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Lakhal K, Dauvergne JE, Messet-Charriere H, Nay MA, Kamel T, Muller G, Robert-Edan V, Rozec B, Ehrmann S, Jacquier S, Boulain T. Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study. Anaesth Crit Care Pain Med 2024; 43:101333. [PMID: 38048986 DOI: 10.1016/j.accpm.2023.101333] [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: 10/21/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance. METHODS Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT). RESULTS Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance. CONCLUSIONS Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema. REGISTRATION ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic. CLINICALTRIALS gov/ct2/show/NCT04269382.
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Affiliation(s)
- Karim Lakhal
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France.
| | - Jérôme E Dauvergne
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | | | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France; CRICS-TriggerSep F-CRIN research network, Tours, France; Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Vincent Robert-Edan
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France; CRICS-TriggerSep F-CRIN research network, Tours, France; INSERM, Centre d'étude des pathologies respiratoires, U1100 Tours, France; Université de Tours, Tours, France
| | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
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Poulain C, Launey Y, Bouras M, Lakhal K, Dargelos L, Crémet L, Gibaud SA, Corvec S, Seguin P, Rozec B, Asehnoune K, Feuillet F, Roquilly A. Clinical evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia: A multicenter, quality improvement project. Anaesth Crit Care Pain Med 2024; 43:101353. [PMID: 38355044 DOI: 10.1016/j.accpm.2024.101353] [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: 10/20/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP). METHODS We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy. RESULTS A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%-50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before versus 0.55 ± 1.13 days after the intervention (p = 0.56). CONCLUSION Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.
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Affiliation(s)
- Cécile Poulain
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France.
| | - Yoann Launey
- Univ Rennes, CHU Rennes, Department of Anaesthesia, Critical Care and Perioperative Medicine, F-35000 Rennes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Karim Lakhal
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France
| | - Laura Dargelos
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France
| | - Lise Crémet
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France; Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France
| | - Sophie-Anne Gibaud
- Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France
| | - Stéphane Corvec
- Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France
| | - Philippe Seguin
- Univ Rennes, CHU Rennes, Department of Anaesthesia, Critical Care and Perioperative Medicine, F-35000 Rennes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Fanny Feuillet
- Nantes Université, CHU de Nantes, DRI, Département promotion, cellule vigilances, Nantes, France; Nantes Université, CHU de Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
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Charles A, Jaffre S, Lakhal K, Cinotti R, Lejus-Bourdeau C. Evaluation of preoxygenation devices using a lung simulator mimicking normal adult spontaneous breathing. Anaesth Crit Care Pain Med 2024:101378. [PMID: 38508392 DOI: 10.1016/j.accpm.2024.101378] [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] [Received: 03/01/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Antoine Charles
- Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu - Hôpital Mère Enfant, Place Alexis Ricordeau, CHU Nantes, F-44093
| | - Sandrine Jaffre
- Service de Pneumologie, Hôpital Nord Laennec, boulevard Jacques-Monod, Saint-Herblain CHU Nantes, F-44093
| | - Karim Lakhal
- Service d'Anesthésie Réanimation Chirurgicale, Hôpital Nord Laennec, Boulevard Jacques-Monod, Saint-Herblain, CHU Nantes, F-44093
| | - Raphael Cinotti
- Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu - Hôpital Mère Enfant, Place Alexis Ricordeau, CHU Nantes, F-44093
| | - Corinne Lejus-Bourdeau
- Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu - Hôpital Mère Enfant, Place Alexis Ricordeau, CHU Nantes, F-44093; Laboratoire expérimental de simulation de médecine intensive de l'Université de Nantes, 9 rue Bias, F-44000.
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4
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Rambaud T, Hajage D, Dreyfuss D, Lebbah S, Martin-Lefevre L, Louis G, Moschietto S, Titeca-Beauport D, La Combe B, Pons B, De Prost N, Besset S, Combes A, Robine A, Beuzelin M, Badie J, Chevrel G, Bohe J, Coupez E, Chudeau N, Barbar S, Vinsonneau C, Forel JM, Thevenin D, Boulet E, Lakhal K, Aissaoui N, Grange S, Leone M, Lacave G, Nseir S, Poirson F, Mayaux J, Ashenoune K, Geri G, Klouche K, Thiery G, Argaud L, Rozec B, Cadoz C, Andreu P, Reignier J, Ricard JD, Quenot JP, Sonneville R, Gaudry S. Renal replacement therapy initiation strategies in comatose patients with severe acute kidney injury: a secondary analysis of a multicenter randomized controlled trial. Intensive Care Med 2024; 50:385-394. [PMID: 38407824 DOI: 10.1007/s00134-024-07339-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The effect of renal replacement therapy (RRT) in comatose patients with acute kidney injury (AKI) remains unclear. We compared two RRT initiation strategies on the probability of awakening in comatose patients with severe AKI. METHODS We conducted a post hoc analysis of a trial comparing two delayed RRT initiation strategies in patients with severe AKI. Patients were monitored until they had oliguria for more than 72 h and/or blood urea nitrogen higher than 112 mg/dL and then randomized to a delayed strategy (RRT initiated after randomization) or a more-delayed one (RRT initiated if complication occurred or when blood urea nitrogen exceeded 140 mg/dL). We included only comatose patients (Richmond Agitation-Sedation scale [RASS] < - 3), irrespective of sedation, at randomization. A multi-state model was built, defining five mutually exclusive states: death, coma (RASS < - 3), incomplete awakening (RASS [- 3; - 2]), awakening (RASS [- 1; + 1] two consecutive days), and agitation (RASS > + 1). Primary outcome was the transition from coma to awakening during 28 days after randomization. RESULTS A total of 168 comatose patients (90 delayed and 78 more-delayed) underwent randomization. The transition intensity from coma to awakening was lower in the more-delayed group (hazard ratio [HR] = 0.36 [0.17-0.78]; p = 0.010). Time spent awake was 10.11 days [8.11-12.15] and 7.63 days [5.57-9.64] in the delayed and the more-delayed groups, respectively. Two sensitivity analyses were performed based on sedation status and sedation practices across centers, yielding comparable results. CONCLUSION In comatose patients with severe AKI, a more-delayed RRT initiation strategy resulted in a lower chance of transitioning from coma to awakening.
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Affiliation(s)
- Thomas Rambaud
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France
- Département de Médecine Intensive Réanimation Neuro, APHP Hôpital Pitié-Salpêtrière, Paris, France
| | - David Hajage
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France
| | - Saïd Lebbah
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | | | - Guillaume Louis
- Réanimation Polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | | | | | | | - Bertrand Pons
- Réanimation, CHU Pointe-à-Pitre/Abymes, Pointe-a-Pitre, France
| | | | - Sébastien Besset
- Médecine Intensive-Réanimation, APHP, Hôpital Louis Mourier, Colombes, France
| | - Alain Combes
- Service de Réanimation Médicale, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Adrien Robine
- Réanimation Soins Continus, CH de Bourg-en-Bresse - Fleyriat, 01012, Bourg-en-Bresse, France
| | | | - Julio Badie
- Réanimation Polyvalente, Hôpital Nord Franche-Comte CH Belfort, Belfort, France
| | - Guillaume Chevrel
- Réanimation Polyvalente, CH Sud Francilien, Corbeil Essonnes, France
| | - Julien Bohe
- Anesthésie Réanimation Médicale et Chirurgicale, CH Lyon Sud Pierre Benite, Lyon, France
| | - Elisabeth Coupez
- Réanimation Polyvalente, Hôpital G. Montpied, Clermont Ferrand, France
| | - Nicolas Chudeau
- Réanimation Médico-Chirurgicale, CH du Mans, Le Mans, France
| | | | | | | | | | - Eric Boulet
- Réanimation et USC, GH Carnelle Portes de l'Oise, 95260, Beaumont Sur Oise, France
| | - Karim Lakhal
- Réanimation Chirurgicale Polyvalente, Hôpital Nord Laennec, Nantes, France
| | - Nadia Aissaoui
- Réanimation Médicale, Hôpital Georges Pompidou, Paris, France
| | | | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, Marseille, France
| | - Guillaume Lacave
- Réanimation Médico-Chirurgicale, Hôpital André Mignot, Versailles, France
| | - Saad Nseir
- Réanimation Médicale, CHRU de Lille, Hôpital Roger Salengro, Lille, France
| | - Florent Poirson
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Julien Mayaux
- Pneumologie et Réanimation Médicale, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Guillaume Geri
- Réanimation Médico-Chirurgicale, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Kada Klouche
- Médecine Intensive Réanimation,, Hôpital Lapeyronnie, Montpellier, France
| | - Guillaume Thiery
- Réanimation Médicale, CHU Saint Etienne, Saint Priest en Jarez, France
| | - Laurent Argaud
- Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyril Cadoz
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Pascal Andreu
- Médecine Intensive Réanimation, Hôtel Dieu, Nantes, France
| | | | - Jean-Damien Ricard
- Médecine Intensive-Réanimation, APHP, Hôpital Louis Mourier, Colombes, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- NSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France
- Université Paris Cité, INSERM UMR1137, IAME, 75018, Paris, France
| | - Stéphane Gaudry
- Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France.
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France.
- Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.
- Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France.
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Kamel T, Sauvage B, Lakhal K, Ottavy G, Janssen-Langenstein R, Jacquier M, Larrat C, Jacq G, Dauvergne JE, Maugars D, Labruyere M, Simeon V, Cugnart C, Girault C, Boulain T. The accuracy of intensive care nurses' interpretation of chest radiographs to recognise misplacement of endotracheal and nasogastric tubes after a single training session and comparison with residents' interpretation. Aust Crit Care 2023; 36:948-954. [PMID: 36872100 DOI: 10.1016/j.aucc.2023.01.002] [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: 04/18/2022] [Revised: 09/23/2022] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Misplacements of endotracheal and nasogastric tubes are frequent encounters in critically ill patients. OBJECTIVES The purpose of this study was to assess the effectiveness of a single standardised training session on the ability of intensive care registered nurses (RNs) to recognise the misplacement of endotracheal and nasogastric tubes on bedside chest radiographs of patients in intensive care units (ICUs). METHODS In eight French ICUs, RNs received a 110-min standardised teaching on the position of endotracheal and nasogastric tubes on chest radiographs. Their knowledge was evaluated within the subsequent weeks. For 20 chest radiographs, each with an endotracheal and nasogastric tube, RNs had to indicate whether each tube was in the proper or incorrect position. Training success was defined as >90% for the lower bound of the 95% confidence interval (95% CI) of the mean correct response rate (CRR). Residents of the participating ICUs underwent the same evaluation (without prior specific training). RESULTS In total, 181 RNs were trained and evaluated and 110 residents were evaluated. The global mean CRR for RNs was 84.6% (95% CI: 83.3-85.9), significantly higher than for residents (81.4% [95% CI: 79.7-83.2]) (P < 0.0001). The mean CRR for RNs and residents was 95.9% (93.9-98.0) and 97.0% (94.7-99.3) for misplaced nasogastric tubes (P = 0.54), 86.8% (85.2-88.5) and 82.6% (79.4-85.7) (P = 0.07) for nasogastric tubes in the correct position, 86.6% (83.8-89.3) and 62.7% (57.9-67.5) for misplaced endotracheal tubes (P < 0.0001), and 79.1% (76.6-81.6) and 84.7% (82.1-87.2) for endotracheal tubes in the correct position (P = 0.01), respectively. CONCLUSIONS The ability of trained RNs to detect tube misplacement did not reach the predetermined arbitrary level, indicating training success. Their mean CRR was higher than that for residents and was considered satisfactory for detecting misplaced nasogastric tubes. This finding is encouraging but insufficient to ensure patient safety. Transferring responsibility for reading radiographs to detect the misplacement of endotracheal tubes to intensive care RNs will need a more advanced or more in-depth teaching method.
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Affiliation(s)
- Toufik Kamel
- Service de Médicine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14 Avenue de l'hôpital, 45100 Orléans, France; ED 393, Université de Paris, France.
| | - Brice Sauvage
- Service de Médicine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14 Avenue de l'hôpital, 45100 Orléans, France.
| | - Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France.
| | - Grégoire Ottavy
- Service de Médicine Intensive-Réanimation, CHU de Nantes, France.
| | | | - Marine Jacquier
- Service de Médecine Intensive et Réanimation CHU de Dijon, France.
| | - Charlotte Larrat
- Service de Médecine Intensive et Réanimation CHRU de Tours, France.
| | - Gwenaëlle Jacq
- Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Versailles, France.
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France.
| | - Diane Maugars
- Service de Médicine Intensive-Réanimation, CHU de Nantes, France.
| | - Marie Labruyere
- Service de Médecine Intensive et Réanimation CHU de Dijon, France.
| | - Véronique Simeon
- Service de Médecine Intensive et Réanimation CHRU de Tours, France.
| | - Cécile Cugnart
- Rouen University Hospital, Medical Intensive Care Unit, F-76000 Rouen, France.
| | - Christophe Girault
- Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, Medical Intensive Care Unit, F-76000 Rouen, France.
| | - Thierry Boulain
- Service de Médicine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14 Avenue de l'hôpital, 45100 Orléans, France.
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6
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Lakhal K, Dauvergne JE, Kamel T, Messet-Charriere H, Jacquier S, Robert-Edan V, Nay MA, Rozec B, Ehrmann S, Muller G, Boulain T. Noninvasive Monitoring of Arterial Pressure: Finger or Lower Leg As Alternatives to the Upper Arm: A Prospective Study in Three ICUs. Crit Care Med 2023; 51:1350-1362. [PMID: 37232853 DOI: 10.1097/ccm.0000000000005945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES When the upper arm is inaccessible for measurements of arterial pressure (AP), the best alternative site is unknown. We performed a between-site comparison of the agreement between invasive and noninvasive readings of AP taken at the lower leg, the finger, and the upper arm. The risk associated with measurement errors and the trending ability were also assessed. DESIGN Prospective observational study. SETTING Three ICUs. PATIENTS Patients having an arterial catheter and an arm circumference less than 42 cm. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three triplicates of AP measurements were collected via an arterial catheter (reference AP), a finger cuff system (ClearSight; Edward Lifesciences, Irvine, CA), and an oscillometric cuff (at the lower leg then the upper arm). Trending ability was assessed through an additional set of measurements after a cardiovascular intervention. The default bed backrest angle was respected. Failure to measure and display AP occurred in 19 patients (13%) at the finger, never at other sites. In 130 patients analyzed, the agreement between noninvasive and invasive readings was worse at the lower leg than that observed at the upper arm or the finger (for mean AP, bias ± sd of 6.0 ± 15.8 vs 3.6 ± 7.1 and 0.1 ± 7.4 mm Hg, respectively; p < 0.05), yielding a higher frequency of error-associated clinical risk (no risk for 64% vs 84% and 86% of measurements, respectively, p < 0.0001). According to the International Organization for Standardization (ISO) 81060-2:2018 standard, mean AP measurements were reliable at the upper arm and the finger, not the lower leg. In 33 patients reassessed after a cardiovascular intervention, both the concordance rate for change in mean AP and the ability to detect a therapy-induced significant change were good and similar at the three sites. CONCLUSIONS As compared with lower leg measurements of AP, finger measurements were, when possible, a preferable alternative to upper arm ones.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
- INSERM, Centre d'étude des pathologies respiratoires, Tours, France
- Université de Tours, Tours, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
- Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
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Robert-Edan V, Lakhal K. Treating Vasospasm with IV Milrinone: Relax (The Vessel) or Don't Do It! Neurocrit Care 2023; 39:547-548. [PMID: 37434104 DOI: 10.1007/s12028-023-01789-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France.
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Lakhal K, Fresco MH, Hivert A, Rozec B, Cadiet J. Cerebral Vasospasm After Subarachnoid Hemorrhage: Respective Short-Term Effects of Induced Arterial Hypertension and its Combination With IV Milrinone: A Proof-of-Concept Study Using Transcranial Doppler Ultrasound. Crit Care Explor 2023; 5:e0973. [PMID: 37720356 PMCID: PMC10503695 DOI: 10.1097/cce.0000000000000973] [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] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (Vmean). In patients treated for cerebral vasospasm, we aimed to assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler. DESIGN Observational proof-of-concept prospective study. SETTING ICU in a French tertiary care center. PATIENTS Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure [MBP] of 100-120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Vmean was measured at vasospasm diagnosis (TDIAGNOSIS), after the induction of hypertension (THTN), and 1 (THTN+MILRINONE_H1) and 12 hours after the adjunction of IV milrinone (THTN+MILRINONE_H12). Thirteen patients were included. Median Vmean was significantly lower (p < 0.01) at THTN+MILRINONE_H1 (99 [interquartile range (IQR) 89; 134] cm.s-1) and THTN+MILRINONE_H12 (85 [IQR 73-127] cm/s) than at TDIAGNOSIS (136 [IQR 115-164] cm/s) and THTN (148 [IQR 115-183] cm/s), whereas TDIAGNOSIS and THTN did not significantly differ. In all patients but one, Vmean at THTN+MILRINONE_H1 was lower than its value at TDIAGNOSIS (p = 0.0005). Vmean-to-MBP and Vmean-to-cardiac output (CO) ratios (an assessment of Vmean regardless of the level of MBP [n = 13] or CO [n = 7], respectively) were, respectively, similar at TDIAGNOSIS and THTN but were significantly lower after the adjunction of milrinone (p < 0.01). CONCLUSIONS The induction of arterial hypertension was not associated with a significant decrease in Vmean, whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.
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Affiliation(s)
- Karim Lakhal
- Department of Anesthesia and Critical Care, Laënnec Hospital, University Hospital of Nantes, France
| | - Marion H Fresco
- Department of Anesthesia and Critical Care, Laënnec Hospital, University Hospital of Nantes, France
| | - Antoine Hivert
- Department of Anesthesia and Critical Care, Laënnec Hospital, University Hospital of Nantes, France
| | - Bertrand Rozec
- Department of Anesthesia and Critical Care, Laënnec Hospital, University Hospital of Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Julien Cadiet
- Department of Anesthesia and Critical Care, Laënnec Hospital, University Hospital of Nantes, France
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Roquilly A, Francois B, Huet O, Launey Y, Lasocki S, Weiss E, Petrier M, Hourmant Y, Bouras M, Lakhal K, Le Bel C, Flattres Duchaussoy D, Fernández-Barat L, Ceccato A, Flet L, Jobert A, Poschmann J, Sebille V, Feuillet F, Koulenti D, Torres A. Interferon gamma-1b for the prevention of hospital-acquired pneumonia in critically ill patients: a phase 2, placebo-controlled randomized clinical trial. Intensive Care Med 2023; 49:530-544. [PMID: 37072597 PMCID: PMC10112824 DOI: 10.1007/s00134-023-07065-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE We aimed to determine whether interferon gamma-1b prevents hospital-acquired pneumonia in mechanically ventilated patients. METHODS In a multicenter, placebo-controlled, randomized trial conducted in 11 European hospitals, we randomly assigned critically ill adults, with one or more acute organ failures, under mechanical ventilation to receive interferon gamma-1b (100 µg every 48 h from day 1 to 9) or placebo (following the same regimen). The primary outcome was a composite of hospital-acquired pneumonia or all-cause mortality on day 28. The planned sample size was 200 with interim safety analyses after enrolling 50 and 100 patients. RESULTS The study was discontinued after the second safety analysis for potential harm with interferon gamma-1b, and the follow-up was completed in June 2022. Among 109 randomized patients (median age, 57 (41-66) years; 37 (33.9%) women; all included in France), 108 (99%) completed the trial. Twenty-eight days after inclusion, 26 of 55 participants (47.3%) in the interferon-gamma group and 16 of 53 (30.2%) in the placebo group had hospital-acquired pneumonia or died (adjusted hazard ratio (HR) 1.76, 95% confidence interval (CI) 0.94-3.29; P = 0.08). Serious adverse events were reported in 24 of 55 participants (43.6%) in the interferon-gamma group and 17 of 54 (31.5%) in the placebo group (P = 0.19). In an exploratory analysis, we found that hospital-acquired pneumonia developed in a subgroup of patients with decreased CCL17 response to interferon-gamma treatment. CONCLUSIONS Among mechanically ventilated patients with acute organ failure, treatment with interferon gamma-1b compared with placebo did not significantly reduce the incidence of hospital-acquired pneumonia or death on day 28. Furthermore, the trial was discontinued early due to safety concerns about interferon gamma-1b treatment.
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Affiliation(s)
- Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France.
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France.
| | - Bruno Francois
- ICU Department and Inserm CIC 1435 & UMR 1092, University Hospital of Limoges, Limoges, France
| | - Olivier Huet
- Département d'anesthésie réanimation et medecine peri-operatoire, CHRU de Brest, Université de Bretagne Occidentale, 29000, Brest, France
| | - Yoann Launey
- Department of Anaesthesia, Critical Care and Perioperative Medicine, Univ Rennes, CHU Rennes, 35000, Rennes, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Angers, 49000, Angers, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Université Paris Cité, INSERM UMR_S1149, and AP-HP Nord, Hôpital Beaujon, Clichy, France
| | - Melanie Petrier
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Yannick Hourmant
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Karim Lakhal
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | - Cecilia Le Bel
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | | | - Laia Fernández-Barat
- CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
| | - Adrian Ceccato
- Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
| | - Laurent Flet
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
| | - Alexandra Jobert
- Nantes Université, CHU Nantes, DRI, Département promotion, cellule vigilances recherche, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Jeremie Poschmann
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Veronique Sebille
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Fanny Feuillet
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Despoina Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Antoni Torres
- CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Pajot O, Lakhal K, Lambert J, Gros A, Bruel C, Boulain T, Garot D, Das V, Timsit JF, Cerf C, Souweine B, Chaffaut C, Mentec H, Zahar JR, Mira JP, Jullien V. Empirical Antibiotic Therapy for Gram-Negative Bacilli Ventilator-Associated Pneumonia: Observational Study and Pharmacodynamic Assessment. Antibiotics (Basel) 2022; 11:antibiotics11111664. [PMID: 36421308 PMCID: PMC9686941 DOI: 10.3390/antibiotics11111664] [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: 10/13/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Strong evidence suggests a correlation between pharmacodynamics (PD) index and antibiotic efficacy while dose adjustment should be considered in critically ill patients due to modified pharmacokinetic (PK) parameters and/or higher minimum inhibitory concentrations (MICs). This study aimed to assess pharmacodynamic (PD) target attainment considering both antibiotics serum concentrations and measured MICs in these patients. Method: A multicentric prospective open-label trial conducted in 11 French ICUs involved patients with Gram-negative bacilli (GNB) ventilator-associated pneumonia (VAP) confirmed by quantitative cultures. Results: We included 117 patients. Causative GNBs were P. aeruginosa (40%), Enterobacter spp. (23%), E. coli (20%), and Klebsiella spp. (16%). Hence, 117 (100%) patients received β-lactams, 65 (58%) aminoglycosides, and two (1.5%) fluoroquinolones. For β-lactams, 83% of the patients achieved a Cmin/MIC > 1 and 70% had a Cmin/MIC > 4. In the case of high creatinine clearance (CrCL > 100 mL/min/1.73 m2), 70.4% of the patients achieved a Cmin/MIC ratio > 1 versus 91% otherwise (p = 0.041), and 52% achieved a Cmin/MIC ratio > 4 versus 81% (p = 0.018). For aminoglycosides, 94% of the patients had a Cmax/MIC ratio > 8. Neither β-lactams nor aminoglycosides PK/PD parameters were associated clinical outcomes, but our data suggest a correlation between β-lactams Cmin/MIC and microbiological success. Conclusion: In our ICU patients treated for GNB VAP, using recommended antibiotic dosage led in most cases to PK/PD targets attainment for aminoglycosides and β-lactams. High creatinine clearance should encourage clinicians to focus on PK/PD issues.
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Affiliation(s)
- Olivier Pajot
- Victor Dupouy Hospital, Intensive Care Unit, F-95100 Argenteuil, France
- Correspondence: ; Tel.: +33-134232455
| | - Karim Lakhal
- Service d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, F-44093 Nantes, France
| | - Jérome Lambert
- Department of Biostatistics and Medical Information, APHP, Saint-Louis Hospital, F-75010 Paris, France
| | - Antoine Gros
- Medical-Surgical Intensive Care Unit, André Mignot Hospital, F-78150 Le Chesnay, France
| | - Cédric Bruel
- Medical and Surgical Intensive Care Unit, Paris Saint-Joseph Hospital Network, F-75014 Paris, France
| | - Thierry Boulain
- Intensive Care Unit, Orleans Regional Hospital, 14 Avenue de L’Hôpital CS 86709, CEDEX 02, F-45067 Orléans, France
| | - Denis Garot
- Service de Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Vincent Das
- Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, F-93100 Montreuil, France
| | - Jean François Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases Intensive Care Unit (MI2), F-75018 Paris, France
| | - Charles Cerf
- Intensive Care Unit, Foch Hospital, F-92150 Suresnes, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Réanimation Médicale, F-63000 Clermont-Ferrand, France
| | - Cendrine Chaffaut
- Department of Biostatistics and Medical Information, APHP, Saint-Louis Hospital, F-75010 Paris, France
| | - Hervé Mentec
- Victor Dupouy Hospital, Intensive Care Unit, F-95100 Argenteuil, France
| | - Jean Ralph Zahar
- AP-HP, Hôpital Avicenne, Prévention du Risque Infectieux, GH Paris Seine Saint-Denis, F-93000 Bobigny, France
| | - Jean Paul Mira
- Department of Medical Intensive Care, Cochin University Hospital, F-75014 Paris, France
| | - Vincent Jullien
- Pharmacology Unit, University Sorbonne Paris Nord, Groupe Hospitalier Paris Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, F-93140 Bondy, France
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11
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Bémer P, Aubry A, Tessier E, Ruffier d'Epenoux L, Lakhal K, Lepoivre T, Boutoille D, Deschanvres C, Lecomte R, Navas D, Guillouzouic A, Corvec S. Emergence of methicillin-resistant Staphylococcus epidermidis resistant to linezolid: activity of ceftaroline versus ceftobiprole in a French University Hospital. Int J Antimicrob Agents 2022; 60:106613. [PMID: 35691604 DOI: 10.1016/j.ijantimicag.2022.106613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Pascale Bémer
- Service de Bactériologie et des Contrôles Microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France.
| | - Arthur Aubry
- Service de Bactériologie et des Contrôles Microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Eve Tessier
- Service de Bactériologie et des Contrôles Microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Louise Ruffier d'Epenoux
- Service de Bactériologie et des Contrôles Microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Thierry Lepoivre
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - David Boutoille
- Service des Maladies Infectieuses, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France; Centre d'Investigation Clinique Unité d'Investigation Clinique, Centre Hospitalier Universitaire, Nantes, France
| | - Colin Deschanvres
- Service des Maladies Infectieuses, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France; Centre d'Investigation Clinique Unité d'Investigation Clinique, Centre Hospitalier Universitaire, Nantes, France
| | - Raphaël Lecomte
- Service des Maladies Infectieuses, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France; Centre d'Investigation Clinique Unité d'Investigation Clinique, Centre Hospitalier Universitaire, Nantes, France
| | - Dominique Navas
- Pharmacie, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Aurélie Guillouzouic
- Service de Bactériologie et des Contrôles Microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France
| | - Stéphane Corvec
- Service de Bactériologie et des Contrôles Microbiologiques, Université de Nantes, CHU Nantes, Nantes, France
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Guillemin L, Goronflot T, Desal H, Rozec B, Lakhal K. Early Acute Kidney Injury in Patients with Non-Traumatic Subarachnoid Hemorrhage who Undergo Catheter Angiography: Incidence, Associated Risk Factors and Impact on Outcome. J Stroke Cerebrovasc Dis 2022; 31:106488. [PMID: 35472654 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES After subarachnoid hemorrhage (SAH), potential renal insults are numerous but the burden of early acute kidney injury (AKI) is unclear. We determined its incidence, rate of persistence, risk factors, and impact on patients' outcomes. MATERIALS AND METHODS Patients with non-traumatic SAH were retrospectively included if they underwent catheter angiography within the 48 h after their admission to the intensive care unit. Early AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria, analyzed from the time of catheter angiography. Early AKI was considered as persistent if the KDIGO stage did not decrease between the 48th and the 60th hour. RESULTS Among 499 consecutive patients, early AKI (mostly oliguria) occurred in 132 (26%): stage 1, 2 and 3 in 72 (14%), 44 (9%), and 16 (3%) patients, respectively. It persisted in 36% of cases. Early AKI occurred more likely when SAH was severe or renal function was impaired at hospital admission: adjusted odds ratio of 2.76 [95% 1.77-4.30] and 3.32 [1.17-9.46], respectively. ICU and hospital lengths of stay were longer in patients who developed early AKI than in patients who did not: 16 [9-29] versus 12 [4-24] days (p = 0.0003) and 21 [14-43] versus 16 [11-32] days (p = 0.007), respectively. There was an independent link between early AKI and renal outcome (n = 274 in the model) but not with hospital mortality (n = 453). CONCLUSIONS One quarter of our population developed early AKI, mostly oliguria. It persisted beyond the 48th hour in one third of cases. The associated risk factors we identified were non-modifiable.
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Affiliation(s)
- Laureen Guillemin
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France
| | - Thomas Goronflot
- CHU de Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes F-44093, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France.
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13
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Lakhal K, Rozec B, Souab F, Senage T, Leroy M, Legrand A, Boissier E, Bigot-Corbel E. Plasma haemolysis index and interleukine-6 for the early prediction of cardiac surgery-associated acute kidney injury. A proof-of-concept study. Perfusion 2022; 38:807-817. [PMID: 35430909 DOI: 10.1177/02676591221083791] [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: 11/15/2022]
Abstract
Introduction Haemolysis and inflammation contribute to cardiac surgery-associated acute kidney injury (CS-AKI). We aimed to assess the performance of plasma haemolysis index (HI) and interleukine-6 (IL-6) for the prediction of all-stage CS-AKI. We also assessed their ability to predict moderate-to-severe CS-AKI and to discriminate persistent from transient CS-AKI. Methods Adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were prospectively included. Haemolysis index and IL-6 were measured immediately after the end of CPB and 6 hours later. Correction for haemodilution relied upon changes in albuminaemia. Persistent CS-AKI was defined as a steady/increasing CS-AKI stage between the 48th and the 60th postoperative hour as compared with the worst stage observed within the 48 first hours. Results Among 82 patients, CS-AKI occurred in 37 (45%) patients. Postoperative HI and IL-6 were positively correlated to the duration of CPB (r ≤ 0.51, p ≤ 0.0003). Whether we considered isolated measurements of HI or IL-6, their indexation to haemodilution or not, their kinetics and/or their combination, the prediction of all stage CS-AKI was inaccurate (area under the receiver operating characteristic curve [AUCROC]≤ 0.68) whereas moderate-to-severe CS-AKI (6 patients only) was predicted with an honourable performance (AUCROC = 0.77 [95%CI 0.67;0.86] and 0.87 [95%CI 0.77;0.93] for HI and IL-6, respectively). The persistent/transient nature of CS-AKI was inaccurately predicted (AUCROC ≤ 0.68). Conclusions In a population in which most CS-AKI cases were mild, although they frequently (41%) persisted >48 hours, CS-AKI was inaccurately predicted by HI and/or IL-6. A better performance for moderate-to-severe CS-AKI prediction is likely. These preliminary findings are yet to be validated.
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Affiliation(s)
- Karim Lakhal
- Service d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, France
| | - Bertrand Rozec
- Service d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, France
| | - Fouzia Souab
- Service d’Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, France
| | - Thomas Senage
- Service de Chirurgie Cardiaque, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) N°1246, Study of Perinatal, Paediatric and Adolescent Health, Epidemiological Research and Evaluation (SPHERE) Unit, Centre National de la Recherche Scientifique (CNRS), Université de Nantes, France
| | - Maxime Leroy
- direction de la Recherche Clinique et de l’Innovation, Centre Hospitalier Universitaire de Nantes, France
| | - Arnaud Legrand
- direction de la Recherche Clinique et de l’Innovation, Centre Hospitalier Universitaire de Nantes, France
| | - Elodie Boissier
- laboratoire d’Hématologie, Hôpital laënnec, Centre Hospitalier Universitaire de Nantes, France
| | - Edith Bigot-Corbel
- Laboratoire de Biochimie, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, France
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Guillotin F, Poulain C, Gaborit B, Bouras M, Cinotti R, Lakhal K, Vourc’h M, Rozec B, Asehnoune K, Vibet MA, Riche VP, Gibaud SA, Crémet L, Roquilly A. Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study. Front Cell Infect Microbiol 2022; 12:804611. [PMID: 35493730 PMCID: PMC9043525 DOI: 10.3389/fcimb.2022.804611] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 10/29/2021] [Accepted: 03/14/2022] [Indexed: 01/23/2023] Open
Abstract
ObjectivesTo investigate the potential impact of the syndromic multiplex FilmArray® Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP).MethodsRespiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio.ResultsThe predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p<0.0001) and 2 [2-3.25] days in the recommendations-based simulation (p<0.0001). Treatment failure was predicted in 3% of cases with FAPP results versus observed in 11% in real-life (p=0.08) and 6% with recommendations-based simulation (p=0.37). The incremental cost-effectiveness ratio was 1 121 € [-7021; 6794] to avoid one day of non-optimized antimicrobial therapy.ConclusionsOur results suggest that using FAPP in patients with VHAP has the potential to reduce the use of broad-spectrum antimicrobial therapy without increasing the risk of microbial treatment failure.
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Affiliation(s)
- Florian Guillotin
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- *Correspondence: Florian Guillotin, ; Antoine Roquilly,
| | - Cécile Poulain
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Benjamin Gaborit
- Service de Maladies Infectieuses et Tropicales et CIC 1413, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Raphaël Cinotti
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Karim Lakhal
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Mickael Vourc’h
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Marie-Anne Vibet
- Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Valéry-Pierre Riche
- Cellule Innovation - Département Partenariat et Innovation - Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Sophie-Anne Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU de Nantes, Nantes, France
| | - Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU de Nantes, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- *Correspondence: Florian Guillotin, ; Antoine Roquilly,
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Lakhal K, Hivert A, Rozec B, Cadiet J. Induced Hypertension or Intravenous Milrinone for Cerebral Vasospasm: Why Choose? Neurocrit Care 2021; 35:922-923. [PMID: 34725779 DOI: 10.1007/s12028-021-01378-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France.
| | - Antoine Hivert
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France.,Centre National de la Recherche Scientifique, Institut du Thorax, Institut National de la Santé et de la Recherche Médicale, National de la Recherche Scientifique, Université de Nantes, Nantes, France
| | - Julien Cadiet
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France
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16
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Lakhal K, Bigot-Corbel E, Sacchetto E, Chabrun F, Senage T, Figueres L, Leroy M, Legrand A, Rozec B. Early recognition of cardiac surgery-associated acute kidney injury: lack of added value of TIMP2 IGFBP7 over short-term changes in creatinine (an observational pilot study). BMC Anesthesiol 2021; 21:244. [PMID: 34641779 PMCID: PMC8513334 DOI: 10.1186/s12871-021-01387-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 12/05/2022] Open
Abstract
Background For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesized that, in the context of perioperative haemodilution, lack of postoperative decrease in pCr would be of honourable performance for the detection of CS-AKI. We therefore aimed at comparing these biomarkers and their kinetics (primary objective). As secondary objectives, we assessed plasma neutrophil gelatinase-associated lipocalin (pNGAL), cystatin C (pCysC) and urea (pUrea). We also determined the ability of these biomarkers to early discriminate persistent from transient CS-AKI. Methods Patients over 75 years-old undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in this prospective observational study. Biomarkers were measured before/after CPB and at the sixth postoperative hour (H6). Results In 65 patients, CS-AKI occurred in 27 (42%). ∆pCr from post-CPB to H6 (∆pCrpostCPB-H6): outperformed TIMP2 IGFBP7 at H6 and its intra- or postoperative changes: area under the receiver operating characteristic curve (AUCROC) of 0.84 [95%CI:0.73–0.92] vs. ≤0.67 [95%CI:0.54–0.78], p ≤ 0.03. The AUCROC of pNGAL, pCysC and pUrea did not exceed 0.72 [95%CI:0.59–0.83]. Indexing biomarkers levels for blood or urine dilution did not improve their performance. Combining TIMP2 IGFBP7 and ∆pCrpostCPB-H6 was of no evident added value over considering ∆pCrpostCPB-H6 alone. For the early recognition of persistent CS-AKI, no biomarker outperformed ∆pCrpostCPB-H6 (AUCROC = 0.69 [95%CI:0.48–0.85]). Conclusions In this hypothesis-generating study mostly testing early detection of mild CS-AKI, there was no evident added value of the tested modern biomarkers over early minimal postoperative changes in pCr: despite the common perioperative hemodilution in the setting of cardiac surgery, if pCr failed to decline within the 6 h after CPB, the development of CS-AKI was likely. Confirmatory studies with more severe forms of CS-AKI are required. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01387-6.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France.
| | - Edith Bigot-Corbel
- Laboratoire de Biochimie, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Emilie Sacchetto
- Laboratoire de Biochimie, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Floris Chabrun
- Laboratoire de Biochimie, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Thomas Senage
- Service de Chirurgie Cardiaque, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) n°1246, Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation (SPHERE) Unit, Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Lucile Figueres
- Service de Néphrologie et d'Immunologie clinique, institut de transplantation urologie-néphrologie, Hôtel-Dieu, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Maxime Leroy
- Direction de la Recherche Clinique et de l'Innovation, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Arnaud Legrand
- Direction de la Recherche Clinique et de l'Innovation, Centre Hospitalier Universitaire, 44093, Nantes, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes, France.,Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, 44093, Nantes, France
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Lakhal K, Hivert A, Alexandre PL, Fresco M, Robert-Edan V, Rodie-Talbere PA, Ambrosi X, Bourcier R, Rozec B, Cadiet J. Intravenous Milrinone for Cerebral Vasospasm in Subarachnoid Hemorrhage: The MILRISPASM Controlled Before-After Study. Neurocrit Care 2021; 35:669-679. [PMID: 34478028 DOI: 10.1007/s12028-021-01331-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intravenous (IV) milrinone, in combination with induced hypertension, has been proposed as a treatment option for cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). However, data on its safety and efficacy are scarce. METHODS This was a controlled observational study conducted in an academic hospital with prospectively and retrospectively collected data. Consecutive patients with cerebral vasospasm following aSAH and treated with both IV milrinone (0.5 µg/kg/min-1, as part of a strict protocol) and induced hypertension were compared with a historical control group receiving hypertension alone. Multivariable analyses aimed at minimizing potential biases. We assessed (1) 6-month functional disability (defined as a score between 2 and 6 on the modified Rankin Scale) and vasospasm-related brain infarction, (2) the rate of first-line or rescue endovascular angioplasty for vasospasm, and (3) immediate tolerance to IV milrinone. RESULTS Ninety-four patients were included (41 and 53 in the IV milrinone and the control group, respectively). IV milrinone infusion was independently associated with a lower likelihood of 6-month functional disability (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI] = 0.10-0.77]) and vasospasm-related brain infarction (aOR = 0.19, 95% CI 0.04-0.94). Endovascular angioplasty was less frequent in the IV milrinone group (6 [15%] vs. 28 [53%] patients, p = 0.0001, aOR = 0.12, 95% CI 0.04-0.38). IV milrinone (median duration of infusion, 5 [2-8] days) was prematurely discontinued owing to poor tolerance in 12 patients, mostly (n = 10) for "non/hardly-attained induced hypertension" (mean arterial blood pressure < 100 mmHg despite 1.5 µg/kg/min-1 of norepinephrine). However, this event was similarly observed in IV milrinone and control patients (n = 10 [24%] vs. n = 11 [21%], respectively, p = 0.68). IV milrinone was associated with a higher incidence of polyuria (IV milrinone patients had creatinine clearance of 191 [153-238] ml/min-1) and hyponatremia or hypokalemia, whereas arrhythmia, myocardial ischemia, and thrombocytopenia were infrequent. CONCLUSIONS Despite its premature discontinuation in 29% of patients as a result of its poor tolerance, IV milrinone was associated with a lower rate of endovascular angioplasty and a positive impact on long-term neurological and radiological outcomes. These preliminary findings encourage the conduction of confirmatory randomized trials.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France.
| | - Antoine Hivert
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France
| | - Pierre-Louis Alexandre
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Marion Fresco
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France
| | - Pierre-André Rodie-Talbere
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France
| | - Xavier Ambrosi
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France.,Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, 44093, Nantes, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France.,Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, 44093, Nantes, France
| | - Julien Cadiet
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, 44093, Nantes Cedex 1, France
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Lakhal K, Dauvergne JE, Rozec B. Regulation of Tracheal Cuff Pressure: Get Connected, Stay Connected. Chest 2021; 160:e245. [PMID: 34366054 DOI: 10.1016/j.chest.2021.03.068] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France.
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
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19
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Asquier-Khati A, Deschanvres C, Boutoille D, Lefebvre M, Le Turnier P, Gaborit B, Lakhal K, Buffenoir K, Khatchatourian L, Asseray N. Switch from parenteral to oral antibiotics for brain abscesses: a retrospective cohort study of 109 patients. J Antimicrob Chemother 2021; 75:3062-3066. [PMID: 32699907 DOI: 10.1093/jac/dkaa285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Brain abscess is one of the most serious diseases of the CNS and is associated with high morbidity and mortality. With regard to the lack of data supporting an optimal therapeutic strategy, this study aimed to explore the prognostic factors of brain abscess, putting emphasis on the impact of therapeutic decisions. METHODS We retrospectively included patients hospitalized for brain abscess during a period of 13 years. Comorbidities (Charlson scale), clinical presentation, microbiology culture, radiological features and therapeutic management were collected. Glasgow Outcome Scale (GOS) at 3 months and length of hospital stay were, respectively, the main and the secondary outcomes. Logistic regression was used to determine factors associated with outcome independently. RESULTS Initial Glasgow Coma Scale (GCS) ≤14 and comorbidities (Charlson scale ≥2) were associated with poor neurological outcome while oral antibiotic switch was associated with better neurological outcome. Oral switch did not appear to be associated with an unfavourable evolution in the subset of patients without initial neurological severity (GCS >14) on admission. Duration of IV regimen and time to oral switch were associated with the length of inpatient stay. CONCLUSIONS This study confirms the role of GCS and comorbidities as prognostic factors and presents reassuring data regarding the safety of oral switch for the antibiotic treatment of brain abscesses. Oral switch could prevent catheter-induced iatrogenic complications and allow a higher quality of life for patients.
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Affiliation(s)
| | | | | | | | | | | | - Karim Lakhal
- Intensive Care Unit, CHU Laënnec, Nantes, France
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20
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Gaudry S, Hajage D, Martin-Lefevre L, Lebbah S, Louis G, Moschietto S, Titeca-Beauport D, Combe BL, Pons B, de Prost N, Besset S, Combes A, Robine A, Beuzelin M, Badie J, Chevrel G, Bohé J, Coupez E, Chudeau N, Barbar S, Vinsonneau C, Forel JM, Thevenin D, Boulet E, Lakhal K, Aissaoui N, Grange S, Leone M, Lacave G, Nseir S, Poirson F, Mayaux J, Asehnoune K, Geri G, Klouche K, Thiery G, Argaud L, Rozec B, Cadoz C, Andreu P, Reignier J, Ricard JD, Quenot JP, Dreyfuss D. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet 2021; 397:1293-1300. [PMID: 33812488 DOI: 10.1016/s0140-6736(21)00350-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [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: 07/16/2020] [Revised: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Delaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury and no severe complication is safe and allows optimisation of the use of medical devices. Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy. METHODS This was an unmasked, multicentre, prospective, open-label, randomised, controlled trial done in 39 intensive care units in France. We monitored critically ill patients with severe acute kidney injury (defined as Kidney Disease: Improving Global Outcomes stage 3) until they had oliguria for more than 72 h or a blood urea nitrogen concentration higher than 112 mg/dL. Patients were then randomly assigned (1:1) to either a strategy (delayed strategy) in which RRT was started just after randomisation or to a more-delayed strategy. With the more-delayed strategy, RRT initiation was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen concentration reached 140 mg/dL. The primary outcome was the number of days alive and free of RRT between randomisation and day 28 and was done in the intention-to-treat population. The study is registered with ClinicalTrial.gov, NCT03396757 and is completed. FINDINGS Between May 7, 2018, and Oct 11, 2019, of 5336 patients assessed, 278 patients underwent randomisation; 137 were assigned to the delayed strategy and 141 to the more-delayed strategy. The number of complications potentially related to acute kidney injury or to RRT were similar between groups. The median number of RRT-free days was 12 days (IQR 0-25) in the delayed strategy and 10 days (IQR 0-24) in the more-delayed strategy (p=0·93). In a multivariable analysis, the hazard ratio for death at 60 days was 1·65 (95% CI 1·09-2·50, p=0·018) with the more-delayed versus the delayed strategy. The number of complications potentially related to acute kidney injury or renal replacement therapy did not differ between groups. INTERPRETATION In severe acute kidney injury patients with oliguria for more than 72 h or blood urea nitrogen concentration higher than 112 mg/dL and no severe complication that would mandate immediate RRT, longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm. FUNDING Programme Hospitalier de Recherche Clinique.
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Affiliation(s)
- Stéphane Gaudry
- Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France; Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France; Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France
| | - David Hajage
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Saïd Lebbah
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Guillaume Louis
- Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | | | | | | | - Bertrand Pons
- Réanimation, CHU Pointe-à-Pitre-Abymes, Pointe-a-Pitre, France
| | | | - Sébastien Besset
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive-Réanimation, Colombes, France
| | - Alain Combes
- Service de Réanimation Médicale, Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | - Adrien Robine
- Réanimation Soins continus, CH de Bourg-en-Bresse-Fleyriat, 01012 Bourg-en-Bresse, France
| | | | - Julio Badie
- Réanimation polyvalente, Hôpital Nord Franche-Comte CH Belfort, Belfort, France
| | | | - Julien Bohé
- Anesthésie réanimation médicale et chirurgicale, CH Lyon Sud, Pierre Benite
| | - Elisabeth Coupez
- Réanimation polyvalente, Hôpital G. Montpied, Clermont Ferrand, France
| | - Nicolas Chudeau
- Réanimation médico-chirurgicale, CH du Mans, Le Mans, France
| | | | | | | | | | - Eric Boulet
- Réanimation et USC, GH Carnelle Portes de l'Oise, Beaumont sur Oise, France
| | - Karim Lakhal
- Réanimation chirurgicale polyvalente, Hôpital Nord laennec, Nantes, France
| | - Nadia Aissaoui
- Réanimation médicale, Hôpital Georges Pompidou, Paris, France
| | | | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, Marseille, France
| | - Guillaume Lacave
- Réanimation médico-chirurgicale, Hôpital André Mignot, Versailles, France
| | - Saad Nseir
- Réanimation médicale, CHRU de Lille, Hôpital Roger Salengro, Lille, France
| | - Florent Poirson
- Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Julien Mayaux
- Pneumologie et Réanimation médicale, Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Guillaume Geri
- Réanimation médico-chirurgicale, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Kada Klouche
- Médecine Intensive Réanimation, Hôpital Lapeyronnie, Montpellier, France
| | - Guillaume Thiery
- Réanimation médicale, CHU Saint Etienne, Saint Priest en Jarez, France
| | - Laurent Argaud
- Réanimation médicale, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyril Cadoz
- Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France
| | - Pascal Andreu
- Médecine intensive réanimation, Hôtel Dieu, Nantes, France
| | - Jean Reignier
- Médecine intensive réanimation, Hôtel Dieu, Nantes, France
| | - Jean-Damien Ricard
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive-Réanimation, Colombes, France; INSERM, IAME, U1137, Paris, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France; Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Didier Dreyfuss
- Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France; Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive-Réanimation, Colombes, France.
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Brisard L, Lakhal K, Le Thuaut A, Fresco M, Asehnoune K, Reignier J, Rozec B. Rôle de la fonte musculaire acquise en réanimation sur le devenir du patient traité par ventilation mécanique invasive : étude de cohorte observationnelle. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.003] [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: 11/26/2022]
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22
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Lakhal K, Robert-Edan V, Ehrmann S. In the Name of Contrast-Induced Acute Kidney Injury…. Chest 2021; 157:751-752. [PMID: 32252919 DOI: 10.1016/j.chest.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/19/2019] [Accepted: 12/22/2019] [Indexed: 02/08/2023] Open
Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSep network, CHRU Tours, Tours, France; Centre d'étude des pathologies respiratoires INSERM U1100), Université de Tours, Tours, France
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23
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Lakhal K, Ehrmann S, Robert-Edan V. Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review. Crit Care 2020; 24:641. [PMID: 33168006 PMCID: PMC7653744 DOI: 10.1186/s13054-020-03365-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France.
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep Network, CHRU Tours, Tours France and Centre d'étude des Pathologies Respiratoires INSERM U1100, Université de Tours, Tours, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France
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Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sébille V, Leone M. Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial. Clin Infect Dis 2020; 73:e1601-e1610. [PMID: 32970811 DOI: 10.1093/cid/ciaa1441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) for can improve the outcomes of patients in intensive care units (ICUs). METHODS This study was conducted at 35 ICUs in 30 hospitals. We included consecutive adult patients hospitalized in ICUs for three days or more. After a three-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a three-month cluster-randomized trial. We randomly assigned ICUs to either audit and feedback (intervention group) or participation to a national registry (control group). The primary outcome was the duration of ICU stay. RESULTS Among 1,856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measure of compliance was 47(38-56)% in the intervention group and 42(25-53)% in the control group (p=0.001). As compared to the baseline period, the ICU length of stay was reduced by 3.2 days in the intervention group (p=0.07) and by 2.8 days in the control group (p=0.02). The duration of ICU stay was 7 (5-14) in the control group and 9 (5-20) days in the intervention group (p=0.10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from ICU in the control group was 1.17 (95% CI, 0.69 to 2.01; p=0.10). CONCLUSIONS The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes.
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Affiliation(s)
- Antoine Roquilly
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Gérald Chanques
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Montpellier, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - Arnaud Foucrier
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Beaujon (AP/HP), Beaujon, France
| | - Brice Fermier
- Intensive Care Unit, Simone Veil Hospital, Blois, France
| | - Hugues De Courson
- Department of Neuro-Critical Care, Pellegrin Hospital, Bordeaux, France
| | - Cedric Carrie
- Surgical and trauma Intensive Care, Pellegrin Hospital, Bordeaux, France
| | - Marc Danguy des Deserts
- Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care, CHU Caen, Caen, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Kevin Lagarde
- Neuroréanimation-Anesthésie Neuroradiologie Interventionnelle, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | | | - Sami Blidi
- Intensive Care Unit, Eaubonne Hospital, Eaubonne, France
| | - Achille Sossou
- Department of Anesthesiology and Critical Care, Emile Roux Hospital, Le Puy en Velay, France
| | | | - Celine Monard
- Department of Anesthesiology and Critical Care, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Adrien Oudotte
- Department of Neuro-Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Calypso Mathieu
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
| | - Jeremy Bourenne
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Emergency Intensive Care Unit, Hopital la Timone, Marseille, France
| | - Christian Isetta
- Department of Anesthesiology and Cardiothoracic Intensive Care, Pierre Zobda-Quitman, Martinique, France
| | | | - Karim Lakhal
- Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, France
| | - Armine Rouhani
- Severe Burn Intensive Care Unit, Hotel Dieu, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Philippe Guerci
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Nancy, France
| | - Alexy Tran Dinh
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Bichat (AP/ HP), Paris, France
| | - Benjamin Chousterman
- Department of Anesthesiology and Critical Care, Severe Burn Unit, Centre Hospitalier Universitaire de Lariboisiere (AP/HP), Paris, France
| | - Alexandru Cupaciu
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Saint Louis (AP/ HP), Paris, France
| | | | - Remy Bellier
- Neuro-Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, France
| | - Jonathan Au Duong
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Rangueil Hospital, Centre Hospitalier Universitaire, Toulouse, France
| | - Alexandre Mansour
- Department of Anesthesiology and Critical Care, Pontchaillou Hospital, CHU Rennes, Rennes, France
| | - Jérome Morel
- Department of Anesthesiology and Critical Care, CHU Saint Etienne, Saint Etienne, France
| | - Ghilain Beauplet
- Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, France
| | - Marie-Anne Vibet
- Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Université de Nantes, Nantes, France.,DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France
| | - Fanny Feuillet
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Véronique Sébille
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Marc Leone
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
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Boissier E, Lakhal K, Talon L, Senage T, Rozec B, Roussel JC, Sinegre T, Lebreton A. The centrifuge brake impacts neither routine coagulation assays nor platelet count in platelet-poor plasma. Clin Chem Lab Med 2020; 58:e185-e188. [PMID: 32069229 DOI: 10.1515/cclm-2019-1273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/17/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Elodie Boissier
- Service d'Hématologie Biologique, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karim Lakhal
- Service d'Anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Laurie Talon
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Thomas Senage
- Service de chirurgie thoracique et cardiovasculaire, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Rozec
- Service d'Anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Christian Roussel
- Service de chirurgie thoracique et cardiovasculaire, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Thomas Sinegre
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Aurélien Lebreton
- Service d'Hématologie Biologique, CHU Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
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26
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Crémet L, Gaborit B, Bouras M, Drumel T, Guillotin F, Poulain C, Persyn E, Lakhal K, Rozec B, Vibet MA, Roquilly A, Gibaud S. Evaluation of the FilmArray ® Pneumonia Plus Panel for Rapid Diagnosis of Hospital-Acquired Pneumonia in Intensive Care Unit Patients. Front Microbiol 2020; 11:2080. [PMID: 32983057 PMCID: PMC7477898 DOI: 10.3389/fmicb.2020.02080] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 06/29/2020] [Accepted: 08/07/2020] [Indexed: 12/19/2022] Open
Abstract
The FilmArray® Pneumonia plus Panel (FAPP) is a new multiplex molecular test for hospital-acquired pneumonia (HAP), which can rapidly detect 18 bacteria, 9 viruses, and 7 resistance genes. We aimed to compare the diagnosis performance of FAPP with conventional testing in 100 intensive care unit (ICU) patients who required mechanical ventilation, with clinically suspected HAP. A total of 237 samples [76 bronchoalveolar lavages (BALDS) and 82 endotracheal aspirates (ETADS) obtained at HAP diagnosis, and 79 ETA obtained during follow-up (ETATT)], were analyzed independently by routine microbiology testing and FAPP. 58 patients had paired BALDS and ETADS. The positivity thresholds of semi-quantified bacteria were 103–104 CFUs/mL or 104 copies/mL for BAL, and 105 CFUs/mL or copies/mL for ETA. Respiratory commensals (H. influenzae, S. aureus, E. coli, S. pneumoniae) were the most common pathogens. Discordant results for bacterial identification were observed in 33/76 (43.4%) BALDS and 36/82 (43.9%) ETADS, and in most cases, FAPP identified one supplemental bacteria (23/33 BALDS and 21/36 ETADS). An absence of growth, or polybacterial cultures, explained almost equally the majority of the non-detections in culture. No linear relationship was observed between bin and CFUs/mL variables. Concordant results between paired BALDS and ETADS were obtained in 46/58 (79.3%) patients with FAPP. One of the 17 resistance genes detected with FAPP (mecA/C and MREJ) was not confirmed by conventional testing. Overall, FAPP enhanced the positivity rate of diagnostic testing, with increased recognition of coinfections. Implementing this strategy may allow clinicians to make more timely and informed decisions.
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Affiliation(s)
- Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France.,Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France
| | - Benjamin Gaborit
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service de Maladies Infectieuses et Tropicales et CIC 1413, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Thomas Drumel
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Florian Guillotin
- Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Cécile Poulain
- Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Elise Persyn
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Karim Lakhal
- Service de Réanimation en Chirurgie Polyvalente, Pôle Anesthésie-Réanimation, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Service de Réanimation en Chirurgie Cardio-Thoracique et Vasculaire, Pôle Anesthésie-Réanimation, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Marie-Anne Vibet
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Antoine Roquilly
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Sophie Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
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27
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Boissier E, Lakhal K, Lepoivre T. Donor-imported and transmitted malaria after lung transplantation. Br J Haematol 2020; 190:485. [PMID: 32383159 DOI: 10.1111/bjh.16712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Elodie Boissier
- Centre hospitalier universitaire de Nantes, Hématologie biologique, Nantes, France
| | - Karim Lakhal
- Centre hospitalier universitaire de Nantes, Anesthésie-Réanimation, Nantes, France
| | - Thierry Lepoivre
- Centre hospitalier universitaire de Nantes, Anesthésie-Réanimation, Nantes, France
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28
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Le Turnier P, Gregoire M, Deslandes G, Lakhal K, Deschanvres C, Lecomte R, Talarmin JP, Dubée V, Bellouard R, Boutoille D, Leroy AG, Gaborit BJ. Should we reconsider cefazolin for treating staphylococcal meningitis? A retrospective analysis of cefazolin and cloxacillin cerebrospinal fluid levels in patients treated for staphylococcal meningitis. Clin Microbiol Infect 2020; 26:1415.e1-1415.e4. [PMID: 32437956 DOI: 10.1016/j.cmi.2020.04.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the meningeal penetration of cefazolin and cloxacillin in individuals treated for methicillin-susceptible staphylococcal meningitis. METHODS We retrospectively identified individuals treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a validated assay of liquid chromatography coupled with mass spectrometry at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific PCR). Medical charts were retrospectively reviewed to collect microbiological and clinical data, and to assess therapeutic success. RESULTS Among the 17 included individuals, eight (47%) were treated with cefazolin and nine (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 g (range 6-12 g) and 12 g (range 10-13 g), respectively. Cefazolin and cloxacillin were mainly administered by continuous infusion. Eleven individuals (65%) were men, median (interquartile range (IQR)) age was 54 years (50; 70), 14 (82%) had postoperative meningitis and 3 (18%) had haematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 mg/L (2.1; 5.2) and 0.66 mg/L (0.5; 0.9) for cefazolin and cloxacillin groups, respectively. Cloxacillin was discontinued in two individuals for therapeutic failure. CONCLUSIONS Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate that should be properly evaluated in this indication.
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Affiliation(s)
- P Le Turnier
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, INSERM, Nantes, France
| | - M Gregoire
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France; UMR INSERM 1235, The Enteric Nervous System in Gut and Brain Disorders, University of Nantes, France
| | - G Deslandes
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France
| | - K Lakhal
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nantes, Nantes, France
| | - C Deschanvres
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, INSERM, Nantes, France
| | - R Lecomte
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, INSERM, Nantes, France
| | - J-P Talarmin
- Internal Medicine and Infectious Diseases Department, Centre hospitalier de Cornouaille, Quimper, France
| | - V Dubée
- Department of Infectious Diseases, University Hospital of Angers, Angers, France
| | - R Bellouard
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France
| | - D Boutoille
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, INSERM, Nantes, France; EA 3826, Laboratory of Clinical and Experimental Therapeutics of Infections, IRS2-Nantes Biotech, Nantes, France
| | - A-G Leroy
- EA 3826, Laboratory of Clinical and Experimental Therapeutics of Infections, IRS2-Nantes Biotech, Nantes, France; Department of Bacteriology, Nantes University Hospital, Nantes, France
| | - B J Gaborit
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, INSERM, Nantes, France; EA 3826, Laboratory of Clinical and Experimental Therapeutics of Infections, IRS2-Nantes Biotech, Nantes, France.
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29
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Dauvergne JE, Geffray AL, Asehnoune K, Rozec B, Lakhal K. Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomised controlled study. Anaesth Crit Care Pain Med 2020; 39:435-441. [PMID: 32376293 DOI: 10.1016/j.accpm.2020.04.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/26/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intermittent manual correction of the endotracheal tube cuff pressure (Pcuff) may delay the detection of underinflation (source of contaminated oropharyngeal content microaspiration) or overinflation (exposing to airway damage). Devices for automated continuous correction of Pcuff are appealing but some are inconvenient, expensive or even harmful. This prospective randomised controlled study tested whether the tracoe Smart Cuff Manager™ reduced the rate of patients undergoing≥1 episode of underinflation (Pcuff<20 cmH2O), as compared with routine manual Pcuff correction. The rate of patients with≥1 overinflation episode (Pcuff>30 cmH2O) and the incidence of under/overinflation were also compared. METHODS Patients with acute brain injury and likely to receive invasive mechanical ventilation for>48h were randomly allocated to receive, during 48h, automated Pcuff correction (combined with manual correction) or manual correction alone. Pcuff was measured with a dedicated manual manometer, at least every 8h. RESULTS Sixty patients were included and randomised (32 patients with manual and 28 with automated Pcuff correction) for 506 measurements of Pcuff (269 and 237, respectively). Automated correction of Pcuff was associated with a lower rate of patients with≥1 episode of underinflation (63% and 18%, respectively, P<0.001), a lower incidence of underinflation episodes (15% vs. 2%; P<0.001), a lower rate of manual corrections (77% vs. 58%; P<0.001). For overinflation, there were no significant between-groups differences (2% vs. 2%). The incidence of early respiratory infections was similar in both groups (29% vs. 25%, P=0.78). CONCLUSIONS The adjunction of continuous Pcuff control with the Tracoe Smart Cuff Manager™ to routine manual intermittent correction reduced the incidence of Pcuff underinflation episodes without provoking overinflation. TRIAL REGISTRATION ClinicalTrials NCT03330379. Registered 6 November 2017, https://clinicaltrials.gov/ct2/show/NCT03330379.
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Affiliation(s)
- Jérôme E Dauvergne
- Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
| | - Anne-Laure Geffray
- Service d'anesthésie-réanimation, Hôtel-Dieu, centre hospitalier universitaire, 44093, Nantes, France
| | - Karim Asehnoune
- Service d'anesthésie-réanimation, Hôtel-Dieu, centre hospitalier universitaire, 44093, Nantes, France
| | - Bertrand Rozec
- Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France
| | - Karim Lakhal
- Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
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La Combe B, Clermont O, Messika J, Eveillard M, Kouatchet A, Lasocki S, Corvec S, Lakhal K, Billard-Pomares T, Fernandes R, Armand-Lefevre L, Bourdon S, Reignier J, Fihman V, de Prost N, Bador J, Goret J, Wallet F, Denamur E, Ricard JD. Pneumonia-Specific Escherichia coli with Distinct Phylogenetic and Virulence Profiles, France, 2012-2014. Emerg Infect Dis 2019; 25:710-718. [PMID: 30882313 PMCID: PMC6433033 DOI: 10.3201/eid2504.180944] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In a prospective, nationwide study in France of Escherichia coli responsible for pneumonia in patients receiving mechanical ventilation, we determined E. coli antimicrobial susceptibility, phylotype, O-type, and virulence factor gene content. We compared 260 isolates with those of 2 published collections containing commensal and bacteremia isolates. The preponderant phylogenetic group was B2 (59.6%), and the predominant sequence type complex (STc) was STc73. STc127 and STc141 were overrepresented and STc95 underrepresented in pneumonia isolates compared with bacteremia isolates. Pneumonia isolates carried higher proportions of virulence genes sfa/foc, papGIII, hlyC, cnf1, and iroN compared with bacteremia isolates. Virulence factor gene content and antimicrobial drug resistance were higher in pneumonia than in commensal isolates. Genomic and phylogenetic characteristics of E. coli pneumonia isolates from critically ill patients indicate that they belong to the extraintestinal pathogenic E. coli pathovar but have distinguishable lung-specific traits.
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Gaudry S, Hajage D, Martin-Lefevre L, Louis G, Moschietto S, Titeca-Beauport D, La Combe B, Pons B, de Prost N, Besset S, Combes A, Robine A, Beuzelin M, Badie J, Chevrel G, Reignier J, Bohé J, Coupez E, Chudeau N, Barbar S, Vinsonneau C, Forel JM, Thevenin D, Boulet E, Lakhal K, Aissaoui N, Grange S, Leone M, Lacave G, Nseir S, Poirson F, Mayaux J, Asehnoune K, Geri G, Klouche K, Thiery G, Argaud L, Ricard JD, Quenot JP, Dreyfuss D. The Artificial Kidney Initiation in Kidney Injury 2 (AKIKI2): study protocol for a randomized controlled trial. Trials 2019; 20:726. [PMID: 31843007 PMCID: PMC6915917 DOI: 10.1186/s13063-019-3774-9] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Artificial Kidney Initiation in Kidney Injury (AKIKI) trial showed that a delayed renal replacement therapy (RRT) strategy for severe acute kidney injury (AKI) in critically ill patients was safe and associated with major reduction in RRT initiation compared with an early strategy. The five criteria which mandated RRT initiation in the delayed arm were: severe hyperkalemia, severe acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia, serum urea concentration > 40 mmol/l and oliguria/anuria > 72 h. However, duration of anuria/oliguria and level of blood urea are still criteria open to debate. The objective of the study is to compare the delayed strategy used in AKIKI (now termed "standard") with another in which RRT is further delayed for a longer period (termed "delayed strategy"). METHODS/DESIGN This is a prospective, multicenter, open-label, two-arm randomized trial. The study is composed of two stages (observational and randomization stages). At any time, the occurrence of a potentially severe condition (severe hyperkalemia, severe metabolic or mixed acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia) suggests immediate RRT initiation. Patients receiving (or who have received) intravenously administered catecholamines and/or invasive mechanical ventilation and presenting with AKI stage 3 of the KDIGO classification and with no potentially severe condition are included in the observational stage. Patients presenting a serum urea concentration > 40 mmol/l and/or an oliguria/anuria for more than 72 h are randomly allocated to a standard (RRT is initiated within 12 h) or a delayed RRT strategy (RRT is initiated only if an above-mentioned potentially severe condition occurs or if the serum urea concentration reaches 50 mmol/l). The primary outcome will be the number of RRT-free days at day 28. One interim analysis is planned. It is expected to include 810 patients in the observational stage and to randomize 270 subjects. DISCUSSION The AKIKI2 study should improve the knowledge of RRT initiation criteria in critically ill patients. The potential reduction in RRT use allowed by a delayed RRT strategy might be associated with less invasive care and decreased costs. Enrollment is ongoing. Inclusions are expected to be completed by November 2019. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03396757. Registered on 11 January 2018.
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Affiliation(s)
- Stéphane Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France
- AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, 125 Rue de Stalingrad, 93000 Bobigny, France
- Health Care Simulation Center, UFR SMBH, Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - David Hajage
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, CIC-1421, F75013 Paris, France
| | - Laurent Martin-Lefevre
- Réanimation polyvalente, CHR départementale La Roche Sur Yon, 85025 La Roche Sur Yon, France
| | - Guillaume Louis
- Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, 57085 Metz, France
| | | | | | | | - Bertrand Pons
- Réanimation, CHU Pointe-a-Pitre/Abymes, 97159 Pointe-a-Pitre, France
| | - Nicolas de Prost
- Réanimation médicale, Hôpital Henri Mondor, 94010 Créteil, France
| | - Sébastien Besset
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700 Colombes, France
| | - Alain Combes
- Service de Réanimation Médicale, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | - Adrien Robine
- Réanimation Soins continus, CH de Bourg-en-Bresse – Fleyriat, 01012 Bourg-en-Bresse, France
| | | | - Julio Badie
- Réanimation polyvalente, Hôpital Nord Franche-Comte CH Belfort, 90016 Belfort, France
| | - Guillaume Chevrel
- Réanimation polyvalente, CH Sud Francilien, 91106 Corbeil Essones, France
| | - Jean Reignier
- Réanimation médicale, Hôtel Dieu, 44035 Nantes, France
| | - Julien Bohé
- Anesthésie réanimation médicale et chirurgicale, CH Lyon Sud, 69495 Pierre Benite,, France
| | - Elisabeth Coupez
- Réanimation polyvalente, Hôpital G. Montpied, 63003 Clermont Ferrand, France
| | - Nicolas Chudeau
- Réanimation médico-chirurgicale, CH du Mans, 72037 Le Mans, France
| | - Saber Barbar
- Réanimation, Hôpital Caremeau, 30029 Nimes, France
| | | | | | | | - Eric Boulet
- Réanimation et USC, GH Carnelle Portes de l’Oise, 95260 Beaumont sur Oise, France
| | - Karim Lakhal
- Anesthésie Réanimation, hôpital Nord laennec, 44093 Nantes, France
| | - Nadia Aissaoui
- Réanimation médicale, Hôpital Georges Pompidou, 75014 Paris, France
| | - Steven Grange
- Réanimation médicale, CHU Rouen, 76031 Rouen, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015 Marseille, France
| | - Guillaume Lacave
- Réanimation médico-chirurgicale, Hôpital André Mignot, 78000 Versailles, France
| | - Saad Nseir
- Réanimation médicale, CHRU de Lille, Hôpital Roger Salengro, 59037 Lille, France
| | - Florent Poirson
- AP-HP, Hôpital Avicenne, Service de Réanimation Médico-Chirurgicale, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Julien Mayaux
- Pneumologie et Réanimation médicale, Hôpital Pitié Salpêtrière, 75013 Paris, France
| | | | - Guillaume Geri
- Réanimation médico-chirurgicale, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - Kada Klouche
- Médecine Intensive Réanimation, Hôpital lapeyronnie, 34295 Montpellier, France
| | - Guillaume Thiery
- Réanimation médicale, CHU Saint Etienne, 42270 Saint Priest en Jarez, France
| | - Laurent Argaud
- Réanimation médicale, Hôpital Edouard Herriot, 69437 Lyon, France
| | - Jean-Damien Ricard
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700 Colombes, France
- Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, F-75018 Paris, France
- INSERM, IAME, U1137, F-75018 Paris, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Didier Dreyfuss
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France
- Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, F-92700 Colombes, France
- Sorbonne Paris-Cité, Paris, France
- Present address: Intensive Care Unit, Hôpital Louis Mourier, 178 rue des Renouillers, 92110 Colombes, France
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Rigal JC, Boissier E, Lakhal K, Riche VP, Durand-Zaleski I, Rozec B. Cost-effectiveness of point-of-care viscoelastic haemostatic assays in the management of bleeding during cardiac surgery: protocol for a prospective multicentre pragmatic study with stepped-wedge cluster randomised controlled design and 1-year follow-up (the IMOTEC study). BMJ Open 2019; 9:e029751. [PMID: 31694845 PMCID: PMC6858223 DOI: 10.1136/bmjopen-2019-029751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/18/2022] Open
Abstract
INTRODUCTION During cardiac surgery-associated bleeding, the early detection of coagulopathy is crucial. However, owing to time constraints or lack of suitable laboratory tests, transfusion of haemostatic products is often inappropriately triggered, either too late (exposing to prolonged bleeding and thus to avoidable administration of blood products) or blindly to the coagulation status (exposing to unnecessary haemostatic products administration in patients with no coagulopathy). Undue exposition to transfusion risks and additional healthcare costs may arise. With the perspective of secondary care-related costs, the IMOTEC study (Intérêt MédicO-économique de la Thrombo-Elastographie, dans le management transfusionnel des hémorragies péri-opératoires de chirurgies Cardiaques sous circulation extracorporelle) aims at assessing the cost-effectiveness of a point-of-care viscoelastic haemostatic assay (VHA: RoTem or TEG)-guided management of bleeding. Among several outcome measures, particular emphasis will be put on quality of life with a 1-year follow-up. METHODS AND ANALYSIS This is a multicentre, prospective, pragmatic study with stepped-wedge cluster randomised controlled design. Over a 36-month period (24 months of enrolment and 12 months of follow-up), 1000 adult patients undergoing cardiac surgery with cardiopulmonary bypass will be included if a periprocedural significant bleeding occurs. The primary outcome is the cost-effectiveness of a VHA-guided algorithm over a 1-year follow-up, including patients' quality of life. Secondary outcomes are the cost-effectiveness of the VHA-guided algorithm with regard to the rate of surgical reexploration and 1-year mortality, its cost per-patient, its effectiveness with regard to haemorrhagic, infectious, renal, neurological, cardiac, circulatory, thrombotic, embolic complications, transfusion requirements, mechanical ventilation free-days, duration of intensive care unit and in-hospital stay and mortality. ETHICS AND DISSEMINATION The study was registered at Clinicaltrials.gov and was approved by the Committee for the Protection of Persons of Nantes University Hospital, The French Advisory Board on Medical Research Data Processing and the French Personal Data Protection Authority. A publication of the results in a peer-reviewed journal is planned. TRIAL REGISTRATION NUMBER NCT02972684; Pre-results.
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Affiliation(s)
- Jean-Christophe Rigal
- Anesthésie et réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Elodie Boissier
- Laboratoire d'hématologie, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Karim Lakhal
- Anesthésie et réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Valéry-Pierre Riche
- Direction de la recherche, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Isabelle Durand-Zaleski
- URCECo Ile de France, Groupe hospitalier A.Chenevier, Henri Mondor, AP-HP, Paris, France
- AP-HP Public Health, Henri Mondor Hospital, ECEVE-UMR1123 - INSERM & UPEC, Paris, France
| | - Bertrand Rozec
- Anesthésie et réanimation chirurgicale, Hôpital Guillaume et René Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
- l'institut du thorax, INSERM, CNRS, Nantes Université, Nantes, France
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Asquier-Khati A, Deschanvres C, Boutoille D, Lakhal K, Buffenoir K, Khatchatourian L, Asseray N. Abcès cérébraux à pyogènes : facteurs pronostiques et intérêt du relais des antibiotiques par voie orale au sein d’une cohorte rétrospective de 109 patients. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.234] [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: 11/26/2022]
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Roger C, Zieleskiewicz L, Demattei C, Lakhal K, Piton G, Louart B, Constantin JM, Chabanne R, Faure JS, Mahjoub Y, Desmeulles I, Quintard H, Lefrant JY, Muller L. Time course of fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study. Crit Care 2019; 23:179. [PMID: 31097012 PMCID: PMC6524325 DOI: 10.1186/s13054-019-2448-z] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/17/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC. METHODS This is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC. RESULTS From May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43-63], median SOFA score 10 [8-12]). Among the 76/143 (53%) patient responders to FC at T10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T30 (49%, 95%CI = [37-60]), and 39 (51%, 95%CI = [38-62]) patients were persistent responders (PR), i.e., remained responders at T30. Among the 67 NR at T10, 4 became responders at T30, (6%, 95%CI = [1.9-15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups. CONCLUSIONS This study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent. TRIAL REGISTRATION ClinicalTrials.gov , NCT02116413 . Registered on April 16, 2014.
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Affiliation(s)
- Claire Roger
- Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France.,Physiology Department. EA 2992, Faculty of Medicine, Univ Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Marseille, 13000, Marseille, France.,Aix Marseille University, INSERM1263, INRA1260, C2VN, Marseille, France
| | - Christophe Demattei
- Department of Biostatistics Epidemiology and Medical information, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France
| | - Karim Lakhal
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nantes, 44000, Nantes, France
| | - Gael Piton
- Medical Intensive Care unit, University Hospital of Besançon, 25030, Besançon, France
| | - Benjamin Louart
- Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France.,Physiology Department. EA 2992, Faculty of Medicine, Univ Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Russell Chabanne
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jean-Sébastien Faure
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Amiens, 80000, Amiens, France
| | - Isabelle Desmeulles
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Caen, 14033, Caen, France
| | - Hervé Quintard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nice, 06000, Nice, France
| | - Jean-Yves Lefrant
- Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France.,Physiology Department. EA 2992, Faculty of Medicine, Univ Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Laurent Muller
- Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France. .,Physiology Department. EA 2992, Faculty of Medicine, Univ Montpellier, Montpellier-Nimes University, Nîmes, France.
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Lakhal K, Rodie-Talbere PA, Alexandre PL, Testard N, Rozec B, Daumas-Duport B. Continuous intravenous milrinone for severe reversible cerebral vasoconstriction syndrome (a case report). J Neurol Sci 2019; 397:55-57. [PMID: 30590342 DOI: 10.1016/j.jns.2018.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Karim Lakhal
- Réanimation chirurgicale polyvalente, Service d'anesthésie-réanimation, Hôpital Laënnec, Centre hospitalier universitaire de Nantes, F-44093 Nantes, France.
| | - Pierre-André Rodie-Talbere
- Réanimation chirurgicale polyvalente, Service d'anesthésie-réanimation, Hôpital Laënnec, Centre hospitalier universitaire de Nantes, F-44093 Nantes, France.
| | - Pierre-Louis Alexandre
- Service de radiologie, Hôpital Laënnec, Centre hospitalier universitaire de Nantes, F-44093 Nantes, France.
| | - Nathalie Testard
- Service de neurologie, Hôpital Laënnec, Centre hospitalier universitaire de Nantes, F-44093 Nantes, France.
| | - Bertrand Rozec
- Réanimation chirurgicale polyvalente, Service d'anesthésie-réanimation, Hôpital Laënnec, Centre hospitalier universitaire de Nantes, F-44093 Nantes, France; Institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France.
| | - Benjamin Daumas-Duport
- Service de radiologie, Hôpital Laënnec, Centre hospitalier universitaire de Nantes, F-44093 Nantes, France.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France,
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Rouve E, Lakhal K, Salmon Gandonnière C, Jouan Y, Bodet-Contentin L, Ehrmann S. Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients. BMC Nephrol 2018; 19:308. [PMID: 30400873 PMCID: PMC6219088 DOI: 10.1186/s12882-018-1091-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 10/09/2018] [Indexed: 12/26/2022] Open
Abstract
Background Iodinated contrast media may contribute to acute kidney injury. However, several recent works suggest that this toxicity is minimal in the clinical setting. Recently, urinary G1 cell-cycle arrest proteins tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin like growth factor binding protein 7 (IGFBP-7) were identified as highly sensitive and specific biomarkers for early detection of kidney aggression. The impact of contrast administration on those biomarkers has not been specifically evaluated but could provide clues about the toxicity of contrast media. This study aimed at measuring changes in TIMP-2 and IGFBP-7 urinary concentrations before and after a contrast-enhanced computed tomography in critically ill patients. Methods 77 patients were included in a prospective observational cohort study. Urinary [TIMP -2]·[IGFBP-7] was measured before, 6 and 24 h after contrast infusion. Urine output and serum creatinine were followed 3 days. Results Median [TIMP-2]·[IGFBP-7] was 0.06 [interquartile range 0.04;0.26], 0.07 [0.03;0.34] and 0.10 [0.04;0.37] (ng/mL)2/1000 respectively before, 6 and 24 h after contrast infusion. Individual changes from baseline were − 0.01 [− 0.11;0.11] and 0.00 [− 0.10;0.09] (ng/ml)2/1000 at 6 and 24 h. These changes were not higher among the patients increasing their Kidney Disease Improving Global Outcome (KDIGO) classification within 3 days after contrast infusion (n = 14 [18%] based on creatinine criterion only, n = 42 [55%] based on creatinine and urine output). Conclusions Changes in [TIMP-2]·[IGFBP-7] urinary concentration after contrast-enhanced computed tomography were insignificant, suggesting minimal kidney aggression by modern iodinated contrast media.
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Affiliation(s)
- Emmanuelle Rouve
- Medecine Intensive Reanimation, CIC 1415, CRICS-Triggersep network, CHRU de Tours, Tours, France
| | - Karim Lakhal
- Reanimation chirurgicale polyvalente, service d'anesthesie-reanimation, Hôpital Laënnec, centre hospitalier universitaire, Nantes, France
| | - Charlotte Salmon Gandonnière
- Medecine Intensive Reanimation, CIC 1415, CRICS-Triggersep network, CHRU de Tours, Tours, France.,Faculté de médecine, Université de Tours, Tours, France
| | - Youenn Jouan
- Medecine Intensive Reanimation, CIC 1415, CRICS-Triggersep network, CHRU de Tours, Tours, France.,Faculté de médecine, Université de Tours, Tours, France
| | - Laetitia Bodet-Contentin
- Medecine Intensive Reanimation, CIC 1415, CRICS-Triggersep network, CHRU de Tours, Tours, France.,Faculté de médecine, Université de Tours, Tours, France
| | - Stephan Ehrmann
- Medecine Intensive Reanimation, CIC 1415, CRICS-Triggersep network, CHRU de Tours, Tours, France. .,Faculté de médecine, Université de Tours, Tours, France.
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Cinotti R, Putegnat JB, Lakhal K, Desal H, Chenet A, Buffenoir K, Frasca D, Allaouchiche B, Asehnoune K, Rozec B. Evolution of neurological recovery during the first year after subarachnoid haemorrhage in a French university centre. Anaesth Crit Care Pain Med 2018; 38:251-257. [PMID: 31079704 DOI: 10.1016/j.accpm.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The evolution of neurological recovery during the first year after aneurysmal Subarachnoid Haemorrhage (SAH) is poorly described. PATIENTS Patients with SAH in one university hospital from March the 1st 2010, to December 31st 2012, with a one-year follow-up. METHOD Evaluation was performed via phone call at 3, 6 and 12 months. Primary endpoint was poor neurological recovery (modified Rankin Scale 3-4-5-6), one year after SAH. Secondary endpoints were the incidence of lack of self-perceived previous health status recovery and incidence of cognitive disorders, one year after SAH. Risk factors of poor neurological recovery were retrieved with multivariable logistic regression. RESULTS Two hundred and eleven patients were included and 208 had a complete follow-up. One hundred and twenty (57.7%) patients were female, 112 (53.8%) had a WFNS grade I-II-III. Seventy (33.6%) patients displayed one-year poor neurological outcome and risk factors of poor outcome were age, baseline Glasgow Coma Score ≤ 8, external ventricular drainage, intra-cranial hypertension and angiographic vasospasm. We observed an improvement in good outcome at 3 months [112 (53.8%) patients], 6 months [127 (61.1%) patients] and one-year [138 (66.3%) patients]. Fifty-nine (35.3%) patients recovered previous health status, 96 (57.5%) had persistent behaviour disorders, and 71 (42.5%) suffered from memory losses at one year. DISCUSSION Neurological recovery seems to improve over time. The same key complications should be targeted worldwide in SAH patients. CONCLUSION Neurological complications in the following of SAH should be actively treated in order to improve outcome. The early neuro-ICU phase remains a key determinant of long-term recovery.
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Affiliation(s)
- Raphaël Cinotti
- Anaesthesia and critical care department, Hôtel Dieu, 1, place Alexis-Ricordeau 44093 Nantes, university hospital of Nantes, France.
| | - Jean-Baptiste Putegnat
- Anaesthesia and critical care department, centre régional hospitalier universitaire, route de Chauvel, Les Abymes, BP 465, 97159, Pointe-à-Pitre cedex, Guadeloupe, France.
| | - Karim Lakhal
- Anaesthesia and critical care department, hôpital Guillaume et René-Laennec, university hospital of Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
| | - Hubert Desal
- Department of neuroradiology, hôpital Guillaume et René-Laennec, university hospital of Nantes boulevard Jacques-Monod, 44800 Saint-Herblain, France.
| | - Amandine Chenet
- Service de médecine physique et de réadaptation, hôpital Saint-Jacques, university hospital of Nantes, 85, rue Saint-Jacques, 44200 Nantes, France.
| | - Kévin Buffenoir
- Department of neurotraumatology, university hospital of Nantes Hôtel Dieu, 1, place Alexis-Ricordeau 44093 Nantes, France.
| | - Denis Frasca
- Anaesthesia and critical care department, centre hospitalo-universitaire, university hospital of Poitiers 2, rue de la Milétrie 86021, Poitiers, France; Inserm SPHERE U1246 "Methods for Patients-centered outcomes and Health Research", UFR des sciences pharmaceutiques, university of Nantes, university of Tours, 22, boulevard Benoni-Goullin, 44200 Nantes, France.
| | - Bernard Allaouchiche
- Intensive care unit, anaesthesia and critical care department, centre hospitalier Lyon-Sud, Pierre-Bénite France Hospice Civils de Lyon 165, chemin du Grand Revoyet, 69310, France; Université Claude Bernard Lyon 1, 43, boulevard du 11 Novembre 1918, 69100, Villeurbanne, France; Université de Lyon, VetAgroSup, APCSé, 1, avenue Bourgelat, 69280, Marcy-l'Etoile, France.
| | - Karim Asehnoune
- Anaesthesia and critical care department, Hôtel Dieu, 1, place Alexis-Ricordeau 44093 Nantes, university hospital of Nantes, France; Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections" university hospital of Nantes. 22, boulevard Benoni-Goullin, 44200 Nantes, France.
| | - Bertrand Rozec
- Anaesthesia and critical care department, hôpital Guillaume et René-Laennec, university hospital of Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Institut du thorax, Inserm UMR1087 IRT, UN 8 quai Moncousu, University hospital of Nantes, BP 7072 44007 Nantes cedex 1, France.
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Jaber S, Quintard H, Cinotti R, Asehnoune K, Arnal JM, Guitton C, Paugam-Burtz C, Abback P, Mekontso Dessap A, Lakhal K, Lasocki S, Plantefeve G, Claud B, Pottecher J, Corne P, Ichai C, Hajjej Z, Molinari N, Chanques G, Papazian L, Azoulay E, De Jong A. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. Crit Care 2018; 22:236. [PMID: 30243304 PMCID: PMC6151191 DOI: 10.1186/s13054-018-2150-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 06/07/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients liberated from invasive mechanical ventilation are at risk of extubation failure, including inability to breathe without a tracheal tube (airway failure) or without mechanical ventilation (non-airway failure). We sought to identify respective risk factors for airway failure and non-airway failure following extubation. METHODS The primary endpoint of this prospective, observational, multicenter study in 26 intensive care units was extubation failure, defined as need for reintubation within 48 h following extubation. A multinomial logistic regression model was used to identify risk factors for airway failure and non-airway failure. RESULTS Between 1 December 2013 and 1 May 2015, 1514 patients undergoing extubation were enrolled. The extubation-failure rate was 10.4% (157/1514), including 70/157 (45%) airway failures, 78/157 (50%) non-airway failures, and 9/157 (5%) mixed airway and non-airway failures. By multivariable analysis, risk factors for extubation failure were either common to airway failure and non-airway failure: intubation for coma (OR 4.979 (2.797-8.864), P < 0.0001 and OR 2.067 (1.217-3.510), P = 0.003, respectively, intubation for acute respiratory failure (OR 3.395 (1.877-6.138), P < 0.0001 and OR 2.067 (1.217-3.510), P = 0.007, respectively, absence of strong cough (OR 1.876 (1.047-3.362), P = 0.03 and OR 3.240 (1.786-5.879), P = 0.0001, respectively, or specific to each specific mechanism: female gender (OR 2.024 (1.187-3.450), P = 0.01), length of ventilation > 8 days (OR 1.956 (1.087-3.518), P = 0.025), copious secretions (OR 4.066 (2.268-7.292), P < 0.0001) were specific to airway failure, whereas non-obese status (OR 2.153 (1.052-4.408), P = 0.036) and sequential organ failure assessment (SOFA) score ≥ 8 (OR 1.848 (1.100-3.105), P = 0.02) were specific to non-airway failure. Both airway failure and non-airway failure were associated with ICU mortality (20% and 22%, respectively, as compared to 6% in patients with extubation success, P < 0.0001). CONCLUSIONS Specific risk factors have been identified, allowing us to distinguish between risk of airway failure and non-airway failure. The two conditions will be managed differently, both for prevention and curative strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT 02450669 . Registered on 21 May 2015.
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Affiliation(s)
- Samir Jaber
- PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France.
| | - Hervé Quintard
- Université Cote d'Azur, CNRS U7275, CHU de Nice, Service réanimation polyvalente et U 7275, IPMC, Nice, France
| | - Raphael Cinotti
- Intensive Care & Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital, Nantes, France
| | - Karim Asehnoune
- Intensive Care & Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital, Nantes, France
| | | | - Christophe Guitton
- Medical Intensive Care Unit, Hôtel-Dieu Teaching Hospital, Nantes, France
| | - Catherine Paugam-Burtz
- Intensive Care & Anesthesiology Department, Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Beaujon, F-75018, Paris, France
| | - Paer Abback
- Intensive Care & Anesthesiology Department, Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Beaujon, F-75018, Paris, France
| | - Armand Mekontso Dessap
- Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil Cedex, France
| | - Karim Lakhal
- Intensive Care & Anesthesiology Department, University of Nantes, Laennec Nord Hospital, Nantes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, 49933, Angers, Cedex 9, France
| | - Gaetan Plantefeve
- Medical-Surgical Intensive Care Unit, General Hospital Centre, Argenteuil, France
| | - Bernard Claud
- Medical-Surgical Intensive Care Unit, General Hospital Centre, Le Puy-en-Velay, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle Anesthésie Réanimation Chirurgicale SAMU, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation Chirurgicale, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, stress oxydant et protection musculaire", Strasbourg, France
| | - Philippe Corne
- Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Carole Ichai
- Université Cote d'Azur, CNRS U7275, CHU de Nice, Service réanimation polyvalente et U 7275, IPMC, Nice, France
| | - Zied Hajjej
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Gerald Chanques
- PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France
| | - Laurent Papazian
- APHM, URMITE UMR CNRS 7278, Hôpital Nord, Réanimation des Détresses Respiratoires et Infections Sévères, Aix-Marseille Univ, Marseille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France
| | - Audrey De Jong
- PhyMedExp, University of Montpellier, Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, cedex 5, France
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Boissier E, Genebrier S, Lakhal K, Nedelec-Gac F, Trossaërt M, Ternisien C, Gouin-Thibault I. Rivaroxaban and Apixaban Anti-Xa Measurements: Impact of Plasma Storage for 7 Days at Room Temperature. Thromb Haemost 2018; 118:1488-1490. [PMID: 29960274 DOI: 10.1055/s-0038-1661391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Elodie Boissier
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Steve Genebrier
- Hématologie Biologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Karim Lakhal
- Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Fabienne Nedelec-Gac
- Hématologie Biologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Marc Trossaërt
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Centre de Traitement de l'Hémophilie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Catherine Ternisien
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Centre de Traitement de l'Hémophilie, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Grégoire M, Pineau A, Bretonnière C, Niang J, Lakhal K, Deslandes G. Difference between plasma and red blood cell acetone distribution during the first 60 h of a massive intoxication. Clin Toxicol (Phila) 2018; 56:1207-1208. [PMID: 29893588 DOI: 10.1080/15563650.2018.1480025] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Matthieu Grégoire
- a Clinical Pharmacology Department , CHU Nantes , Nantes , France.,b UMR Inserm 1235 The enteric Nervous System in Gut and Brain Disorders , University of Nantes , France
| | - Alain Pineau
- a Clinical Pharmacology Department , CHU Nantes , Nantes , France
| | - Cédric Bretonnière
- c Intensive Care Unit Department , CHU Nantes , Nantes , France.,d EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections , University of Nantes , France
| | - Joyce Niang
- a Clinical Pharmacology Department , CHU Nantes , Nantes , France
| | - Karim Lakhal
- e Réanimation Chirurgicale Polyvalente , Service d'Anesthésie-Réanimation, hôpital Laënnec, CHU Nantes , Nantes , France
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Bourigault C, Birgand G, Lakhal K, Bretonnière C. Quelle surveillance des infections associées aux soins en réanimation en 2018 ? Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La surveillance des infections associées aux soins (IAS) est prioritaire en réanimation, secteur à haut risque du fait de l’état critique des patients et de leur exposition aux dispositifs invasifs. Elle présente un triple objectif : décrire l’épidémiologie et l’incidence des IAS ; évaluer l’impact des actions de prévention ou de contrôle et alerter face à une épidémie ou des phénomènes émergents. Cette surveillance des IAS peut être réalisée selon une méthodologie interne, définie par l’établissement, ou intégrée à un réseau de surveillance. L’intérêt de la surveillance pour la prévention des IAS en réanimation n’est plus à démontrer, mais la surveillance manuelle reste chronophage pour les cliniciens et les équipes d’hygiène, limitant ainsi le temps dédié à la prévention de ces infections. La surveillance automatisée apparaît aujourd’hui comme un outil intéressant, tant par ses performances que par le gain de temps qu’elle représente pour les équipes. Plusieurs éléments sont primordiaux pour obtenir des résultats fiables : la nécessité d’une harmonisation des définitions et des méthodes de surveillance ; la mise à disposition d’outils informatiques performants pour faciliter le suivi des patients ; le leadership des réanimateurs dans la surveillance. Cet article fait le point sur les méthodes de surveillance des IAS utilisées aujourd’hui en réanimation, l’intérêt de la mise en place de cette surveillance épidémiologique ainsi que la fiabilité des données recueillies et, enfin, les avantages du développement d’une surveillance semi-automatisée ou automatisée des IAS dans ce secteur.
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La Combe B, Bleibtreu A, Messika J, Fernandes R, Clermont O, Branger C, Billard-Pomares T, Barnaud G, Magdoud F, Eveillard M, Kouatchet A, Lasocki S, Asfar P, Corvec S, Lakhal K, Armand-Lefevre L, Wolff M, Timsit JF, Bourdon S, Reignier J, Martin S, Fihman V, de Prost N, Bador J, Charles PE, Goret J, Boyer A, Wallet F, Jaillette E, Nseir S, Landraud L, Ruimy R, Danin PE, Dellamonica J, Cremniter J, Frat JP, Jauréguy F, Clec’h C, Decré D, Maury E, Dreyfuss D, Denamur E, Ricard JD. Decreased susceptibility to chlorhexidine affects a quarter of Escherichia coli isolates responsible for pneumonia in ICU patients. Intensive Care Med 2018; 44:531-533. [DOI: 10.1007/s00134-018-5061-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/30/2022]
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Lakhal K, Robert-Edan V. Invasive monitoring of blood pressure: a radiant future for brachial artery as an alternative to radial artery catheterisation? J Thorac Dis 2017; 9:4812-4816. [PMID: 29312664 PMCID: PMC5756991 DOI: 10.21037/jtd.2017.10.166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Karim Lakhal
- Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Vincent Robert-Edan
- Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
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Lakhal K, Martin M, Ehrmann S, Faiz S, Rozec B, Boulain T. Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia. J Clin Monit Comput 2017; 32:707-715. [DOI: 10.1007/s10877-017-0067-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
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Bettan A, Rodie-Talbere PA, Martin SA, Lakhal K. Noninvasive positive pressure ventilation after skull base surgery. Intensive Care Med 2017. [PMID: 28642984 DOI: 10.1007/s00134-017-4866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Armel Bettan
- Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques Monod, Saint Herblain, 44093, Nantes Cedex 1, France
| | - Pierre-André Rodie-Talbere
- Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques Monod, Saint Herblain, 44093, Nantes Cedex 1, France
| | - Stéphane André Martin
- Service de neurochirurgie, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Karim Lakhal
- Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques Monod, Saint Herblain, 44093, Nantes Cedex 1, France.
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Boissier E, Sévin-Allouet M, Le Thuaut A, De Gaalon S, Trossaërt M, Rozec B, Lakhal K, Rigal JC. A 2-min at 4500 g rather than a 15-min at 2200 g centrifugation does not impact the reliability of 10 critical coagulation assays. Clin Chem Lab Med 2017; 55:e118-e121. [PMID: 27732555 DOI: 10.1515/cclm-2016-0670] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/10/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Elodie Boissier
- Service d'hématologie biologique, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Bd Jacques Monod, 44 093 Nantes Cedex 1
| | | | - Aurélie Le Thuaut
- Direction de la recherche, Centre Hospitalier Universitaire de Nantes, Nantes
| | - Solène De Gaalon
- Service de neurologie, Centre Hospitalier Universitaire de Nantes, Nantes
| | - Marc Trossaërt
- Service d'hématologie biologique, Centre Hospitalier Universitaire de Nantes, Nantes
| | - Bertrand Rozec
- Service d'anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes
| | - Karim Lakhal
- Service d'anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes
| | - Jean-Christophe Rigal
- Service d'anesthésie-réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes
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Affiliation(s)
- Karim Lakhal
- Réanimation Chirurgicale Polyvalente, CHU LaënnecNantes, France
| | | | - Thierry Boulain
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier RégionalOrléans, France
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Lakhal K, Nay M, Kamel T, Lortat-Jacob B, Ehrmann S, Rozec B, Boulain T. Change in end-tidal carbon dioxide outperforms other surrogates for change in cardiac output during fluid challenge. Br J Anaesth 2017; 118:355-362. [DOI: 10.1093/bja/aew478] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 01/20/2023] Open
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