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Huet O, Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Bouglé A, Kerforne T, Lasocki S, Eljezi V, Dessertaine G, Amour J, Chapalain X. Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial. Crit Care 2024; 28:64. [PMID: 38419119 PMCID: PMC10902989 DOI: 10.1186/s13054-024-04842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND After cardiac surgery, post-operative delirium (PoD) is acknowledged to have a significant negative impact on patient outcome. To date, there is no valuable and specific treatment for PoD. Critically ill patients often suffer from poor sleep condition. There is an association between delirium and sleep quality after cardiac surgery. This study aimed to establish whether promoting sleep using an overnight infusion of dexmedetomidine reduces the incidence of delirium after cardiac surgery. METHODS Randomized, pragmatic, multicentre, double-blind, placebo controlled trial from January 2019 to July 2021. All adult patients aged 65 years or older requiring elective cardiac surgery were randomly assigned 1:1 either to the dexmedetomidine group or the placebo group on the day of surgery. Dexmedetomidine or matched placebo infusion was started the night after surgery from 8 pm to 8 am and administered every night while the patient remained in ICU, or for a maximum of 7 days. Primary outcome was the occurrence of postoperative delirium (PoD) within the 7 days after surgery. RESULTS A total of 348 patients provided informed consent, of whom 333 were randomized: 331 patients underwent surgery and were analysed (165 assigned to dexmedetomidine and 166 assigned to placebo). The incidence of PoD was not significantly different between the two groups (12.6% vs. 12.4%, p = 0.97). Patients treated with dexmedetomidine had significantly more hypotensive events (7.3% vs 0.6%; p < 0.01). At 3 months, functional outcomes (Short-form 36, Cognitive failure questionnaire, PCL-5) were comparable between the two groups. CONCLUSION In patients recovering from an elective cardiac surgery, an overnight infusion of dexmedetomidine did not decrease postoperative delirium. Trial registration This trial was registered on ClinicalTrials.gov (number: NCT03477344; date: 26th March 2018).
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Affiliation(s)
- Olivier Huet
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France.
| | - Thomas Gargadennec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Jean-Ferréol Oilleau
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Bertrand Rozec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
| | - Nicolas Nesseler
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, University Hospital of Rennes, Rennes, France
| | - Adrien Bouglé
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Thomas Kerforne
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine CHU de POITIERS, Poitiers, France
| | - Sigismond Lasocki
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, CHU de ANGERS, I, Angers, France
| | - Vedat Eljezi
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Géraldine Dessertaine
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Amour
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Privé Jacques Cartier, Massy, France
| | - Xavier Chapalain
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
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Descamps R, Amour J, Besnier E, Bougle A, Charbonneau H, Charvin M, Cholley B, Desebbe O, Fellahi JL, Frasca D, Labaste F, Lena D, Mahjoub Y, Mertes PM, Molliex S, Moury PH, Moussa MD, Oilleau JF, Ouattara A, Provenchere S, Rozec B, Parienti JJ, Fischer MO. Perioperative individualized hemodynamic optimization according to baseline mean arterial pressure in cardiac surgery patients: Rationale and design of the OPTIPAM randomized trial. Am Heart J 2023; 261:10-20. [PMID: 36934980 DOI: 10.1016/j.ahj.2023.03.005] [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] [Received: 11/04/2022] [Revised: 03/02/2023] [Accepted: 03/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Postoperative morbidity and mortality after cardiac surgery with cardiopulmonary bypass (CPB) remain high despite recent advances in both anesthesia and perioperative management. Among modifiable risk factors for postoperative complications, optimal arterial pressure during and after surgery has been under debate for years. Recent data suggest that optimizing arterial pressure to the baseline of the patient may improve outcomes. We hypothesize that optimizing the mean arterial pressure (MAP) to the baseline MAP of the patient during cardiac surgery with CPB and during the first 24 hours postoperatively may improve outcomes. STUDY DESIGN The OPTIPAM trial (NCT05403697) will be a multicenter, randomized, open-label controlled trial testing the superiority of optimized MAP management as compared with a MAP of 65 mm Hg or more during both the intraoperative and postoperative periods in 1,100 patients scheduled for cardiac surgery with CPB. The primary composite end point is the occurrence of acute kidney injury, neurological complications including stroke or postoperative delirium, and death. The secondary end points are hospital and intensive care unit lengths of stay, Day 7 and Day 90 mortality, postoperative cognitive dysfunction on Day 7 and Day 90, and quality of life at Day 7 and Day 90. Two interim analyses will assess the safety of the intervention. CONCLUSION The OPTIPAM trial will assess the effectiveness of an individualized target of mean arterial pressure in cardiac surgery with CPB in reducing postoperative morbidity. CLINICAL TRIAL REGISTRATION NCT05403697.
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Affiliation(s)
- Richard Descamps
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Caen, France.
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery (IPRA), Hôpital Privé Jacques Cartier, Massy, France
| | - Emmanuel Besnier
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Department of Anesthesiology and Critical Care, Rouen, France
| | - Adrien Bougle
- Sorbonne Université, GRC 29, Assistance Publique - Hôpitaux de Paris, DMU DREAM, Département d'Anesthésie et Réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Hélène Charbonneau
- Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, France
| | - Martin Charvin
- CHU Clermont-Ferrand, Médecine Péri-Opératoire (MC, FL, PJ, A-LC, EF); Université Clermont-Auvergne (EF), France
| | | | - Olivier Desebbe
- Department of Anesthesiology and Intensive Care, Ramsay Sante Sauvegarde Clinic, Lyon, France
| | - Jean-Luc Fellahi
- Service d'anesthésie-Réanimation, Hôpital Louis Pradel, Boulevard Pinel, Bron Cedex, France
| | - Denis Frasca
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, France
| | - François Labaste
- Anesthesiology and Intensive Care Department, University Hospital of Toulouse, Toulouse, France
| | - Diane Lena
- Institut Arnault Tzanck, Cardiologie Médico-chirurgicale, Saint Laurent du Var, France
| | - Yazine Mahjoub
- Anesthesia and Critical Care Medicine Department, Amiens University Medical Center, Amiens, France
| | - Paul-Michel Mertes
- Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Serge Molliex
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Nord, Saint Etienne, France
| | | | | | - Jean-Ferreol Oilleau
- Department of Anaesthesia and Critical Care, Brest University Hospital, Brest, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medical Surgical Centre, Bordeaux, France
| | - Sophie Provenchere
- Anesthesiology and surgical critical care department, DMU PARABOL, AP-HP, Bichat Hospital, Paris, France
| | - Bertand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
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Bouglé A, Tuffet S, Federici L, Leone M, Monsel A, Dessalle T, Amour J, Dahyot-Fizelier C, Barbier F, Luyt CE, Langeron O, Cholley B, Pottecher J, Hissem T, Lefrant JY, Veber B, Legrand M, Demoule A, Kalfon P, Constantin JM, Rousseau A, Simon T, Foucrier A. Correction to: Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial. Intensive Care Med 2022; 48:992-994. [PMID: 35727349 DOI: 10.1007/s00134-022-06776-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Sophie Tuffet
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil, France
| | - Marc Leone
- Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesioloy and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Dessalle
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de l'Hôpital, 45100, Orléans, France
| | - Charles-Edouard Luyt
- Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Olivier Langeron
- Multidisciplinary Intensive Care Unit, Department of Anesthesioloy and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Cholley
- Département d'Anesthésie et Réanimation, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Julien Pottecher
- Anaesthesiology, Critical Care and Perioperative Medicine, Strasbourg University Hospital-EA3072, FMTS, Strasbourg, France
| | - Tarik Hissem
- General Intensive Care Unit, Sud-Essonne Hospital, Étampes, France
| | - Jean-Yves Lefrant
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France
| | - Benoit Veber
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Matthieu Legrand
- Department of Anaesthesiology and Critical Care and Burn Unit, Groupe Hospitalier Lariboisière-Saint Louis, APHP, Paris, France
| | - Alexandre Demoule
- Service de Médecine Intensive Et Réanimation (Département R3S), APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Pierre Kalfon
- Service de Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Chartres, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Clichy, France
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Mertes PM, Kindo M, Amour J, Baufreton C, Camilleri L, Caus T, Chatel D, Cholley B, Curtil A, Grimaud JP, Houel R, Kattou F, Fellahi JL, Guidon C, Guinot PG, Lebreton G, Marguerite S, Ouattara A, Provenchère Fruithiot S, Rozec B, Verhoye JP, Vincentelli A, Charbonneau H. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med 2022; 41:101059. [PMID: 35504126 DOI: 10.1016/j.accpm.2022.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. METHODS Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. CONCLUSIONS Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
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Affiliation(s)
- Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation, d'Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | - Christophe Baufreton
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France; MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
| | - Lionel Camilleri
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
| | - Thierry Caus
- Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
| | - Didier Chatel
- Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
| | - Bernard Cholley
- Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
| | - Alain Curtil
- Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
| | | | - Rémi Houel
- Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Fehmi Kattou
- Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France; University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France; INSERM, LNC UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Sophie Provenchère Fruithiot
- Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France; Centre d'Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
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Bouglé A, Tuffet S, Federici L, Leone M, Monsel A, Dessalle T, Amour J, Dahyot-Fizelier C, Barbier F, Luyt CE, Langeron O, Cholley B, Pottecher J, Hissem T, Lefrant JY, Veber B, Legrand M, Demoule A, Kalfon P, Constantin JM, Rousseau A, Simon T, Foucrier A. Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial. Intensive Care Med 2022; 48:841-849. [PMID: 35552788 DOI: 10.1007/s00134-022-06690-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 01/08/2022] [Accepted: 03/22/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Compared to long duration of antibiotic therapy, a short duration has a comparable clinical efficacy for ventilator-associated pneumonia (VAP), with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP). METHODS We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days. RESULTS In intention-to-treat population (n = 186), the percentage of patients who reached the composite endpoint was 25.5% (N = 25/98) in the 15-day group versus 35.2% (N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) 0.0-21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay. CONCLUSIONS Our study showed no differences in the composite or separate outcomes (90-day mortality or VAP recurrence) between short- and long-duration treatments for PA-VAP. However, the lack of power limits the interpretation of this study.
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Affiliation(s)
- Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Sophie Tuffet
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil, France
| | - Marc Leone
- Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesioloy and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Dessalle
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de l'Hôpital, 45100, Orléans, France
| | - Charles-Edouard Luyt
- Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Olivier Langeron
- Multidisciplinary Intensive Care Unit, Department of Anesthesioloy and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Cholley
- Département d'Anesthésie et Réanimation, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Julien Pottecher
- Anaesthesiology, Critical Care and Perioperative Medicine, Strasbourg University Hospital-EA3072, FMTS, Strasbourg, France
| | - Tarik Hissem
- General Intensive Care Unit, Sud-Essonne Hospital, Étampes, France
| | - Jean-Yves Lefrant
- Service des Réanimations, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France
| | - Benoit Veber
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Matthieu Legrand
- Department of Anaesthesiology and Critical Care and Burn Unit, Groupe Hospitalier Lariboisière-Saint Louis, APHP, Paris, France
| | - Alexandre Demoule
- Service de Médecine Intensive Et Réanimation (Département R3S), APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Pierre Kalfon
- Service de Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Chartres, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform, Sorbonne University, AP-HP, Paris, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Clichy, France
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Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Lasocki S, Futier E, Amour J, Durand M, Bougle A, Kerforne T, Consigny M, Eddi D, Huet O. Dexmedetomidine after Cardiac Surgery for Prevention of Delirium (EXACTUM) trial protocol: a multicentre randomised, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e058968. [PMID: 35396310 PMCID: PMC8996049 DOI: 10.1136/bmjopen-2021-058968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Incidence of delirium after cardiac surgery remains high and delirium has a significant burden on short-term and long-term outcomes. Multiple causes can trigger delirium occurence, and it has been hypothesised that sleep disturbances can be one of them. Preserving the circadian rhythm with overnight infusion of low-dose dexmedetomidine has been shown to lower the occurrence of delirium in older patients after non-cardiac surgery. However, these results remain controversial. The aim of this study was to demonstrate the usefulness of sleep induction by overnight infusion of dexmedetomidine to prevent delirium after cardiac surgery. METHODS AND ANALYSIS Dexmedetomidine after Cardiac Surgery for Prevention of Delirium is an investigator-initiated, randomised, placebo-controlled, parallel, multicentre, double-blinded trial. Nine centres in France will participate in the study. Patients aged 65 years or older and undergoing cardiac surgery will be enrolled in the study. The intervention starts on day 0 (the day of surgery) until intensive care unit (ICU) discharge; the treatment is administered from 20:00 to 08:00 on the next day. Infusion rate is modified by the treating nurse or the clinician with an objective of Richmond Agitation and Sedation Scale score from -1 to +1. The primary outcome is delirium occurrence evaluated with confusion assessment method for the ICU two times per day during 7 days following surgery. Secondary outcomes include incidence of agitation related events, self-evaluated quality of sleep, cognitive evaluation 3 months after surgery and quality of life 3 months after surgery. The sample size is 348. ETHICS AND DISSEMINATION The study was approved for all participating centers by the French Central Ethics Committee (Comité de Protection des Personnes Ile de France VI, registration number 2018-000850-22). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03477344.
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Affiliation(s)
- Thomas Gargadennec
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
| | - Jean-Ferréol Oilleau
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
| | - Bertrand Rozec
- Intensive Care Unit, Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
- CNRS, INSERM, l'institut du thorax, Université de Nantes, Nantes, France
| | - Nicolas Nesseler
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, Angers, France
- Université Angers Faculté des Sciences, Angers, France
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie Réanimation, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
- CNRS, Inserm U-1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiothoracic Surgery (IPRA), Jacques Cartier Private Hospital, Massy, France
| | - Michel Durand
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Adrien Bougle
- Sorbonne Universite, Paris, France
- Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, GRC 29, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Thomas Kerforne
- Faculté de Médecine, INSERM U1082, Ischémie Reperfusion en Transplantation Modélisation et Innovations Thérapeutiques, Université de Poitiers, Poitiers, France
- Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU Poitiers, Poitiers, France
| | - Maëlys Consigny
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Dauphou Eddi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Olivier Huet
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
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Levy B, Girerd N, Amour J, Besnier E, Nesseler N, Helms J, Delmas C, Sonneville R, Guidon C, Rozec B, David H, Bougon D, Chaouch O, Walid O, Hervé D, Belin N, Gaide-Chevronnay L, Rossignol P, Kimmoun A, Duarte K, Slutsky AS, Brodie D, Fellahi JL, Ouattara A, Combes A. Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Randomized Clinical Trial. JAMA 2022; 327:442-453. [PMID: 35103766 PMCID: PMC8808325 DOI: 10.1001/jama.2021.24776] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The optimal approach to the use of venoarterial extracorporeal membrane oxygenation (ECMO) during cardiogenic shock is uncertain. OBJECTIVE To determine whether early use of moderate hypothermia (33-34 °C) compared with strict normothermia (36-37 °C) improves mortality in patients with cardiogenic shock receiving venoarterial ECMO. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of patients (who were eligible if they had been endotracheally intubated and were receiving venoarterial ECMO for cardiogenic shock for <6 hours) conducted in the intensive care units at 20 French cardiac shock care centers between October 2016 and July 2019. Of 786 eligible patients, 374 were randomized. Final follow-up occurred in November 2019. INTERVENTIONS Early moderate hypothermia (33-34 °C; n = 168) for 24 hours or strict normothermia (36-37 °C; n = 166). MAIN OUTCOMES AND MEASURES The primary outcome was mortality at 30 days. There were 31 secondary outcomes including mortality at days 7, 60, and 180; a composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at days 30, 60, and 180; and days without requiring a ventilator or kidney replacement therapy at days 30, 60, and 180. Adverse events included rates of severe bleeding, sepsis, and number of units of packed red blood cells transfused during venoarterial ECMO. RESULTS Among the 374 patients who were randomized, 334 completed the trial (mean age, 58 [SD, 12] years; 24% women) and were included in the primary analysis. At 30 days, 71 patients (42%) in the moderate hypothermia group had died vs 84 patients (51%) in the normothermia group (adjusted odds ratio, 0.71 [95% CI, 0.45 to 1.13], P = .15; risk difference, -8.3% [95% CI, -16.3% to -0.3%]). For the composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at day 30, the adjusted odds ratio was 0.61 (95% CI, 0.39 to 0.96; P = .03) for the moderate hypothermia group compared with the normothermia group and the risk difference was -11.5% (95% CI, -23.2% to 0.2%). Of the 31 secondary outcomes, 30 were inconclusive. The incidence of moderate or severe bleeding was 41% in the moderate hypothermia group vs 42% in the normothermia group. The incidence of infections was 52% in both groups. The incidence of bacteremia was 20% in the moderate hypothermia group vs 30% in the normothermia group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial involving patients with refractory cardiogenic shock treated with venoarterial ECMO, early application of moderate hypothermia for 24 hours did not significantly increase survival compared with normothermia. However, because the 95% CI was wide and included a potentially important effect size, these findings should be considered inconclusive. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02754193.
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Affiliation(s)
- Bruno Levy
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France
- INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, France
- Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d’Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, Frances
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation et d’Anesthésie de Chirurgie Cardiaque Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
- Normandie University, UNIROUEN, INSERM U1096, EnVi, Rouen, France
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- University Rennes, CHU de Rennes, Inra, INSERM, Institut NUMECAN – UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
| | - Julie Helms
- Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and infectious diseases ICU, Paris, France
| | | | - Bertrand Rozec
- Service d’Anesthésie-Réanimation, Hôpital G&R Laennec CHU de Nantes, Nantes, France
- L’institut du Thorax INSERM, CNRS, CHU Nantes, UNIV Nantes, Nantes, France
| | - Helène David
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
- Montpellier University, INSERM, CNRS, PhyMedExp, Montpellier, France
| | - David Bougon
- Service de Réanimation, Centre Hospitalier Annecy, Genevois, France
| | - Oussama Chaouch
- Hôpital Européen Georges Pompidou, AP-HP, Department of Anesthesiology and Critical Care Medicine, Université Paris Descartes, Paris, France
| | - Oulehri Walid
- Service d’Anesthésie-Réanimation et Médecine péri-Opératoire, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Dupont Hervé
- Réanimation Médico-Chirurgicale Cardio-Thoracique, Vasculaire et Respiratoire, CHU Amiens Picardie, Amiens, France
| | - Nicolas Belin
- Service de Réanimation Médicale, CHU Besançon, Besançon, France
| | - Lucie Gaide-Chevronnay
- Unité de Réanimation Cardiovasculaire et Thoracique, Pôle Anesthésie Réanimation, CHU de Grenoble Alpes, Grenoble, France
| | | | - Antoine Kimmoun
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France
| | - Arthur S. Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, Surgery, and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Brodie
- Department of Medicine, College of Physicians and Surgeons, Columbia University, and the Center for Acute Respiratory Failure, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jean-Luc Fellahi
- Service d’Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM 1060, Université Lyon 1 Claude Bernard, Lyon, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France
- University Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–Salpêtrière, Paris, France
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Laverdure F, Frossard B, Monnet C, Amour J. Extracorporeal membrane oxygenation for COVID-19: Some answers and a remaining question. Anaesth Crit Care Pain Med 2021; 41:100986. [PMID: 34838733 PMCID: PMC8612749 DOI: 10.1016/j.accpm.2021.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Florent Laverdure
- Institut de Perfusion, de Réanimation et d'Anesthésie en Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France.
| | - Benjamin Frossard
- Institut de Perfusion, de Réanimation et d'Anesthésie en Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | | | - Julien Amour
- Institut de Perfusion, de Réanimation et d'Anesthésie en Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
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Mazeraud A, Jamme M, Mancusi RL, Latroche C, Megarbane B, Siami S, Zarka J, Moneger G, Santoli F, Argaud L, Chillet P, Muller G, Bruel C, Asfar P, Beloncle F, Reignier J, Vinsonneau C, Schimpf C, Amour J, Goulenok C, Lemaitre C, Rohaut B, Mateu P, De Rudnicki S, Mourvillier B, Declercq PL, Schwebel C, Stoclin A, Garnier M, Madeux B, Gaudry S, Bailly K, Lamer C, Aegerter P, Rieu C, Sylla K, Lucas B, Sharshar T. Intravenous immunoglobulins in patients with COVID-19-associated moderate-to-severe acute respiratory distress syndrome (ICAR): multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2021; 10:158-166. [PMID: 34774185 PMCID: PMC8585489 DOI: 10.1016/s2213-2600(21)00440-9] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023]
Abstract
Background Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 and is associated with high mortality and morbidity. We aimed to assess whether intravenous immunoglobulins (IVIG) could improve outcomes by reducing inflammation-mediated lung injury. Methods In this multicentre, double-blind, placebo-controlled trial, done at 43 centres in France, we randomly assigned patients (1:1) receiving invasive mechanical ventilation for up to 72 h with PCR confirmed COVID-19 and associated moderate-to-severe ARDS to receive either IVIG (2 g/kg over 4 days) or placebo. Random assignment was done with a web-based system and was stratified according to the participating centre and the duration of invasive mechanical ventilation before inclusion in the trial (<12 h, 12–24 h, and >24–72 h), and treatment was administered within the first 96 h of invasive mechanical ventilation. To minimise the risk of adverse events, the IVIG administration was divided into four perfusions of 0·5 g/kg each administered over at least 8 hours. Patients in the placebo group received an equivalent volume of sodium chloride 0·9% (10 mL/kg) over the same period. The primary outcome was the number of ventilation-free days by day 28, assessed according to the intention-to-treat principle. This trial was registered on ClinicalTrials.gov, NCT04350580. Findings Between April 3, and October 20, 2020, 146 patients (43 [29%] women) were eligible for inclusion and randomly assigned: 69 (47%) patients to the IVIG group and 77 (53%) to the placebo group. The intention-to-treat analysis showed no statistical difference in the median number of ventilation-free days at day 28 between the IVIG group (0·0 [IQR 0·0–8·0]) and the placebo group (0·0 [0·0–6·0]; difference estimate 0·0 [0·0–0·0]; p=0·21). Serious adverse events were more frequent in the IVIG group (78 events in 22 [32%] patients) than in the placebo group (47 events in 15 [20%] patients; p=0·089). Interpretation In patients with COVID-19 who received invasive mechanical ventilation for moderate-to-severe ARDS, IVIG did not improve clinical outcomes at day 28 and tended to be associated with an increased frequency of serious adverse events, although not significant. The effect of IVIGs on earlier disease stages of COVID-19 should be assessed in future trials. Funding Programme Hospitalier de Recherche Clinique.
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Affiliation(s)
- Aurélien Mazeraud
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Société Française d'Anesthésie-Réanimation Research Network, France; Department of Neurosiences, Université de Paris, Paris, France.
| | - Matthieu Jamme
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France; INSERM U1018, CESP, Équipe Epidémiologie Clinique, Université Paris Saclay, Villejuif, France
| | - Rossella Letizia Mancusi
- Direction de la recherche clinique et de l'innovation, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Paris, France
| | - Claire Latroche
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Bruno Megarbane
- Department of Neurosiences, Université de Paris, Paris, France; Service de Médecine Intensive et Réanimation, Centre Hospitalo-universitaire Lariboisière Paris, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, Centre Hospitalier Sud-Essonnes, Etampes, France
| | - Jonathan Zarka
- Service de Médecine Intensive et Réanimation, Grand hôpital de l'Est francilien site Marne-la-Vallée, Marne-la-Vallée, France
| | - Guy Moneger
- Service de Réanimation polyvalente, Hôpital Nord Franche Comté, Trevenans, France
| | - Francesco Santoli
- Service de Réanimation Médicale, Centre Hospitalo-universitaire Robert Ballanger, Aulnay, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Patrick Chillet
- Service de Réanimation Polyvalente, Centre Hospitalier Chalons en Champagne, Chalons en Champagne, France
| | - Gregoire Muller
- Service de Médecine Intensive et Réanimation, Centre hospitalier, Orléans, France; Clinical Research in Intensive Care and Sepsis - TRIal Group for global Evaluation and Research in Sepsis research network, Tours, France
| | - Cedric Bruel
- Service de Réanimation Médico-chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Francois Beloncle
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Béthune, France
| | - Caroline Schimpf
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery, Ramsay Health Care, Hôpital Privé Jacques Cartier, Massy, France
| | - Cyril Goulenok
- Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Caroline Lemaitre
- Département de Gastroentérologie et Hépatologie, Hôpital Jacques Monod, Montivilliers, France; Département de Médecine Intensive et Réanimation, Hôpital Jacques Monod, Avenue Pierre Mendès France, Montivilliers, France
| | - Benjamin Rohaut
- Département de Neurologie, Neurointensive care unit, Assistance Publique -Hopitaux de Paris-Pitié Salpêtrière, Paris, France; Department of Neurology, Sorbonne Université, Paris, France; Institut du Cerveau-Paris Brain Institute-Institut du Cerveau et de la Moelle, Paris, France; Pinic Lab, INSERM, Paris, France; Centre National de la Recherche Scientifique, Paris, France
| | - Philippe Mateu
- Service de Réanimation polyvalente, Centre Hospitalier Interrégional Nord Ardennes, Charleville-Mézières, France
| | - Stephane De Rudnicki
- Service d'Anesthésie Réanimation, Hôpital d'instruction des Armées de Percy, Clamart, France
| | - Bruno Mourvillier
- Service de Médecine Intensive et Réanimation Polyvalente, Centre Hospitalo-Universitaire Robert Debré, Reims, France
| | | | - Carole Schwebel
- Service de Médecine Intensive et Réanimation, Centre Hospitalo-Universitaire de Grenoble Alpe, Grenoble, France
| | | | - Marc Garnier
- Service d'Anesthésie-Réanimation, Centre Hospitalo-Universitaire Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Benjamin Madeux
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France; Service de Médecine Intensive et Réanimation, Centre Hospitalier De Tarbes, Tarbes, France
| | - Stéphane Gaudry
- Service de Médecine Intensive et Réanimation Centre Hospitalo-Universitaire Avicenne, Bobigny, France
| | - Karine Bailly
- Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Christian Lamer
- Service de Réanimation Polyvalente, Institut mutualiste Montsouris, Paris, France
| | - Philippe Aegerter
- Groupement inter-régional de recherche clinique et d'innovation - Île de France, Cellule Méthodologie, Paris, France; Équipe d'Épidémiologie respiratoire intégrative, Centre de recherche en Epidémiologie et Santé des Populations, U1018 INSERM Université Paris Saclay - Université Versailles Saint Quentin en Yveline, Villejuif, France
| | - Christine Rieu
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Khaoussou Sylla
- Direction de la recherche clinique et de l'innovation, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Paris, France
| | - Bruno Lucas
- Department of Neurosiences, Université de Paris, Paris, France; Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Tarek Sharshar
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Department of Neurosiences, Université de Paris, Paris, France; INSERM UMR S894, Sorbonne Université, Paris, France
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Nguyen LS, Salem JE, Bories MC, Coutance G, Amour J, Bougle A, Suberbielle C, Kheav VD, Carmagnat M, Rouvier P, Kirsch M, Varnous S, Leprince P, Saheb S. Impact of Sex in the Efficacy of Perioperative Desensitization Procedures in Heart Transplantation: A Retrospective Cohort Study. Front Immunol 2021; 12:659303. [PMID: 34305891 PMCID: PMC8292826 DOI: 10.3389/fimmu.2021.659303] [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: 02/19/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Sensitized patients, i.e. recipients with preformed donor-specific HLA antibodies (pfDSA), are at high-risk of developing antibody-mediated rejections (AMR) and dying after heart transplantation (HTx). Perioperative desensitization procedures are associated with better outcomes but can cause sensitization, which may influence their efficacy. Methods In sensitized patients (pfDSA>1000 mean immunofluorescence (MFI) units), we assessed the effect of perioperative desensitization by comparing treated patients to a historical control cohort. Multivariable survival analyses were performed on the time to main outcome, a composite of death and biopsy-proven AMR with 5-year follow-up. Results The study included 68 patients: 31 control and 37 treated patients. There was no difference in preoperative variables between the two groups, including cumulative pfDSA [4026 (1788;8725) vs 4560 (3162;13392) MFI units, p=0.28]. The cause of sensitization was pregnancy in 24/68, 35.3%, transfusion in 61/68, 89.7%, and previous HTx in 4/68, 5.9% patients. Multivariable analysis yielded significant protective association between desensitization and events (adjusted (adj.) hazard ratio (HR)=0.44 (95% confidence interval (95CI)=0.25-0.79), p=0.006) and deleterious association between cumulative pfDSA and events [per 1000-MFI increase, adj.HR=1.028 (1.002-1.053), p=0.031]. There was a sex-difference in the efficacy of desensitization: in men (n=35), the benefit was significant [unadj.HR=0.33 (95CI=0.14-0.78); p=0.01], but not in women (n=33) [unadj.HR=0.52 (0.23-1.17), p=0.11]. In terms of the number of patients treated, in men, 2.1 of patients that were treated prevented 1 event, while in women, 3.1 required treatment to prevent 1 event. Conclusion Perioperative desensitization was associated with fewer AMR and deaths after HTx, and efficacy was more pronounced in men than women.
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Affiliation(s)
- Lee S Nguyen
- Sorbonne Université, Department of Cardiothoracic Surgery, AP.HP.6 Pitie-Salpetriere, Paris, France.,CMC Ambroise Paré, Research and Innovation, RICAP, Neuilly-sur-Seine, France.,Sorbonne Université, Clinical Investigations Center, AP.HP.6, INSERM, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, Clinical Investigations Center, AP.HP.6, INSERM, Paris, France
| | - Marie-Cécile Bories
- Sorbonne Université, Department of Cardiothoracic Surgery, AP.HP.6 Pitie-Salpetriere, Paris, France
| | - Guillaume Coutance
- Sorbonne Université, Department of Cardiothoracic Surgery, AP.HP.6 Pitie-Salpetriere, Paris, France
| | - Julien Amour
- Jacques Cartier Private Hospital, Department of Cardiothoracic Surgery, Massy, France
| | - Adrien Bougle
- Sorbonne Université, Department of Anesthesiology, AP.HP.6 Pitie-Salpetriere, Paris, France
| | | | | | | | - Philippe Rouvier
- Sorbonne Université, Department of Anatomopathology, AP.HP.6 Pitie-Salpetriere, Paris, France
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
| | - Shaida Varnous
- Sorbonne Université, Department of Cardiothoracic Surgery, AP.HP.6 Pitie-Salpetriere, Paris, France
| | - Pascal Leprince
- Sorbonne Université, Department of Cardiothoracic Surgery, AP.HP.6 Pitie-Salpetriere, Paris, France
| | - Samir Saheb
- Sorbonne Université, service d'hémobiologie, AP.HP.6 Pitie-Salpetriere, Paris, France
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11
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Roger C, Louart B, Elotmani L, Barton G, Escobar L, Koulenti D, Lipman J, Leone M, Muller L, Boutin C, Amour J, Banakh I, Cousson J, Bourenne J, Constantin JM, Albanese J, Roberts JA, Lefrant JY. An international survey on aminoglycoside practices in critically ill patients: the AMINO III study. Ann Intensive Care 2021; 11:49. [PMID: 33740157 PMCID: PMC7979853 DOI: 10.1186/s13613-021-00834-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/29/2020] [Accepted: 03/05/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND While aminoglycosides (AG) have been used for decades, debate remains on their optimal dosing strategy. We investigated the international practices of AG usage specifically regarding dosing and therapeutic drug monitoring (TDM) in critically ill patients. We conducted a prospective, multicentre, observational, cohort study in 59 intensive-care units (ICUs) in 5 countries enrolling all ICU patients receiving AG therapy for septic shock. RESULTS We enrolled 931 septic ICU patients [mean ± standard deviation, age 63 ± 15 years, female 364 (39%), median (IQR) SAPS II 51 (38-65)] receiving AG as part of empirical (761, 84%) or directed (147, 16%) therapy. The AG used was amikacin in 614 (66%), gentamicin in 303 (33%), and tobramycin in 14 (1%) patients. The median (IQR) duration of therapy was 2 (1-3) days, the number of doses was 2 (1-2), the median dose was 25 ± 6, 6 ± 2, and 6 ± 2 mg/kg for amikacin, gentamicin, and tobramycin respectively, and the median dosing interval was 26 (23.5-43.5) h. TDM of Cmax and Cmin was performed in 437 (47%) and 501 (57%) patients, respectively, after the first dose with 295 (68%) patients achieving a Cmax/MIC > 8 and 353 (71%) having concentrations above Cmin recommended thresholds. The ICU mortality rate was 27% with multivariable analysis showing no correlation between AG dosing or pharmacokinetic/pharmacodynamic target attainment and clinical outcomes. CONCLUSION Short courses of high AG doses are mainly used in ICU patients with septic shock, although wide variability in AG usage is reported. We could show no correlation between PK/PD target attainment and clinical outcome. Efforts to optimize the first AG dose remain necessary. Trial registration Clinical Trials, NCT02850029, registered on 29th July 2016, retrospectively registered, https://www.clinicaltrials.gov.
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Affiliation(s)
- Claire Roger
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France. .,Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France.
| | - Benjamin Louart
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France.,Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France
| | - Loubna Elotmani
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France.,Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France
| | - Greg Barton
- St Helens and Knowsley Hospitals NHS Trust, Liverpool, UK
| | - Leslie Escobar
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Despoina Koulenti
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Second Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Jeffrey Lipman
- Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France.,The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Marseille, Marseille, France
| | - Laurent Muller
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France.,Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France
| | - Caroline Boutin
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery (IPRA), Hôpital Privé Jacques Cartier, Massy, France
| | | | - Joel Cousson
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Reims, Reims, France
| | - Jeremy Bourenne
- Department of Emergency and Intensive Care Medicine, University Hospital of Marseille, Hôpital de La Timone, Marseille, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jacques Albanese
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Marseille, Hôpital de La Conception, Marseille, France
| | - Jason A Roberts
- Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France.,The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jean-Yves Lefrant
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Place du Professeur Robert Debré, 30 029, Nîmes cedex 9, France.,Equipe D, Caractéristiques Féminines Des Interfaces Vasculaires (IMAGINE), Faculté de Médecine, Univ Montpellier, 2992, Montpellier, France
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12
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Galeone A, Lebreton G, Coutance G, Demondion P, Schmidt M, Amour J, Varnous S, Leprince P. A single‐center long‐term experience with marginal donor utilization for heart transplantation. Clin Transplant 2020; 34:e14057. [DOI: 10.1111/ctr.14057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Antonella Galeone
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Guillaume Coutance
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Pierre Demondion
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Matthieu Schmidt
- Medical Intensive Care Unit Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Julien Amour
- Department of Anesthesiology Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Shaida Varnous
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
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13
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Lepère V, Duceau B, Lebreton G, Bombled C, Dujardin O, Boccara L, Charfeddine A, Amour J, Hajage D, Bouglé A. Risk Factors for Developing Severe Acute Kidney Injury in Adult Patients With Refractory Postcardiotomy Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation. Crit Care Med 2020; 48:e715-e721. [PMID: 32697513 DOI: 10.1097/ccm.0000000000004433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Postcardiotomy cardiogenic shock occurs in 2-6% of patients undergoing cardiac surgery, and 1% of cardiac surgery patients will require mechanical circulatory support using venoarterial extracorporeal membrane oxygenation. Acute kidney injury is a frequent complication in this population and negatively impacts the survival. We aimed to determine whether the timing of extracorporeal membrane oxygenation implantation influences the renal prognosis of these patients. DESIGN Retrospective observational cohort study between January 2013 and December 2016. SETTING An 18-bed surgical ICU in a university hospital. PATIENTS A total of 4,796 consecutive adult patients who underwent cardiac surgery were included in the study, and 347 (7.2%) were assisted with venoarterial extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. The patients who died during the first 48 hours after venoarterial extracorporeal membrane oxygenation implantation were excluded. The complete-case analysis included 257 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the occurrence, within 10 days following the venoarterial extracorporeal membrane oxygenation implantation, of a stage 3 acute kidney injury defined by the Kidney Disease: Improving Global Outcomes group. One hundred sixty-nine patients (65.7%) presented with a Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury; 14 patients (5.4%) died before the end of the follow-up period, without developing the primary outcome. Ninety-two percent of patients with Kidney Disease: Improving Global Outcomes 3 acute kidney injury received renal replacement therapy, for a median duration of 7 days (3-16 d). Late implantation of venoarterial extracorporeal membrane oxygenation was independently associated with an increased risk of Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury (odds ratio, 2.81 [95% CI, 1.31-6.07]; p = 0.008). The other factors associated with Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury were preoperative left ventricular ejection fraction (odds ratio, 1.03 [95% CI, 1.01-1.05]; p = 0.007), intraoperative plasma transfusion (odds ratio, 1.13 [95% CI, 1.02-1.26]; p = 0.022), increased bilirubinemia level (odds ratio, 1.013 [95% CI, 1.001-1.026]; p = 0.032), and increased creatinine levels (odds ratio, 1.012 [95% CI, 1.006-1.018]; p < 0.001) on the day of implantation. CONCLUSIONS Significant kidney dysfunction is particularly frequent in patients with refractory postcardiotomy cardiogenic shock assisted with venoarterial extracorporeal membrane oxygenation. Early implantation of extracorporeal membrane oxygenation may help prevent acute kidney injury.
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Affiliation(s)
- Victoria Lepère
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Baptiste Duceau
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, AP-HP, Department of Cardio-Vascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Camille Bombled
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Dujardin
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Lucile Boccara
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Ahmed Charfeddine
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Julien Amour
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis de Santé Publique, Equipe Pharmacoépidémiologie et évaluation des soins, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
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14
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Velly L, Gayat E, Quintard H, Weiss E, De Jong A, Cuvillon P, Audibert G, Amour J, Beaussier M, Biais M, Bloc S, Bonnet MP, Bouzat P, Brezac G, Dahyot-Fizelier C, Dahmani S, de Queiroz M, Di Maria S, Ecoffey C, Futier E, Geeraerts T, Jaber H, Heyer L, Hoteit R, Joannes-Boyau O, Kern D, Langeron O, Lasocki S, Launey Y, le Saché F, Lukaszewicz AC, Maurice-Szamburski A, Mayeur N, Michel F, Minville V, Mirek S, Montravers P, Morau E, Muller L, Muret J, Nouette-Gaulain K, Orban JC, Orliaguet G, Perrigault PF, Plantet F, Pottecher J, Quesnel C, Reubrecht V, Rozec B, Tavernier B, Veber B, Veyckmans F, Charbonneau H, Constant I, Frasca D, Fischer MO, Huraux C, Blet A, Garnier M. Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39:395-415. [PMID: 32512197 PMCID: PMC7274119 DOI: 10.1016/j.accpm.2020.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
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Affiliation(s)
- Lionel Velly
- Aix-Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005 Marseille, France; Aix-Marseille University, CNRS, Institut Neuroscience Timone, UMR7289, Marseille, France.
| | - Etienne Gayat
- Department of Anaesthesiology and Critical Care, Lariboisière Hospital, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Hervé Quintard
- Intensive Care Unit, Centre Hospitalier Universitaire de Nice, Pasteur 2 Hospital, Nice, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France; Inserm UMR_S1149, Inserm, Université de Paris, Paris, France
| | - Audrey De Jong
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France; PhyMedExp, University of Montpellier, Inserm U1046, CNRS UMR, 9214, Montpellier, France
| | - Philippe Cuvillon
- Department of Anaesthesiology, Beaujon Hospital, CHU Carémeau, Nîmes, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, Lorraine University, Nancy University Hospital, 54000 Nancy, France
| | - Julien Amour
- Cardiovascular and Thoracic Surgery Department, Hôpital Privé Jacques-Cartier, 91300 Massy, France
| | - Marc Beaussier
- Département d'Anesthésie, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Matthieu Biais
- Department of Anaesthesiology and Critical Care, Pellegrin Hospital, CHU de Bordeaux, Bordeaux, France; Inserm UMR-S 1034, Biology of Cardiovascular Diseases, Bordeaux University, Bordeaux, France
| | - Sébastien Bloc
- CMC Ambroise-Paré, Département d'anesthésie, 92200 Neuilly-sur-Seine, France
| | - Marie Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand-Trousseau University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesiology and Intensive Care Medicine, Grenoble University Hospital, 38000 Grenoble, France
| | - Gilles Brezac
- Anaesthesiology, Lenval Children's Hospital, 06200 Nice, France
| | - Claire Dahyot-Fizelier
- Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France; Inserm UMR1070, Pharmacology of Anti-infective Agents, University of Poitiers, Poitiers, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, AP-HP, DHU PROTECT, Inserm U1141, Paris, France
| | - Mathilde de Queiroz
- Department of Paediatric Anaesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Claude Ecoffey
- Department of Anaesthesia and Intensive Care, CHU de Rennes, Inserm UMR 991, CIC 1414, Rennes 1 University, Rennes, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Thomas Geeraerts
- Pôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Centre (ToNIC), université Toulouse 3 - Paul-Sabatier, CHU de Toulouse, 31059 Toulouse, France
| | - Haithem Jaber
- Departments of Anaesthesia and Intensive Care, Caen University Hospital, Caen, France
| | - Laurent Heyer
- Intensive Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Croix-Rousse Hospital, Lyon, France
| | - Rim Hoteit
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Delphine Kern
- Departments of Anaesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Olivier Langeron
- Department of Anaesthesiology and Critical Care Medicine, Henri-Mondor University Hospital, University Paris-Est Créteil (UPEC), Assistance publique-Hôpitaux de Paris, Paris, France
| | - Sigismond Lasocki
- Department of Anaesthesiology and Critical Care Medicine, UBL Université d'Angers, CHU d'Angers, Angers, France
| | - Yoan Launey
- Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frederic le Saché
- Department of Anaesthesiology and Intensive Care, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Clinique Remusat, 75016 Paris, France; Clinique Jouvenet, 75016 Paris, France
| | - Anne Claire Lukaszewicz
- University of Lyon, EA 7426: Pathophysiology of Injury-Induced Immunosuppression (PI3), Lyon, France; Department of Anaesthesiology and Critical Care, Neurological hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Nicolas Mayeur
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Fabrice Michel
- Department of Paediatric Intensive Care Unit, Assistance publique-Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Vincent Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, 31432 Toulouse, France; Inserm, U1048, Université Paul-Sabatier, Institute of Metabolic and Cardiovascular Diseases, I2MC, 31432 Toulouse, France
| | - Sébastien Mirek
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, 21079 Dijon, France; U-SEEM, Healthcare Simulation Centre of University Hospital of Dijon, 21079 Dijon, France
| | - Philippe Montravers
- Department of Anaesthesiology and Critical Care, CHU Bichat-Claude-Bernard, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France
| | - Estelle Morau
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | - Laurent Muller
- Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Université Montpellier, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Physiology Department, EA 2992, Faculty of Medicine, Université Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Jane Muret
- Institut Curie PSL Research University, 75005 Paris, France
| | - Karine Nouette-Gaulain
- Department of Anaesthesiology, Intensive Care and Pain, Institut Curie, 75005 Paris, France
| | - Jean Christophe Orban
- Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France
| | - Gilles Orliaguet
- Surgical Paediatric Intensive Care Unit, Universitary Hospital Necker-Enfants-Malades, Paris, France; EA08 Pharmacologie et Évaluation des Thérapeutiques chez l'Enfant et la Femme Enceinte, Paris Descartes University (Paris V), Paris, France
| | - Pierre François Perrigault
- Department of Anaesthesia and Critical Care Medicine, Montpellier University, Gui-de-Chauliac Hospital, Montpellier, France
| | - Florence Plantet
- Service d'Anesthésie-Réanimation, Clinique Générale, 4, chemin de la Tour-la-Reine, Annecy, France
| | - Julien Pottecher
- Department of Anaesthesiology and Critical Care, Les Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Christophe Quesnel
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Tenon Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université School of Medicine, Paris, France
| | - Vanessa Reubrecht
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bertrand Rozec
- Anesthésie-Réanimation, CHU Nantes, Hôpital Laennec, 1, boulevard Jacques-Monod, 44093 Nantes cedex, France
| | - Benoit Tavernier
- Department of Anaesthesiology and Critical Care, CHU de Lille, Pôle d'Anesthésie-Réanimation, 59000 Lille, France
| | - Benoit Veber
- Department of Anaesthesiology and Critical Care, Université de Rouen Normandie, Rouen, France
| | - Francis Veyckmans
- Department of Paediatric Anaesthesia, Jeanne-de-Flandre Hospital, University Hospitals of Lille, Lille, France
| | - Hélène Charbonneau
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, DMU DREAM, Sorbonne Université, Paris, France
| | - Denis Frasca
- Department of Anaesthesiology and Critical Care, Poitiers University, CHU de Poitiers, Poitiers, France
| | - Marc-Olivier Fischer
- Department of Anaesthesiology and Critical Care, Normandie Université, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Catherine Huraux
- Department of Anaesthesiology, Clinique des Cèdres, 38130 Échirolles, France
| | - Alice Blet
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Garnier
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Saint-Antoine Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Sorbonne Université School of Medicine, Paris, France
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Couffignal C, Amour J, Ait-Hamou N, Cholley B, Fellahi JL, Duval X, Costa De Beauregard Y, Nataf P, Dilly MP, Provenchère S, Montravers P, Mentré F, Longrois D. Timing of β-Blocker Reintroduction and the Occurrence of Postoperative Atrial Fibrillation after Cardiac Surgery: A Prospective Cohort Study. Anesthesiology 2020; 132:267-279. [PMID: 31939841 DOI: 10.1097/aln.0000000000003064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of β-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. METHODS This multicenter prospective French cohort study included patients on β-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of β-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of β-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). RESULTS Of 663 patients, β-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of β-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. CONCLUSIONS β-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) β-blocker reintroduction after cardiac surgery.
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Affiliation(s)
- Camille Couffignal
- From the Department of Biostatistics, Bichat-Claude Bernard Hospital, AP-HP.Nord, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (C.C., F.M.) University of Paris, IAME, UMR1137, Paris, France (C.C., X.D., F.M.) INSERM, IAME, UMR 1137, Paris, France (C.C., X.D., F.M.) Clinical Investigation Center, CIC-1425, AP-HP, INSERM, Paris, France (X.D., Y.C.D.B.) Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, APHP, Sorbonne University, UPMC University, Paris 06, UMR INSERM 1166, IHU ICAN, Paris, France (J.A., N.A.-H.) Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, APHP Paris-Ouest, University of Paris, Paris, France (B.C.) Department of Anesthesia and Intensive Care, Hôpital Cardiologique Louis Pradel, IHU OPERA Inserm U1060/Faculté de Médecine Lyon Est, University Claude Bernard Lyon 1, Lyon, France (J.-L.F.) Department of Cardiac Surgery, Bichat-Claude Bernard Hospital, AP-HP.Nord, APHP, Paris, France (P.N.) Department of Anesthesia and Intensive Care, Bichat-Claude Bernard Hospital, AP-HP.Nord, APHP, Paris, France (M.-P.D., S.P., P.M., D.L.) University of Paris, Paris, France (P.M., D.L.)
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Vidal C, Pasqualotto R, James A, Dureau P, Rasata J, Coutance G, Varnous S, Leprince P, Amour J, Bouglé A. Predictive risk factors for postoperative pneumonia after heart transplantation. BMC Anesthesiol 2020; 20:8. [PMID: 31910812 PMCID: PMC6947950 DOI: 10.1186/s12871-019-0923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients. Methods In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P < 0.05 was necessary to reject the null hypothesis. Results A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12–1.80], P < 0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20–1.70], P < 0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3–12.4], P = 0.01) and 1 year (OR: 6.8 [2.5–8.4], P < 0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP. Conclusion After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP.
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Affiliation(s)
- Charles Vidal
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France. .,Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France.
| | - Romain Pasqualotto
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Arthur James
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Pauline Dureau
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Julie Rasata
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Guillaume Coutance
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis de la Réunion, France
| | - Shaida Varnous
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis de la Réunion, France
| | - Pascal Leprince
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis de la Réunion, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
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17
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Cholley B, Levy B, Fellahi JL, Longrois D, Amour J, Ouattara A, Mebazaa A. Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper. Crit Care 2019; 23:385. [PMID: 31783891 PMCID: PMC6883606 DOI: 10.1186/s13054-019-2674-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
Abstract
Despite interesting and unique pharmacological properties, levosimendan has not proven a clear superiority to placebo in the patient populations that have been enrolled in the various recent multicenter randomized controlled trials. However, the pharmacodynamic effects of levosimendan are still considered potentially very useful in a number of specific situations. Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent the most widely accepted indication. Repeated infusions of levosimendan are increasingly used to facilitate weaning from dobutamine and avoid prolonged hospitalizations in patients with end-stage heart failure, awaiting heart transplantation or left ventricular assist device implantation. New trials are under way to confirm or refute the potential usefulness of levosimendan to facilitate weaning from veno-arterial ECMO, to treat cardiogenic shock due to left or right ventricular failure because the current evidence is mostly retrospective and requires confirmation with better-designed studies. Takotsubo syndrome may represent an ideal target for this non-adrenergic inotrope, but this statement also relies on expert opinion. There is no benefit from levosimendan in patients with septic shock. The two large trials evaluating the prophylactic administration of levosimendan (pharmacological preconditioning) in cardiac surgical patients with poor left ventricular ejection fraction could not show a significant reduction in their composite endpoints reflecting low cardiac output syndrome with respect to placebo. However, the subgroup of those who underwent isolated CABG appeared to have a reduction in mortality. A new study will be required to confirm this exploratory finding. Levosimendan remains a potentially useful inodilator agent in a number of specific situations due to its unique pharmacological properties. More studies are needed to provide a higher level of proof regarding these indications.
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Affiliation(s)
- Bernard Cholley
- Department of Anesthesiology and Critical Care MedicineP, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,Université Paris Descartes - Université de Paris, Paris, France. .,INSERM UMR_S1140, Paris, France.
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Jean-Luc Fellahi
- Department of Anesthesiology and Critical Care, Hôpital Cardiologique Louis Pradel, Lyon, France.,INSERM U1060, University Claude Bernard, Lyon, France
| | - Dan Longrois
- Department of Anesthesiology and Critical Care, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Hôpital de La Pitié Salpêtrière, AP-HP, Paris, France.,University Pierre & Marie Curie, Paris, France
| | - Alexandre Ouattara
- Department of Anesthesiology and Critical Care, Magellan Medico-Surgical Center, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,INSERM, UMR 1034, Biology of Cardiovascular Diseases, Bordeaux, France
| | - Alexandre Mebazaa
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, AP-HP, Paris, France
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18
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David CH, Quessard A, Mastroianni C, Hekimian G, Amour J, Leprince P, Lebreton G. Mechanical circulatory support with the Impella 5.0 and the Impella Left Direct pumps for postcardiotomy cardiogenic shock at La Pitié-Salpêtrière Hospital. Eur J Cardiothorac Surg 2019; 57:183-188. [DOI: 10.1093/ejcts/ezz179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
OBJECTIVES
Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates of 50–80%. Although veno-arterial extracorporeal membrane oxygenation has been used as mechanical circulatory support in patients with PCCS, it is associated with a high rate of complications and poor quality of life. The Impella 5.0 and Impella Left Direct (LD) (Impella 5.0/LD) are minimally invasive left ventricular assist devices that provide effective haemodynamic support resulting in left ventricular unloading and systemic perfusion. Our goal was to describe the outcome of patients with PCCS supported with the Impella 5.0/LD at La Pitié-Salpêtrière Hospital.
METHODS
We retrospectively reviewed consecutive patients supported with the Impella 5.0/LD for PCCS between December 2010 and June 2015. Survival outcome and in-hospital complications were assessed.
RESULTS
A total of 29 patients (63 ± 14 years, 17% women) with PCCS were supported with the Impella 5.0/LD. At baseline, 69% experienced chronic heart failure, 66% had dilated cardiomyopathy and 57% had valvular disease. The mean EuroSCORE II was 22 ± 17 and the ejection fraction was 28 ± 11%. Most of the patients underwent isolated valve surgery (45%) or isolated coronary artery bypass grafting (38%). The mean duration of Impella support was 9 ± 7 days. Weaning from the Impella was successful in 72.4%, and 58.6% survived to discharge. Recovery of native heart function was observed in 100% of discharged patients. Survival to 30 days and to 1 year from Impella implant was 58.6% and 51.7%, respectively.
CONCLUSIONS
The Impella 5.0 and the Impella LD represent an excellent treatment option for critically ill patients with PCCS and are associated with favourable survival outcome and native heart recovery.
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Affiliation(s)
- Charles-Henri David
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Astrid Quessard
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Ciro Mastroianni
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Guillaume Hekimian
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Julien Amour
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Pascal Leprince
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Guillaume Lebreton
- Department of Cardiac Surgery, Institute of Cardiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
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19
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Gaudard P, Barbanti C, Rozec B, Mauriat P, M'rini M, Cambonie G, Liet JM, Girard C, Leger PL, Assaf Z, Damas P, Loron G, Lecourt L, Amour J, Pouard P. New Modalities for the Administration of Inhaled Nitric Oxide in Intensive Care Units After Cardiac Surgery or for Neonatal Indications: A Prospective Observational Study. Anesth Analg 2019; 126:1234-1240. [PMID: 29341967 DOI: 10.1213/ane.0000000000002813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. METHODS This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed. Concomitant pulmonary vasodilator treatments, safety data, and outcome were also collected. Quantitative data are expressed as median (25th, 75th percentile). RESULTS Over 1 year, 236 patients were included from 14 equipped and trained centers: 117 adults and 81 children with PH associated with cardiac surgery and 38 neonates with persistent PH of the newborn. Inhaled NO was initiated before intensive care unit (ICU) admission in 57%, 12.7%, and 38.9% with an initial dose of 10 (10, 15) ppm, 20 (18, 20) ppm, and 17 (11, 20) ppm, and a median duration of administration of 3.9 (1.9, 6.1) days, 3.8 (1.8, 6.8) days, and 3.1 (1.0, 5.7) days, respectively, for the adult population, pediatric cardiac group, and newborns. The treatment was performed using administration synchronized to the mechanical ventilation. The dose was gradually decreased before withdrawal in 86% of the cases according to the usual procedure of each center. Adverse events included rebound effect for 3.4% (95% confidence interval [CI], 0.9%-8.5%) of adults, 1.2% (95% CI, 0.0%-6.7%) of children, and 2.6% (95% CI, 0.1%-13.8%) of neonates and methemoglobinemia exceeded 2.5% for 5 of 62 monitored patients. Other pulmonary vasodilators were associated with NO in 23% of adults, 95% of children, and 23.7% of neonates. ICU stay was respectively 10 (6, 22) days, 7.5 (5.5, 15) days, and 9 (8, 15) days and ICU mortality was 22.2%, 6.2%, and 7.9% for adults, children, and neonates, respectively. CONCLUSIONS This study confirms the safety of NO therapy in the 3 populations with a low rate of rebound effect. Gradual withdrawal of NO combined with pulmonary vasodilators are current practices in this population. The use of last-generation NO devices allowed good compliance with recommendations.
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Affiliation(s)
- Philippe Gaudard
- From the Cardiothoracic Intensive Care Unit, Centre Hospitalier Universitaire de Montpellier, and PhyMedExp, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Claudio Barbanti
- Pediatric Cardiac Intensive Care, Anesthesia and Perfusion Unit, Reference Centre for Complex Congenital Cardiac Disease, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Rozec
- Department of Anesthesia and Intensive Care, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Philippe Mauriat
- Congenital Cardiac Surgery Unit, Department of Anesthesia and Intensive Care II, Maison du Haut Lévêque - Groupe Hospitalier Sud, Pessac, France
| | | | - Gilles Cambonie
- Neonatal and pediatric Intensive Care Unit, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean Michel Liet
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Claude Girard
- Cardiovascular Intensive Care Unit, Centre Hospitalier Universitaire Bocage Central, Dijon, France
| | | | - Ziad Assaf
- Pediatric Cardiac Intensive Care, Anesthesia and Perfusion Unit, Reference Centre for Complex Congenital Cardiac Disease, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Damas
- Intensive Care Unit, Centre Hospitalier Universitaire de Liège, Liège, Belgique
| | - Gauthier Loron
- Neonatal Intensive Care Unit, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Julien Amour
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Pouard
- Pediatric Cardiac Intensive Care, Anesthesia and Perfusion Unit, Reference Centre for Complex Congenital Cardiac Disease, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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20
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Nguyen LS, Coutance G, Salem JE, Ouldamar S, Lebreton G, Combes A, Amour J, Laali M, Leprince P, Varnous S. Effect of recipient gender and donor-specific antibodies on antibody-mediated rejection after heart transplantation. Am J Transplant 2019; 19:1160-1167. [PMID: 30286278 DOI: 10.1111/ajt.15133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/21/2018] [Accepted: 09/23/2018] [Indexed: 01/25/2023]
Abstract
Gender-difference regarding antibody-mediated rejection (AMR) after heart transplantation has been described. However, no study accounted for the presence of preformed donor-specific antibodies (pfDSA), a known risk factor of AMR, more common among women than men. In a single-institution 6-year cohort (2010-2015), time to AMR was assessed, comparing men with women by survival analysis with a 1-year death-censored follow-up. All AMRs were biopsy proven. Confounding variables that were accounted for included mean intensity fluorescence (MFI) of pfDSA, recipient age, HLA-, size- and sex-mismatch. 463 patients were included. Overall incidence of AMR was 10.3% at 1 year. After adjusting for confounding variables, independent risk factors of AMR were female recipient gender (adjusted hazard-ratio [adj. HR] = 1.78 [1.06-2.99]), P = .03) and the presence of pfDSA (adj. HR = 3.20 [1.80-5.70], P < .001). This association remained significant when considering pfDSA by their MFI; female recipient gender had an adj. HR = 2.2 (P = .026) and MFI of pfDSA (per 1 MFI-increase) adj. HR = 1.0002 (P < .0001). In this cohort, women were at higher risk of AMR than men and this risk increase was additive to that of pfDSA. These findings may suggest a gender-related difference in the severity of pfDSA.
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Affiliation(s)
- Lee S Nguyen
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France.,APHP, Pitié-Salpétrière, Sorbonne University, Center of Clinical Investigation, ICAN, Paris, France
| | - Guillaume Coutance
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Joe-Elie Salem
- APHP, Pitié-Salpétrière, Sorbonne University, Center of Clinical Investigation, ICAN, Paris, France.,Department of Medicine, Clinical Pharmacology, Cardio-oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Salima Ouldamar
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Guillaume Lebreton
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Alain Combes
- APHP, Pitié-Salpétrière, Sorbonne University, Intensive Care Medicine Department, ICAN, Paris, France
| | - Julien Amour
- APHP, Pitié-Salpétrière, Sorbonne University, Anesthesiology & Critical Care Medicine Department, Paris, France
| | - Mojgan Laali
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Pascal Leprince
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
| | - Shaida Varnous
- APHP, Pitié-Salpétrière, Sorbonne University, Cardiac Surgery Department, Institute of Cardiology, Paris, France
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21
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Bouglé A, Dujardin O, Lepère V, Ait Hamou N, Vidal C, Lebreton G, Salem JE, El-Helali N, Petijean G, Amour J. PHARMECMO: Therapeutic drug monitoring and adequacy of current dosing regimens of antibiotics in patients on Extracorporeal Life Support. Anaesth Crit Care Pain Med 2019; 38:493-497. [PMID: 30831307 DOI: 10.1016/j.accpm.2019.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 10/05/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Optimisation of antibiotic therapy for extracorporeal membrane oxygenation (ECMO) patients remains a pharmacological challenge. The objective of this study was to observe the plasma concentrations of commonly used antibiotics in intensive care for patients treated with extracorporeal membrane oxygenation. PATIENTS AND METHODS The PHARMECMO study was a pilot, prospective study, conducted in a cardiac surgery intensive care unit. Every adult patient under ECMO support, with known or suspected sepsis and receiving antibiotic therapy, was eligible for inclusion. Plasma concentrations of antibiotics were determined by a combination of liquid chromatography and mass spectrometry. RESULTS Forty-four eligible patients were enrolled for 68 inclusions on a twelve-month period. For the association piperacillin-tazobactam (n=19), 68.7% of CT50 and 93.7% of Cmin reached the pharmacokinetic goals defined (64 mg.L-1 for CT50 and 16 mg.L-1 for Cmin). For cefotaxime (n=12), the pharmacokinetic goals (4 mg.L-1 for CT50 and 1 mg.L-1 for Cmin) were achieved in 100% of the cases for CT50 and in 81.8% of the cases for Cmin. Regarding imipenem (n=10), the pharmacokinetic goals were 16 mg.L-1 for CT50 and 4 mg.L-1 for Cmin. Only one CT50 was above 16 mg.L-1. For Cmin, 60% of the doses did not reach the target concentration. In our 10 patients, only one patient was considered as reaching the pharmacokinetic goals. Finally, for amikacin (n=6), four Cmax (66.7%) were infra-therapeutics for a target between 60 and 80 mg.L-1. CONCLUSION These preliminary results suggest that therapeutic drug monitoring could optimise the achievement of pharmacokinetic objectives associated with an effective antibiotic therapy. For most patients, the recommended doses of imipenem and amikacin did not achieve the pK targets.
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Affiliation(s)
- Adrien Bouglé
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France.
| | - Olivier Dujardin
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Victoria Lepère
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Nora Ait Hamou
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Charles Vidal
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Cardio-Vascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Najoua El-Helali
- Department of Clinical Microbiology and Therapeutic Monitoring of Anti-infective drugs, Hospital Group Paris Saint-Joseph, Paris, France
| | - Grégoire Petijean
- Department of Clinical Microbiology and Therapeutic Monitoring of Anti-infective drugs, Hospital Group Paris Saint-Joseph, Paris, France
| | - Julien Amour
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
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Schoell T, Genser L, Clément M, Amour J, Leprince P, Lebreton G, Tavakoli R. Bilateral Internal Thoracic Artery Grafting in Women: A Word of Caution. Heart Surg Forum 2019; 22:E045-E049. [DOI: 10.1532/hsf.2067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022]
Abstract
Background: Despite the superior hemodynamic performance of internal thoracic arteries, total arterial revascularization with exclusive bilateral internal thoracic arteries (BITA) is less frequently used especially in specific subsets of patients, including females. We report our experience with total arterial revascularization with exclusive BITA regardless of sex and analyze the impact of female sex on the early and midterm outcomes.
Methods: Total arterial revascularization with exclusive BITA was performed with equal frequency in females (79/99, 80%) and males (392/477, 82%; P = .68) undergoing isolated CABG for 3-vessel disease. Pre, intra and postoperative data were compared between these two groups.
Results: Complete revascularization was achieved in 77% of females and 72% of males (P = .08). Early mortality did not differ between the groups (6.3% versus 4.6%, P = .7). The incidence of re-sternotomy for bleeding, postoperative stroke, myocardial infarction, new onset atrial fibrillation, and hemofiltration for renal failure did not differ between the two groups. However, there were significantly more wound revision for combined superficial and deep sternal wound infection in females (26.5% versus 5.1%, P = .0001). Nevertheless, midterm survival, freedom from repeat revascularization, myocardial infarction, stroke, and major adverse cardiovascular and cerebral events at five years were very good and compared favorably between females and males.
Conclusions: Our findings suggest that total arterial myocardial revascularization with exclusive internal thoracic arteries in females carries the same midterm benefits as in males. Early outcomes are comparable except for a higher incidence of wound revision for combined superficial and deep sternal wound infections in females compared to males. Benefits of bilateral internal thoracic artery grafting in females should be weighed against increased risk of early wound revision.
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation : recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF) et de la Société française d’anesthésie et de réanimation (SFAR), en collaboration avec la Société française de médecine d’urgence (SFMU) et la Société française d’otorhinolaryngologie (SFORL). Méd Intensive Réa 2019. [DOI: 10.3166/rea-2018-0066] [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: 11/20/2022]
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Coutance G, Lebreton G, Demondion P, Jacob N, Nguyen L, Combes A, Amour J, Ouldamar S, Varnous S, Leprince P. Survival after heart transplantation in patients on ECMO support at the time of transplant improved over time in a high-volume center. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.312] [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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Langeron O, Bourgain JL, Francon D, Amour J, Baillard C, Bouroche G, Chollet Rivier M, Lenfant F, Plaud B, Schoettker P, Fletcher D, Velly L, Nouette-Gaulain K. Difficult intubation and extubation in adult anaesthesia. Anaesth Crit Care Pain Med 2018; 37:639-651. [DOI: 10.1016/j.accpm.2018.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/17/2022]
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26
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Danial P, Hajage D, Nguyen LS, Mastroianni C, Demondion P, Schmidt M, Bouglé A, Amour J, Leprince P, Combes A, Lebreton G. Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study. Intensive Care Med 2018; 44:2153-2161. [PMID: 30430207 DOI: 10.1007/s00134-018-5442-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Femoral artery surgical cannulation is the reference for venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults. However, the less invasive percutaneous approach has been associated with lower rates of complications. This retrospective study compared complication rates and overall survival in a large series of patients who received surgical or percutaneous peripheral VA-ECMO. METHODS All consecutive patients implanted with VA-ECMO between January 2015 and December 2017 in a high ECMO-volume university hospital were included. Surgical cannulation was the only approach until late 2016 after which the percutaneous approach became the first line strategy. Propensity score framework analyzes were used to compare outcomes of percutaneous and surgical groups while controlling for confounders. RESULTS Among the 814 patients who received VA-ECMO (485 surgical and 329 percutaneous), propensity-score matching selected 266 unique pairs of patients with similar characteristics. Percutaneous cannulation was associated with fewer local infections (16.5% versus 27.8%, p = 0.001), similar rates of limb ischemia (8.6% versus 12.4%, p = 0.347) and sensory-motor complications (2.6% versus 2.3%, p = 0.779) and improved 30-day survival (63.8% versus 56.3%, p = 0.034). However, more vascular complications following decannulation (14.7% versus 3.4%, p < 0.001), mainly persistent bleeding requiring surgical revision (9.4% vs. 1.5%, p < 0.001), occurred after percutaneous cannulation. CONCLUSIONS Compared to the surgical approach, percutaneous cannulation for peripheral VA-ECMO was associated with fewer local infections, similar rates of ischemia and sensory-motor complications and improved 30-day survival. The higher rate of vascular complications following decannulation suggests that improvements in cannula removal techniques are needed to further improve patients' outcomes after percutaneous cannulation.
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Affiliation(s)
- Pichoy Danial
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France
| | - David Hajage
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Lee S Nguyen
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France
| | - Ciro Mastroianni
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France
| | - Pierre Demondion
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France
| | - Alain Combes
- Medical Intensive Care Unit, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83, Boulevard de l'hopital, Paris, 75013, France.
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation. Anesthésie & Réanimation 2018. [DOI: 10.1016/j.anrea.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Kimmoun A, Oulehri W, Sonneville R, Grisot PH, Zogheib E, Amour J, Aissaoui N, Megarbane B, Mongardon N, Renou A, Schmidt M, Besnier E, Delmas C, Dessertaine G, Guidon C, Nesseler N, Labro G, Rozec B, Pierrot M, Helms J, Bougon D, Chardonnal L, Medard A, Ouattara A, Girerd N, Lamiral Z, Borie M, Ajzenberg N, Levy B. Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study. Intensive Care Med 2018; 44:1460-1469. [PMID: 30136139 DOI: 10.1007/s00134-018-5346-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/10/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Thrombocytopenia is a frequent and serious adverse event in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. Similarly to postcardiac surgery patients, heparin-induced thrombocytopenia (HIT) could represent the causative underlying mechanism. However, the epidemiology as well as related mortality regarding HIT and VA-ECMO remains largely unknown. We aimed to define the prevalence and associated 90-day mortality of HIT diagnosed under VA-ECMO. METHODS This retrospective study included patients under VA-ECMO from 20 French centers between 2012 and 2016. Selected patients were hospitalized for more than 3 days with high clinical suspicion of HIT and positive anti-PF4/heparin antibodies. Patients were classified according to results of functional tests as having either Confirmed or Excluded HIT. RESULTS A total of 5797 patients under VA-ECMO were screened; 39/5797 met the inclusion criteria, with HIT confirmed in 21/5797 patients (0.36% [95% CI] [0.21-0.52]). Fourteen of 39 patients (35.9% [20.8-50.9]) with suspected HIT were ultimately excluded because of negative functional assays. Drug-induced thrombocytopenia tended to be more frequent in Excluded HIT at the time of HIT suspicion (p = 0.073). The platelet course was similar between Confirmed and Excluded HIT (p = 0.65). Mortality rate was 33.3% [13.2-53.5] in Confirmed and 50% [23.8-76.2] in Excluded HIT (p = 0.48). CONCLUSIONS Prevalence of HIT among patients under VA-ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA-ECMO without HIT. In addition, HIT was ultimately ruled out in one-third of patients with clinical suspicion of HIT and positive anti-PF4/heparin antibodies.
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Affiliation(s)
- Antoine Kimmoun
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, 54511, Nancy, France
| | - Walid Oulehri
- Department of Anesthesiology and Surgical Critical Care, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Hôpital Bichat Claude Bernard, Assistance Publique, Hôpitaux de Paris, INSERM, UMR 1148, Université Paris Diderot, Paris, France
| | - Paul-Henri Grisot
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, 54511, Nancy, France
| | - Elie Zogheib
- Cardiothoracic and Vascular Intensive Care Unit, Amiens University Hospital, INSERM U1088, Jules Verne University of Picardy, Amiens, France
| | - Julien Amour
- Department of Anesthesiology and Surgical Critical Care, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Hôpital Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris, UMR INSERM 1166, Université Sorbonne, Paris, France
| | - Nadia Aissaoui
- Critical Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, INSERM U970, Université Paris-Descartes, Paris, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, INSERM UMRS-1144, Université Paris Diderot, Paris, France
| | - Nicolas Mongardon
- Department of Anesthesiology and Surgical Critical Care, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, INSERM U955 Team 3, Université Paris Est, Paris, France
| | - Amelie Renou
- Department of Anesthesiology and Surgical Critical Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, UMR INSERM 1166, Université Sorbonne, Paris, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Surgical Critical Care, Hôpital de Rouen, Université de Rouen, Rouen, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Hôpital de Rangueil, Université de Toulouse 3 Paul Sabatier, Toulouse, France
| | - Geraldine Dessertaine
- Intensive Cardiac Care Unit, Hôpital de Grenoble, Université de Grenoble Alpes, Grenoble, France
| | - Catherine Guidon
- Department of Cardiac Surgery, Hôpital La Timone, Marseille, France
| | - Nicolas Nesseler
- Department of Anesthesiology and Surgical Critical Care, Hôpital de Pontchaillou, INSERM, UMR 1214 and INSERM 1414, Université de Rennes 1, Rennes, France
| | - Guylaine Labro
- Medical Intensive Care Unit, Hôpital Jean Minjoz, Université de Franche-Comté, Besançon, France
| | - Bertrand Rozec
- Department of Anesthesiology and Surgical Critical Care, Hôpital Guillaume et René Laennec, CHRU Nantes, Institut du Thorax, Université de Nantes, Nantes, France
| | - Marc Pierrot
- Department of Medical Intensive Care and Hyperbaric Medicine, Hôpital d'Angers, Université d' Angers, Angers, France
| | - Julie Helms
- Medical Intensive Care Unit, Nouvel Hôpital Civil, CHU de Strasbourg, INSERM, UMR_S1109, Université de Strasbourg, Strasbourg, France
| | - David Bougon
- Intensive Care Unit, Hôpital Annecy Genevois, Annecy, France
| | - Laurent Chardonnal
- Department of Anesthesiology and Surgical Critical Care, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Anne Medard
- Department of Anesthesiology and Surgical Critical Care, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Ouattara
- Department of Anesthesiology and Surgical Critical Care, Centre Médico-Chirurgical Magellan, CHU de Bordeaux, INSERM, UMR 1034, Université de Bordeaux, Bordeaux, France
| | - Nicolas Girerd
- INSERM CIC1433, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Zohra Lamiral
- INSERM CIC1433, CHRU de Nancy, Université de Lorraine, Nancy, France
| | | | - Nadine Ajzenberg
- Department of Hematology, Hôpital Bichat Claude Bernard, Assistance Publique, Hôpitaux de Paris, INSERM, UMR 1148, Université Paris Diderot, Paris, France
| | - Bruno Levy
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, 54511, Nancy, France.
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Nguyen LS, Squara P, Amour J, Carbognani D, Bouabdallah K, Thierry S, Apert-Verneuil C, Moyne A, Cholley B. Intravenous ivabradine versus placebo in patients with low cardiac output syndrome treated by dobutamine after elective coronary artery bypass surgery: a phase 2 exploratory randomized controlled trial. Crit Care 2018; 22:193. [PMID: 30115103 PMCID: PMC6097391 DOI: 10.1186/s13054-018-2124-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/10/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Low cardiac output syndrome (LCOS) is a severe condition which can occur after cardiac surgery, especially among patients with pre-existing left ventricular dysfunction. Dobutamine, its first-line treatment, is associated with sinus tachycardia. This study aims to assess the ability of intravenous ivabradine to decrease sinus tachycardia associated with dobutamine infused for LCOS after coronary artery bypass graft (CABG) surgery. METHODS In a phase 2, multi-center, single-blind, randomized controlled trial, patients with left ventricular ejection fraction below 40% presenting sinus tachycardia of at least 100 beats per minute (bpm) following dobutamine infusion for LCOS after CABG surgery received either intravenous ivabradine or placebo (three ivabradine for one placebo). Treatment lasted until dobutamine weaning or up to 48 h. The primary endpoint was the proportion of patients achieving a heart rate (HR) in the 80- to 90-bpm range. Secondary endpoints were invasive and non-invasive hemodynamic parameters and arrhythmia events. RESULTS Nineteen patients were included. More patients reached the primary endpoint in the ivabradine than in the placebo group (13 (93%) versus 2 (40%); P = 0.04). Median times to reach target HR were 1.0 h in the ivabradine group and 5.7 h in the placebo group. Ivabradine decreased HR (112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02), stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the placebo group, these parameters remained unchanged from baseline. In the ivabradine group, five patients (36%) developed atrial fibrillation (AF) and one (7%) was discontinued for sustained AF; two (14%) were discontinued for bradycardia. CONCLUSION Intravenous ivabradine achieved effective and rapid correction of sinus tachycardia in patients who received dobutamine for LCOS after CABG surgery. Simultaneously, stroke volume and systolic blood pressure increased, suggesting a beneficial effect of this treatment on tissue perfusion. TRIAL REGISTRATION European Clinical Trials Database: EudraCT 2009-018175-14 . Registered February 2, 2010.
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Affiliation(s)
- Lee S Nguyen
- Critical Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Pierre Squara
- Critical Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Julien Amour
- Anesthesiology and Critical Care Medicine, Hôpital de la Pitié-Salpétrière, AP-HP, and Université Pierre et Marie Curie, Paris, France
| | - Daniel Carbognani
- Anesthesiology and Critical Care Medicine, Institut Mutualiste Monsouris, Paris, France
| | - Kamel Bouabdallah
- Anesthesiology and Critical Care Medicine, Institut Mutualiste Monsouris, Paris, France
| | - Stéphane Thierry
- Anesthesiology and Critical Care Medicine, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Aurélie Moyne
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Bernard Cholley
- Anesthesiology and Critical Care Medicine Department, Hôpital Européen Georges Pompidou, AP-HP, and Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
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Coutance G, Leprince P, Demondion P, Jacob N, Nguyen L, Combes A, Amour J, Ouldamar S, Varnous S, Lebreton G. P4222Pre-heart transplantation ECMO support achieved favorable post-transplant outcomes in selected patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Coutance
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - P Demondion
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - N Jacob
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - L Nguyen
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - A Combes
- Hospital Pitie-Salpetriere, Intensive Care Unit, Paris, France
| | - J Amour
- Hospital Pitie-Salpetriere, Anesthesiology, Paris, France
| | - S Ouldamar
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - S Varnous
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
| | - G Lebreton
- Hospital Pitie-Salpetriere, Cardiovascular and Thoracic surgery, Paris, France
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Vincent F, Rauch A, Loobuyck V, Robin E, Nix C, Vincentelli A, Smadja DM, Leprince P, Amour J, Lemesle G, Spillemaeker H, Debry N, Latremouille C, Jansen P, Capel A, Moussa M, Rousse N, Schurtz G, Delhaye C, Paris C, Jeanpierre E, Dupont A, Corseaux D, Rosa M, Sottejeau Y, Barth S, Mourran C, Gomane V, Coisne A, Richardson M, Caron C, Preda C, Ung A, Carpentier A, Hubert T, Denis C, Staels B, Lenting PJ, Van Belle E, Susen S. Arterial Pulsatility and Circulating von Willebrand Factor in Patients on Mechanical Circulatory Support. J Am Coll Cardiol 2018; 71:2106-2118. [DOI: 10.1016/j.jacc.2018.02.075] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/25/2018] [Accepted: 02/25/2018] [Indexed: 01/27/2023]
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Bouglé A, Bombled C, Margetis D, Lebreton G, Vidal C, Coroir M, Hajage D, Amour J. Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: Epidemiology and risk factors of treatment failure. PLoS One 2018; 13:e0194976. [PMID: 29652913 PMCID: PMC5898723 DOI: 10.1371/journal.pone.0194976] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/14/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is frequent in Intensive Care Unit (ICU) patients. In the specific case of patients treated with Veno-Arterial Extracorporeal Membrane Oxygenation Support (VA-ECMO), VAP treatment failures (VAP-TF) have been incompletely investigated. METHODS To investigate the risk factors of treatment failure (VAP-TF) in a large cohort of ICU patients treated with VA-ECMO, we conducted a retrospective study in a Surgical ICU about patients assisted with VA-ECMO between January 1, 2013, and December 31, 2014. Diagnosis of VAP was confirmed by a positive quantitative culture of a respiratory sample. VAP-TF was defined as composite of death attributable to pneumonia and relapse within 28 days of the first episode. RESULTS In total, 152 patients underwent ECMO support for > 48h. During the VA-ECMO support, 85 (55.9%) patients developed a VAP, for a rate of 60.6 per 1000 ECMO days. The main pathogens identified were Pseudomonas aeruginosa and Enterobacteriaceae. VAP-TF occurred in 37.2% of patients and was associated with an increased 28-day mortality (Hazard Ratio 3.05 [1.66; 5.63], P<0.001), and VA-ECMO assistance duration (HR 1.47 [1.05-2.05], P = 0.025). Risk factors for VAP-TF were renal replacement therapy (HR 13.05 [1.73; 98.56], P = 0.013) and documentation of Pseudomonas aeruginosa (HR 2.36 [1.04; 5.35], P = 0.04). CONCLUSIONS VAP in patients treated with VA-ECMO is associated with an increased morbidity and mortality. RRT and infection by Pseudomonas aeruginosa appear as strong risks factors of treatment failure. Further studies seem necessary to precise the best antibiotic management in these patients.
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Affiliation(s)
- Adrien Bouglé
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Camille Bombled
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Dimitri Margetis
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Thoracic and Cardiovascular Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Charles Vidal
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Marine Coroir
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - David Hajage
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Biostatistics, Public Health and Medical Information, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Paris Cité, UMR 1123 ECEVE, Université Paris Diderot, Paris, France
- INSERM, UMR 1123 ECEVE, Paris, France
| | - Julien Amour
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, Pitié-Salpêtrière Hospital, Paris, France
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Velly L, Perlbarg V, Boulier T, Adam N, Delphine S, Luyt CE, Battisti V, Torkomian G, Arbelot C, Chabanne R, Jean B, Di Perri C, Laureys S, Citerio G, Vargiolu A, Rohaut B, Bruder N, Girard N, Silva S, Cottenceau V, Tourdias T, Coulon O, Riou B, Naccache L, Gupta R, Benali H, Galanaud D, Puybasset L, Constantin JM, Chastre J, Amour J, Vezinet C, Rouby JJ, Raux M, Langeron O, Degos V, Bolgert F, Weiss N, Similowski T, Demoule A, Duguet A, Tollard E, Veber B, Lotterie JA, SANCHEZ-PENA P, Génestal M, Patassini M. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol 2018; 17:317-326. [DOI: 10.1016/s1474-4422(18)30027-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023]
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Vidal C, Pasqualotto R, James A, Bouglé A, Lebreton G, Varnous S, Leprince P, Amour J. Epidemiology and Risk Factors of Post Operative Pneumonias After Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Tavakoli R, Leprince P, Gassmann M, Jamshidi P, Yamani N, Amour J, Lebreton G. Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement. J Vis Exp 2018. [PMID: 29630054 DOI: 10.3791/57323] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer tomography measurements. The indications and limitations of this technique, as well as its alternatives, are discussed.
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Affiliation(s)
- Reza Tavakoli
- Department of Cardiovascular and Thoracic Surgery, Pitié Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris (APHP), Institut de Cardiologie; Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology, University of Zurich;
| | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Pitié Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris (APHP), Institut de Cardiologie
| | - Max Gassmann
- Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology, University of Zurich
| | | | | | - Julien Amour
- Department of Anesthesiology and Intensive Care Unit, Pitié Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris (APHP), Institut de Cardiologie
| | - Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Pitié Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris (APHP), Institut de Cardiologie
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Amour J, Kersten JR. Glycaemic control in diabetic patient: Towards a global care of glycaemia. Anaesth Crit Care Pain Med 2018; 37 Suppl 1:S1-S2. [PMID: 29572100 DOI: 10.1016/j.accpm.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Julien Amour
- Sorbonne University, department of anaesthesiology and intensive care, pitié-Salpetrière hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Judy R Kersten
- Department of Anesthesiology and Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine. Anaesth Crit Care Pain Med 2018; 37:281-294. [PMID: 29559211 DOI: 10.1016/j.accpm.2018.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean-Louis Trouillet
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Olivier Collange
- Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, pôle d'anesthésie-réanimation chirurgicale, SAMU, SMUR, NHC, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France.
| | - Fouad Belafia
- Inserm, U1046, intensive care unit and department of anesthesiology, research unit, university of Montpellier, Saint-Éloi hospital, Montpellier school of medicine, 34000 Montpellier, France
| | - François Blot
- Medical-surgical intensive care unit, Gustave-Roussy Cancer Campus, 94800 Villejuif, France
| | - Gilles Capellier
- EA3920, université de Franche-Comté, CHRU de Besançon, 25000 Besançon, France; Australian and New Zealand intensive care research centre, department of epidemiology and preventive medicine, Monash University Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and department of emergency medicine, Hospices Civils de Lyon, Edouard-Herriot hospital, 69003 Lyon, France; Lyon Sud, school of medicine, university Lyon 1, 69600 Oullins, France
| | - Jean-Michel Constantin
- Department of preoperative medicine university hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France; EA-7281, R2D2, Auvergne University, 63000 Clermont-Ferrand, France
| | - Alexandre Demoule
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Jean-Luc Diehl
- Medical ICU, Georges-Pompidou European Hospital, AP-HP, 75016 Paris, France; Inserm UMR-S1140 Paris Descartes University and Sorbonne Paris Cité, 75006 Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and critical care department, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens, France; Inserm, U1088, Jules-Verne University of Picardy, 80054 Amiens, France
| | - Franck Jegoux
- Service ORL et chirurgie cervico-maxillofaciale, CHU de Pontchaillou, rue H.-Le-Guilloux, 35033 Rennes cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM Inserm, UMR 1101, université de Bretagne Occidentale, rue Camille-Desmoulins, 29200 Brest cedex, France; Médecine intensive et réanimation CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest cedex, France
| | - Charles-Edouard Luyt
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Inserm, UMRS-1166, UPMC, université Paris 06, ICAN, institute of cardiometabolism and nutrition sorbonne universités, 75013 Paris, France
| | - Yazine Mahjoub
- Department of anesthesia and intensive care, Amiens-Picardie, university Hospital, 80054 Amiens, France
| | - Julien Mayaux
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Hervé Quintard
- Réanimation médico-chirurgicale, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France; CNRS, UMR 7275, IPMC, 06560 Sophia Antipolis Valbonne, France
| | - François Ravat
- Centre des brûlés, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Sébastien Vergez
- ORL chirurgie cervicofaciale, CHU de Toulouse, Rangueil-Larrey, 24, chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | - Julien Amour
- Département d'anesthésie et de réanimation chirurgicale, institut de cardiologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Max Guillot
- EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France; Hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, réanimation médicale, avenue Molière, 67200 Strasbourg, France.
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care 2018; 8:37. [PMID: 29546588 PMCID: PMC5854567 DOI: 10.1186/s13613-018-0381-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 12/18/2017] [Accepted: 02/08/2018] [Indexed: 12/29/2022] Open
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean Louis Trouillet
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Collange
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle d'Anesthésie-Réanimation Chirurgicale, SAMU, SMUR, NHC, 1 Place de l'Hôpital, 67000, Strasbourg, France.,EA 3072, FMTS, Université de Strasbourg, Strasbourg, France
| | - Fouad Belafia
- Intensive Care Unit and Department of Anesthesiology, Research Unit INSERM U1046, University of Montpellier Saint Eloi Hospital and Montpellier School of Medicine, Montpellier, France
| | - François Blot
- Medical-Surgical Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilles Capellier
- CHRU Besançon 25000, EA3920 Université de Franche-Comté, Besançon, France.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Lyon Sud School of Medicine, University Lyon 1, Oullins, France
| | - Jean-Michel Constantin
- Department of Preoperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France
| | - Alexandre Demoule
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Jean-Luc Diehl
- Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.,INSERM UMR-S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.,INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France
| | - Franck Jegoux
- Service ORL et Chirurgie Cervico-maxillo-Faciale, CHU PONTCHAILLOU, Rue H. Le Guilloux, 35033, Rennes Cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM INSERM UMR 1101, Université de Bretagne Occidentale, Rue Camille Desmoulins, 29200, Brest Cedex, France.,Médecine Intensive et Réanimation, CHRU de Brest, Boulevard Tanguy Prigent, 29200, Brest Cedex, France
| | - Charles-Edouard Luyt
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France
| | - Yazine Mahjoub
- Department of Anesthesia and Intensive Care, Amiens-Picardie University Hospital, Amiens, France
| | - Julien Mayaux
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Hervé Quintard
- Réanimation médico chirurgicale Hôpital Pasteur 2 CHU de Nice, 30 voie romaine, 06000, Nice, France.,CNRS UMR 7275, IPMC Sophia Antipolis, Valbonne, France
| | - François Ravat
- Centre des brûlés, Centre Hospitalier St Joseph et St Luc, 20 quai Claude Bernard, 69007, Lyon, France
| | - Sebastien Vergez
- ORL Chirurgie Cervicofaciale, CHU Toulouse Rangueil-Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France
| | - Julien Amour
- Département d'Anesthésie et de Réanimation Chirurgicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Max Guillot
- EA 3072, FMTS, Université de Strasbourg, Strasbourg, France. .,Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Réanimation Médicale, Avenue Molière, 67200, Strasbourg, France.
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Bouglé A, Allain PA, Favard S, Ait Hamou N, Carillion A, Leprince P, Granger B, Amour J. Postoperative serum levels of Endocan are associated with the duration of norepinephrine support after coronary artery bypass surgery. Anaesth Crit Care Pain Med 2018; 37:565-570. [PMID: 29476941 DOI: 10.1016/j.accpm.2018.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response and an endothelial dysfunction, whose qualitative assessment appears to be a major issue. Endocan (ESM-1, endothelial cell specific molecule-1) is a protein preferentially expressed by the endothelium and previously associated with prognosis of septic shock or acute respiratory distress syndrome. In this pilot study, we investigated the kinetic of Endocan in planned coronary artery bypass grafting (CABG) surgery with CPB. PATIENTS AND METHODS We conducted an observational, prospective, mono centre study. All adult patients with left systolic ejection fraction>50%, undergoing planned on-pump CABG, were screened for inclusion. A written informed consent was obtained. Measurements and main results Serum Endocan concentrations were respectively 2.4 [2.1-3.0] ng. mL-1, 10.4 [7.4-13.9] ng.mL-1, 5.7 [4.4-8.2] ng.mL-1, and 5.4 [4.1-7.5] ng.mL-1 at day 0, day 1, day 3 and day 5. Endocan concentrations increased at day 1, day 3, and day 5 in comparison with preoperative concentration (P<0.001). In the multivariate analysis, age (P=0.002), history of acute coronary syndrome (P=0.024) and the catecholamine-free days at day 28 (P=0.007) were associated to the increase of perioperative Endocan concentrations. CONCLUSION Serum Endocan concentration increases after CABG surgery with CPB until day 1. The norepinephrine support increases the risk of Endocan release, suggesting a relationship between the kinetic of Endocan and the vasoplegic syndrome. At day 3, Endocan concentration decreases slowly but is not normalised at day 5. Further studies should investigate the prognostic value of the magnitude of postoperative Endocan concentration after cardiac surgery.
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Affiliation(s)
- Adrien Bouglé
- Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - Pierre-Antoine Allain
- Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Séverine Favard
- Department of biological endocrinology and oncology hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), 75651 Paris cedex 13, France
| | - Nora Ait Hamou
- Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Aude Carillion
- Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Pascal Leprince
- Department of cardiothoracic and vascular surgery, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 75651 Paris cedex 13, France; UMR INSERM 1166, IHU ICAN, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, 75651 Paris cedex 13, France
| | - Benjamin Granger
- Department of Clinical Epidemiology and Biostatistics, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 75651 Paris cedex 13, France
| | - Julien Amour
- Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France; UMR INSERM 1166, IHU ICAN, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, 75651 Paris cedex 13, France
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Nguyen L, Squara P, Amour J, Cholley B. Intravenous ivabradine in low cardiac output syndrome after cardiac surgery treated by dobutamine: A phase II trial. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Dorent R, Gandjbakhch E, Goéminne C, Ivanes F, Sebbag L, Bauer F, Epailly E, Boissonnat P, Nubret K, Amour J, Vermes E, Ou P, Guendouz S, Chevalier P, Lebreton G, Flecher E, Obadia JF, Logeart D, de Groote P. Assessment of potential heart donors: A statement from the French heart transplant community. Arch Cardiovasc Dis 2017; 111:126-139. [PMID: 29277435 DOI: 10.1016/j.acvd.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors.
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Affiliation(s)
- Richard Dorent
- Agence de la biomédecine, direction prélèvement greffe organes-tissus, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France.
| | - Estelle Gandjbakhch
- Département de cardiologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Céline Goéminne
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
| | - Fabrice Ivanes
- Service de cardiologie, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Laurent Sebbag
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Fabrice Bauer
- Département de cardiologie, hôpital Charles-Nicolle, centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Eric Epailly
- Service de chirurgie cardiaque, nouvel hôpital civil, centre hospitalier universitaire de Strasbourg, 67091 Strasbourg, France
| | - Pascale Boissonnat
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Karine Nubret
- Département d'anesthésie-réanimation II, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France
| | - Julien Amour
- Département d'anesthésie-réanimation, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Emmanuelle Vermes
- Service de chirurgie cardiaque, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Phalla Ou
- Département de radiologie, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75877 Paris, France
| | - Soulef Guendouz
- Département de cardiologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France
| | - Philippe Chevalier
- Service de rythmologie, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Guillaume Lebreton
- Service de chirurgie cardiovasculaire, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Erwan Flecher
- Service de chirurgie cardiovasculaire, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - Jean-François Obadia
- Service de chirurgie cardiovasculaire, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Damien Logeart
- Département de cardiologie, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75475 Paris, France
| | - Pascal de Groote
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
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Omar E, Lebreton G, Bouglé A, Amour J. Massive air embolism from central venous catheter during veno-arterial ECMO therapy. Anaesth Crit Care Pain Med 2017; 37:271-272. [PMID: 28927734 DOI: 10.1016/j.accpm.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Edris Omar
- Anaesthesiology and critical care medicine department, heart institute, Pitié-Salpêtrière hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Guillaume Lebreton
- Cardiac surgery department, heart institute, Pitié-Salpêtrière hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Adrien Bouglé
- Anaesthesiology and critical care medicine department, heart institute, Pitié-Salpêtrière hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Julien Amour
- Anaesthesiology and critical care medicine department, heart institute, Pitié-Salpêtrière hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Cholley B, Caruba T, Grosjean S, Amour J, Ouattara A, Villacorta J, Miguet B, Guinet P, Lévy F, Squara P, Aït Hamou N, Carillon A, Boyer J, Boughenou MF, Rosier S, Robin E, Radutoiu M, Durand M, Guidon C, Desebbe O, Charles-Nelson A, Menasché P, Rozec B, Girard C, Fellahi JL, Pirracchio R, Chatellier G. Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass: The LICORN Randomized Clinical Trial. JAMA 2017; 318:548-556. [PMID: 28787507 PMCID: PMC5817482 DOI: 10.1001/jama.2017.9973] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. OBJECTIVE To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). INTERVENTIONS Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. MAIN OUTCOMES AND MEASURES Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. RESULTS Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, -7% [95% CI, -17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse events did not significantly differ between levosimendan and placebo. CONCLUSIONS AND RELEVANCE Among patients with low ejection fraction who were undergoing coronary artery bypass grafting with cardiopulmonary bypass, levosimendan compared with placebo did not result in a significant difference in the composite end point of prolonged catecholamine infusion, use of left ventricular mechanical assist device, or renal replacement therapy. These findings do not support the use of levosimendan for this indication. TRIAL REGISTRATION EudraCT Number: 2012-000232-25; clinicaltrials.gov Identifier: NCT02184819.
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Affiliation(s)
- Bernard Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Sandrine Grosjean
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalo-Universitaire de Dijon-Bourgogne, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Hôpital de La Pitié Salpêtrière, AP-HP, and University Pierre & Marie Curie, Paris, France
| | - Alexandre Ouattara
- Department Department of Anaesthesiology and Critical Care II, Magellan Medico-Surgical Center, and University of Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Bordeaux, France
| | - Judith Villacorta
- Department of Anesthesiology and Critical Care, CHU La Timone, Marseille, France
| | - Bertrand Miguet
- Department of Anesthesiology and Critical Care Medicine, Hôpital Laënnec, Nantes, France
| | - Patrick Guinet
- Department of Anesthesiology and Critical Care Medicine, Hôpital Pontchaillou, Rennes, France
| | - François Lévy
- Department of Anesthesiology and Critical Care, Nouvel Hôpital Civil, Strasbourg, France
| | - Pierre Squara
- Department of Anesthesiology and Critical Care, Clinique Ambroise Paré, Neuilly, France
| | - Nora Aït Hamou
- Department of Anesthesiology and Critical Care Medicine, Hôpital de La Pitié Salpêtrière, AP-HP, and University Pierre & Marie Curie, Paris, France
| | - Aude Carillon
- Department of Anesthesiology and Critical Care Medicine, Hôpital de La Pitié Salpêtrière, AP-HP, and University Pierre & Marie Curie, Paris, France
| | - Julie Boyer
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalo-Universitaire de Dijon-Bourgogne, France
| | - Marie-Fazia Boughenou
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Sebastien Rosier
- Department of Anesthesiology and Critical Care Medicine, Hôpital Pontchaillou, Rennes, France
| | - Emmanuel Robin
- Department of Anesthesiology and Critical Care, Hôpital Claude Huriez, Lille, France
| | - Mihail Radutoiu
- Department of Anesthesiology and Critical Care, CHU Côte de Nacre, Caen, France
| | - Michel Durand
- Department of Anesthesiology and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | - Catherine Guidon
- Department of Anesthesiology and Critical Care, CHU La Timone, Marseille, France
| | - Olivier Desebbe
- Department of Anesthesiology and Critical Care, Hôpital Cardiologique Louis Pradel and INSERM U1060, University Claude Bernard, Lyon, France
| | - Anaïs Charles-Nelson
- Department of Biostatistics, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Philippe Menasché
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Bertrand Rozec
- Department of Anesthesiology and Critical Care Medicine, Hôpital Laënnec, Nantes, France
| | - Claude Girard
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalo-Universitaire de Dijon-Bourgogne, France
| | - Jean-Luc Fellahi
- Department of Anesthesiology and Critical Care, Hôpital Cardiologique Louis Pradel and INSERM U1060, University Claude Bernard, Lyon, France
| | - Romain Pirracchio
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Gilles Chatellier
- Department of Biostatistics, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France
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Carillion A, Feldman S, Na N, Biais M, Carpentier W, Birenbaum A, Cagnard N, Loyer X, Bonnefont-Rousselot D, Hatem S, Riou B, Amour J. Atorvastatin reduces β-Adrenergic dysfunction in rats with diabetic cardiomyopathy. PLoS One 2017; 12:e0180103. [PMID: 28727746 PMCID: PMC5519044 DOI: 10.1371/journal.pone.0180103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/09/2017] [Indexed: 12/12/2022] Open
Abstract
Background In the diabetic heart the β-adrenergic response is altered partly by down-regulation of the β1-adrenoceptor, reducing its positive inotropic effect and up-regulation of the β3-adrenoceptor, increasing its negative inotropic effect. Statins have clinical benefits on morbidity and mortality in diabetic patients which are attributed to their “pleiotropic” effects. The objective of our study was to investigate the role of statin treatment on β-adrenergic dysfunction in diabetic rat cardiomyocytes. Methods β-adrenergic responses were investigated in vivo (echocardiography) and ex vivo (left ventricular papillary muscles) in healthy and streptozotocin-induced diabetic rats, who were pre-treated or not by oral atorvastatin over 15 days (50 mg.kg-1.day-1). Micro-array analysis and immunoblotting were performed in left ventricular homogenates. Data are presented as mean percentage of baseline ± SD. Results Atorvastatin restored the impaired positive inotropic effect of β-adrenergic stimulation in diabetic hearts compared with healthy hearts both in vivo and ex vivo but did not suppress the diastolic dysfunction of diabetes. Atorvastatin changed the RNA expression of 9 genes in the β-adrenergic pathway and corrected the protein expression of β1-adrenoceptor and β1/β3-adrenoceptor ratio, and multidrug resistance protein 4 (MRP4). Nitric oxide synthase (NOS) inhibition abolished the beneficial effects of atorvastatin on the β-adrenoceptor response. Conclusions Atorvastatin restored the positive inotropic effect of the β-adrenoceptor stimulation in diabetic cardiomyopathy. This effect is mediated by multiple modifications in expression of proteins in the β-adrenergic signaling pathway, particularly through the NOS pathway.
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Affiliation(s)
- Aude Carillion
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Sarah Feldman
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Na Na
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Matthieu Biais
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Anesthesiology and Critical Care, Université Bordeaux Segalen, Hôpital Pellegrin, Bordeaux, France
| | - Wassila Carpentier
- Sorbonne Universités, UPMC Univ Paris 06, Post-Genomic Platform, Paris, France
| | - Aurélie Birenbaum
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Nicolas Cagnard
- Sorbonne Universités, Université Paris Descartes, Bioinformatics Platform, Paris, France
| | - Xavier Loyer
- Sorbonne Universités, Université Paris Descartes, UMRS INSERM U970, Cardiovascular Research center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Dominique Bonnefont-Rousselot
- Sorbonne Paris Cité, Paris Descartes University, CNRS UMR8258—INSERM U1022, Faculty of Pharmacy, Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Paris, France
| | - Stéphane Hatem
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, Sorbonne Universités, UPMC Univ Paris 06, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Bruno Riou
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Julien Amour
- Sorbonne Universités, UPMC Univ Paris 06, UMR INSERM 1166, IHU ICAN, and Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- * E-mail:
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Coutance G, Van Aelst L, Ouldammar S, Rouvier P, Saheb S, Brechot N, Lebreton G, Bouglé A, Combes A, Amour J, Leprince P, Varnous S. Early Acute Humoral Rejection Does Not Alter Prognosis After Heart Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bouglé A, Foucrier A, Dupont H, Montravers P, Ouattara A, Kalfon P, Squara P, Simon T, Amour J. Impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for a randomized controlled study. Trials 2017; 18:37. [PMID: 28114979 PMCID: PMC5260072 DOI: 10.1186/s13063-017-1780-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 05/24/2016] [Accepted: 01/02/2017] [Indexed: 11/16/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) accounts for 25% of infections in intensive care units. Compared to a long duration (LD) of antibiotic therapy, a short duration (SD) has a comparable clinical efficacy with less antibiotic use and less multidrug-resistant (MDR) pathogen emergence, with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). These results have led the American Thoracic Society to recommend SD therapy for VAP, except for PA-VAP. Thus the beneficial effect of SD therapy in PA-VAP is still a matter of debate. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) versus prolonged antibiotic therapy (15 days) in PA-VAP. Methods/design The impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia (iDIAPASON) trial is a randomized, open-labeled non-inferiority controlled trial, conducted in 34 French intensive care units (ICUs), comparing two groups of patients with PA-VAP according to the duration (8 days or 15 days) of effective antibiotic therapy against PA. The primary outcome is a composite endpoint combining day 90 mortality and PA-VAP recurrence rate during hospitalization in the ICU. Furthermore, durations of mechanical ventilation and hospitalization, as well as number and types of extrapulmonary infections or acquisition of MDR pathogens during the hospitalization in the ICU will be recorded. Recurrence with predefined criteria (clinical suspicion of VAP associated with a positive quantitative culture of a respiratory sample) will be evaluated by two independent experts. Discussion Demonstrating that an SD (8 days) versus LD (15 days) therapy strategy in PA-VAP treatment is safe and not associated with an increased mortality or recurrence rate could lead to a change in practices and guidelines in the management of antibiotic therapy of this frequent ICU complication. This strategy could lead to decreased antibiotic exposure during hospitalization in the ICU and in turn reduce the acquisition and the spread of MDR pathogens. Trial registration ClinicalTrials.gov: NCT02634411. Registered on 19 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1780-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adrien Bouglé
- Department of Anesthesiology and Critical Care, CHU La Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
| | - Arnaud Foucrier
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, APHP, Paris, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care, CHU Amiens, Amiens, France.,Université de Picardie Jules Verne, Amiens, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care, CHU Bichat, APHP, Paris, France.,Université Diderot, Paris, France
| | - Alexandre Ouattara
- Department of Anesthesiology and Critical Care, Groupe Hospitalier Sud, Pessac, Bordeaux, France.,Université Bordeaux Segalen, Bordeaux, France
| | - Pierre Kalfon
- Intensive Care Unit, Hôpital Louis Pasteur, CH de Chartres, Chartres, France
| | - Pierre Squara
- Intensive Care Unit, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Tabassome Simon
- Unité de Recherche Clinique du GH HUEP (URC-Est), Hôpital Saint-Antoine, APHP, Paris, France.,UPMC - Sorbonne universités (Paris 6), Paris, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care, CHU La Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,UPMC - Sorbonne universités (Paris 6), Paris, 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 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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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C, Zerhouni A, Tabeliouna K, Gaja A, Hamrouni B, Malouch A, Fourati S, Messaoud R, Zarrouki Y, Ziadi A, Rhezali M, Zouizra Z, Boumzebra D, Samkaoui MA, Brunet J, Canoville B, Verrier P, Ivascau C, Seguin A, Valette X, Du Cheyron D, Daubin C, Bougouin W, Aissaoui N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Dumas F, Marijon E, Jouven X, Cariou A, Poirson F, Chaput U, Beeken T, Maxime L, Haikel O, Vodovar D, Chelly J, Marteau P, Chocron R, Juvin P, Loeb T, Adnet F, Lecarpentier E, Riviere A, De Cagny B, Soupison T, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Leteurtre S, Fresco M, Bubenheim M, Beduneau G, Carpentier D, Grange S, Artaud-Macari E, Misset B, Tamion F, Girault C, Dumas G, Chevret S, Lemiale V, Mokart D, Mayaux J, Pène F, Nyunga M, Perez P, Moreau AS, Bruneel F, Vincent F, Klouche K, Reignier J, Rabbat A, Azoulay E, Frat JP, Ragot S, Constantin JM, Prat G, Mercat A, Boulain T, Demoule A, Devaquet J, Nseir S, Charpentier J, Argaud L, Beuret P, Ricard JD, Teiten C, Marjanovic N, Palamin N, L’Her E, Bailly A, Boisramé-Helms J, Champigneulle B, Kamel T, Mercier E, Le Thuaut A, Lascarrou JB, Rolle A, De Jong A, Chanques G, Jaber S, Hariri G, Baudel JL, Dubée V, Preda G, Bourcier S, Joffre J, Bigé N, Ait-Oufella H, Maury E, Mater H, Merdji H, Grimaldi D, Rousseau C, Mira JP, Chiche JD, Sedghiani I, Benabderrahim A, Hamdi D, Jendoubi A, Cherif MA, Hechmi YZE, Zouheir J, Bagate F, Bousselmi R, Schortgen F, Asfar P, Guérot E, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Dreyfuss D, Radermacher P, Frère A, Martin-Lefèvre L, Colin G, Fiancette M, Henry-Laguarrigue M, Lacherade JC, Lebert C, Vinatier I, Yehia A, Joret A, Menunier-Beillard N, Benzekri-Lefevre D, Desachy A, Bellec F, Plantefève G, Quenot JP, Meziani F, Tavernier E, Ehrmann S, Chudeau N, Raveau T, Moal V, Houillier P, Rouve E, Lakhal K, Gandonnière CS, Jouan Y, Bodet-Contentin L, Balmier A, Messika J, De Montmollin E, Pouyet V, Sztrymf B, Thiagarajah A, Roux D, De Chambrun MP, Luyt CE, Beloncle F, Zapella N, Ledochowsky S, Terzi N, Mazou JM, Sonneville R, Paulus S, Fedun Y, Landais M, Raphalen JH, Combes A, Amoura Z, Jacquemin A, Guerrero F, Marcheix B, Hernandez N, Fourcade O, Georges B, Delmas C, Makoudi S, Genton A, Bernard R, Lebreton G, Amour J, Mazet C, Bounes F, Murat G, Cronier L, Robin G, Biendel C, Silva S, Boubeche S, Abriou C, Wurtz V, Scherrer V, Rey N, Gastaldi G, Veber B, Doguet F, Gay A, Dureuil B, Besnier E, Rouget A, Gantois G, Magalhaes E, Wanono R, Smonig R, Lermuzeaux M, Lebut J, Olivier A, Dupuis C, Radjou A, Mourvillier B, Neuville M, D’ortho MP, Bouadma L, Rouvel-Tallec A, Rudler M, Weiss N, Perlbarg V, Galanaud D, Thabut D, Rachdi E, Mhamdi G, Trifi A, Abdelmalek R, Abdellatif S, Daly F, Nasri R, Tiouiri H, Lakhal SB, Rousseau G, Asmolov R, Grammatico-Guillon L, Auvet A, Laribi S, Garot D, Dequin PF, Guillon A, Fergé JL, Abgrall G, Hinault R, Vally S, Roze B, 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Marchalot A, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Meunier-Beillard N, Devilliers H, Rigaud JP, Verrière C, Ardisson F, Kentish-Barnes N, Jacq G, Chermak A, Lautrette A, Legrand M, Soummer A, Thiery G, Cottereau A, Canet E, Caujolle M, Allyn J, Valance D, Brulliard C, Martinet O, Jabot J, Gallas T, Vandroux D, Allou N, Durand A, Nevière R, Delguste F, Boulanger E, Preau S, Martin R, Cochet H, Ponthus JP, Amilien V, Tchir M, Barsam E, Ayoub M, Georger JF, Guillame I, Assaraf J, Tripon S, Mallet M, Barbara G, Louis G, Gaudry S, Barbarot N, Jamet A, Outin H, Gibot S, Bollaert PE, Holleville M, Legriel S, Chateauneuf AL, Cavelot S, Moyer JD, Bedos JP, Merle P, Laine A, Natalie DS, Cornuault M, Libot J, Asehnoune K, Rozec B, Dantal J, Videcoq M, Degroote T, Jaillette E, Zerimech F, Malika B, Llitjos JF, Amara M, Lacave G, Pangon B, Mavinga J, Makunza JN, Mafuta ME, Yanga Y, Eric A, Ilunga J, Kilembe M, Alby-Laurent F, Toubiana J, Mokline A, Laajili A, Amri H, Rahmani I, Mensi N, Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Amour J, Garnier M, Szymezak J, Le Manach Y, Helley D, Bertil S, Ouattara A, Riou B, Gaussem P. Prospective observational study of the effect of dual antiplatelet therapy with tranexamic acid treatment on platelet function and bleeding after cardiac surgery. Br J Anaesth 2016; 117:749-757. [DOI: 10.1093/bja/aew357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/20/2022] Open
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Colson PH, Gaudard P, Fellahi JL, Bertet H, Faucanie M, Amour J, Blanloeil Y, Lanquetot H, Ouattara A, Picot MC. Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study. PLoS One 2016; 11:e0162396. [PMID: 27588817 PMCID: PMC5010224 DOI: 10.1371/journal.pone.0162396] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
MAIN OBJECTIVES To estimate the incidence of active bleeding after cardiac surgery (AB) based on a definition directly related on blood flow from chest drainage; to describe the AB characteristics and its management; to identify factors of postoperative complications. METHODS AB was defined as a blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation for hemostasis during the first 12 postoperative hours. The definition was applied in a prospective longitudinal observational study involving 29 French centers; all adult patients undergoing cardiac surgery with cardiopulmonary bypass were included over a 3-month period. Perioperative data (including blood product administration) were collected. To study possible variation in clinical practice among centers, patients were classified into two groups according to the AB incidence of the center compared to the overall incidence: "Low incidence" if incidence is lower and "High incidence" if incidence is equal or greater than overall incidence. Logistic regression analysis was used to identify risk factors of postoperative complications. RESULTS Among 4,904 patients, 129 experienced AB (2.6%), among them 52 reoperation. Postoperative bleeding loss was 1,000 [820;1,375] ml and 1,680 [1,280;2,300] ml at 6 and 24 hours respectively. Incidence of AB varied between centers (0 to 16%) but was independent of in-centre cardiac surgical experience. Comparisons between groups according to AB incidence showed differences in postoperative management. Body surface area, preoperative creatinine, emergency surgery, postoperative acidosis and red blood cell transfusion were risk factors of postoperative complication. CONCLUSIONS A blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or early reoperation for hemostasis seems a relevant definition of AB. This definition, independent of transfusion, adjusted to body weight, may assess real time bleeding occurring early after surgery.
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Affiliation(s)
- Pascal H. Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, Montpellier University, Montpellier, France
- Institut de Génomique Fonctionnelle, Endocrinology Department, CNRS UMR 5203, INSERM U1191, University of Montpellier, 34094, Montpellier, France
- * E-mail:
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Academic Hospital, Montpellier University, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, cedex 5, France
| | - Jean-Luc Fellahi
- Department of Anesthesiology and Critical Care Medicine, Louis Pradel Academic Hospital, Lyon Bron, France
| | - Héléna Bertet
- Clinical Research and Epidemiology Unit, Academic Hospital, Montpellier, France
- Clinical Investigation Center, Academic Hospital, Montpellier, France
| | - Marie Faucanie
- Clinical Research and Epidemiology Unit, Academic Hospital, Montpellier, France
| | - Julien Amour
- Department of Anaesthesiology and Critical Care Medicine, Sorbonne University UPMC Univ Paris 06, UMR INSERM 1166 and Post-Genomic Platform, IHU ICAN, Paris, France
| | - Yvonnick Blanloeil
- Department of Anaesthesiology and Critical Care Medicine, Laënnec Academic Hôpital, Nantes, France
| | - Hervé Lanquetot
- Department of Anaesthesiology and Critical Care Medicine, Academic Hospital, Poitiers, France
| | - Alexandre Ouattara
- Department of Anaesthesiology and Critical Care Medicine II, Academic Hospital, Bordeaux-Pessac, France
| | - Marie Christine Picot
- Clinical Research and Epidemiology Unit, Academic Hospital, Montpellier, France
- Clinical Investigation Center, Academic Hospital, Montpellier, France
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