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Mezidi M, Yonis H, Chauvelot L, Deniel G, Dhelft F, Gaillet M, Noirot I, Folliet L, Chabert P, David G, Danjou W, Baboi L, Bettinger C, Bernon P, Girard M, Provoost J, Bazzani A, Bitker L, Richard JC. Spontaneous breathing trial with pressure support on positive end-expiratory pressure and extensive use of non-invasive ventilation versus T-piece in difficult-to-wean patients from mechanical ventilation: a randomized controlled trial. Ann Intensive Care 2024; 14:59. [PMID: 38630372 PMCID: PMC11024068 DOI: 10.1186/s13613-024-01290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The aim of this study is to assess whether a strategy combining spontaneous breathing trial (SBT) with both pressure support (PS) and positive end-expiratory pressure (PEEP) and extended use of post-extubation non-invasive ventilation (NIV) (extensively-assisted weaning) would shorten the time until successful extubation as compared with SBT with T-piece (TP) and post-extubation NIV performed in selected patients as advocated by guidelines (standard weaning), in difficult-to-wean patients from mechanical ventilation. METHODS The study is a single-center prospective open label, randomized controlled superiority trial with two parallel groups and balanced randomization with a 1:1 ratio. Eligible patients were intubated patients mechanically ventilated for more than 24 h who failed their first SBT using TP. In the extensively-assisted weaning group, SBT was performed with PS (7 cmH2O) and PEEP (5 cmH2O). In case of SBT success, an additional SBT with TP was performed. Failure of this SBT-TP was an additional criterion for post-extubation NIV in this group in addition to other recommended criteria. In the standard weaning group, SBT was performed with TP, and NIV was performed according to international guidelines. The primary outcome criterion was the time between inclusion and successful extubation evaluated with a Cox model with adjustment on randomization strata. RESULTS From May 2019 to March 2023, 98 patients were included and randomized in the study (49 in each group). Four patients were excluded from the intention-to-treat population (2 in both groups); therefore, 47 patients were analyzed in each group. The extensively-assisted weaning group had a higher median age (68 [58-73] vs. 62 [55-71] yrs.) and similar sex ratio (62% male vs. 57%). Time until successful extubation was not significantly different between extensively-assisted and standard weaning groups (median, 172 [50-436] vs. 95 [47-232] hours, Cox hazard ratio for successful extubation, 0.88 [95% confidence interval: 0.55-1.42] using the standard weaning group as a reference; p = 0.60). All secondary outcomes were not significantly different between groups. CONCLUSION An extensively-assisted weaning strategy did not lead to a shorter time to successful extubation than a standard weaning strategy. Trial registration The trial was registered on ClinicalTrials.gov (NCT03861117), on March 1, 2019, before the inclusion of the first patient. https://clinicaltrials.gov/study/NCT03861117 .
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Affiliation(s)
- Mehdi Mezidi
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
- Université Lyon 1, Université de Lyon, Lyon, France.
| | - Hodane Yonis
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Louis Chauvelot
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Deniel
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
- CREATIS INSERM, 1044 CNRS 5220, Villeurbanne, France
| | - François Dhelft
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Maxime Gaillet
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Ines Noirot
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laure Folliet
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Paul Chabert
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume David
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - William Danjou
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Loredana Baboi
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Clotilde Bettinger
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pauline Bernon
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mehdi Girard
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Judith Provoost
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alwin Bazzani
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Bitker
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
- CREATIS INSERM, 1044 CNRS 5220, Villeurbanne, France
| | - Jean-Christophe Richard
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
- CREATIS INSERM, 1044 CNRS 5220, Villeurbanne, France
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Bitker L, Biscarrat C, Yonis H, Chivot M, Chauvelot L, Chazot G, Mezidi M, Deniel G, Richard JC. Determinants of Urine Output Using Advanced Hemodynamic Monitoring in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy. Blood Purif 2023; 53:189-199. [PMID: 38104538 DOI: 10.1159/000535544] [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: 06/01/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Low cardiac output and hypovolemia are candidate macrocirculatory mechanisms explanatory of de novo anuria in intensive care unit (ICU) patients undergoing continuous renal replacement therapy (CRRT). We aimed to determine the hemodynamic parameters and CRRT settings associated with the longitudinal course of UO during CRRT. METHODS This is an ancillary analysis of the PRELOAD CRRT observational, single-center study (NCT03139123). Enrolled adult patients had severe acute kidney injury treated with CRRT for less than 24 h and were monitored with a calibrated continuous cardiac output monitoring device. Hemodynamics (including stroke volume index [SVI] and preload-dependence, identified by continuous cardiac index variation during postural maneuvers), net ultrafiltration (UFNET), and UO were reported 4-hourly, over 7 days. Two study groups were defined at inclusion: non-anuric participants if the cumulative 24 h UO at inclusion was ≥0.05 mL kg-1 h-1, and anuric otherwise. Quantitative data were reported by its median [interquartile range]. RESULTS Forty-two patients (age 68 [58-76] years) were enrolled. At inclusion, 32 patients (76%) were not anuric. During follow-up, UO decreased significantly in non-anuric patients, with 25/32 (78%) progressing to anuria within 19 [10-50] hours. Mean arterial pressure (MAP) and UFNET did not significantly differ between study groups during follow-up, while SVI and preload-dependence were significantly associated with the interaction of study group and time since inclusion. Higher UFNET flow rates were significantly associated with higher systemic vascular resistances and lower cardiac output during follow-up. Multivariate analyses showed that (1) lower UO was significantly associated with lower SVI, lower MAP, and preload-independence; and (2) higher UFNET was significantly associated with lower UO. CONCLUSIONS In ICU patients treated with CRRT, those without anuria showed a rapid loss of diuresis after CRRT initiation. Hemodynamic indicators of renal perfusion and effective volemia were the principal determinants of UO during follow-up, in relation with the hemodynamic impact of UFNET setting.
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Affiliation(s)
- Laurent Bitker
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, Villeurbanne, France
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Charlotte Biscarrat
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hodane Yonis
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Chivot
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Louis Chauvelot
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Chazot
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Mehdi Mezidi
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Deniel
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, Villeurbanne, France
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, Villeurbanne, France
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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Haoutar M, Pinero D, Yonis H, Cesareo E, Mezidi M, Peguet O, Tazarourte K, Pozzi M, Dubien PY, Richard JC, Bitker L. Safety of inter-facility transport strategies for patients referred for severe acute respiratory distress syndrome. BMC Emerg Med 2023; 23:129. [PMID: 37924020 PMCID: PMC10625194 DOI: 10.1186/s12873-023-00901-y] [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: 02/27/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Inter-facility transport of patients with acute respiratory distress syndrome (ARDS) in the prone position (PP) is a high-risk situation, compared to other strategies. We aimed to quantify the prevalence of complications during transport in PP, compared to transports with veno-venous extracorporeal membrane oxygenation (VV-ECMO) or in the supine position (SP). METHODS We performed a retrospective, single center cohort study in Lyon university hospital, France. We included patients ≥ 16 years with ARDS (Berlin definition) transported to an ARDS referral center between 01/12/2016 and 31/12/2021. We compared patients transported in PP, to those transported in SP without VV-ECMO, and those transported with VV-ECMO (in SP), by a multidisciplinary and specialized medical transport team, including an emergency physician and an intensivist. The primary outcome was the rate of transport-related complications (hypoxemia, hypotension, cardiac arrest, cannula or tube dislodgement) in each study groups, compared using a Fisher test. RESULTS One hundred thirty-four patients were enrolled (median PaO2/FiO2 70 [58-82] mmHg), of which 11 (8%) were transported in PP, 44 (33%) with VV-ECMO, and 79 (59%) in SP. The most frequent risk factor for ARDS in the PP group was bacterial pneumonitis, and viral pneumonitis in the other 2 groups. Transport-related complications occurred in 36% (n = 4) of transports in PP, compared to 39% (n = 30) in SP and 14% (n = 6) with VV-ECMO, respectively (p = 0.33). VV-ECMO implantation after transport was not different between SP and PP patients (n = 7, 64% vs. n = 31, 39%, p = 0.19). CONCLUSIONS In the context of a specialized multi-disciplinary ARDS transport team, transport-related complication rates were similar between patients transported in PP and SP, while there was a trend of lower rates in patients transported with VV-ECMO.
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Affiliation(s)
- Malik Haoutar
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - David Pinero
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Hodane Yonis
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Eric Cesareo
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Mehdi Mezidi
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Olivier Peguet
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- INSERM 1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - Matteo Pozzi
- INSERM 1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
- Service de Chirurgie Cardiaque, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Dubien
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1294, Villeurbanne, France
| | - Laurent Bitker
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France.
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1294, Villeurbanne, France.
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Richard JC, Terzi N, Yonis H, Chorfa F, Wallet F, Dupuis C, Argaud L, Delannoy B, Thiery G, Pommier C, Abraham P, Muller M, Sigaud F, Rigault G, Joffredo E, Mezidi M, Souweine B, Baboi L, Serrier H, Rabilloud M, Bitker L. Ultra-low tidal volume ventilation for COVID-19-related ARDS in France (VT4COVID): a multicentre, open-label, parallel-group, randomised trial. Lancet Respir Med 2023; 11:991-1002. [PMID: 37453445 DOI: 10.1016/s2213-2600(23)00221-7] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND COVID-19-related acute respiratory distress syndrome (ARDS) is associated with a high mortality rate and longer mechanical ventilation. We aimed to assess the effectiveness of ventilation with ultra-low tidal volume (ULTV) compared with low tidal volume (LTV) in patients with COVID-19-related ARDS. METHODS This study was a multicentre, open-label, parallel-group, randomised trial conducted in ten intensive care units in France. Eligible participants were aged 18 years or older, received invasive mechanical ventilation for COVID-19 (confirmed by RT-PCR), had ARDS according to the Berlin definition, a partial pressure of arterial oxygen to inspiratory oxygen fraction (PaO2/FiO2) ratio of 150 mm Hg or less, a tidal volume (VT) of 6·0 mL/kg predicted bodyweight or less, and received continuous intravenous sedation. Patients were randomly assigned (1:1) using randomisation blocks to receive ULTV (intervention group) aiming for VT of 4·0 mL/kg predicted bodyweight or LTV (control group) aiming for VT 6·0 mL/kg predicted bodyweight. Participants, investigators, and outcome assessors were not masked to group assignment. The primary outcome was a ranked composite score based on all-cause mortality at day 90 as the first criterion and ventilator-free days among patients alive at day 60 as the second criterion. Effect size was computed with the unmatched win ratio, on the basis of pairwise prioritised comparison of primary outcome components between every patient in the ULTV group and every patient in the LTV group. The unmatched win ratio was calculated as the ratio of the number of pairs with more favourable outcome in the ULTV group over the number of pairs with less favourable outcome in the ULTV group. Primary analysis was done in the modified intention-to-treat population, which included all participants who were randomly assigned and not lost to follow-up. This trial is registered with ClinicalTrials.gov, NCT04349618. FINDINGS Between April 15, 2020, and April 13, 2021, 220 patients were included and five (2%) were excluded. 215 patients were randomly assigned (106 [49%] to the ULTV group and 109 [51%] to the LTV group). 58 (27%) patients were female and 157 (73%) were male. The median age was 68 years (IQR 60-74). 214 patients completed follow-up (one lost to follow-up in the ULTV group) and were included in the modified intention-to-treat analysis. The primary outcome was not significantly different between groups (unmatched win ratio in the ULTV group 0·85 [95% CI 0·60 to 1·19]; p=0·38). 46 (44%) of 105 patients in the ULTV group and 43 (39%) of 109 in the LTV group died by day 90 (absolute difference 4% [-9 to 18]; p=0·52). The rate of severe respiratory acidosis in the first 28 days was higher in the ULTV group than in the LTV group (35 [33%] vs 14 [13%]; absolute difference 20% [95% CI 9 to 31]; p=0·0004). INTERPRETATION In patients with moderate-to-severe COVID-19-related ARDS, there was no significant difference with ULTV compared with LTV in the composite score based on mortality and ventilator-free days among patients alive at day 60. These findings do not support the systematic use of ULTV in patients with COVID-19-related ARDS. FUNDING French Ministry of Solidarity and Health and Hospices Civils de Lyon.
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Affiliation(s)
- Jean-Christophe Richard
- Hospices Civils de Lyon, Croix-Rousse Hospital, Medical Intensive Care Unit, Lyon, France; Université de Lyon, Université Lyon 1, Lyon, France; CREATIS INSERM 1044 CNRS 5220, Lyon, France.
| | - Nicolas Terzi
- CHU Grenoble Alpes, Service de Médecine Intensive Réanimation, Grenoble, France; Université de Grenoble-Alpes, Grenoble, France; INSERM U1042, Grenoble, France
| | - Hodane Yonis
- Hospices Civils de Lyon, Croix-Rousse Hospital, Medical Intensive Care Unit, Lyon, France
| | - Fatima Chorfa
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Florent Wallet
- Hospices Civils de Lyon, Lyon-Sud Hospital, Medical-Surgical Intensive Care Unit, Lyon, France; International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
| | - Claire Dupuis
- CHU Gabriel Montpied, Medical Intensive Care Unit, Clermont-Ferrand, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Edouard Herriot Hospital, Medical Intensive Care Unit, Lyon, France
| | - Bertrand Delannoy
- Clinique de la Sauvegarde, Medical-Surgical Intensive Care Unit, Lyon, France
| | - Guillaume Thiery
- CHU Saint-Etienne, Hopital Nord, Medical Intensive Care Unit, Saint-Priest-En-Jarez, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, Lyon, France
| | - Christian Pommier
- Centre Hospitalier Saint Joseph-Saint Luc, Medical-Surgical Intensive Care Unit, Lyon, France
| | - Paul Abraham
- Hospices Civils de Lyon, Edouard Herriot Hospital, Surgical Intensive Care Unit, Lyon, France
| | - Michel Muller
- Centre Hospitalier Annecy Genevois, Medical-Surgical Intensive Care Unit, Pringy, France
| | - Florian Sigaud
- CHU Grenoble Alpes, Service de Médecine Intensive Réanimation, Grenoble, France
| | - Guillaume Rigault
- CHU Grenoble Alpes, Service de Médecine Intensive Réanimation, Grenoble, France; Université de Grenoble-Alpes, Grenoble, France
| | - Emilie Joffredo
- Hospices Civils de Lyon, Lyon-Sud Hospital, Medical-Surgical Intensive Care Unit, Lyon, France
| | - Mehdi Mezidi
- Hospices Civils de Lyon, Croix-Rousse Hospital, Medical Intensive Care Unit, Lyon, France
| | - Bertrand Souweine
- CHU Gabriel Montpied, Medical Intensive Care Unit, Clermont-Ferrand, France
| | - Loredana Baboi
- Hospices Civils de Lyon, Croix-Rousse Hospital, Medical Intensive Care Unit, Lyon, France
| | - Hassan Serrier
- Hospices Civils de Lyon, Cellule Innovation, Délégation à la Recherche Clinique et à l'Innovation, Lyon, France
| | - Muriel Rabilloud
- Université de Lyon, Université Lyon 1, Lyon, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Lyon, France
| | - Laurent Bitker
- Hospices Civils de Lyon, Croix-Rousse Hospital, Medical Intensive Care Unit, Lyon, France; Université de Lyon, Université Lyon 1, Lyon, France; CREATIS INSERM 1044 CNRS 5220, Lyon, France
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Chaïbi K, Ehooman F, Pons B, Martin-Lefevre L, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Schortgen F, Couchoud C, Dreyfuss D, Gaudry S. Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study. Ann Intensive Care 2023; 13:18. [PMID: 36907976 PMCID: PMC10008759 DOI: 10.1186/s13613-023-01108-x] [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: 09/25/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The extent of the consequences of an episode of severe acute kidney injury (AKI) on long-term outcome of critically ill patients remain debated. We conducted a prospective follow-up of patients included in a large multicenter clinical trial of renal replacement therapy (RRT) initiation strategy during severe AKI (the Artificial Kidney Initiation in Kidney Injury, AKIKI) to investigate long-term survival, renal outcome and health related quality of life (HRQOL). We also assessed the influence of RRT initiation strategy on these outcomes. RESULTS Follow-up of patients extended from 60 days to a median of 3.35 years [interquartile range (IQR), 1.89 to 4.09] after the end of initial study. Of the 619 patients included in the AKIKI trial, 316 survived after 60 days. The overall survival rate at 3 years from inclusion was 39.4% (95% CI 35.4 to 43.4). A total of 46 patients (on the 175 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up [overall incidence of 26%, cumulative incidence at 4 years: 20.6% (CI 95% 13.0 to 28.3)]. Fifteen patients required chronic dialysis (5% of patients who survived after day 90). Among the 226 long-term survivors, 80 (35%) answered the EQ-5D questionnaire. The median index value reported was 0.67 (IQR 0.40 to 1.00) indicating a noticeable alteration of quality of life. Initiation strategy for RRT had no effect on any long-term outcome. CONCLUSION Severe AKI in critically ill patients was associated with a high proportion of death within the first 2 months but less so during long-term follow-up. A quarter of long-term survivors experienced a WRF and suffered from a noticeable impairment of quality of life. Renal replacement therapy initiation strategy was not associated with mortality outcome.
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Affiliation(s)
- Khalil Chaïbi
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France.,UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Franck Ehooman
- UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Service Anesthésie Réanimation Hôpital Privé Claude Gallien, Quincy-Sous-Sénart, France
| | - Bertrand Pons
- Service de Réanimation, CHU de Pointe à Pitre-Abymes, CHU de la Guadeloupe, France
| | | | - Eric Boulet
- Réanimation polyvalente, CH René Dubos, Pontoise, France
| | - Alexandre Boyer
- Réanimation médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Guillaume Chevrel
- Service de réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- Département de réanimation médicale et médecine hyperbare, CHU Angers, Universitéd'Angers, Angers, France
| | | | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de réanimation médicale, Créteil, France.,CARMAS research group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- Réanimation médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont- Ferrand, France
| | - Anne Bretagnol
- Réanimation médico-chirurgicale, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, 45067, Orléans Cedex, France
| | - Julien Mayaux
- Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Saad Nseir
- Centre de Réanimation, Faculté de Médecine, CHU de Lille, Université de Lille, 59000, Lille, France
| | - Bruno Megarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France
| | - Marina Thirion
- Réanimation polyvalente, CH Victor Dupouy, 95107, Argenteuil Cedex, France
| | - Jean-Marie Forel
- Service de réanimation des Détresses respiratoires aiguës et infections sévères, Hôpital Nord Marseille, Marseille, France
| | - Julien Maizel
- Service de réanimation médicale INSERM U1088, Centre hospitalier universitaire de picardie, Amiens, France
| | - Hodane Yonis
- Réanimation médicale, Hôpital de la Croix Rousse, Lyon, France
| | | | - Guillaume Thiery
- Réanimation médicale, CHU Saint Etienne, 42270, Saint Priest en Jarez, France
| | - Frédérique Schortgen
- Centre Hospitalier Intercommunal, Service de Réanimation Polyvalente Adulte, Créteil, France
| | - Cécile Couchoud
- REIN registry, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Didier Dreyfuss
- UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Cité, Paris, France
| | - Stephane Gaudry
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, 125 rue de Stalingrad, 93000, Bobigny, France. .,UMR_S1155, French National Institute of Health and Medical Research (INSERM), CORAKID, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
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6
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Penarrubia L, Verstraete A, Orkisz M, Davila E, Boussel L, Yonis H, Mezidi M, Dhelft F, Danjou W, Bazzani A, Sigaud F, Bayat S, Terzi N, Girard M, Bitker L, Roux E, Richard JC. Precision of CT-derived alveolar recruitment assessed by human observers and a machine learning algorithm in moderate and severe ARDS. Intensive Care Med Exp 2023; 11:8. [PMID: 36797424 PMCID: PMC9934943 DOI: 10.1186/s40635-023-00495-6] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Assessing measurement error in alveolar recruitment on computed tomography (CT) is of paramount importance to select a reliable threshold identifying patients with high potential for alveolar recruitment and to rationalize positive end-expiratory pressure (PEEP) setting in acute respiratory distress syndrome (ARDS). The aim of this study was to assess both intra- and inter-observer smallest real difference (SRD) exceeding measurement error of recruitment using both human and machine learning-made lung segmentation (i.e., delineation) on CT. This single-center observational study was performed on adult ARDS patients. CT were acquired at end-expiration and end-inspiration at the PEEP level selected by clinicians, and at end-expiration at PEEP 5 and 15 cmH2O. Two human observers and a machine learning algorithm performed lung segmentation. Recruitment was computed as the weight change of the non-aerated compartment on CT between PEEP 5 and 15 cmH2O. RESULTS Thirteen patients were included, of whom 11 (85%) presented a severe ARDS. Intra- and inter-observer measurements of recruitment were virtually unbiased, with 95% confidence intervals (CI95%) encompassing zero. The intra-observer SRD of recruitment amounted to 3.5 [CI95% 2.4-5.2]% of lung weight. The human-human inter-observer SRD of recruitment was slightly higher amounting to 5.7 [CI95% 4.0-8.0]% of lung weight, as was the human-machine SRD (5.9 [CI95% 4.3-7.8]% of lung weight). Regarding other CT measurements, both intra-observer and inter-observer SRD were close to zero for the CT-measurements focusing on aerated lung (end-expiratory lung volume, hyperinflation), and higher for the CT-measurements relying on accurate segmentation of the non-aerated lung (lung weight, tidal recruitment…). The average symmetric surface distance between lung segmentation masks was significatively lower in intra-observer comparisons (0.8 mm [interquartile range (IQR) 0.6-0.9]) as compared to human-human (1.0 mm [IQR 0.8-1.3] and human-machine inter-observer comparisons (1.1 mm [IQR 0.9-1.3]). CONCLUSIONS The SRD exceeding intra-observer experimental error in the measurement of alveolar recruitment may be conservatively set to 5% (i.e., the upper value of the CI95%). Human-machine and human-human inter-observer measurement errors with CT are of similar magnitude, suggesting that machine learning segmentation algorithms are credible alternative to humans for quantifying alveolar recruitment on CT.
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Affiliation(s)
- Ludmilla Penarrubia
- grid.7849.20000 0001 2150 7757Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France
| | - Aude Verstraete
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Maciej Orkisz
- grid.7849.20000 0001 2150 7757Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France
| | - Eduardo Davila
- grid.7849.20000 0001 2150 7757Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France
| | - Loic Boussel
- grid.7849.20000 0001 2150 7757Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France ,grid.413852.90000 0001 2163 3825Service de Radiologie, Hôpital De La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hodane Yonis
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Mehdi Mezidi
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Francois Dhelft
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France ,grid.7849.20000 0001 2150 7757Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - William Danjou
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Alwin Bazzani
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Florian Sigaud
- grid.410529.b0000 0001 0792 4829Service de Médecine-Intensive Réanimation, CHU Grenoble-Alpes, Grenoble, France
| | - Sam Bayat
- grid.450307.50000 0001 0944 2786Synchrotron Radiation for Biomedicine Laboratory (STROBE), INSERM UA07, Univ. Grenoble Alpes, Grenoble, France ,grid.410529.b0000 0001 0792 4829Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France
| | - Nicolas Terzi
- grid.411154.40000 0001 2175 0984Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France ,grid.410368.80000 0001 2191 9284Faculté de Médecine, Biosit, Université Rennes1, Rennes, France ,grid.410368.80000 0001 2191 9284INSERM-CIC-1414, Faculté de Médecine, IFR 140, Université Rennes I, Rennes, France
| | - Mehdi Girard
- grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Laurent Bitker
- grid.7849.20000 0001 2150 7757Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France ,grid.413852.90000 0001 2163 3825Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004 Lyon, France
| | - Emmanuel Roux
- grid.7849.20000 0001 2150 7757Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France
| | - Jean-Christophe Richard
- Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1294, Université de Lyon, Villeurbanne, France. .,Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
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7
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Mezidi M, Yonis H, Chauvelot L, Danjou W, Dhelft F, Bazzani A, Girard M, Bitker L, Richard JC. Pressure support and positive end-expiratory pressure versus T-piece during spontaneous breathing trial in difficult weaning from mechanical ventilation: study protocol for the SBT-ICU study. Trials 2022; 23:993. [PMID: 36503500 PMCID: PMC9742015 DOI: 10.1186/s13063-022-06896-4] [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: 08/01/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Spontaneous breathing trials are performed in critically ill intubated patients in order to assess readiness to be weaned from mechanical ventilation. In patients with difficult weaning (i.e. not extubated after their first SBT), performing SBT using pressure support with or without positive end-expiratory pressure or using T-piece is debated. As ventilatory support during SBT is greater on pressure support than on T-piece and as positive end-expiratory pressure can prevent weaning-induced pulmonary oedema, we hypothesized that their combination and large use of post-extubation non-invasive ventilation may shorten the time until successful extubation as compared with T-piece, without increasing the rate of reintubation. METHODS SBT-ICU is a monocentric prospective open labelled, randomized controlled superiority trial comparing two mechanical ventilation weaning strategies; i.e. daily spontaneous breathing trials using pressure support with positive end-expiratory pressure or T-piece. The primary outcome will be time until successful extubation (defined by as extubation, without reintubation or death within the seven following days). DISCUSSION This paper describes the protocol of the SBT-ICU trial. Enrolment of patients in the study is ongoing. TRIAL REGISTRATION ClinicalTrials.gov NCT03861117. Registered on March 1, 2019, before the beginning of inclusion.
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Affiliation(s)
- Mehdi Mezidi
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Hodane Yonis
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Louis Chauvelot
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - William Danjou
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - François Dhelft
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France ,grid.25697.3f0000 0001 2172 4233Université de Lyon, Université Lyon 1, Lyon, France
| | - Alwin Bazzani
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Mehdi Girard
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Laurent Bitker
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France ,grid.25697.3f0000 0001 2172 4233Université de Lyon, Université Lyon 1, Lyon, France ,grid.7429.80000000121866389CREATIS INSERM U1294 CNRS UMR 5220, Villeurbanne, France
| | - Jean-Christophe Richard
- grid.413852.90000 0001 2163 3825Medical Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France ,grid.25697.3f0000 0001 2172 4233Université de Lyon, Université Lyon 1, Lyon, France ,grid.7429.80000000121866389CREATIS INSERM U1294 CNRS UMR 5220, Villeurbanne, France
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8
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Richard JC, Sigaud F, Gaillet M, Orkisz M, Bayat S, Roux E, Ahaouari T, Davila E, Boussel L, Ferretti G, Yonis H, Mezidi M, Danjou W, Bazzani A, Dhelft F, Folliet L, Girard M, Pozzi M, Terzi N, Bitker L. Response to PEEP in COVID-19 ARDS patients with and without extracorporeal membrane oxygenation. A multicenter case–control computed tomography study. Crit Care 2022; 26:195. [PMID: 35780154 PMCID: PMC9250720 DOI: 10.1186/s13054-022-04076-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background PEEP selection in severe COVID-19 patients under extracorporeal membrane oxygenation (ECMO) is challenging as no study has assessed the alveolar recruitability in this setting. The aim of the study was to compare lung recruitability and the impact of PEEP on lung aeration in moderate and severe ARDS patients with or without ECMO, using computed tomography (CT). Methods We conducted a two-center prospective observational case–control study in adult COVID-19-related patients who had an indication for CT within 72 h of ARDS onset in non-ECMO patients or within 72 h after ECMO onset. Ninety-nine patients were included, of whom 24 had severe ARDS under ECMO, 59 severe ARDS without ECMO and 16 moderate ARDS. Results Non-inflated lung at PEEP 5 cmH2O was significantly greater in ECMO than in non-ECMO patients. Recruitment induced by increasing PEEP from 5 to 15 cmH2O was not significantly different between ECMO and non-ECMO patients, while PEEP-induced hyperinflation was significantly lower in the ECMO group and virtually nonexistent. The median [IQR] fraction of recruitable lung mass between PEEP 5 and 15 cmH2O was 6 [4–10]%. Total superimposed pressure at PEEP 5 cmH2O was significantly higher in ECMO patients and amounted to 12 [11–13] cmH2O. The hyperinflation-to-recruitment ratio (i.e., a trade-off index of the adverse effects and benefits of PEEP) was significantly lower in ECMO patients and was lower than one in 23 (96%) ECMO patients, 41 (69%) severe non-ECMO patients and 8 (50%) moderate ARDS patients. Compliance of the aerated lung at PEEP 5 cmH2O corrected for PEEP-induced recruitment (CBABY LUNG) was significantly lower in ECMO patients than in non-ECMO patients and was linearly related to the logarithm of the hyperinflation-to-recruitment ratio. Conclusions Lung recruitability of COVID-19 pneumonia is not significantly different between ECMO and non-ECMO patients, with substantial interindividual variations. The balance between hyperinflation and recruitment induced by PEEP increase from 5 to 15 cmH2O appears favorable in virtually all ECMO patients, while this PEEP level is required to counteract compressive forces leading to lung collapse. CBABY LUNG is significantly lower in ECMO patients, independently of lung recruitability. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04076-z.
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9
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Tardiveau C, Monneret G, Lukaszewicz AC, Cheynet V, Cerrato E, Imhoff K, Peronnet E, Bodinier M, Kreitmann L, Blein S, Llitjos JF, Conti F, Gossez M, Buisson M, Yonis H, Cour M, Argaud L, Delignette MC, Wallet F, Dailler F, Monard C, Brengel-Pesce K, Venet F. A 9-mRNA signature measured from whole blood by a prototype PCR panel predicts 28-day mortality upon admission of critically ill COVID-19 patients. Front Immunol 2022; 13:1022750. [DOI: 10.3389/fimmu.2022.1022750] [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] [Received: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Immune responses affiliated with COVID-19 severity have been characterized and associated with deleterious outcomes. These approaches were mainly based on research tools not usable in routine clinical practice at the bedside. We observed that a multiplex transcriptomic panel prototype termed Immune Profiling Panel (IPP) could capture the dysregulation of immune responses of ICU COVID-19 patients at admission. Nine transcripts were associated with mortality in univariate analysis and this 9-mRNA signature remained significantly associated with mortality in a multivariate analysis that included age, SOFA and Charlson scores. Using a machine learning model with these 9 mRNA, we could predict the 28-day survival status with an Area Under the Receiver Operating Curve (AUROC) of 0.764. Interestingly, adding patients’ age to the model resulted in increased performance to predict the 28-day mortality (AUROC reaching 0.839). This prototype IPP demonstrated that such a tool, upon clinical/analytical validation and clearance by regulatory agencies could be used in clinical routine settings to quickly identify patients with higher risk of death requiring thus early aggressive intensive care.
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10
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Richard JC, Frobert E, Destras G, Yonis H, Mezidi M, Dhelft F, Trouillet-Assant S, Bastard P, Gervais A, Danjou W, Aubrun F, Roumieu F, Labaune JM, Josset L, Bal A, Simon B, Casanova JL, Lina B, Picaud JC, Dupont C, Huissoud C, Bitker L. Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study. CRIT CARE RESUSC 2022; 24:242-250. [PMID: 38046204 PMCID: PMC10692609 DOI: 10.51893/2022.3.oa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective: Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy. Design: Single-centre, retrospective observational case-control study. Setting: Adult level 3 ICU in a French university hospital. Participants: Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia. Main outcome measure: The primary endpoint of the study was viral load in pregnant and non-pregnant patients. Results: 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; P < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 v 35%; P < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not. Conclusions: Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.
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Affiliation(s)
- Jean-Christophe Richard
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSA- Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
| | - Emilie Frobert
- Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Dssepartment of Virology, Infective Agents Institute, North Hospital Network, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, Lyon, France
| | - Grégory Destras
- Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Dssepartment of Virology, Infective Agents Institute, North Hospital Network, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, Lyon, France
| | - Hodane Yonis
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Mehdi Mezidi
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francois Dhelft
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSA- Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
| | - Sophie Trouillet-Assant
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, Lyon, France
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Imagine Institute, University of Paris, Paris, France
| | - Adrian Gervais
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Imagine Institute, University of Paris, Paris, France
| | - William Danjou
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frederic Aubrun
- Service d'Anesthésie-Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Fanny Roumieu
- Service de gynécologie-Obstétrique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-Marc Labaune
- Service de réanimation néonatale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Laurence Josset
- Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Dssepartment of Virology, Infective Agents Institute, North Hospital Network, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, Lyon, France
| | - Antonin Bal
- Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Dssepartment of Virology, Infective Agents Institute, North Hospital Network, Lyon, France
| | - Bruno Simon
- Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Dssepartment of Virology, Infective Agents Institute, North Hospital Network, Lyon, France
| | - Jean-Laurent Casanova
- Imagine Institute, University of Paris, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Necker Hospital for Sick Children, Paris, France
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, USA
- Howard Hughes Medical Institute, New York, USA
| | - Bruno Lina
- Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Dssepartment of Virology, Infective Agents Institute, North Hospital Network, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, Lyon, France
| | - Jean-Charles Picaud
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service de réanimation néonatale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Corinne Dupont
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Réseau périnatal Aurore, Lyon, France
| | - Cyril Huissoud
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service de gynécologie-obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSA- Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak 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D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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12
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Yonis H, Winkel B, Andersen MP, Wissenberg M, Kober L, Gislason G, Larsen JM, Folke F, Pedersen CT, Sogaard P, Kragholm K. Duration of resuscitation efforts and long-term prognosis following in-hospital cardiac arrest (IHCA). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The decision to terminate resuscitation efforts can be challenging. Notably, the association between duration of resuscitation and long-term survival and functional outcomes after in-hospital cardiac arrest (IHCA) is unknown.
Purpose
To examine 30-day and 1-year survival stratified by duration of resuscitation efforts. Further, to report long term outcome (1-year survival) without anoxic brain damage or nursing home admission among 30-day IHCA survivors.
Methods
We included all patients with IHCA from 13 Danish hospitals between January 1st, 2013 to December 31st, 2015. Patients were only included if there was clinical indication for a resuscitation attempt. Data on IHCA was obtained from the DANARREST database, which was linked to national registries to retrieve information on patient characteristics, survival, anoxic brain damage and nursing home admission. Patients were stratified into four groups (A-D) according to quartiles of duration of resuscitation efforts: Group A (<5 minutes), group B (5–11 minutes), group C (12–20 minutes) and group D (≥21 minutes).
Using multivariable regression analysis, outcomes were standardized for patient age, sex, Charlson Comorbidity Index, witnessed arrest, monitored arrest, cardiopulmonary resuscitation (CPR) prior to arrival of the in-hospital cardiac arrest team and defibrillation.
Results
The study population comprised of 1868 patients, median age was 74 (1st-3rd quartile [Q1-Q3] 65–81 years) and 65.0% were men. In total, 52.1% (n=973) of the patients achieved return of spontaneous circulation (ROSC). The overall median duration of resuscitation was 12 min (Q1-Q3 5–21 min).
The standardized absolute chance of 30-day survival was 63.6% (95% CI 58.0%-69.0%) for group A, 34.0% (95% CI 29.7%-38.2%) for group B, 14.1% (95% CI 10.7%-17.5%) for group C and 9.0% (95% CI 6.8%-11.8%) for group D. Similarly, the chance of 1-year survival was highest for group A (51.5%; 95% CI 46.3%-56.7%) gradually decreasing to 7.0% (95% CI 4.5%-9.5%) in group D (Fig. 1).
Among 30-day survivors of an IHCA, the standardized absolute chance of survival without anoxic brain damage or nursing home admission within one-year post-arrest was highest for patients resuscitated in group A (83.2%; 95% CI 78.4%-88.1%), decreasing to 72.3% (95% CI 64.5%-80.0%) in group B, 68.3% (95% CI 55.3%-81.2%) in group C and 71.1% (95% CI 54.2%-88.0%) in group D (Fig. 2).
Conclusion
Short time to ROSC after in-hospital cardiac arrest is associated with better long-term prognosis. However, the majority of 30-day survivors are alive 1-year post-arrest without anoxic brain damage and without need for nursing home admission despite prolonged resuscitation.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- H Yonis
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - B Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Heart Center, Copenhagen, Denmark
| | - M P Andersen
- Nordsjællands Hospital, Department of Cardiology, Hillerød, Denmark
| | - M Wissenberg
- Copenhagen University Hospital, Department of Cardiology, Herlev and Gentofte, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Heart Center, Copenhagen, Denmark
| | - G Gislason
- Copenhagen University Hospital, Department of Cardiology, Herlev and Gentofte, Denmark
| | - J M Larsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - F Folke
- Copenhagen University Hospital, Department of Cardiology, Herlev and Gentofte, Denmark
| | - C T Pedersen
- Nordsjællands Hospital, Department of Cardiology, Hillerød, Denmark
| | - P Sogaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - K Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
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Richard JC, Yonis H, Bitker L, Roche S, Wallet F, Dupuis C, Serrier H, Argaud L, Thiery G, Delannoy B, Pommier C, Abraham P, Muller M, Aubrun F, Sigaud F, Rigault G, Joffredo E, Mezidi M, Terzi N, Rabilloud M. Open-label randomized controlled trial of ultra-low tidal ventilation without extracorporeal circulation in patients with COVID-19 pneumonia and moderate to severe ARDS: study protocol for the VT4COVID trial. Trials 2021; 22:692. [PMID: 34635128 PMCID: PMC8503716 DOI: 10.1186/s13063-021-05665-z] [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: 03/19/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19 pneumonia, with a mortality rate amounting to 34–50% in moderate and severe ARDS, and is associated with prolonged duration of invasive mechanical ventilation. Such as in non-COVID ARDS, harmful mechanical ventilation settings might be associated with worse outcomes. Reducing the tidal volume down to 4 mL kg−1 of predicted body weight (PBW) to provide ultra-low tidal volume ventilation (ULTV) is an appealing technique to minimize ventilator-inducted lung injury. Furthermore, in the context of a worldwide pandemic, it does not require any additional material and consumables and may be applied in low- to middle-income countries. We hypothesized that ULTV without extracorporeal circulation is a credible option to reduce COVID-19-related ARDS mortality and duration of mechanical ventilation. Methods The VT4COVID study is a randomized, multi-centric prospective open-labeled, controlled superiority trial. Adult patients admitted in the intensive care unit with COVID-19-related mild to severe ARDS defined by a PaO2/FiO2 ratio ≤ 150 mmHg under invasive mechanical ventilation for less than 48 h, and consent to participate to the study will be eligible. Patients will be randomized into two balanced parallels groups, at a 1:1 ratio. The control group will be ventilated with protective ventilation settings (tidal volume 6 mL kg−1 PBW), and the intervention group will be ventilated with ULTV (tidal volume 4 mL kg−1 PBW). The primary outcome is a composite score based on 90-day all-cause mortality as a prioritized criterion and the number of ventilator-free days at day 60 after inclusion. The randomization list will be stratified by site of recruitment and generated using random blocks of sizes 4 and 6. Data will be analyzed using intention-to-treat principles. Discussion The purpose of this manuscript is to provide primary publication of study protocol to prevent selective reporting of outcomes, data-driven analysis, and to increase transparency. Enrollment of patients in the study is ongoing. Trial registration ClinicalTrials.govNCT04349618. Registered on April 16, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05665-z.
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Affiliation(s)
- Jean-Christophe Richard
- Université Lyon 1, Université de Lyon, Lyon, France. .,Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
| | - Hodane Yonis
- Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laurent Bitker
- Université Lyon 1, Université de Lyon, Lyon, France.,Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France
| | - Sylvain Roche
- Université Lyon 1, Université de Lyon, Lyon, France.,Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Florent Wallet
- Medical-Surgical Intensive Care Unit, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France.,International Center of Research in Infectiology, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon University, Lyon, France
| | - Claire Dupuis
- Medical Intensive Care Unit, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Hassan Serrier
- Cellule Innovation, Délégation à la Recherche Clinique et à l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Thiery
- Medical Intensive Care Unit, Hopital Nord, CHU Saint-Etienne, Saint-Priest En Jarez, France
| | - Bertrand Delannoy
- Medical-Surgical Intensive Care Unit, Clinique de la Sauvegarde, Lyon, France
| | - Christian Pommier
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
| | - Paul Abraham
- Surgical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michel Muller
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy Genevois, Pringy, France
| | - Frederic Aubrun
- Surgical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florian Sigaud
- Service de Médecine Intensive Réanimation, CHU Grenoble Alpes, La Tronche, France
| | - Guillaume Rigault
- Service de Médecine Intensive Réanimation, CHU Grenoble Alpes, La Tronche, France.,Université de Grenoble-Alpes, Grenoble, France
| | - Emilie Joffredo
- Medical-Surgical Intensive Care Unit, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mehdi Mezidi
- Université Lyon 1, Université de Lyon, Lyon, France.,Medical Intensive Care Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU Grenoble Alpes, La Tronche, France.,Université de Grenoble-Alpes, Grenoble, France.,INSERM U1042, Grenoble, France
| | - Muriel Rabilloud
- Université Lyon 1, Université de Lyon, Lyon, France.,Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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Chazot G, Bitker L, Mezidi M, Chebib N, Chabert P, Chauvelot L, Folliet L, David G, Provoost J, Yonis H, Richard JC. Prevalence and risk factors of hemodynamic instability associated with preload-dependence during continuous renal replacement therapy in a prospective observational cohort of critically ill patients. Ann Intensive Care 2021; 11:95. [PMID: 34125314 PMCID: PMC8200783 DOI: 10.1186/s13613-021-00883-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Hemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e., passive leg raising in the supine position or Trendelenburg maneuver in the prone position) combined with measurement of cardiac output are highly reliable to identify preload-dependence and may provide new insights into the mechanisms involved in hemodynamic instability related to CRRT (HIRRT). We aimed to assess the prevalence and risk factors of HIRRT associated with preload-dependence in ICU patients. We conducted a single-center prospective observational cohort study in ICU patients with acute kidney injury KDIGO 3, started on CRRT in the last 24 h, and monitored with a PiCCO® device. The primary endpoint was the rate of HIRRT episodes associated with preload-dependence during the first 7 days after inclusion. HIRRT was defined as the occurrence of a mean arterial pressure below 65 mmHg requiring therapeutic intervention. Preload-dependence was assessed by postural tests every 4 h, and during each HIRRT episode. Data are expressed in median [1st quartile–3rd quartile], unless stated otherwise. Results 42 patients (62% male, age 69 [59–77] year, SAPS-2 65 [49–76]) were included 6 [1–16] h after CRRT initiation and studied continuously for 121 [60–147] h. A median of 5 [3–8] HIRRT episodes occurred per patient, for a pooled total of 243 episodes. 131 episodes (54% [CI95% 48–60%]) were associated with preload-dependence, 108 (44%, [CI95% 38–51%]) without preload-dependence, and 4 were unclassified. Multivariate analysis (using variables collected prior to HIRRT) identified the following variables as risk factors for the occurrence of HIRRT associated with preload-dependence: preload-dependence before HIRRT [odds ratio (OR) = 3.82, p < 0.001], delay since last HIRRT episode > 8 h (OR = 0.56, p < 0.05), lactate (OR = 1.21 per 1-mmol L−1 increase, p < 0.05), cardiac index (OR = 0.47 per 1-L min−1 m−2 increase, p < 0.001) and SOFA at ICU admission (OR = 0.91 per 1-point increase, p < 0.001). None of the CRRT settings was identified as risk factor for HIRRT. Conclusions In this single-center study, HIRRT associated with preload-dependence was slightly more frequent than HIRRT without preload-dependence in ICU patients undergoing CRRT. Testing for preload-dependence could help avoiding unnecessary decrease of fluid removal in preload-independent HIRRT during CRRT. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00883-9.
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Affiliation(s)
- Guillaume Chazot
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France.,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France
| | - Mehdi Mezidi
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Nader Chebib
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Paul Chabert
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Louis Chauvelot
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laure Folliet
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Guillaume David
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Judith Provoost
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Hodane Yonis
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive - Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
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Coudereau R, Waeckel L, Cour M, Rimmele T, Pescarmona R, Fabri A, Jallades L, Yonis H, Gossez M, Lukaszewicz AC, Argaud L, Venet F, Monneret G. Emergence of immunosuppressive LOX-1+ PMN-MDSC in septic shock and severe COVID-19 patients with acute respiratory distress syndrome. J Leukoc Biol 2021; 111:489-496. [PMID: 33909917 PMCID: PMC8242532 DOI: 10.1002/jlb.4covbcr0321-129r] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Myeloid‐derived suppressor cells (MDSC) are a heterogeneous population of immature myeloid cells with immunosuppressive properties. In cancer patients, the expression of lectin‐type oxidized LDL receptor 1 (LOX‐1) on granulocytic MDSC identifies a subset of MDSC that retains the most potent immunosuppressive properties. The main objective of the present work was to explore the presence of LOX‐1+ MDSC in bacterial and viral sepsis. To this end, whole blood LOX‐1+ cells were phenotypically, morphologically, and functionally characterized. They were monitored in 39 coronavirus disease‐19 (COVID‐19, viral sepsis) and 48 septic shock (bacterial sepsis) patients longitudinally sampled five times over a 3 wk period in intensive care units (ICUs). The phenotype, morphology, and immunosuppressive functions of LOX‐1+ cells demonstrated that they were polymorphonuclear MDSC. In patients, we observed the significant emergence of LOX‐1+ MDSC in both groups. The peak of LOX‐1+ MDSC was 1 wk delayed with respect to ICU admission. In COVID‐19, their elevation was more pronounced in patients with acute respiratory distress syndrome. The persistence of these cells may contribute to long lasting immunosuppression leaving the patient unable to efficiently resolve infections.
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Affiliation(s)
- Rémy Coudereau
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France
| | - Louis Waeckel
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Edouard Herriot Hospital, Medical Intensive Care Department, Lyon, France
| | - Thomas Rimmele
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France.,Hospices Civils de Lyon, Edouard Herriot Hospital, Anesthesia and Critical Care Medicine Department, Lyon, France
| | - Rémi Pescarmona
- Hospices Civils de Lyon, Lyon-Sud University Hospital, Immunology Laboratory, PierreBénite, France
| | - Astrid Fabri
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France
| | - Laurent Jallades
- Hospices Civils de Lyon, Lyon-Sud University Hospital, Hematology Laboratory, PierreBénite, France
| | - Hodane Yonis
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Medical Intensive Care Department
| | - Morgane Gossez
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France.,International Research Center on Infectiology (CIRI), Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Team "NLRP3 inflammation and immune response to sepsis, Lyon, France
| | - Anne-Claire Lukaszewicz
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France.,Hospices Civils de Lyon, Edouard Herriot Hospital, Anesthesia and Critical Care Medicine Department, Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France
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- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France.,International Research Center on Infectiology (CIRI), Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Team "NLRP3 inflammation and immune response to sepsis, Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France
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16
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Venet F, Cour M, Rimmelé T, Viel S, Yonis H, Coudereau R, Amaz C, Abraham P, Monard C, Casalegno JS, Brengel-Pesce K, Lukaszewicz AC, Argaud L, Monneret G. Longitudinal assessment of IFN-I activity and immune profile in critically ill COVID-19 patients with acute respiratory distress syndrome. Crit Care 2021; 25:140. [PMID: 33845874 PMCID: PMC8040759 DOI: 10.1186/s13054-021-03558-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the onset of the pandemic, only few studies focused on longitudinal immune monitoring in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) whereas their hospital stay may last for several weeks. Consequently, the question of whether immune parameters may drive or associate with delayed unfavorable outcome in these critically ill patients remains unsolved. METHODS We present a dynamic description of immuno-inflammatory derangements in 64 critically ill COVID-19 patients including plasma IFNα2 levels and IFN-stimulated genes (ISG) score measurements. RESULTS ARDS patients presented with persistently decreased lymphocyte count and mHLA-DR expression and increased cytokine levels. Type-I IFN response was initially induced with elevation of IFNα2 levels and ISG score followed by a rapid decrease over time. Survivors and non-survivors presented with apparent common immune responses over the first 3 weeks after ICU admission mixing gradual return to normal values of cellular markers and progressive decrease of cytokines levels including IFNα2. Only plasma TNF-α presented with a slow increase over time and higher values in non-survivors compared with survivors. This paralleled with an extremely high occurrence of secondary infections in COVID-19 patients with ARDS. CONCLUSIONS Occurrence of ARDS in response to SARS-CoV2 infection appears to be strongly associated with the intensity of immune alterations upon ICU admission of COVID-19 patients. In these critically ill patients, immune profile presents with similarities with the delayed step of immunosuppression described in bacterial sepsis.
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Affiliation(s)
- Fabienne Venet
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France. .,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.
| | - Martin Cour
- Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Thomas Rimmelé
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Sebastien Viel
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.,Immunology Laboratory, Lyon-Sud University Hospital, Hospices Civils de Lyon, 69495, Pierre-Bénite, France
| | - Hodane Yonis
- Medical Intensive Care Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004, Lyon, France
| | - Remy Coudereau
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
| | - Camille Amaz
- Centre d'Investigation Clinique de Lyon (CIC 1407 Inserm), Hospices Civils de Lyon, 69677, Lyon, France
| | - Paul Abraham
- Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Céline Monard
- Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Jean-Sebastien Casalegno
- Virology Laboratory, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004, Lyon, France
| | - Karen Brengel-Pesce
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
| | - Anne-Claire Lukaszewicz
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Guillaume Monneret
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
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17
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Benichou N, Lebbah S, Hajage D, Martin-Lefèvre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Schortgen F, Tubach F, Ricard JD, Dreyfuss D, Gaudry S. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial. Ann Intensive Care 2021; 11:56. [PMID: 33830370 PMCID: PMC8032839 DOI: 10.1186/s13613-021-00843-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury. PATIENTS AND METHODS We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected. RESULTS Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34-4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98-1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64-1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred. CONCLUSION Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.
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Affiliation(s)
- Nicolas Benichou
- AP-HP, Hôpital Européen Georges Pompidou, Service de Néphrologie, 75015, Paris, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Saïd Lebbah
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - David Hajage
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Faculté de Médecine Sorbonne, Sorbonne Université, Université, Paris, France
| | | | - Bertrand Pons
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Eric Boulet
- Réanimation Polyvalente, CH René Dubos, 95301, Pontoise, France
| | - Alexandre Boyer
- Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, 33000, Bordeaux, France
| | - Guillaume Chevrel
- Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale Et Médecine Hyperbare, CHU Angers, Université D'Angers, Angers, France
| | | | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.,CARMAS Research Group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Bretagnol
- Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional D'Orléans, BP 6709, 45067, Orléans Cedex, France
| | - Julien Mayaux
- Service de Pneumologie Et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, Faculté de Médecine, Université de Lille, 59000, Lille, France
| | - Bruno Megarbane
- Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France
| | - Marina Thirion
- Réanimation Polyvalente, CH Victor Dupouy, 95107, Argenteuil Cedex, France
| | - Jean-Marie Forel
- Service de Réanimation Des Détresses Respiratoires Aiguës Et Infections Sévères, Hôpital Nord Marseille, 13015, Marseille, France
| | - Julien Maizel
- Service de Réanimation Médicale INSERM U1088, Centre Hospitalier Universitaire de Picardie, Amiens, France
| | - Hodane Yonis
- Réanimation Médicale, Hôpital de La Croix Rousse, 69004, Lyon, France
| | | | - Guillaume Thiery
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Frederique Schortgen
- Centre Hospitalier Inter-Communal, Service de Réanimation Polyvalente Adulte, Créteil, France
| | - Florence Tubach
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Univ Pierre Et Marie Curie, Sorbonne Universités, 75013, Paris, France
| | - Jean-Damien Ricard
- Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, 75018, Paris, France.,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France
| | - Didier Dreyfuss
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Stéphane Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 93008, Bobigny, France. .,Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France.
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18
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Ortillon M, Coudereau R, Cour M, Rimmelé T, Godignon M, Gossez M, Yonis H, Argaud L, Lukaszewicz AC, Venet F, Monneret G. Monocyte CD169 expression in COVID-19 patients upon intensive care unit admission. Cytometry A 2021; 99:466-471. [PMID: 33547747 PMCID: PMC8014094 DOI: 10.1002/cyto.a.24315] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
During the second surge of COVID‐19 in France (fall 2020), we assessed the expression of monocyte CD169 (i.e., Siglec‐1, one of the numerous IFN‐stimulated genes) upon admission to intensive care units of 45 patients with RT‐PCR‐confirmed SARS‐CoV2 pulmonary infection. Overall, CD169 expression was strongly induced on circulating monocytes of COVID‐19 patients compared with healthy donors and patients with bacterial sepsis. Beyond its contribution at the emergency department, CD169 testing may be also helpful for patients' triage at the ICU to rapidly reinforce suspicion of COVID‐19 etiology in patients with acute respiratory failure awaiting for PCR results for definitive diagnosis.
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Affiliation(s)
- Marine Ortillon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France
| | - Remy Coudereau
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Médecine intensive-réanimation, Lyon, France
| | - Thomas Rimmelé
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'anesthésie-réanimation, Lyon, France
| | - Marine Godignon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France
| | - Morgane Gossez
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France
| | - Hodane Yonis
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Medical intensive Care Department, Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Médecine intensive-réanimation, Lyon, France
| | - Anne-Claire Lukaszewicz
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'anesthésie-réanimation, Lyon, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard-Lyon 1, Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d'Immunologie, Lyon, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Hôpital Edouard Herriot, Lyon, France
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19
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Yonis H, Ringgren KB, Andersen MP, Wissenberg M, Gislason G, Køber L, Torp-Pedersen C, Søgaard P, Larsen JM, Folke F, Kragholm KH. Long-term outcomes after in-hospital cardiac arrest: 30-day survival and 1-year follow-up of mortality, anoxic brain damage, nursing home admission and in-home care. Resuscitation 2020; 157:23-31. [PMID: 33069866 DOI: 10.1016/j.resuscitation.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/26/2022]
Abstract
AIMS Long-term functional outcomes after in-hospital cardiac arrest (IHCA) are scarcely studied. However, survivors are at risk of neurological impairment from anoxic brain damage which could affect quality of life and lead to need of care at home or in a nursing home. METHODS We linked data on ICHAs in Denmark with nationwide registries to report 30-day survival as well as factors associated with survival. Furthermore, among 30-day survivors we reported the one-year cumulative risk of anoxic brain damage or nursing home admission with mortality as the competing risk. RESULTS In total, 517 patients (27.3%) survived to day 30 out of 1892 eligible patients; 338 (65.9%) were men and median age was 68 (interquartile range 58-76). Lower age, witnessed arrest by health care personnel, monitored arrest and presumed cardiac cause of arrest were associated with 30-day survival. Among 454 30-day survivors without prior anoxic brain damage or nursing home admission, the risk of anoxic brain damage or nursing home admission within the first-year post-arrest was 4.6% (n = 21; 95% CI 2.7-6.6%) with a competing risk of death of 15.6% (n = 71; 95% CI 12.3-19.0%), leaving 79.7% (n = 362) alive without anoxic brain damage or nursing home admission. When adding the risk of need of in-home care among 343 30-day survivors without prior home care needs, 68.8% (n = 236) were alive without any of the composite events one-year post-arrest. CONCLUSION The majority of 30-day survivors of IHCA are alive at one-year follow-up without anoxic brain damage, nursing home admission or need of in-home care.
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Affiliation(s)
- H Yonis
- Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark; Department of Cardiology, Aalborg University Hospital, Denmark.
| | | | | | - M Wissenberg
- Gentofte University Hospital, Department of Cardiology, Denmark; Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Denmark
| | - L Køber
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - C Torp-Pedersen
- Department of Clinical Research, Nordsjaellands Hospital, Denmark; Department of Cardiology, Aalborg University Hospital, Denmark
| | - P Søgaard
- Department of Cardiology, Aalborg University Hospital, Denmark
| | | | - F Folke
- Gentofte University Hospital, Department of Cardiology, Denmark; Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark
| | - K Hay Kragholm
- Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark; Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
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20
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Mezidi M, Daviet F, Chabert P, Hraiech S, Bitker L, Forel JM, Yonis H, Gragueb I, Dhelft F, Papazian L, Richard JC, Guervilly C. Transpulmonary pressures in obese and non-obese COVID-19 ARDS. Ann Intensive Care 2020; 10:129. [PMID: 33001320 PMCID: PMC7527784 DOI: 10.1186/s13613-020-00745-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on respiratory mechanics of COVID-19 ARDS patients are scarce. Respiratory mechanics and response to positive expiratory pressure (PEEP) may be different in obese and non-obese patients. METHODS We investigated esophageal pressure allowing determination of transpulmonary pressures (PL ) and elastances (EL) during a decremental PEEP trial from 20 to 6 cm H2O in a cohort of COVID-19 ARDS patients. RESULTS Fifteen patients were investigated, 8 obese and 7 non-obese patients. PEEP ≥ 16 cm H2O for obese patients and PEEP ≥10 cm H2O for non-obese patients were necessary to obtain positive expiratory PL. Change of PEEP did not alter significantly ΔPL or elastances in obese patients. However, in non-obese patients lung EL and ΔPL increased significantly with PEEP increase. Chest wall EL was not affected by PEEP variations in both groups.
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Affiliation(s)
- Mehdi Mezidi
- Medical ICU, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University, Lyon, France
| | - Florence Daviet
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France.,Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
| | - Paul Chabert
- Medical ICU, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sami Hraiech
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France.,Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
| | - Laurent Bitker
- Medical ICU, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University, Lyon, France.,CREATIS, CNRS UMR5220, INSERM U1044, INSA, Lyon, France
| | - Jean-Marie Forel
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France.,Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
| | - Hodane Yonis
- Medical ICU, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ines Gragueb
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France
| | - Francois Dhelft
- Medical ICU, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Papazian
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France.,Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
| | - Jean-Christophe Richard
- Medical ICU, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University, Lyon, France.,CREATIS, CNRS UMR5220, INSERM U1044, INSA, Lyon, France
| | - Christophe Guervilly
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France. .,Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France.
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21
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Chauvelot L, Bitker L, Dhelft F, Mezidi M, Orkisz M, Davila Serrano E, Penarrubia L, Yonis H, Chabert P, Folliet L, David G, Provoost J, Lecam P, Boussel L, Richard JC. Quantitative-analysis of computed tomography in COVID-19 and non COVID-19 ARDS patients: A case-control study. J Crit Care 2020; 60:169-176. [PMID: 32854088 PMCID: PMC7423516 DOI: 10.1016/j.jcrc.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of this study was to assess whether the computed tomography (CT) features of COVID-19 (COVID+) ARDS differ from those of non-COVID-19 (COVID-) ARDS patients. MATERIALS AND METHODS The study is a single-center prospective observational study performed on adults with ARDS onset ≤72 h and a PaO2/FiO2 ≤ 200 mmHg. CT scans were acquired at PEEP set using a PEEP-FiO2 table with VT adjusted to 6 ml/kg predicted body weight. RESULTS 22 patients were included, of whom 13 presented with COVID-19 ARDS. Lung weight was significantly higher in COVID- patients, but all COVID+ patients presented supranormal lung weight values. Noninflated lung tissue was significantly higher in COVID- patients (36 ± 14% vs. 26 ± 15% of total lung weight at end-expiration, p < 0.01). Tidal recruitment was significantly higher in COVID- patients (20 ± 12 vs. 9 ± 11% of VT, p < 0.05). Lung density histograms of 5 COVID+ patients with high elastance (type H) were similar to those of COVID- patients, while those of the 8 COVID+ patients with normal elastance (type L) displayed higher aerated lung fraction.
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Affiliation(s)
- Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - François Dhelft
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Mehdi Mezidi
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, 69622 Villeurbanne, Cedex, France
| | - Maciej Orkisz
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Eduardo Davila Serrano
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Ludmilla Penarrubia
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France
| | - Hodane Yonis
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Paul Chabert
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Laure Folliet
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Guillaume David
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Judith Provoost
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Pierre Lecam
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Loic Boussel
- Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France; Service de Radiologie, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 93 grande rue de la Croix-Rousse, 69004 Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 7 Avenue Jean Capelle, 69621 Villeurbanne, France.
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22
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Guérin C, Terzi N, Galerneau LM, Mezidi M, Yonis H, Baboi L, Kreitmann L, Turbil E, Cour M, Argaud L, Louis B. Lung and chest wall mechanics in patients with acute respiratory distress syndrome, expiratory flow limitation, and airway closure. J Appl Physiol (1985) 2020; 128:1594-1603. [PMID: 32352339 DOI: 10.1152/japplphysiol.00059.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tidal expiratory flow limitation (EFL), which may herald airway closure (AC), is a mechanism of loss of aeration in ARDS. In this prospective, short-term, two-center study, we measured static and dynamic chest wall (Est,cw and Edyn,cw) and lung (Est,L and Edyn,L) elastance with esophageal pressure, EFL, and AC at 5 cmH2O positive end-expiratory pressure (PEEP) in intubated, sedated, and paralyzed ARDS patients. For EFL determination, we used the atmospheric method and a new device allowing comparison of tidal flow during expiration to PEEP and to atmosphere. AC was validated when airway opening pressure (AOP) assessed from volume-pressure curve was found greater than PEEP by at least 1 cmH2O. EFL was defined whenever flow did not increase between exhalation to PEEP and to atmosphere over all or part of expiration. Elastance values were expressed as percentage of normal predicted values (%N). Among the 25 patients included, eight had EFL (32%) and 13 AOP (52%). Between patients with and without EFL Edyn,cw [median (1st to 3rd quartiles)] was 70 (16-127) and 102 (70-142) %N (P = 0.32) and Edyn,L338 (332-763) and 224 (160-275) %N (P < 0.001). The corresponding values for Est,cw and Est,L were 70 (56-88) and 85 (64-103) %N (P = 0.35) and 248 (206-348) and 170 (144-195) (P = 0.02), respectively. Dynamic EL had an area receiver operating characteristic curve of 0.88 [95% confidence intervals 0.83-0.92] for EFL and 0.74[0.68-0.79] for AOP. Higher Edyn,L was accurate to predict EFL in ARDS patients; AC can occur independently of EFL, and both should be assessed concurrently in ARDS patients.NEW & NOTEWORTHY Expiratory flow limitation (EFL) and airway closure (AC) were observed in 32% and 52%, respectively, of 25 patients with ARDS investigated during mechanical ventilation in supine position with a positive end-expiratory pressure of 5 cmH2O. The performance of dynamic lung elastance to detect expiratory flow limitation was good and better than that to detect airway closure. The vast majority of patients with EFL also had AC; however, AC can occur in the absence of EFL.
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Affiliation(s)
- Claude Guérin
- Medecine Intensive-Réanimation, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France.,Institut Mondor de Recherches Biomédicales INSERM 955 CNRS ERL 7000, Créteil, France
| | - Nicolas Terzi
- Medecine Intensive-Réanimation, CHU Grenoble-Alpes, Grenoble, France.,Université de Grenoble-Alpes, Grenoble, France
| | - Louis-Marie Galerneau
- Medecine Intensive-Réanimation, CHU Grenoble-Alpes, Grenoble, France.,Université de Grenoble-Alpes, Grenoble, France
| | - Mehdi Mezidi
- Université de Lyon, Lyon, France.,Médecine Intensive-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Hodane Yonis
- Médecine Intensive-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Loredana Baboi
- Médecine Intensive-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Louis Kreitmann
- Medecine Intensive-Réanimation, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Emanuele Turbil
- Department of Anesthesia and Critical Care, University of Sassari, Sassari, Italy
| | - Martin Cour
- Medecine Intensive-Réanimation, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Laurent Argaud
- Medecine Intensive-Réanimation, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Bruno Louis
- Institut Mondor de Recherches Biomédicales INSERM 955 CNRS ERL 7000, Créteil, France
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23
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Messika J, Boussard N, Guérin C, Michel F, Nseir S, Yonis H, Barbier CM, Rouzé A, Fouilloux V, Gaudry S, Ricard JD, Silverman H, Dreyfuss D. Strengths of the French end-of-life Law as Well as its Shortcomings in Handling Intractable Disputes Between Physicians and Families. New Bioeth 2020; 26:53-74. [PMID: 32065064 DOI: 10.1080/20502877.2020.1720421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
French end-of-life law aims at protecting patients from unreasonable treatments, but has been used to force caregivers to prolong treatments deemed unreasonable. We describe six cases (five intensive care unit patients including two children) where families disagreed with a decision to withdraw treatments and sued medical teams. An emergent inquiry was instigated by the families. In two cases, the court rejected the families' inquiries. In two cases, the families appealed the decision, and in both the first jurisdiction decision was confirmed, compelling caregivers to pursue treatments, even though they deemed them unreasonable. We discuss how this law may be perverted. Legal procedures may result in the units' disorganisation and give rise to caregivers' stress. Families' requests may be subtended by religious beliefs. French end-of-life law has benefits in theoretically constraining physicians to withhold or withdraw disproportionate therapies. These cases underline some caveats and the perverse effects of its literal reading.
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Affiliation(s)
- Jonathan Messika
- Université de Paris, Infection, Antimicrobials, Modelling, Evolution, IAME, UMR 1137, INSERM, Paris, France.,Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Noël Boussard
- CHRU Nancy-Brabois, Hôpital d'Enfants, Réanimation Pédiatrique Spécialisée, Vandoeuvre-Les-Nancy, France
| | - Claude Guérin
- Hospices civils de Lyon, Médecine intensive-Réanimation, Hôpital de la Croix-Rousse, Lyon, France.,Université de Lyon, Lyon, France.,INSERM 955, Créteil, France
| | - Fabrice Michel
- AP-HM Pediatric Anesthesia and Intensive Care Timone Hospital, Marseille, France.,Aix-Marseille Univ. CNRS, EFS, Marseille, France
| | - Saad Nseir
- CHU Lille, Critical Care Center, Lille, France.,School of Medicine, University of Lille, Lille, France
| | - Hodane Yonis
- Hospices civils de Lyon, Médecine intensive-Réanimation, Hôpital de la Croix-Rousse, Lyon, France
| | - Claire-Marie Barbier
- CHRU Nancy-Brabois, Hôpital d'Enfants, Réanimation Pédiatrique Spécialisée, Vandoeuvre-Les-Nancy, France
| | | | | | - Stephane Gaudry
- AP-HP Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, Bobigny, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Common and Rare Kidney Diseases: from Molecular Events to Precision Medicine, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Jean-Damien Ricard
- Université de Paris, Infection, Antimicrobials, Modelling, Evolution, IAME, UMR 1137, INSERM, Paris, France.,Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Henry Silverman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Didier Dreyfuss
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, Colombes, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Common and Rare Kidney Diseases: from Molecular Events to Precision Medicine, Sorbonne Université, Hôpital Tenon, Paris, France.,Université de Paris, Paris, France
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24
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Yonis H, Bundgaard K, Noermark Mortensen R, Wissenberg M, Gislason G, Koeber L, Torp-Pedersen C, Mosgaard Larsen J, Hay Kragholm K. 5226The majority of 30-day survivors of in-hospital cardiac arrest are alive one-year post-arrest without anoxic brain damage, admission to nursing home or need of in-home care. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Survivors of in-hospital cardiac arrest are at risk of anoxic brain damage that can lead to admission to nursing home or need of in-home care. However, studies on long-term outcomes after in-hospital cardiac arrest are scarce with previous research focusing on short term measures such as survival-to-discharge.
Purpose
This study aimed to investigate the composite endpoint of nursing home admission or anoxic brain damage among 30-day survivors of in-hospital cardiac arrest within the first-year post-arrest. As a sub analysis, we also investigated the additional need of in-home care.
Methods
All in-hospital cardiac arrests in 13 Danish hospitals during 2013–2015 were identified from the DANARREST register. Inclusion criteria were indication for a resuscitation attempt and survival to day 30. Patients who, prior to arrest, already lived in a nursing home, and/or had anoxic brain damage were excluded. In the sub analysis patients who received in-home care prior to arrest were also excluded. The DANARREST data was linked to nationwide registries including the National Patient Register and administrative nursing home and home care registries using the Danish Civil Registration Number, a unique personal identification number that is given to every citizen in Denmark.
Results
The primary study population comprised of 454 (26.3%) 30 day-survivors out of 1723 eligible patients. Median age was 67 (Q1-Q3 57–75); 301 (66.9%) were men. In this group, the 1-year risk of anoxic brain damage or nursing home admission was 4.6% (95% CI 2.7%- 6.6%) with a competing risk of death of 15.6% (95% CI 12.3%-19.0%), leaving 79.8% alive without anoxic brain damage or nursing home admission at one-year follow-up (see Figure 1A).
The sub study population comprised of 343 30-day survivors with a 1-year risk of anoxic brain damage, nursing home admission or need of in-home care of 23.6% (95% CI 19.1%-28.1%). The competing risk of death was 7.6% (95% CI 4.8%-10.4%), leaving 68.8% alive without anoxic brain damage, nursing home admission or need of in-home care at one-year follow-up (see Figure 1B).
Figure 1
Conclusion
The majority of 30-day survivors of in-hospital cardiac arrest were alive at one-year follow-up without being diagnosed with anoxic brain damage, admitted to nursing home or without need of in-home care.
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Affiliation(s)
- H Yonis
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - K Bundgaard
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - R Noermark Mortensen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - M Wissenberg
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - J Mosgaard Larsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - K Hay Kragholm
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
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25
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Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Verney C, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Tubach F, Ricard JD, Dreyfuss D. Timing of Renal Support and Outcome of Septic Shock and Acute Respiratory Distress Syndrome. A Post Hoc Analysis of the AKIKI Randomized Clinical Trial. Am J Respir Crit Care Med 2019; 198:58-66. [PMID: 29351007 DOI: 10.1164/rccm.201706-1255oc] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown. OBJECTIVES To examine the effect of an early compared with a delayed RRT initiation strategy on 60-day mortality according to baseline sepsis status, ARDS status, and severity. METHODS Post hoc analysis of the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial. MEASUREMENTS AND MAIN RESULTS Subgroups were defined according to baseline characteristics: sepsis status (Sepsis-3 definition), ARDS status (Berlin definition), Simplified Acute Physiology Score 3 (SAPS 3), and Sepsis-related Organ Failure Assessment (SOFA). Of 619 patients, 348 (56%) had septic shock and 207 (33%) had ARDS. We found no significant influence of the baseline sepsis status (P = 0.28), baseline ARDS status (P = 0.94), and baseline severity scores (P = 0.77 and P = 0.46 for SAPS 3 and SOFA, respectively) on the comparison of 60-day mortality according to RRT initiation strategy. A delayed RRT initiation strategy allowed 45% of patients with septic shock and 46% of patients with ARDS to escape RRT. Urine output was higher in the delayed group. Renal function recovery occurred earlier with the delayed RRT strategy in patients with septic shock or ARDS (P < 0.001 and P = 0.003, respectively). Time to successful extubation in patients with ARDS was not affected by RRT strategy (P = 0.43). CONCLUSIONS Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or ARDS. Unnecessary and potentially risky procedures might often be avoided in these fragile populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01932190).
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Affiliation(s)
- Stéphane Gaudry
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France.,2 Unité Mixte de Recherche (UMR) S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, French National Institute of Health and Medical Research (INSERM), Paris, France
| | - David Hajage
- 3 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Centre d'Investigation Clinique 1421, INSERM, Paris, France.,4 Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France.,5 Département de Biostatistiques, Santé Publique, et Information Médicale, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Frédérique Schortgen
- 6 Service de Réanimation Polyvalente Adulte, Centre Hospitalier Inter-communal, Créteil, France
| | | | - Charles Verney
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - Bertrand Pons
- 8 Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Pointe à Pitre-Abymes, France.,9 CHU de la Guadeloupe, Pointe-à-Pitre, France
| | - Eric Boulet
- 10 Réanimation Polyvalente, Centre Hospitalier René Dubos, Pontoise, France
| | - Alexandre Boyer
- 11 Réanimation Médicale, CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Guillaume Chevrel
- 12 Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- 13 Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers, Angers, France
| | | | - Nicolas de Prost
- 15 Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, AP-HP, Créteil, France.,16 Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- 17 Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Bretagnol
- 18 Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, Orléans, France
| | - Julien Mayaux
- 19 Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris France
| | - Saad Nseir
- 20 Centre de Réanimation, CHU de Lille, Lille, France.,21 Faculté de Médecine, Université de Lille, Lille, France
| | - Bruno Megarbane
- 22 Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Université Paris-Diderot, INSERM U1144, Paris, France
| | - Marina Thirion
- 23 Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Jean-Marie Forel
- 24 Service de Réanimation des Détresses Respiratoires Aiguës et Infections Sévères, Hôpital Nord Marseille, Marseille, France
| | - Julien Maizel
- 25 Service de Réanimation Médicale CHU de Picardie, INSERM U1088, Amiens, France
| | - Hodane Yonis
- 26 Réanimation Médicale, Hôpital de la Croix Rousse, Lyon, France
| | | | - Guillaume Thiery
- 8 Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Pointe à Pitre-Abymes, France.,9 CHU de la Guadeloupe, Pointe-à-Pitre, France
| | - Florence Tubach
- 3 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Centre d'Investigation Clinique 1421, INSERM, Paris, France.,5 Département de Biostatistiques, Santé Publique, et Information Médicale, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.,28 Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Jean-Damien Ricard
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France.,29 Université Paris Diderot, Sorbonne Paris Cité, Infection, Antimicrobials, Modelling, Evolution (IAME), UMRS 1137, Paris, France; and.,30 INSERM, IAME, U1137, Paris, France
| | - Didier Dreyfuss
- 1 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France.,29 Université Paris Diderot, Sorbonne Paris Cité, Infection, Antimicrobials, Modelling, Evolution (IAME), UMRS 1137, Paris, France; and.,30 INSERM, IAME, U1137, Paris, France
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26
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Ruste M, Bitker L, Yonis H, Riad Z, Louf-Durier A, Lissonde F, Perinel-Ragey S, Guerin C, Richard JC. Hemodynamic effects of extended prone position sessions in ARDS. Ann Intensive Care 2018; 8:120. [PMID: 30535921 PMCID: PMC6286298 DOI: 10.1186/s13613-018-0464-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/30/2018] [Indexed: 01/24/2023] Open
Abstract
Background Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to describe hemodynamic response to PP and during the shift from PP to supine position. Methods The study was a single-center retrospective observational study, performed on ARDS patients, undergoing at least one PP session under monitoring by transpulmonary thermodilution. PP sessions performed more than 10 days after ARDS onset, or with any missing cardiac index measurements before (T1), at the end (T3), and after the PP session (T4) were excluded. Changes in hemodynamic parameters during PP were tested after statistical adjustment for volume of fluid challenges, vasopressor and dobutamine dose at each time point to take into account therapeutic changes during PP sessions. Results In total, 107 patients fulfilled the inclusion criteria, totalizing 197 PP sessions. Changes in cardiac index between T1 and T2 (early response to PP) and between T1 and T3 (late response to PP) were significantly correlated (R2 = 0.42, p < 0.001) with a concordance rate amounting to 85%. Cardiac index increased significantly between T1 and T3 in 49 sessions (25% [95% confidence interval (CI95%) 18–32%]), decreased significantly in 46 (23% [CI95% 16–31%]), and remained stable in 102 (52% [CI95% 45–59%]). Global end-diastolic volume index (GEDVI) increased slightly but significantly from 719 ± 193 mL m−2 at T1 to 757 ± 209 mL m−2 at T3 and returned to baseline values at T4. Cardiac index and oxygen delivery decreased slightly but significantly from T3 to T4, without detectable increase in lactate level. Patients who increased their cardiac index during PP had significantly lower CI, GEDVI, global ejection fraction at T1, and received significantly more fluids than patients who did not. Conclusion PP is associated with an increase in cardiac index in 18% to 32% of all PP sessions and a sustained increase in GEDVI reversible after return to supine position. Return from prone to supine position is associated with a slight hemodynamic impairment. Electronic supplementary material The online version of this article (10.1186/s13613-018-0464-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Ruste
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laurent Bitker
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France
| | - Hodane Yonis
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Zakaria Riad
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Aurore Louf-Durier
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Floriane Lissonde
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Sophie Perinel-Ragey
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Claude Guerin
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France.,IMRB, INSERM 955Eq13, Créteil, France
| | - Jean-Christophe Richard
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
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27
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Mezidi M, Parrilla FJ, Yonis H, Riad Z, Böhm SH, Waldmann AD, Richard JC, Lissonde F, Tapponnier R, Baboi L, Mancebo J, Guérin C. Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome. Ann Intensive Care 2018; 8:86. [PMID: 30203117 PMCID: PMC6134472 DOI: 10.1186/s13613-018-0434-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 06/25/2018] [Accepted: 09/01/2018] [Indexed: 02/05/2023] Open
Abstract
Background In acute respiratory distress syndrome (ARDS) patients, it has recently been proposed to set positive end-expiratory pressure (PEEP) by targeting end-expiratory transpulmonary pressure. This approach, which relies on the measurement of absolute esophageal pressure (Pes), has been used in supine position (SP) and has not been investigated in prone position (PP). Our purposes were to assess Pes-guided strategy to set PEEP in SP and in PP as compared with a PEEP/FIO2 table and to explore the early (1 h) and late (16 h) effects of PP on lung and chest wall mechanics. Results We performed a prospective, physiologic study in two ICUs in university hospitals on ARDS patients with PaO2/FIO2 < 150 mmHg. End-expiratory Pes (Pes,ee) was measured in static (zero flow) condition. Patients received PEEP set according to a PEEP/FIO2 table then according to the Pes-guided strategy targeting a positive (3 ± 2 cmH2O) static end-expiratory transpulmonary pressure in SP. Then, patients were turned to PP and received same amount of PEEP from PEEP/FIO2 table then Pes-guided strategy. Respiratory mechanics, oxygenation and end-expiratory lung volume (EELV) were measured after 1 h of each PEEP in each position. For the rest of the 16-h PP session, patients were randomly allocated to either PEEP strategy with measurements done at the end. Thirty-eight ARDS patients (27 male), mean ± SD age 63 ± 13 years, were included. There were 33 primary ARDS and 26 moderate ARDS. PaO2/FIO2 ratio was 120 ± 23 mmHg. At same PEEP/FIO2 table-related PEEP, Pes,ee averaged 9 ± 4 cmH2O in both SP and PP (P = 0.88). With PEEP/FIO2 table and Pes-guided strategy, PEEP was 10 ± 2 versus 12 ± 4 cmH2O in SP and 10 ± 2 versus 12 ± 5 cmH2O in PP (PEEP strategy effect P = 0.05, position effect P = 0.96, interaction P = 0.96). With the Pes-guided strategy, chest wall elastance increased regardless of position. Lung elastance and transpulmonary driving pressure decreased in PP, with no effect of PEEP strategy. Both PP and Pes-guided strategy improved oxygenation without interaction. EELV did not change with PEEP strategy. At the end of PP session, respiratory mechanics did not vary but EELV and PaO2/FIO2 increased while PaCO2 decreased. Conclusions There was no impact of PP on Pes measurements. PP had an immediate improvement effect on lung mechanics and a late lung recruitment effect independent of PEEP strategy. Electronic supplementary material The online version of this article (10.1186/s13613-018-0434-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mehdi Mezidi
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | | | - Hodane Yonis
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Zakaria Riad
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Stephan H Böhm
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany
| | - Andreas D Waldmann
- Swisstom AG, Lanquart, Switzerland.,Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, Kliniken der Stadt Koln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jean-Christophe Richard
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Floriane Lissonde
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Romain Tapponnier
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Loredana Baboi
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jordi Mancebo
- Intensive Care Unit, Sant Pau Hospital, Barcelona, Spain
| | - Claude Guérin
- Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. .,Université de Lyon, Lyon, France. .,INSERM 955, Créteil, France.
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Yonis H, Mortaza S, Baboi L, Mercat A, Guérin C. Expiratory Flow Limitation Assessment in Patients with Acute Respiratory Distress Syndrome. A Reappraisal. Am J Respir Crit Care Med 2018; 198:131-134. [DOI: 10.1164/rccm.201711-2326le] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | | | - Alain Mercat
- CHU LarreyAngers, France
- Université d’AngersAngers, France
| | - Claude Guérin
- Hospices Civils de LyonLyon, France
- Université de LyonLyon, Franceand
- INSERM 955Créteil, France
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Moro B, Baboi L, Yonis H, Subtil F, Louis B, Guérin C. Accuracy of Delivery and Effects on Absolute Humidity of Low Tidal Volume by ICU Ventilators. Respir Care 2018; 63:1253-1263. [PMID: 29945908 DOI: 10.4187/respcare.06132] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND During extracorporeal membrane oxygenation for ARDS, a range of 1-4 mL/kg predicted body weight tidal volume (VT) is commonly used. We explored whether such a low VT could be adequately delivered by ICU ventilators, and whether such low VTs prevent the heated humidifier (HH) from reaching the recommended target of 33 mg/L absolute humidity (AH). METHODS We attached a lung model to 5 ICU ventilators set in volume controlled mode and body temperature and pressure saturated. We ran 2 protocols over a 100-280 mL VT range used with adult or neonatal breathing circuit at a breathing frequency (f) of 15 (f15) or 30 (f30) breaths/min. In the first protocol, with the HH off, VT was measured with a dedicated data logger and expressed in body temperature and pressure saturated. The relationships of measured VT to set VT were studied, and the relative error in VT was analyzed within its 10% boundaries. In the second protocol, the HH was on, and we measured AH using a psychrometric method. The relationship of AH to set VT was analyzed with linear regression. RESULTS For the 5 ventilators used, the slope (95% CI) between measured VT versus set VT averaged 0.93 (0.92-0.93), 0.93 (0.93-0.94), 0.91 (0.90-0.91), and 0.91 (0.90-0.91) mL/mL for adult and neonatal circuits at f15 and f30, respectively (P < .05 vs 1 in each instance), indicating a systematic under-delivery of VT. The VT relative error fell within the ±10% accuracy range for only 2 ventilators with adult circuits at f15 and f30. AH increased linearly with VT. The recommended target of 33 mg/L AH was reached with all of the ventilators for the adult circuit at f30 only. The minimum volume that met the recommended threshold for AH was 100, 150, 190, 160, and 100 mL for the G5, Carestation, PB980, Servo-U, and V500 ventilators, respectively, at f30. CONCLUSION Low VT was systematically under-delivered by modern ICU ventilators by roughly 7-9%. To meet the recommended target of 33 mg/L AH, adult circuit at f30 should be used.
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Affiliation(s)
- Barbara Moro
- Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Loredana Baboi
- Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hodane Yonis
- Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France and Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Bruno Louis
- Institut Mondor de Recherche Biomédicale INSERM 955, Créteil, France
| | - Claude Guérin
- Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France. .,Institut Mondor de Recherche Biomédicale INSERM 955, Créteil, France
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Yonis H, Bitker L, Aublanc M, Perinel Ragey S, Riad Z, Lissonde F, Louf-Durier A, Debord S, Gobert F, Tapponnier R, Guérin C, Richard JC. Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation. Crit Care 2017; 21:295. [PMID: 29208025 PMCID: PMC5718075 DOI: 10.1186/s13054-017-1881-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 08/21/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Predicting fluid responsiveness may help to avoid unnecessary fluid administration during acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate the diagnostic performance of the following methods to predict fluid responsiveness in ARDS patients under protective ventilation in the prone position: cardiac index variation during a Trendelenburg maneuver, cardiac index variation during an end-expiratory occlusion test, and both pulse pressure variation and change in pulse pressure variation from baseline during a tidal volume challenge by increasing tidal volume (VT) to 8 ml.kg-1. Methods This study is a prospective single-center study, performed in a medical intensive care unit, on ARDS patients with acute circulatory failure in the prone position. Patients were studied at baseline, during a 1-min shift to the Trendelenburg position, during a 15-s end-expiratory occlusion, during a 1-min increase in VT to 8 ml.kg-1, and after fluid administration. Fluid responsiveness was deemed present if cardiac index assessed by transpulmonary thermodilution increased by at least 15% after fluid administration. Results There were 33 patients included, among whom 14 (42%) exhibited cardiac arrhythmia at baseline and 15 (45%) were deemed fluid-responsive. The area under the receiver operating characteristic (ROC) curve of the pulse contour-derived cardiac index change during the Trendelenburg maneuver and the end-expiratory occlusion test were 0.90 (95% CI, 0.80–1.00) and 0.65 (95% CI, 0.46–0.84), respectively. An increase in cardiac index ≥ 8% during the Trendelenburg maneuver enabled diagnosis of fluid responsiveness with sensitivity of 87% (95% CI, 67–100), and specificity of 89% (95% CI, 72–100). The area under the ROC curve of pulse pressure variation and change in pulse pressure variation during the tidal volume challenge were 0.52 (95% CI, 0.24–0.80) and 0.59 (95% CI, 0.31–0.88), respectively. Conclusions Change in cardiac index during a Trendelenburg maneuver is a reliable test to predict fluid responsiveness in ARDS patients in the prone position, while neither change in cardiac index during end-expiratory occlusion, nor pulse pressure variation during a VT challenge reached acceptable predictive performance to predict fluid responsiveness in this setting. Trial registration ClinicalTrials.gov, NCT01965574. Registered on 16 October 2013. The trial was registered 6 days after inclusion of the first patient. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1881-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hodane Yonis
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laurent Bitker
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Mylène Aublanc
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Sophie Perinel Ragey
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Zakaria Riad
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Floriane Lissonde
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Aurore Louf-Durier
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Sophie Debord
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Florent Gobert
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France
| | - Romain Tapponnier
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Claude Guérin
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université LYON I, Lyon, France.,IMRB, INSERM 955Eq13, Créteil, France
| | - Jean-Christophe Richard
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
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Gobert F, Yonis H, Tapponnier R, Fernandez R, Labaune MA, Burle JF, Barbier J, Vincent B, Cleyet M, Richard JC, Guérin C. Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter. Respir Care 2017; 62:1505-1519. [PMID: 28900041 DOI: 10.4187/respcare.05460] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. METHODS This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (VT) in the preceding inspiration. Early extubation success rate was defined as the proportion of subjects not re-intubated 48 h after extubation. Diagnostic performance of CPF and VT was assessed by using the area under the curve of the receiver operating characteristic curve. Cut-off values for CPF and VT were defined according to median values and used to describe the performance of a predictive test combining them with risk factors of early extubation failure. RESULTS Among 673 subjects admitted, 92 had a cough assessment before extubation. For the 81 subjects with early extubation success, the median CPF was -67.7 L/min, and median VT was 0.646 L. For the 11 subjects with early extubation failure, the median CPF was -57.3 L/min, and median VT was 0.448 L. Area under the curve was 0.61 (95% CI 0.37-0.83) for CPF and 0.64 (95% CI 0.42-0.84) for CPF/VT combined. After dichotomization (CPF < -60 L/min or VT > 0.55 L), there was a synergistic effect to predict early extubation success (P < .001). The predictive value of success reached 94.2% for CPF/VT combined. The overall model including pH before extubation < 7.45 reached a 66.7% predictive value of failure. CONCLUSIONS CPF measured using the flow meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. (ClinicalTrials.gov registration NCT02847221.).
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Affiliation(s)
- Florent Gobert
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France. .,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Hodane Yonis
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Romain Tapponnier
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Raul Fernandez
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Marie-Aude Labaune
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Jean-François Burle
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Jack Barbier
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Bernard Vincent
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Maria Cleyet
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Jean-Christophe Richard
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Claude Guérin
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,INSERM 955 Equipe 13, Créteil, France
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Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer D, Jost D, Lamhaut L, Beganton F, Cariou A, Meyer G, Jouven X, Bureau C, Charpentier J, Salem OBH, Guillemet L, Arnaout M, Ferre A, Geri G, Mongardon N, Pène F, Chiche JD, Mira JP, Labro G, Belon F, Luu VP, Chenet J, Besch G, Puyraveau M, Piton G, Capellier G, Martin M, Lascarrou JB, Le Thuaut A, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Henry-Laguarrigue M, Colin G, Reignier J, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Robert-Edan V, Lakhal K, Quartin A, Hobbs B, Cely C, Bell C, Pham T, Schein R, Geng Y, Ng C, Ehrmann S, Gandonnière CS, Boisramé-Helms J, Le Tilly O, De Bretagne IB, Mercier E, Mankikian J, Bretagnol A, Meziani F, Halimi JM, Le Guellec CB, Gaudry S, Hajage D, Tubach F, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Mayaux J, Nseir S, Ricard JD, Dreyfuss D, Robert R, Garzotto F, Kipnis E, Tetta C, Ronco C, Schnell D, Aurelie B, Reynaud M, Clec’h C, Benyamina M, Vincent F, Mariat C, Bornstain C, Gloulou O, Boussarsar M, Zelmat SA, Batouche DD, Chaffi B, Mazour F, Benatta N, Fathallah I, Aloui R, Zoubli A, Rouleau S, Kouraichi N, Fathallah I, Kouraichi N, Salem S, Vicaut E, Megarbane B, Ambroise D, Loriot AM, Bourgogne E, Megarbane B, Leroy C, Ghadhoune H, Jihene G, Trabelsi I, Allouche H, Brahmi H, Samet M, Ghord HE, Lebeau R, Laplanche JL, Benturquia N, Cohen Y, Megarbane B, Blel Y, M’rad A, Essafi F, Benabderrahim A, Jouffroy R, Resiere D, Sanchez B, Inamo J, Megarbane B, Morel J, Batouche DD, Zerhouni A, Tabeliouna K, Negadi A, Mentouri Z, Le Gall F, Hanouz JL, Normand H, Khoury A, Sall FS, Legrand M, De Luca A, Pugin A, Pazart L, Vidal C, Leroux F, Khoury A, L’Her E, Marjanovic N, Khoury A, Desmettre T, Terreaux J, Lambert C, Ragey SP, Baboi L, Bazin JE, Koffel C, Dhonneur G, Bouzit Z, Bradai L, Ayed IB, Aissa F, Darmon M, Haouache H, Marechal Y, Biston P, Piagnerelli M, Bortolotti P, Colling D, Colas V, Voisin B, Dewavrin F, Onimus T, Cantier M, Girardie P, Saulnier F, Urbina T, Nguyen Y, Druoton AL, Soudant M, Barraud D, Conrad M, Cravoisy-Popovic A, Nace L, Morisot A, Bollaert PE, Martin R, Bitker L, Richard JC, Brossier D, Goyer I, Marquis C, Lampin M, Duhamel A, Béhal H, Guérot E, Dhaoui T, Godeffroy V, Devouge E, Evrard D, Delepoulle F, Racoussot S, Grandbastien B, Lampin M, Heilbronner C, Roy E, Canet E, Masson A, Hadchouel-Duvergé A, Rigourd V, Delacroix E, Wroblewski I, Pin I, Ego A, Payen V, Debillon T, Millet A, De Montmollin E, Denot J, Berthelot V, Thueux E, Reymond M, De Larrard A, Amblard A, Leger PL, Aoul NT, Lemiale V, Oziel J, Voiriot G, Brule N, Moreau AS, Marhbène T, Sellami S, Jamoussi A, Ayed S, Mhiri E, Slim L, Khelil JB, Besbes M, Neuville M, Chawki S, Hamdi A, Ciroldi M, Cottereau A, Obadia E, Zerbib Y, Andrejak C, Ricome S, Dupont H, Baudin F, Timsit JF, Dureau P, Tanguy A, Arbelot C, Ben HK, Charfeddine A, Granger B, Laporte L, Hermetet C, Regaieg K, Khemakhem R, Sonneville R, Chelly H, Cheikh CM, Mountij H, Rghioui K, Haddad W, Cherkab R, Barrou H, Naima A, bennani OM, Regaieg K, Fayssoil A, Douib A, Samet A, Cungi PJ, Nguyen C, Cotte J, D’aranda E, Meaudre E, Avaro JP, Slaoui MT, Mokline A, Stojkovic T, Rahmani I, Laajili A, Amri H, Gharsallah L, Gasri B, Tlaili S, Hammouda R, Messadi AA, Behin A, Ogna A, Lofaso F, Laforet P, Wahbi K, Prigent H, Duboc D, Orlikowski D, Eymard B, Annane D, Le Guennec L, Cholet C, Bréchot N, Hekimian G, Besset S, Lebreton G, Nieszkowska A, Trouillet JL, Leprince P, Combes A, Luyt CE, Griton M, Sesay M, De Panthou NS, Bienvenu T, Biais M, Nouette-Gaulain K, Fossat G, Baudin F, Coulanges C, Bobet S, Dupont A, Courtes L, Benzekri D, Kamel T, Muller G, Bercault N, Barbier F, Runge I, Skarzynski M, Mathonnet A, Boulain T, Jouan Y, Teixera N, Hassen-Khodja C, Guillon A, Gaborit C, Grammatico-Guillon L, Rebière C, Azoulay E, Misset B, Ruckly S, Garrouste-Orgeas M, Kentish-Barnes N, Duranteau J, Thuong M, Joseph L, Renault A, Lesieur O, Larbi AGS, Viquesnel G, Zuber B, Marque S, Kandelman S, Pichon N, Floccard B, Galon M, Chevret S, Kentish-Barnes N, Seegers V, Legriel S, Jaber S, Lefrant JY, Reuter D, Guisset O, Cracco C, Seguin A, Durand-Gasselin J, Thirion M, Cohen-Solal Z, Foulgoc H, Rogier J, Delobbe E, Schortgen F, Asfar P, Julie BH, Grimaldi D, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Radermacher P, Kentish-Barnes N, Makunza JN, Nathalie MK, Pierre A, Adolphe KM, Mahieu R, Reydel T, Jamet A, Chudeau N, Huntzinger J, Grange S, Courte A, Lemarie J, Gibot S, Champey J, Dellamonica J, Du Cheyron D, Contou D, Tadié JM, Cour M, Beduneau G, Marchalot A, Guérin L, Jochmans S, Terzi N, Preau S, Brun-Buisson C, Dessap AM, Vedrenne-Cloquet M, Breinig S, Jung C, Brussieux M, Marcoux MO, Durrmeyer X, Blondé R, Angoulvant F, Grasset J, Naudin J, Dauger S, Remy S, Kolev-Descamp K, Demaret J, Monneret G, 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H, Moussati M, Belhabiche K, Mir S, Abada S, Amel Z, Aouffen N, Bouzit Z, Grati AH, Dhonneur GF, Boussarsar M, Lau N, Mezhari I, Roucaud N, Le Meur M, Paulet R, Coudray JM, Ghomari WI, Boumlik R, Peigne V, Daban JL, Boutonnet M, Lenoir B, Yassine H, Mohamed CC, Khalid A, Ihssan M, Said E, Said S, Jazia AB, Fatima J, Wafa S, Maha B, Khaoula BA, Sami T, Abdallah Taeib B, Medhioub FK, Rollet-Cohen V, Sachs P, Merchaoui Z, Renolleau S, Oualha M, Eloi M, Jean S, Demoulin M, Valentin C, Guilbert J, Walti H, Carbajal R, Leger PL, Karaca-Altintas Y, Botte A, Labreuche J, Drumez E, Devos P, Bour F, Leclerc F, Ahmed A, khaled M, Louati A, Aida B, Ammar K, Narjess G, Ahmed H, Asma B, Jaballah NB, Leger PL, Pansiot J, Besson V, Palmier B, Baud O, Cauli B, Charriaut-Marlangue C, Mansuy A, Michel F, Le Bel S, Boubnova J, Ughetto F, Ovaert C, Fouilloux V, Paut O, Jacquet-Lagrèze M, Tiebergien N, Hanna N, Evain JN, Baudin F, Courtil-Teyssedre S, Bompard D, Lilot M, Chardonal L, Fellahi JL, Claverie C, Pouessel G, Dorkenoo A, Renaudin JM, Eb M, Deschildre A, Leteurtre S, Yassine H, Kamal B, Adil O, Ouafa A, Mouhamed M, Rachid C, Lahoucine B, Dachraoui F, Nakkaa S, Zaineb H, Mlika D. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225387 DOI: 10.1186/s13613-016-0223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Tubach F, Ricard JD, Dreyfuss D. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med 2016; 375:122-33. [PMID: 27181456 DOI: 10.1056/nejmoa1603017] [Citation(s) in RCA: 625] [Impact Index Per Article: 78.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The timing of renal-replacement therapy in critically ill patients who have acute kidney injury but no potentially life-threatening complication directly related to renal failure is a subject of debate. METHODS In this multicenter randomized trial, we assigned patients with severe acute kidney injury (Kidney Disease: Improving Global Outcomes [KDIGO] classification, stage 3 [stages range from 1 to 3, with higher stages indicating more severe kidney injury]) who required mechanical ventilation, catecholamine infusion, or both and did not have a potentially life-threatening complication directly related to renal failure to either an early or a delayed strategy of renal-replacement therapy. With the early strategy, renal-replacement therapy was started immediately after randomization. With the delayed strategy, renal-replacement therapy was initiated if at least one of the following criteria was met: severe hyperkalemia, metabolic acidosis, pulmonary edema, blood urea nitrogen level higher than 112 mg per deciliter, or oliguria for more than 72 hours after randomization. The primary outcome was overall survival at day 60. RESULTS A total of 620 patients underwent randomization. The Kaplan-Meier estimates of mortality at day 60 did not differ significantly between the early and delayed strategies; 150 deaths occurred among 311 patients in the early-strategy group (48.5%; 95% confidence interval [CI], 42.6 to 53.8), and 153 deaths occurred among 308 patients in the delayed-strategy group (49.7%, 95% CI, 43.8 to 55.0; P=0.79). A total of 151 patients (49%) in the delayed-strategy group did not receive renal-replacement therapy. The rate of catheter-related bloodstream infections was higher in the early-strategy group than in the delayed-strategy group (10% vs. 5%, P=0.03). Diuresis, a marker of improved kidney function, occurred earlier in the delayed-strategy group (P<0.001). CONCLUSIONS In a trial involving critically ill patients with severe acute kidney injury, we found no significant difference with regard to mortality between an early and a delayed strategy for the initiation of renal-replacement therapy. A delayed strategy averted the need for renal-replacement therapy in an appreciable number of patients. (Funded by the French Ministry of Health; ClinicalTrials.gov number, NCT01932190.).
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Affiliation(s)
- Stéphane Gaudry
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - David Hajage
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Fréderique Schortgen
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Laurent Martin-Lefevre
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Bertrand Pons
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Eric Boulet
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Alexandre Boyer
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Guillaume Chevrel
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Nicolas Lerolle
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Dorothée Carpentier
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Nicolas de Prost
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Alexandre Lautrette
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Anne Bretagnol
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Julien Mayaux
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Saad Nseir
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Bruno Megarbane
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Marina Thirion
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Jean-Marie Forel
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Julien Maizel
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Hodane Yonis
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Philippe Markowicz
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Guillaume Thiery
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Florence Tubach
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Jean-Damien Ricard
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
| | - Didier Dreyfuss
- From Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes (S.G., J.-D.R., D.D.), Universite Paris Diderot, Sorbonne Paris Cité, Epidémiologie Clinique-Évaluation Économique Appliqué aux Populations Vulnérables (ECEVE) (S.G., D.H., F.T.), Institut National de la Santé et de la Recherche Médicale (INSERM), ECEVE, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425 (S.G., D.H., F.T.), APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (D.H.), Service de Pneumologie et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière (J. Mayaux), Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM Unité 1144, Université Paris Diderot (B.M.), APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, CIC-EC 1425 (F.T.), and Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Sorbonne Paris Cité (J.-D.R., D.D.), Paris, APHP, Hôpitaux Universitaires Henri Mondor, Service de Réanimation Médicale (F.S.), and APHP, Hôpitaux Universitaires Henri Mondor, Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood, Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group and Université Paris-Est Créteil Val de Marne (N.P.), Créteil, Réanimation Médico-Chirurgicale, Centre Hospitalier Général, La Roche-sur-Yon (L.M.-L.), Service de Réanimation, Centre Hospitalier Universitaire (CHU) de Pointe à Pitre-Abymes, Guadeloupe (B.P., G.T.), Réanimation Polyvalente, CH René Dubos, Pontoise (E.B.), Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, Bordeaux (A. Boyer), Service de Réanimation, CH Sud Francilien, Corbeil Essonne (G.C.), Département de Réanimation Médicale et Médecine Hyperbare, CHU Angers, Université d'Angers
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Bitker L, Bayle F, Yonis H, Gobert F, Leray V, Taponnier R, Debord S, Stoian-Cividjian A, Guérin C, Richard JC. Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients. Crit Care 2016; 20:44. [PMID: 26907782 PMCID: PMC4765055 DOI: 10.1186/s13054-016-1227-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/30/2015] [Accepted: 02/11/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hypotension is a frequent complication of intermittent hemodialysis (IHD) performed in intensive care units (ICUs). Passive leg raising (PLR) combined with continuous measurement of cardiac output is highly reliable to identify preload dependence, and may provide new insights into the mechanisms involved in IHD-related hypotension. The aim of this study was to assess prevalence and risk factors of preload dependence-related hypotension during IHD in the ICU. METHODS A single-center prospective observational study performed on ICU patients undergoing IHD for acute kidney injury and monitored with a PiCCO® device. Primary end points were the prevalence of hypotension (defined as a mean arterial pressure below 65 mm Hg) and hypotension associated with preload dependence. Preload dependence was assessed by the passive leg raising test, and considered present if the systolic ejection volume increased by at least 10% during the test, as assessed continuously by the PiCCO® device. RESULTS Forty-seven patients totaling 107 IHD sessions were included. Hypotension was observed in 61 IHD sessions (57%, CI95%: 47-66%) and was independently associated with inotrope administration, higher SOFA score, lower time lag between ICU admission and IHD session, and lower MAP at IHD session onset. Hypotension associated with preload dependence was observed in 19% (CI95%: 10-31%) of sessions with hypotension, and was associated with mechanical ventilation, lower SAPS II, higher pulmonary vascular permeability index (PVPI) and dialysate sodium concentration at IHD session onset. ROC curve analysis identified PVPI and mechanical ventilation as the only variables with significant diagnostic performance to predict hypotension associated with preload dependence (respective AUC: 0.68 (CI95%: 0.53-0.83) and 0.69 (CI95%: 0.54-0.85). A PVPI ≥ 1.6 at IHD session onset predicted occurrence of hypotension associated with preload dependence during IHD with a sensitivity of 91% (CI95%: 59-100%), and a specificity of 53% (CI95%: 42-63%). CONCLUSIONS The majority of hypotensive episodes occurring during intermittent hemodialysis are unrelated to preload dependence and should not necessarily lead to reduction of fluid removal by hemodialysis. However, high PVPI at IHD session onset and mechanical ventilation are risk factors of preload dependence-related hypotension, and should prompt reduction of planned fluid removal during the session, and/or an increase in session duration.
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Affiliation(s)
- Laurent Bitker
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Frédérique Bayle
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Hodane Yonis
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
- Faculté de médecine Lyon-Est, Université de Lyon, Université Lyon I, 92 Rue Pasteur, 69007, Lyon, France.
| | - Florent Gobert
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
- Faculté de médecine Lyon-Est, Université de Lyon, Université Lyon I, 92 Rue Pasteur, 69007, Lyon, France.
| | - Véronique Leray
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Romain Taponnier
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Sophie Debord
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
- Faculté de médecine Lyon-Est, Université de Lyon, Université Lyon I, 92 Rue Pasteur, 69007, Lyon, France.
| | - Alina Stoian-Cividjian
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
- Faculté de médecine Lyon-Est, Université de Lyon, Université Lyon I, 92 Rue Pasteur, 69007, Lyon, France.
| | - Claude Guérin
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
- Faculté de médecine Lyon-Est, Université de Lyon, Université Lyon I, 92 Rue Pasteur, 69007, Lyon, France.
- Institut Mondor de Recherche Biomédicale (IMRB), INSERM 955 Eq13, Faculté de Médecine de Créteil, 8, rue du Général Sarrail, 94010, Créteil, France.
| | - Jean-Christophe Richard
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
- Faculté de médecine Lyon-Est, Université de Lyon, Université Lyon I, 92 Rue Pasteur, 69007, Lyon, France.
- CREATIS, CNRS UMR 5220, INSERM 1044, INSA-Lyon, Université Lyon 1, 7 avenue Jean Capelle, 69621, Villeurbanne, France.
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Yonis H, Richard JC. Place du magnésium et de l’hélium dans la prise en charge de l’asthme aigu grave. Réanimation 2016. [DOI: 10.1007/s13546-015-1146-3] [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: 11/29/2022]
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Richard JC, Yonis H, Bayle F, Gobert F, Taponnier R, Leray V, Guérin C. Assessment of fluid responsiveness during prone position in ards. a validation study. Intensive Care Med Exp 2015. [PMCID: PMC4797887 DOI: 10.1186/2197-425x-3-s1-a591] [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: 11/24/2022] Open
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Baboi L, Penet H, Stoian A, Yonis H, Gobert F, Bayle F, Leray V, Tapponnier R, Richard JC, Guérin C. Resistance of endotracheal tubes measured after extubation in ICU patients. Intensive Care Med Exp 2015. [PMCID: PMC4796960 DOI: 10.1186/2197-425x-3-s1-a385] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Baboi L, Penet H, Stoian A, Yonis H, Gobert F, Tapponnier R, Bayle F, Leray V, Richard JC, Guérin C. Bench study of automated tube compensation versus pressure support after extubation in icu patients. Intensive Care Med Exp 2015. [PMCID: PMC4797976 DOI: 10.1186/2197-425x-3-s1-a278] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yonis H, Crognier L, Conil JM, Serres I, Rouget A, Virtos M, Cougot P, Minville V, Fourcade O, Georges B. Patient-ventilator synchrony in Neurally Adjusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV): a prospective observational study. BMC Anesthesiol 2015; 15:117. [PMID: 26253784 PMCID: PMC4528778 DOI: 10.1186/s12871-015-0091-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Weaning from mechanical ventilation is associated with the presence of asynchronies between the patient and the ventilator. The main objective of the present study was to demonstrate a decrease in the total number of patient-ventilator asynchronies in invasively ventilated patients for whom difficulty in weaning is expected by comparing neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) ventilatory modes. Methods We performed a prospective, non-randomized, non-interventional, single-center study. Thirty patients were included in the study. Each patient included in the study benefited in an unpredictable way from both modes of ventilation, NAVA or PSV. Patients were successively ventilated for 23 h in NAVA or in PSV, and then they were ventilated for another 23 h in the other mode. Demographic, biological and ventilatory data were collected during this period. The two modes of ventilatory support were compared using the non-parametric Wilcoxon test after checking for normal distribution by the Kolmogorov–Smirnov test. The groups were compared using the chi-square test. Results The median level of support was 12.5 cmH2O (4–20 cmH2O) in PSV and 0.8 cmH2O/μvolts (0.2–3 cmH2O/μvolts) in NAVA. The total number of asynchronies per minute in NAVA was lower than that in PSV (0.46 vs 1, p < 0.001). The asynchrony index was also reduced in NAVA compared with PSV (1.73 vs 3.36, p < 0.001). In NAVA, the percentage of ineffective efforts (0.77 vs 0.94, p = 0.036) and the percentage of auto-triggering were lower compared with PSV (0.19 vs 0.71, p = 0.038). However, there was a higher percentage of double triggering in NAVA compared with PSV (0.76 vs 0.71, p = 0.046). Conclusion The total number of asynchronies in NAVA is lower than that in PSV. This finding reflects improved patient-ventilator interaction in NAVA compared with the PSV mode, which is consistent with previous studies. Our study is the first to analyze patient-ventilator asynchronies in NAVA and PSV on such an important duration. The decrease in the number of asynchronies in NAVA is due to reduced ineffective efforts and auto-triggering.
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Affiliation(s)
- Hodane Yonis
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Laure Crognier
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Jean-Marie Conil
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Isabelle Serres
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Antoine Rouget
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Marie Virtos
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Pierre Cougot
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Vincent Minville
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Olivier Fourcade
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
| | - Bernard Georges
- Service de Réanimation Polyvalente, CHU Rangueil, 1 Avenue Jean Poulhès, Pôle d'Anesthésie et Réanimation, TSA 50032, 31059, Toulouse, Cedex 9, France.
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Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Tubach F, Pons B, Boulet E, Boyer A, Lerolle N, Chevrel G, Carpentier D, Lautrette A, Bretagnol A, Mayaux J, Thirion M, Markowicz P, Thomas G, Dellamonica J, Richecoeur J, Darmon M, de Prost N, Yonis H, Megarbane B, Loubières Y, Blayau C, Maizel J, Zuber B, Nseir S, Bigé N, Hoffmann I, Ricard JD, Dreyfuss D. Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (AKIKI). Trials 2015; 16:170. [PMID: 25902813 PMCID: PMC4407416 DOI: 10.1186/s13063-015-0718-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/10/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is currently no validated strategy for the timing of renal replacement therapy (RRT) for acute kidney injury (AKI) in the intensive care unit (ICU) when short-term life-threatening metabolic abnormalities are absent. No adequately powered prospective randomized study has addressed this issue to date. As a result, significant practice heterogeneity exists and may expose patients to either unnecessary hazardous procedures or undue delay in RRT. METHODS/DESIGN This is a multicenter, prospective, randomized, open-label parallel-group clinical trial that compares the effect of two RRT initiation strategies on overall survival of critically ill patients receiving intravenous catecholamines or invasive mechanical ventilation and presenting with AKI classification stage 3 (KDIGO 2012). In the 'early' strategy, RRT is initiated immediately. In the 'delayed' strategy, clinical and metabolic conditions are closely monitored and RRT is initiated only when one or more events (severity criteria) occur, including: oliguria or anuria for more than 72 hours after randomization, serum urea concentration >40 mmol/l, serum potassium concentration >6 mmol/l, serum potassium concentration >5.5 mmol/l persisting despite medical treatment, arterial blood pH <7.15 in a context of pure metabolic acidosis (PaCO2 < 35 mmHg) or in a context of mixed acidosis with a PaCO2 ≥ 50 mmHg without possibility of increasing alveolar ventilation, acute pulmonary edema due to fluid overload despite diuretic therapy leading to severe hypoxemia requiring oxygen flow rate >5 l/min to maintain SpO2 > 95% or FiO2 > 50% under invasive or noninvasive mechanical ventilation. The primary outcome measure is overall survival, measured from randomization (D0) until death, regardless of the cause. The minimum follow-up duration for each patient will be 60 days. Two interim analyses are planned, blinded to group allocation. It is expected that there will be 620 subjects in all. DISCUSSION The AKIKI study will be one of the very few large randomized controlled trials evaluating mortality according to the timing of RRT in critically ill patients with AKI classification stage 3 (KDIGO 2012). Results should help clinicians decide when to initiate RRT. TRIAL REGISTRATION ClinicalTrials.gov NCT01932190.
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Affiliation(s)
- Stéphane Gaudry
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010, Paris, France. .,INSERM, ECEVE, U1123, F-75010, Paris, France.
| | - David Hajage
- INSERM, CIC-EC 1425, UMR 1123, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, Paris, France. .,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, Paris, France.
| | - Fréderique Schortgen
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.
| | - Laurent Martin-Lefevre
- Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France.
| | - Florence Tubach
- INSERM, CIC-EC 1425, UMR 1123, Paris, France. .,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France.
| | - Bertrand Pons
- Service de Réanimation, CHU de Pointe à Pitre - Abymes, CHU de la Guadeloupe, Basse-Terre, France.
| | - Eric Boulet
- Réanimation polyvalente, CH René Dubos, 95301, Pontoise, France.
| | | | - Nicolas Lerolle
- Département de réanimation médicale et médecine hyperbare, CHU Angers, Université d'Angers, Angers, France.
| | - Guillaume Chevrel
- Intensive Care Unit, Centre Hospitalier Sud Francilien, Corbeil Essonnes, France.
| | | | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel Montpied Teaching Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Anne Bretagnol
- Medical-Surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, , 45067, Orleans Cedex, France.
| | - Julien Mayaux
- Service de Pneumologie et Réanimation médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
| | - Marina Thirion
- Réanimation polyvalente, CH Victor Dupouy, 95107, Argenteil Cedex, France.
| | | | - Guillemette Thomas
- Service de Réanimation Détresses respiratoires aiguës et infections sévères, Hôpital Nord, Marseille, 13015, France.
| | - Jean Dellamonica
- Medical Intensive Care Unit, Archet I University Hospital, 151 Route Saint Antoine de Ginestière, 06200, Nice, France.
| | | | - Michael Darmon
- Medical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, Saint-Priest en Jarez, France.
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France. .,CARMAS research group, UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France.
| | - Hodane Yonis
- Réanimation médicale, Hôpital de la Croix Rousse, 69000, Lyon, France.
| | - Bruno Megarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris Diderot, Paris, France.
| | - Yann Loubières
- Réanimation, CH Poissy Saint Germain en laye, 78300, Poissy, France.
| | - Clarisse Blayau
- Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020, Paris, France.
| | - Julien Maizel
- Medical intensive care unit, University medical center and INSERM U-1088, University of Picardie, Amiens, France.
| | - Benjamin Zuber
- Réanimation médico-chirurgicale, CH Versailles, 78000, Versailles, France.
| | - Saad Nseir
- Centre de Réanimation, Hôpital R. Salengro, CHRU de Lill, Rue E. Laine, 59037, Lille Cedex, France.
| | - Naïke Bigé
- AP-HP, Hôpital Saint Antoine, Service de Réanimation Médicale, Paris, F-75012, France.
| | - Isabelle Hoffmann
- INSERM, CIC-EC 1425, UMR 1123, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France.
| | - Jean-Damien Ricard
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France. .,INSERM, IAME, U1137, F-75018, Paris, France.
| | - Didier Dreyfuss
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 178 rue des Renouillers, F-92700, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018, Paris, France. .,INSERM, IAME, U1137, F-75018, Paris, France. .,Present address: Intensive care unit, Hôpital Louis Mourier, 178 rue des Renouillers, 92110, Colombes, France.
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Richard JC, Bayle F, Bourdin G, Leray V, Debord S, Delannoy B, Stoian AC, Wallet F, Yonis H, Guerin C. Preload dependence indices to titrate volume expansion during septic shock: a randomized controlled trial. Crit Care 2015; 19:5. [PMID: 25572383 PMCID: PMC4310180 DOI: 10.1186/s13054-014-0734-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/23/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In septic shock, pulse pressure or cardiac output variation during passive leg raising are preload dependence indices reliable at predicting fluid responsiveness. Therefore, they may help to identify those patients who need intravascular volume expansion, while avoiding unnecessary fluid administration in the other patients. However, whether their use improves septic shock prognosis remains unknown. The aim of this study was to assess the clinical benefits of using preload dependence indices to titrate intravascular fluids during septic shock. METHODS In a single-center randomized controlled trial, 60 septic shock patients were allocated to preload dependence indices-guided (preload dependence group) or central venous pressure-guided (control group) intravascular volume expansion with 30 patients in each group. The primary end point was time to shock resolution, defined by vasopressor weaning. RESULTS There was no significant difference in time to shock resolution between groups (median (interquartile range) 2.0 (1.2 to 3.1) versus 2.3 (1.4 to 5.6) days in control and preload dependence groups, respectively). The daily amount of fluids administered for intravascular volume expansion was higher in the control than in the preload dependence group (917 (639 to 1,511) versus 383 (211 to 604) mL, P = 0.01), and the same held true for red cell transfusions (178 (82 to 304) versus 103 (0 to 183) mL, P = 0.04). Physiologic variable values did not change over time between groups, except for plasma lactate (time over group interaction, P <0.01). Mortality was not significantly different between groups (23% in the preload dependence group versus 47% in the control group, P = 0.10). Intravascular volume expansion was lower in the preload dependence group for patients with lower simplified acute physiology score II (SAPS II), and the opposite was found for patients in the upper two SAPS II quartiles. The amount of intravascular volume expansion did not change across the quartiles of severity in the control group, but steadily increased with severity in the preload dependence group. CONCLUSIONS In patients with septic shock, titrating intravascular volume expansion with preload dependence indices did not change time to shock resolution, but resulted in less daily fluids intake, including red blood cells, without worsening patient outcome. TRIAL REGISTRATION Clinicaltrials.gov NCT01972828. Registered 11 October 2013.
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Affiliation(s)
- Jean-Christophe Richard
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, 20 Avenue Albert Einstein, 69621, Villeurbanne, France.
| | - Frédérique Bayle
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Gael Bourdin
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Véronique Leray
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Sophie Debord
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Bertrand Delannoy
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Alina Cividjian Stoian
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France.
| | - Florent Wallet
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Hodane Yonis
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France.
| | - Claude Guerin
- Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France. .,CREATIS INSERM 1044 CNRS 5220, 20 Avenue Albert Einstein, 69621, Villeurbanne, France.
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Guerin C, Bayle F, Leray V, Debord S, Stoian A, Yonis H, Roudaut JB, Bourdin G, Devouassoux-Shisheboran M, Bucher E, Ayzac L, Lantuejoul S, Philipponnet C, Kemeny JL, Souweine B, Richard JC. Open lung biopsy in nonresolving ARDS frequently identifies diffuse alveolar damage regardless of the severity stage and may have implications for patient management. Intensive Care Med 2014; 41:222-30. [DOI: 10.1007/s00134-014-3583-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/24/2014] [Indexed: 11/29/2022]
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