Ferjani M, Dachraoui F, Nakkaa S, M’ghirbi A, Adhieb A, Braiek DB, Hraiech K, Ousji A, Ouanes I, Zaineb H, Abdallah SB, Ouanes-Besbes L, Abroug F, Klein S, Miquet M, Thouret JM, Peigne V, Daban JL, Boutonnet M, Lenoir B, Merhbene T, Derreumaux C, Seguin T, Conil JM, Kelway C, Blasco V, Nafati C, Harti K, Reydellet L, Albanese J, Aicha NB, Meddeb K, Khedher A, Ayachi J, Fraj N, Sma N, Chouchene I, Boussarsar M, Yedder SB, Samoud W, Radhouene B, Mariem B, Ammar A, Cheikh AB, Lakhal HB, Khelfa M, Hamdaoui Y, Bouafia N, Trampont T, Daix T, Legarçon V, Karam HH, Pichon N, Essafi F, Foudhaili N, Thabet H, Blel Y, Brahmi N, Ezzouine H, Kerrous M, Haoui SE, Ahdil S, Benslama A, Abidi K, Dendane T, Oussama S, Belayachi J, Madani N, Abouqal R, Zeggwagh AA, Ghadhoune H, Chaari A, Jihene G, Allouche H, Trabelsi I, Brahmi H, Samet M, Ghord HE, Habiba BSA, Hajer N, Tilouch N, Yaakoubi S, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Arcizet J, Leroy B, Abdulmalack C, Renzullo C, Hamet M, Doise JM, Coutet J, Cheikh CM, Quechar Z, Joris M, Beauport DT, Kontar L, Lebon D, Gruson B, Slama M, Marolleau JP, Maizel J, Gorham J, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP, Guillot M, Ledoux MP, Braun T, Maestraggi Q, Michard B, Castelain V, Herbrecht R, Schneider F, Couffin S, Lobo D, Mongardon N, Dhonneur G, Mounier R, Le Borgne P, Couraud S, Herbrecht JE, Boivin A, Lefebvre F, Bilbault P, Zelmat SA, Batouche DD, Mazour F, Chaffi B, Benatta N, Sik AH, Talik I, Perrier M, Gouteix E, Koubi C, Escavy A, Guilbaut V, Fosse JP, Jazia RB, Abdelghani A, Cungi PJ, Bordes J, Nguyen C, Pierrou C, Cruc M, Benois A, Duprez F, Bonus T, Cuvelier G, Ollieuz S, Machayekhi S, Paciorkowski F, Reychler G, Coudroy R, Thille AW, Drouot X, Diaz V, Meurice JC, Robert R, Turki O, Ben HC, Assefi M, Deransy R, Brisson H, Monsel A, Conti F, Scatton O, Langeron O, Ghezala HB, Snouda S, Ben CI, Kaddour M, Armel A, Youness L, Abdelhak B, Youssef M, Najib AH, Mustapha A, Noufel M, Mohamed Z, Salma EK, Ghizlane M, Mohamed B, Benyounes R, Montini F, Moschietto S, Gregoire E, Claisse G, Guiot J, Morimont P, Krzesinski JM, Mariat C, Lambermont B, Cavalier E, Delanaye P, Benbernou S, Ilies S, Azza A, Bouyacoub K, Louail M, Mokhtari-Djebli H, Arrestier R, Daviaud F, Francois XL, Brocas E, Choukroun G, Peñuelas O, Lorente JA, Cardinal-Fernandez P, Rodriguez JM, Aramburu JA, Esteban A, Frutos-Vivar F, Bitker L, Costes N, Le Bars D, Lavenne F, Devouassoux M, Richard JC, Mechati M, Gainnier M, Papazian L, Guervilly C, Garnero A, Arnal JM, Roze H, Richard JC, Repusseau B, Dewitte A, Joannes-Boyau O, Ouattara A, Harbouze N, Amine AM, Olandzobo AG, Herbland A, Richard M, Girard N, Lambron L, Lesieur O, Wainschtein S, Hubert S, Hugues A, Tran M, Bouillard P, Loteanu V, Leloup M, Laurent A, Lheureux F, Prestifilippo A, Cruz MDM, Romain R, Antonelli M, Blanch TL, Bonnetain F, Grazzia-Bocci M, Mancebo J, Samain E, Paul H, Capellier G, Zavgorodniaia T, Soichot M, Malissin I, Voicu S, Garçon P, Goury A, Kerdjana L, Deye N, Bourgogne E, Megarbane B, Mejri O, Hmida MB, Tannous S, Chevillard L, Labat L, Risede P, Fredj H, Léger M, Brunet M, Le Roux G, Boels D, Lerolle N, Farah S, Amiel-Niemann H, Kubis N, Declèves X, Peyraux N, Baud F, Serafini M, Alvarez JC, Heinzelman A, Jozwiak M, Millasseau S, Teboul JL, Alphonsine JE, Depret F, Richard N, Attal P, Richard C, Monnet X, Chemla D, Jerbi S, Khedhiri W, Necib H, Scarfo P, Chevalier C, Piagnerelli M, Lafont A, Galy A, Mancia C, Zerhouni A, Tabeliouna K, Gaja A, Hamrouni B, Malouch A, Fourati S, Messaoud R, Zarrouki Y, Ziadi A, Rhezali M, Zouizra Z, Boumzebra D, Samkaoui MA, Brunet J, Canoville B, Verrier P, Ivascau C, Seguin A, Valette X, Du Cheyron D, Daubin C, Bougouin W, Aissaoui N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Dumas F, Marijon E, Jouven X, Cariou A, Poirson F, Chaput U, Beeken T, Maxime L, Haikel O, Vodovar D, Chelly J, Marteau P, Chocron R, Juvin P, Loeb T, Adnet F, Lecarpentier E, Riviere A, De Cagny B, Soupison T, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Leteurtre S, Fresco M, Bubenheim M, Beduneau G, Carpentier D, Grange S, Artaud-Macari E, Misset B, Tamion F, Girault C, Dumas G, Chevret S, Lemiale V, Mokart D, Mayaux J, Pène F, Nyunga M, Perez P, Moreau AS, Bruneel F, Vincent F, Klouche K, Reignier J, Rabbat A, Azoulay E, Frat JP, Ragot S, Constantin JM, Prat G, Mercat A, Boulain T, Demoule A, Devaquet J, Nseir S, Charpentier J, Argaud L, Beuret P, Ricard JD, Teiten C, Marjanovic N, Palamin N, L’Her E, Bailly A, Boisramé-Helms J, Champigneulle B, Kamel T, Mercier E, Le Thuaut A, Lascarrou JB, Rolle A, De Jong A, Chanques G, Jaber S, Hariri G, Baudel JL, Dubée V, Preda G, Bourcier S, Joffre J, Bigé N, Ait-Oufella H, Maury E, Mater H, Merdji H, Grimaldi D, Rousseau C, Mira JP, Chiche JD, Sedghiani I, Benabderrahim A, Hamdi D, Jendoubi A, Cherif MA, Hechmi YZE, Zouheir J, Bagate F, Bousselmi R, Schortgen F, Asfar P, Guérot E, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Dreyfuss D, Radermacher P, Frère A, Martin-Lefèvre L, Colin G, Fiancette M, Henry-Laguarrigue M, Lacherade JC, Lebert C, Vinatier I, Yehia A, Joret A, Menunier-Beillard N, Benzekri-Lefevre D, Desachy A, Bellec F, Plantefève G, Quenot JP, Meziani F, Tavernier E, Ehrmann S, Chudeau N, Raveau T, Moal V, Houillier P, Rouve E, Lakhal K, Gandonnière CS, Jouan Y, Bodet-Contentin L, Balmier A, Messika J, De Montmollin E, Pouyet V, Sztrymf B, Thiagarajah A, Roux D, De Chambrun MP, Luyt CE, Beloncle F, Zapella N, Ledochowsky S, Terzi N, Mazou JM, Sonneville R, Paulus S, Fedun Y, Landais M, Raphalen JH, Combes A, Amoura Z, Jacquemin A, Guerrero F, Marcheix B, Hernandez N, Fourcade O, Georges B, Delmas C, Makoudi S, Genton A, Bernard R, Lebreton G, Amour J, Mazet C, Bounes F, Murat G, Cronier L, Robin G, Biendel C, Silva S, Boubeche S, Abriou C, Wurtz V, Scherrer V, Rey N, Gastaldi G, Veber B, Doguet F, Gay A, Dureuil B, Besnier E, Rouget A, Gantois G, Magalhaes E, Wanono R, Smonig R, Lermuzeaux M, Lebut J, Olivier A, Dupuis C, Radjou A, Mourvillier B, Neuville M, D’ortho MP, Bouadma L, Rouvel-Tallec A, Rudler M, Weiss N, Perlbarg V, Galanaud D, Thabut D, Rachdi E, Mhamdi G, Trifi A, Abdelmalek R, Abdellatif S, Daly F, Nasri R, Tiouiri H, Lakhal SB, Rousseau G, Asmolov R, Grammatico-Guillon L, Auvet A, Laribi S, Garot D, Dequin PF, Guillon A, Fergé JL, Abgrall G, Hinault R, Vally S, Roze B, Chaplain A, Chabartier C, Savidan AC, Marie S, Cabie A, Resiere D, Valentino R, Mehdaoui H, Benarous L, Soda-Diop M, Bouzana F, Perrin G, Bourenne J, Eon B, Lambert D, Trebuchon A, Poncelet G, Le Bourgeois F, Michael L, Camille G, Naudin J, Deho A, Dauger S, Sauthier M, Bergeron-Gallant K, Emeriaud G, Jouvet P, Tiebergien N, Jacquet-Lagrèze M, Fellahi JL, Baudin F, Essouri S, Javouhey E, Guérin C, Lampin M, Mamouri O, Devos P, Karaca-Altintas Y, Vinchon M, Brossier D, Eltaani R, Teyssedre S, Sabine M, Bouchut JC, Peguet O, Petitdemange L, Guilbert AS, Aoul NT, Addou Z, Aouffen N, Anas B, Kalouch S, Yaqini K, Chlilek A, Abdou R, Gravellier P, Chantreuil J, Travers N, Listrat A, Le Reun C, Favrais G, Coppere Z, Blanot S, Montmayeur J, Bronchard R, Rolando S, Orliaguet G, Leger PL, Rambaud J, Thueux E, De Larrard A, Berthelot V, Denot J, Reymond M, Amblard A, Morin-Zorman S, Lengliné E, Pichereau C, Mariotte E, Emmanuel C, Poujade J, Trumpff G, Janssen-Langenstein R, Harlay ML, Zaid N, Ait-Ammar N, Bonnal C, Merle JC, Botterel F, Levesque E, Riad Z, Mezidi M, Yonis H, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Louis B, Forel JM, Bisbal M, Lehingue S, Rambaud R, Adda M, Hraiech S, Marchi E, Roch A, Guerin V, Rozencwajg S, Schmidt M, Hekimian G, Bréchot N, Trouillet JL, Besset S, Franchineau G, Nieszkowska A, Pascal L, Loiselle M, Sarah C, Laurence D, Guillemette T, Jacquens A, Kerever S, Guidet B, Aegerter P, Das V, Fartoukh M, Hayon J, Desmard M, Fulgencio JP, Zuber B, Soufi A, Khaleq K, Hamoudi D, Garret C, Peron M, Coron E, Bretonnière C, Audureau E, Audrey W, Christophe D, Christian J, Daniel A, Cyrille F, Aissaoui W, Rghioui K, Haddad W, Barrou H, Carteaux-Taeib A, Lupinacci R, Manceau G, Jeune F, Tresallet C, Habacha S, Fathallah I, Zoubli A, Aloui R, Kouraichi N, Jouet E, Badin J, Fermier B, Feller M, Serie M, Pillot J, Marie W, Gisbert-Mora C, Vinclair C, Lesbordes P, Mathieu P, De Brabant F, Muller E, Robaux MA, Giabicani M, Marchalot A, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Meunier-Beillard N, Devilliers H, Rigaud JP, Verrière C, Ardisson F, Kentish-Barnes N, Jacq G, Chermak A, Lautrette A, Legrand M, Soummer A, Thiery G, Cottereau A, Canet E, Caujolle M, Allyn J, Valance D, Brulliard C, Martinet O, Jabot J, Gallas T, Vandroux D, Allou N, Durand A, Nevière R, Delguste F, Boulanger E, Preau S, Martin R, Cochet H, Ponthus JP, Amilien V, Tchir M, Barsam E, Ayoub M, Georger JF, Guillame I, Assaraf J, Tripon S, Mallet M, Barbara G, Louis G, Gaudry S, Barbarot N, Jamet A, Outin H, Gibot S, Bollaert PE, Holleville M, Legriel S, Chateauneuf AL, Cavelot S, Moyer JD, Bedos JP, Merle P, Laine A, Natalie DS, Cornuault M, Libot J, Asehnoune K, Rozec B, Dantal J, Videcoq M, Degroote T, Jaillette E, Zerimech F, Malika B, Llitjos JF, Amara M, Lacave G, Pangon B, Mavinga J, Makunza JN, Mafuta ME, Yanga Y, Eric A, Ilunga J, Kilembe M, Alby-Laurent F, Toubiana J, Mokline A, Laajili A, Amri H, Rahmani I, Mensi N, Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Moubarak G, Hariri G, Hariri S. [Will the use of Facebook by medical students modify their relationship with patients?]. Rev Prat 2010; 60:600-602. [PMID: 20564838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ghassan Moubarak
- Service de cardiologie, hôpital Lariboisière, AP-HP, université Paris-7 Denis-Diderot 75010 Paris.
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Diaz R, Hariri G, Passarella R, Wu H, Fu A, Hallahan D. Radiation-guided Platinum Drug Delivery using Recombinant Peptides. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hariri G, Han Z, Hallahan D. Radiation-guided Drug Delivery of Nanoparticle Albumin-bound Paclitaxel to Lung Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.531] [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: 10/21/2022]
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Hariri G, Croce T, Harth E, Han Z, Tantawy N, Peterson T, Baldwin R, Hallahan D. Radiation Guided Peptide Targeting to Tumor Microvasculature using Nanoparticle Carriers. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hariri G, Zhang Y, Fu A, Han Z, Brechbiel M, Peterson T, Hallahan D. 2662. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1077] [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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Zhang Y, Mernaugh R, Fu A, Han Z, Hariri G, Hallahan D. 2672. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1087] [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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Hariri G, Fu A, Han Z, Hallahan D. Radiation-Inducible Neoantigens for Antibody Targeted Drug Delivery. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith KG, Austyn JM, Hariri G, Beverley PC, Morris PJ. T cell activation by anti-T3 antibodies: comparison of IgG1 and IgG2b switch variants and direct evidence for accessory function of macrophage Fc receptors. Eur J Immunol 1986; 16:478-86. [PMID: 2938973 DOI: 10.1002/eji.1830160503] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The human T3 antigen is closely associated with the T cell receptor. Some anti-T3 antibodies cause T cell proliferation in the presence of monocytes which have Fc receptors (FcR) that bind particular antibody subclasses. Such an interaction is thought to determine whether or not an anti-T3 antibody is mitogenic. We examined the mitogenicity of an IgG1 antibody, UCHT1, and an IgG2b switch variant of identical specificity, UCHT1B. With autologous monocytes, 76% of individuals responded to UCHT1 and 9% to UCHT1B, falling into three patterns of responsiveness. Both antibodies in the absence of monocytes induced responsiveness to recombinant interleukin 2, even for UCHT1B nonresponder T cells. The proliferation induced by UCHT1B, however, was always less than that induced by UCHT1. These findings demonstrate the critical role played by the Fc region for mitogenesis, and suggest a possible role for the hinge region. We then obtained direct evidence that mitogenicity can be mediated exclusively via FcR. Mouse macrophages have distinct FcR: FcRI binds IgG2a but FcRII binds IgG1 and IgG2b and its function can be inhibited by the specific antibody 2.4G2. Because UCHT1 and UCHT1B were of the correct subclass to interact with FcRII we examined the accessory function of mouse peritoneal macrophages. Without exception, human T cells now responded to both antibodies. Proliferation was drastically inhibited by 2.4G2 but not by an irrelevant anti-macrophage antibody, F4/80, nor by an anti-human neutrophil FcR antibody, 3G8. Furthermore, 2.4G2 did not inhibit the accessory function of mouse macrophages for OKT3, an IgG2a antibody that presumably interacts with FcRI, and did not inhibit the function of human monocytes for UCHT1 and UCHT1B. Mouse B cells, in contrast to macrophages, have an FcR which binds all three subclasses, but which can be inhibited by 2.4G2. B cells, however, were not accessory cells for mitogenesis with UCHT1, UCHT1B or OKT3. These findings are discussed in relation to other requirements for T cell activation by anti-T3 antibodies.
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Ando I, Hariri G, Wallace D, Beverley P. Tumor promoter phorbol esters induce unresponsiveness to antigen and expression of interleukin 2 receptor on T cells. Eur J Immunol 1985; 15:196-9. [PMID: 3918872 DOI: 10.1002/eji.1830150217] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The tumor promoter 12-O-tetradecanoylphorbol 13-acetate induces the expression of the interleukin 2 receptor and the disappearance of the T3 complex in a T cell hybridoma, T cell clones, thymic and peripheral T cells and T cell tumors. These changes are accompanied by an increased sensitivity to interleukin 2 and antigen-specific unresponsiveness in T cell clones.
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Greaves MF, Hariri G, Newman RA, Sutherland DR, Ritter MA, Ritz J. Selective expression of the common acute lymphoblastic leukemia (gp 100) antigen on immature lymphoid cells and their malignant counterparts. Blood 1983; 61:628-39. [PMID: 6338969] [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: 01/19/2023] Open
Abstract
The selectivity of monoclonal antibody J-5 (anti-gp 100, common ALL antigen) for normal and leukemic hemopoietic cells has been investigated. J-5 gave concordant reactions with rabbit anti-cALL, coredistributed on the cell surface, and precipitated a similar if not identical glycoprotein from leukemic and normal tissue. Normal, immature lymphoid cells reactive with J-5 were detected in bone marrow and in fetal thymus. In marrow they were largely coincident with the TdT+ population. J-5 defines a major subgroup of ALL (common ALL) with a favorable prognosis. Of 853 non-ALL acute leukemias investigated, 80 were J-5 positive. These included 14 cases diagnosed as AML, 51 TdT+ blast crises of CGL, and 15 cases diagnosed as "AUL." Of the 14 J-5+ AML, 13 were subsequently rediagnosed either as cALL (10 cases) or mixed lymphoid-myeloid leukemias (3 cases). One-hundred forty-three cases of mature lymphoid cell leukemia (91 B, 52 T) were investigated with J-5; 3 cases only, of disseminated B lymphoma, were positive, albeit weakly. A higher proportion of follicular lymphomas are, however, J-5 positive when studied in sections of biopsy material. A similar pattern of selective reactivity was observed in a series of leukemia/lymphoma cell lines. These studies emphasize the diagnostic value of monoclonal anti-cALL reagents.
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Greaves M, Delia D, Sutherland R, Rao J, Verbi W, Kemshead J, Hariri G, Goldstein G, Kung P. Expression of the OKT monoclonal antibody defined antigenic determinants in malignancy. Int J Immunopharmacol 1981; 3:283-99. [PMID: 6169674 DOI: 10.1016/0192-0561(81)90022-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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