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Hraiech S, Ladjal K, Guervilly C, Hyvernat H, Papazian L, Forel JM, Lopez A, Peres N, Dellamonica J, Leone M, Gragueb-Chatti I. Lung abscess following ventilator-associated pneumonia during COVID-19: a retrospective multicenter cohort study. Crit Care 2023; 27:385. [PMID: 37794402 PMCID: PMC10552315 DOI: 10.1186/s13054-023-04660-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patients undergoing mechanical ventilation (MV) for COVID-19 exhibit an increased risk of ventilator-associated pneumonia (VAP). The occurrence of lung abscesses following VAP in these patients has been poorly studied. We aimed to describe the incidence, characteristics, risk factors and prognosis of lung abscesses complicating VAP after COVID-19. METHODS We conducted an observational, retrospective study in three French intensive care units. Patients admitted for acute respiratory failure with a confirmed SARS-CoV-2 PCR and requiring MV for more than 48 h were included. RESULTS Among the 507 patients included, 326 (64%) had a documented VAP. Of these, 23 (7%) developed a lung abscess. Enterobacterales (15/23, 65%) were the main documentation, followed by non-fermenting Gram-negative bacilli (10/23, 43%) and Gram-positive cocci (8/23, 35%). Lung abscesses were mainly plurimicrobial (15/23, 65%). In multivariate analysis, a plurimicrobial 1st VAP episode (OR (95% CI) 2.93 (1.16-7.51); p = 0.02) and the use of hydrocortisone (OR (95% CI) 4.86 (1.95-12.1); p = 0.001) were associated with lung abscess development. Intensive care unit (ICU) mortality of patients with lung abscesses reached 52%, but was not significantly higher than for patients with VAP but no lung abscess. Patients with lung abscesses had reduced ventilator-free days at day 60, a longer duration of MV and ICU stay than patients with VAP but no lung abscess (respectively, 0 (0-3) vs. 16 (0-42) days; p < 0.001, 49 (32-73) vs. 25 (11-41) days; p < 0.001, 52 (36-77) vs. 28 (16-47) days; p < 0.001). CONCLUSIONS Lung abscessing pneumonia is not uncommon among COVID-19 patients developing VAP. A plurimicrobial first VAP episode and the use of hydrocortisone are independently associated with this complication. In COVID-19 patients with persistent VAP, a chest CT scan investigating the evolution toward lung abscess should be considered.
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Affiliation(s)
- S Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
- Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France.
| | - K Ladjal
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
| | - C Guervilly
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
| | - H Hyvernat
- CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France
- Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - L Papazian
- Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France
- Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France
| | - J M Forel
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France
| | - A Lopez
- Service d'Anesthésie Et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - N Peres
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon - La Seyne sur Mer, Toulon, France
| | - J Dellamonica
- CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France
- Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - M Leone
- Service d'Anesthésie Et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - I Gragueb-Chatti
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
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Bobot M, Boucraut J, Max H, Simeone P, Carvelli J, Heim X, Forel J, Jourde-Chiche N, Papazian L, Burtey S. Prévalence importante et mauvais pronostic de la dysfonction tubulaire proximale au cours du SDRA COVID en réanimation : l’étude URICOV. Nephrol Ther 2021. [PMCID: PMC8435311 DOI: 10.1016/j.nephro.2021.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction La protéinurie et l’insuffisance rénale aiguë sont fréquentes au cours du COVID-19, et associées à la morbi-mortalité, mais la pathogénicité directe du SARS-CoV-2 sur le rein reste débattue. Notre objectif était d’évaluer la prévalence et la valeur pronostique de la tubulopathie proximale chez les patients en SDRA COVID en réanimation. Description Dans cette étude de cohorte prospective multicentrique, étaient inclus les patients majeurs présentant une détresse respiratoire nécessitant la ventilation mécanique avec rapport PaO2/FiO2 < 300 dans les 24 h de l’intubation. Méthodes Nous réalisions une analyse détaillée des marqueurs de dysfonction rénale avec électrophorèse des protéines urinaires (EPU) dans les 24 h de l’intubation chez 85 patients en réanimation pour un SDRA COVID. Résultats Seulement 16 (18,8 %) des patients présentaient une IRA initiale. L’uricémie était abaissée (moyenne 212 μmol/L), 87,1 % des patients présentaient une glycosurie. Une hématurie microscopique était retrouvée chez 74 (87,1 %) patients. Les rapports protéinurie/créatinine et albuminurie/créatinine étaient de 785 et 142 mg/g. L’EPU retrouvant un profil tubulaire chez 91 % des patients, avec une atteinte glomérulaire surajoutée dans chez 17 %. Il existait une fuite urinaire massive d’alpha-1-microglobuline (a1 m, 96,1 % des patients), beta-2-microglobuline (b2 m, 95,8 %), chaînes légères kappa et lambda (CLL) (100 % et 93,5 %) et Vitamine-D-Binding-Protein (87,5 %). Après un suivi moyen de 28 jours, 37 patients (43,5 %) ont développé une insuffisance rénale aiguë (13 KDIGO3, 3 nécessitant la dialyse). Les patients ayant développé une IRA KDIGO3 avaient une urémie, une créatininémie, des rapports protéinurie/créatininurie, albuminurie/créatininurie et a1 m/créatininurie significativement plus élevés et une bicarbonatémie plus basse. La dexamethasone semblait protéger de l’IRA. La survenue d’une IRA et des rapports b2 m/créatininurie et CLLl/créatininurie plus élevés était associés à la mortalité (p = 0,027, p = 0,04, p = 0,005, respectivement) (Fig. 1). Conclusion Les patients développant un SDRA au cours du COVID-19 présentent une dysfonction tubulaire proximale, précédant l’IRA, qui semble être un mécanisme important de la néphropathie COVID et pourrait être un marqueur de sévérité.
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Nguyen C, Montcriol A, Janvier F, Cungi PJ, Esnault P, Mathais Q, Vallet C, Boussen S, Cordier PY, Serpin L, Papazian L, Bordes J. Critical COVID-19 patient evacuation on an amphibious assault ship: feasibility and safety. A case series. BMJ Mil Health 2021; 167:224-228. [PMID: 32764134 PMCID: PMC7411308 DOI: 10.1136/bmjmilitary-2020-001520] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION An amphibious assault ship was deployed on 22 March in Corsica to carry out medical evacuation of 12 critical patients infected with COVID-19. The ship has on-board hospital capacity and is the first time that an amphibious assault ship is engaged in this particular condition. The aim is to evaluate the feasibility and safety of prolonged medical evacuation of critical patients with COVID-19. METHODS We included 12 patients with confirmed COVID-19 infection: six ventilated patients with acute respiratory distress syndrome and six non-ventilated patients with hypoxaemia. Transfer on an amphibious assault ship lasted 20 hours. We collected patients' medical records: age, comorbidities, COVID-19 history and diagnosis, ventilation supply and ventilator settings, and blood gas results. We calculated oxygen consumption (OC). RESULTS All patients had a medical history. The median delay from onset of symptoms to hospitalisation was 8 (7-10) days. The median Sequential Organ Failure Assessment score on admission was 3 (2-5). There was no significant increase in oxygen during ship transport and no major respiratory complication. There was no significant increase in arterial oxygen pressure to fractional inspired oxygen ratio among ventilated patients during ship transport. Among ventilated patients, the median calculated OC was 255 L (222-281) by hours and 5270 L (4908-5616) during all ship transport. Among non-ventilated patients, the median calculated OC was 120 L (120-480) by hours and 2400 L (2400-9600) during all ship transport. CONCLUSION The present work contributes to assessing the feasibility and safety condition of critical COVID-19 evacuation on an amphibious assault ship during an extended transport. The ship needs to prepare a plan and a specialised intensive team and conduct patient screening for prolonged interhospital transfers.
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Affiliation(s)
- Cédric Nguyen
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - A Montcriol
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - F Janvier
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - P-J Cungi
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - P Esnault
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | - Q Mathais
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
| | | | - S Boussen
- APHM, Marseille, Provence-Alpes-Côte d'Azur, France
| | - P-Y Cordier
- Anesthesiology and Intensive Care, HIA LAVERAN, Marseille, France
| | - L Serpin
- Emergency, Hospital Centre Ajaccio, Ajaccio, France
| | - L Papazian
- APHM, Marseille, Provence-Alpes-Côte d'Azur, France
| | - J Bordes
- Anesthesiology and Intensive Care, HIA Sainte Anne, Toulon Armees, France
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Marsot A, Hraiech S, Cassir N, Daviet F, Parzy G, Blin O, Papazian L, Guilhaumou R. Aminoglycosides in critically ill patients: which dosing regimens for which pathogens? Int J Antimicrob Agents 2020; 56:106124. [PMID: 32739478 DOI: 10.1016/j.ijantimicag.2020.106124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/17/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022]
Abstract
Modifications of antibiotic pharmacokinetic parameters have been reported in critically ill patients, resulting in a risk of treatment failure. We aimed to determine optimised amikacin (AMK), gentamicin (GEN) and tobramycin (TOB) intravenous dosing regimens in this patient population. Patients admitted to the medical ICU and treated with AMK, GEN or TOB were included. Analyses were performed using a parametric population approach. Monte Carlo simulations were performed and the probability of target attainment (PTA) was calculated using Cmax/MIC ≥ 8 and trough concentrations as targets. A total of 117 critically ill hospitalised patients were studied. Median values (interindividual variability, ɷ2) of clearance were 3.51 (0.539), 3.53 (0.297), 2.70 (0.339) and 5.07 (0.339) L/h for AMK, GEN, TOB, and TOB in cystic fibrosis (CF), respectively. Median values (ɷ2) of central volume of distribution were 30.2 (0.215), 20.0 (0.109) and 25.6 (0.177) L for AMK, GEN and TOB, respectively. Simulations showed that doses should be adjusted to actual body weight and creatinine clearance (CLCR) for AMK and GEN, and according to CLCR and presence of CF for TOB. In conclusion, our recommendations for treating Pseudomonas aeruginosa infections in this population include using initial doses of 35 mg/kg for AMK or 10 mg/kg for TOB (CF and non-CF patients). GEN demonstrated the best rates of target attainment against Staphylococcus aureus infections with a dose of 5 mg/kg. As high aminoglycoside doses are required in this population, efficacy and safety targets are conflicting and therapeutic drug monitoring remains an important tool to manage this issue.
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Affiliation(s)
- A Marsot
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.
| | - S Hraiech
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - N Cassir
- Aix-Marseille Université, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - F Daviet
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - G Parzy
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - O Blin
- IHU Méditerranée Infection, Marseille, France
| | - L Papazian
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - R Guilhaumou
- Aix-Marseille Univ., APHM, INSERM, CIC CPCET Service de Pharmacologie Clinique et Pharmacovigilance, INS Inst Neurosci Syst, Marseille, France
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Bal A, Casalegno JS, Melenotte C, Daviet F, Ninove L, Edouard S, Morfin F, Valette M, De Lamballerie X, Lina B, Papazian L, Nougairède A, Hraiech S. Influenza-induced acute respiratory distress syndrome during the 2010-2016 seasons: bacterial co-infections and outcomes by virus type and subtype. Clin Microbiol Infect 2020; 26:947.e1-947.e4. [PMID: 32205296 DOI: 10.1016/j.cmi.2020.03.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to describe bacterial co-infections and acute respiratory distress (ARDS) outcomes according to influenza type and subtype. METHODS A retrospective observational study was conducted from 2012 to 2016 in patients admitted to the respiratory intensive care unit (ICU) of Marseille university hospital for influenza-induced ARDS. Microbiological investigations, including multiplex molecular respiratory panel testing and conventional bacteriological cultures, were performed as part of the routine ICU care on the bronchoalveloar lavage collected at admission. Bacterial co-infections, ICU mortality and respiratory function were investigated according to virus type and subtype. RESULTS Among the 45 ARDS patients included, A(H1N1)pdm09 was the most frequent influenza virus identified (28/45 A(H1N1)pdm09, eight out of 45 A(H3N2) and nine out of 45 influenza B). Bacterial co-infections involving a total of 23 bacteria were diagnosed in 16/45 patients (36%). A(H1N1)pdm09 patients presented fewer bacterial co-infections (17.9% vs. 50.0% for A(H3N2) patients and 77.8% for B patients; p < 0.01). Overall, mortality at 90 days post admission was 33.3% (15/45), and there was no significant difference between influenza type and subtype. The need for extracorporeal membrane oxygenation was more frequent for A(H1N1)pdm2009 (20/28, 71.4%) and B patients (7/9, 77.8%) than the A(H3N2) subtype (1/8, 12.5%; p < 0.01). A(H1N1)pdm09-ARDS patients were associated with fewer ventilation-free days at day 28 (median (IQR): 0 (0-8) days) compared with other influenza-ARDS patients (15 (0-25) days, p < 0.05). DISCUSSION In a population of influenza-induced ARDS, A(H1N1)pdm09 was associated with fewer bacterial co-infections but poorer respiratory outcomes. These data underline the major role of A(H1N1)pdm09 subtype on influenza disease severity.
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Affiliation(s)
- A Bal
- Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; University of Lyon, Université Lyon 1, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - J S Casalegno
- Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; University of Lyon, Université Lyon 1, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - C Melenotte
- Aix Marseille University, IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - F Daviet
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS - Centre for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, France
| | - L Ninove
- Unité des Virus Emergents (UVE: Aix- Marseille Univ., IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - S Edouard
- Aix Marseille University, IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - F Morfin
- Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; University of Lyon, Université Lyon 1, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - M Valette
- Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; University of Lyon, Université Lyon 1, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - X De Lamballerie
- Unité des Virus Emergents (UVE: Aix- Marseille Univ., IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - B Lina
- Laboratoire de Virologie, Institut des Agents Infectieux, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; University of Lyon, Université Lyon 1, CIRI, Inserm U1111 CNRS UMR5308, Virpath, Lyon, France
| | - L Papazian
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS - Centre for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, France
| | - A Nougairède
- Unité des Virus Emergents (UVE: Aix- Marseille Univ., IRD 190, INSERM 1207, IHU Méditerranée Infection), Marseille, France
| | - S Hraiech
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS - Centre for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, France.
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Brosseau C, Danger R, Durand M, Durand E, Foureau A, Lacoste P, Tissot A, Roux A, Reynaud-Gaubert M, Kessler R, Mussot S, Dromer C, Brugière O, Mornex JF, Guillemain R, Claustre J, Magnan A, Brouard S, Velly J, Rozé H, Blanchard E, Antoine M, Cappello M, Ruiz M, Sokolow Y, Vanden Eynden F, Van Nooten G, Barvais L, Berré J, Brimioulle S, De Backer D, Créteur J, Engelman E, Huybrechts I, Ickx B, Preiser T, Tuna T, Van Obberghe L, Vancutsem N, Vincent J, De Vuyst P, Etienne I, Féry F, Jacobs F, Knoop C, Vachiéry J, Van den Borne P, Wellemans I, Amand G, Collignon L, Giroux M, Angelescu D, Chavanon O, Hacini R, Martin C, Pirvu A, Porcu P, Albaladejo P, Allègre C, Bataillard A, Bedague D, Briot E, Casez‐Brasseur M, Colas D, Dessertaine G, Francony G, Hebrard A, Marino M, Protar D, Rehm D, Robin S, Rossi‐Blancher M, Augier C, Bedouch P, Boignard A, Bouvaist H, Briault A, Camara B, Chanoine S, Dubuc M, Quétant S, Maurizi J, Pavèse P, Pison C, Saint‐Raymond C, Wion N, Chérion C, Grima R, Jegaden O, Maury J, Tronc F, Flamens C, Paulus S, Philit F, Senechal A, Glérant J, Turquier S, Gamondes D, Chalabresse L, Thivolet‐Bejui F, Barnel C, Dubois C, Tiberghien A, Pimpec‐Barthes F, Bel A, Mordant P, Achouh P, Boussaud V, Méléard D, Bricourt M, Cholley B, Pezella V, Brioude G, D'Journo X, Doddoli C, Thomas P, Trousse D, Dizier S, Leone M, Papazian L, Bregeon F, Coltey B, Dufeu N, Dutau H, Garcia S, Gaubert J, Gomez C, Laroumagne S, Mouton G, Nieves A, Picard C, Rolain J, Sampol E, Secq V, Perigaud C, Roussel J, Senage T, Mugniot A, Danner I, Haloun A, Abbes S, Bry C, Blanc F, Lepoivre T, Botturi‐Cavaillès K, Loy J, Bernard M, Godard E, Royer P, Henrio K, Dartevelle P, Fabre D, Fadel E, Mercier O, Stephan F, Viard P, Cerrina J, Dorfmuller P, Feuillet S, Ghigna M, Hervén P, Le Roy Ladurie F, Le Pavec J, Thomas de Montpreville V, Lamrani L, Castier Y, Mordant P, Cerceau P, Augustin P, Jean‐Baptiste S, Boudinet S, Montravers P, Dauriat G, Jébrak G, Mal H, Marceau A, Métivier A, Thabut G, Lhuillier E, Dupin C, Bunel V, Falcoz P, Massard G, Santelmo N, Ajob G, Collange O, Helms O, Hentz J, Roche A, Bakouboula B, Degot T, Dory A, Hirschi S, Ohlmann‐Caillard S, Kessler L, Schuller A, Bennedif K, Vargas S, Bonnette P, Chapelier A, Puyo P, Sage E, Bresson J, Caille V, Cerf C, Devaquet J, Dumans‐Nizard V, Felten M, Fischler M, Si Larbi A, Leguen M, Ley L, Liu N, Trebbia G, De Miranda S, Douvry B, Gonin F, Grenet D, Hamid A, Neveu H, Parquin F, Picard C, Stern M, Bouillioud F, Cahen P, Colombat M, Dautricourt C, Delahousse M, D'Urso B, Gravisse J, Guth A, Hillaire S, Honderlick P, Lequintrec M, Longchampt E, Mellot F, Scherrer A, Temagoult L, Tricot L, Vasse M, Veyrie C, Zemoura L, Dahan M, Murris M, Benahoua H, Berjaud J, Le Borgne Krams A, Crognier L, Brouchet L, Mathe O, Didier A, Krueger T, Ris H, Gonzalez M, Aubert J, Nicod L, Marsland B, Berutto T, Rochat T, Soccal P, Jolliet P, Koutsokera A, Marcucci C, Manuel O, Bernasconi E, Chollet M, Gronchi F, Courbon C, Hillinger S, Inci I, Kestenholz P, Weder W, Schuepbach R, Zalunardo M, Benden C, Buergi U, Huber L, Isenring B, Schuurmans M, Gaspert A, Holzmann D, Müller N, Schmid C, Vrugt B, Rechsteiner T, Fritz A, Maier D, Deplanche K, Koubi D, Ernst F, Paprotka T, Schmitt M, Wahl B, Boissel J, Olivera‐Botello G, Trocmé C, Toussaint B, Bourgoin‐Voillard S, Séve M, Benmerad M, Siroux V, Slama R, Auffray C, Charron D, Lefaudeux D, Pellet J. Blood CD9 + B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant 2019; 19:3162-3175. [PMID: 31305014 DOI: 10.1111/ajt.15532] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
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Affiliation(s)
- Carole Brosseau
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Richard Danger
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maxim Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Eugénie Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurore Foureau
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Philippe Lacoste
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Adrien Tissot
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Antoine Roux
- Hôpital Foch, Suresnes, France.,Université Versailles Saint-Quentin-en-Yvelines, UPRES EA220, Versailles, France
| | | | | | - Sacha Mussot
- Centre Chirurgical Marie Lannelongue, Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardiopulmonaire, Le Plessis Robinson, France
| | | | - Olivier Brugière
- Hôpital Bichat, Service de Pneumologie et Transplantation Pulmonaire, Paris, France
| | | | | | - Johanna Claustre
- Clinique Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1055, Grenoble, France
| | - Antoine Magnan
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Sophie Brouard
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre d'Investigation Clinique (CIC) Biothérapie, CHU Nantes, Nantes, France
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7
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Timsit JF, Citerio G, Lavilloniere M, Perner A, Ruckly S, Bakker J, Bassetti M, Benoit D, Curtis JR, Doig GS, Herridge M, Jaber S, Papazian L, Peters MJ, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E. Determinants of downloads and citations for articles published in Intensive Care Medicine. Intensive Care Med 2019; 45:1058-1060. [PMID: 30788522 DOI: 10.1007/s00134-019-05569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 01/15/2023]
Affiliation(s)
- J F Timsit
- Inserm U 1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France.
| | - G Citerio
- Università degli Studi di Milano Bicocca, Monza, Italy
| | - M Lavilloniere
- Inserm U 1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - A Perner
- University of Copenhagen, Copenhagen, Denmark
| | - S Ruckly
- Inserm U 1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - J Bakker
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Bassetti
- Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - D Benoit
- Ghent University Hospital, Ghent, Belgium
| | - J R Curtis
- The University of Washington, Seattle, USA
| | - G S Doig
- University of Sydney, Sydney, Australia
| | | | - S Jaber
- Saint Eloi University Hospital, Montpellier, France
| | - L Papazian
- Aix-Marseille Université, Marseille, France
| | - M J Peters
- UCL Institute of Child Health and Great Ormond St Hospital, London, UK
| | - P Singer
- Tel Aviv University, Tel Aviv, Israel
| | - M Smith
- University College London Hospitals, London, UK
| | - M Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A Torres
- Hospital Clinic of Barcelona, CIBERES, IDIBAPS, Barcelona, Spain
| | | | - E Azoulay
- Paris Diderot Sorbonne University, Paris, France
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8
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Bourenne J, Carvelli J, Coiffard B, Daviet F, Parzy G, Gainnier M, Papazian L, Hraiech S. Comment j’utilise les curares dans le SDRA. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Valade S, Biard L, Lemiale V, Argaud L, Pène F, Papazian L, Bruneel F, Seguin A, Kouatchet A, Oziel J, Rouleau S, Bele N, Razazi K, Lesieur O, Boissier F, Megarbane B, Bigé N, Brulé N, Moreau AS, Lautrette A, Peyrony O, Perez P, Mayaux J, Azoulay E. Severe atypical pneumonia in critically ill patients: a retrospective multicenter study. Ann Intensive Care 2018; 8:81. [PMID: 30105627 PMCID: PMC6089852 DOI: 10.1186/s13613-018-0429-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure. METHODS Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs. RESULTS A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44-67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1-4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5-30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation. CONCLUSION In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.
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Affiliation(s)
- S. Valade
- AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
| | - L. Biard
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
- AP-HP, DBIM, Hôpital Saint-Louis, Paris, France
| | - V. Lemiale
- AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
| | - L. Argaud
- Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon, Lyon, France
| | - F. Pène
- AP-HP, Réanimation médicale, Hôpital Cochin, Paris, France
| | - L. Papazian
- Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - F. Bruneel
- Service de Réanimation, Centre Hospitalier de Versailles, Le Chesnay, France
| | - A. Seguin
- Department of Medical Intensive Care, CHU de Caen, Caen, France
| | - A. Kouatchet
- Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers, Angers, France
| | - J. Oziel
- AP-HP, Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France
| | - S. Rouleau
- Service de Réanimation polyvalente, Angoulême, France
| | - N. Bele
- Intensive Care Unit, Draguignan Hospital, Draguignan, France
| | - K. Razazi
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France
| | - O. Lesieur
- Service de Réanimation, CH Saint-Louis, La Rochelle, France
| | - F. Boissier
- AP-HP, Réanimation médicale, Hôpital Européen Georges Pompidou, Paris, France
| | - B. Megarbane
- AP-HP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France
| | - N. Bigé
- AP-HP, Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France
| | - N. Brulé
- Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - A. S. Moreau
- Centre de réanimation, Hôpital Salengro, CHU-Lille, Lille, France
| | - A. Lautrette
- Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - O. Peyrony
- AP-HP, Service des urgences, Hôpital Saint-Louis, Paris, France
| | - P. Perez
- Service de Réanimation médicale, Hôpital Brabois, Nancy, France
| | - J. Mayaux
- AP-HP, Pneumology and Critical Care Medicine Department, Universitary Hospital La Pitié Salpêtrière-Charles Foix, Paris, France
| | - E. Azoulay
- AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
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10
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Dalma J, Arcani R, Koubi M, Rossi P, Kaplanski G, Bernit E, Veit V, Schleinitz N, Harlé R, Albanese J, Papazian L. Pneumocystose en médecine interne en dehors d’une co-infection par le VIH. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.082] [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: 11/15/2022]
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11
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Hraiech S, Bordes J, Mège J, de Lamballerie X, Charrel R, Bechah Y, Pastorino B, Guervilly C, Forel J, Adda M, Rolain J, Lepidi H, Raoult D, Lehingue S, Papazian L. Cytomegalovirus reactivation enhances the virulence of Staphylococcus aureus pneumonia in a mouse model. Clin Microbiol Infect 2017; 23:38-45. [DOI: 10.1016/j.cmi.2016.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/13/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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12
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Richard C, Chastre J, Perrotin D, Papazian L. Médecine intensive-réanimation : une spécialité à part entière dès 2017. Méd Intensive Réa 2016. [DOI: 10.1007/s13546-016-1239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Lagier JC, Papazian L, Fenollar F, Edouard S, Melenotte C, Laroumagne S, Michel G, Martin C, Gainnier M, Lions C, Carrieri P, Stein A, Brouqui P, Raoult D. Tropheryma whipplei DNA in bronchoalveolar lavage samples: a case control study. Clin Microbiol Infect 2016; 22:875-879. [DOI: 10.1016/j.cmi.2016.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
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14
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Denis JB, Coiffard B, Coltey B, Villeret J, Cassir N, Piarroux R, Papazian L. [Histoplasma capsulatum disseminated necrotizing granulomatosis]. Med Mal Infect 2016; 47:61-64. [PMID: 27692830 DOI: 10.1016/j.medmal.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/10/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022]
Affiliation(s)
- J-B Denis
- Service de réanimation médicale, détresses respiratoires-infections sévères (DRIS), CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - B Coiffard
- Service de réanimation médicale, détresses respiratoires-infections sévères (DRIS), CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - B Coltey
- Service de pneumologie et des maladies respiratoires rares, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - J Villeret
- Laboratoire d'anatomopathologie, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - N Cassir
- Service des maladies infectieuses et tropicales, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; URMITE UMR CNRS 7278, faculté de médecine, Aix-Marseille université, 13005 Marseille, France
| | - R Piarroux
- Laboratoire de parasitologie-mycologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - L Papazian
- Service de réanimation médicale, détresses respiratoires-infections sévères (DRIS), CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; URMITE UMR CNRS 7278, faculté de médecine, Aix-Marseille université, 13005 Marseille, France
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15
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung 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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pirracchio R, Rigon MR, Carone M, Chevret S, Annane D, Eladawy S, El-Hamamsy M, Bazan N, Elgendy M, De Pascale G, Vallecoccia MS, Cutuli SL, Di Gravio V, Pennisi MA, Conti G, Antonelli M, Andreis DT, Khaliq W, Singer M, Hartmann J, Harm S, Carmona SA, Almudevar PM, Abellán AN, Ramos JV, Pérez LP, Valbuena BL, Sanz NM, Simón IF, Arrigo M, Feliot E, Deye N, Cariou A, Guidet B, Jaber S, Leone M, Resche-Rigon M, Baron AV, Legrand M, Gayat E, Mebazaa A, Balik M, Kolnikova I, Maly M, Waldauf P, Tavazzi G, Kristof J, Herpain A, Su F, Post E, Taccone F, Vincent JL, Creteur J, Lee C, Hatib F, Jian Z, Buddi S, Cannesson M, Fileković S, Turel M, Knafelj R, Gorjup V, Stanić R, Gradišek P, Cerović O, Mirković T, Noč M, Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S, Lin KC, Hung WT, Chiang CC, Huang WC, Juan WC, Lin SC, Cheng CC, Lin PH, Fong KY, Hou DS, Kang PL, Wann SR, Chen YS, Mar GY, Liu CP, Paul M, Bougouin W, Geri G, Dumas F, Champigneulle B, Legriel S, Charpentier J, Mira JP, Sandroni C, Cariou A, Zimmerman J, Sullivan E, Noursadeghi M, Fox B, Sampson D, McHugh L, Yager T, Cermelli S, Seldon T, Bhide S, Brandon RA, Brandon RB, Zwaag J, Beunders R, Pickkers P, Kox M, Gul F, Arslantas MK, Genc D, Zibandah N, Topcu L, Akkoc T, Cinel I, Greco E, Lauretta MP, Andreis DT, Singer M, Garcia IP, Cordero M, Martin AD, Pallás TA, Montero JG, Rey JR, Malo LR, Montoya AAT, Martinez ADCA, Ayala LYD, Zepeda EM, Granillo JF, Sanchez JA, Alejo GC, Cabrera AR, Montenegro AP, Pham T, Beduneau G, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Grangé S, Barberet G, Guitard PG, Frat JP, Constan A, Chrétien JM, Mancebo J, Mercat A, Richard JCM, Brochard L, Soilemezi E, Koco E, Savvidou S, Nouris C, Matamis D, Di Mussi R, Spadaro S, Volta CA, Mariani M, Colaprico A, Antonio C, Bruno F, Grasso S, Rodriguez A, Martín-Loeches I, Díaz E, Masclans JR, Gordo F, Solé-Violán J, Bodí M, Avilés-Jurado FX, Trefler S, Magret M, Reyes LF, Marín-Corral J, Yebenes JC, Esteban A, Anzueto A, Aliberti S, Restrepo MI, Larsson JS, Redfors B, Ricksten SE, Haines R, Powell-Tuck J, Leonard H, Ostermann M, Berthelsen RE, Itenov TS, Perner A, Jensen JU, Ibsen M, Jensen AEK, Bestle MH, Bucknall T, Dixon J, Boa F, MacPhee I, Philips BJ, Doyle J, Saadat F, Samuels T, Huddart S, McCormick B, DeBrunnar R, Preece J, Swart M, Peden C, Richardson S, Forni L, Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste M, Collange O, Levrat Q, Villard I, Thévenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Mimoz O, Auquier P, Pawar S, Jacques T, Deshpande K, Pusapati R, Wood B, Pulham RA, Wray J, Brown K, Pierce C, Nadel S, Ramnarayan P, Azevedo JR, Montenegro WS, Rodrigues DP, Sousa SC, Araujo VF, Leitao AL, Prazeres PH, Mendonca AV, Paula MP, Das Neves A, Loudet CI, Busico M, Vazquez D, Villalba D, Lischinsky A, Veronesi M, Emmerich M, Descotte E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dubourg G, Sankar SA, Rathored J, Lagier JC, Robert C, Couderc C, Papazian L, Raoult D, Fournier PE. Noncontiguous finished genome sequence and description of Nocardioides massiliensis sp. nov. GD13(T). New Microbes New Infect 2016; 10:47-57. [PMID: 27257488 PMCID: PMC4877605 DOI: 10.1016/j.nmni.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022] Open
Abstract
Nocardioides massiliensis sp. nov strain GD13T is the type strain of N. massiliensis sp. nov., a new species within the genus Nocardioides. This strain was isolated from the faeces of a 62-year-old man admitted to intensive care for Guillain-Barré syndrome. Nocardioides massiliensis is a strictly aerobic Gram-positive rod. Herein we describe the features of this bacterium, together with the complete genome sequence and annotation. The 4 006 620 bp long genome contains 4132 protein-coding and 47 RNA genes.
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Affiliation(s)
- G Dubourg
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France; Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - S A Sankar
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - J Rathored
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - J-C Lagier
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France; Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - C Robert
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - C Couderc
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - L Papazian
- Service de Réanimation Médicale-Détresse Respiratoires et Infections Sévères, Hôpital Nord, Marseille, France
| | - D Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France; Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - P-E Fournier
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Faculté de Médecine, Aix-Marseille Université, Marseille, France; Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, University, Hospital Centre Timone, Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Hraiech S, Bordes J, Mège JL, De Lamballerie X, Lehingue S, Guervilly C, Forel JM, Raoult D, Papazian L. Cytomegalovirus reactivation enhances the virulence of a staphylococcus aureus pneumonia in a mouse model. Intensive Care Med Exp 2015. [PMCID: PMC4798410 DOI: 10.1186/2197-425x-3-s1-a831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Citerio G, Marzorati C, Timsit JF, Perner A, Bakker J, Bassetti M, Benoit D, Curtis JR, Doig GS, Herridge M, Jaber S, Papazian L, Peters MJ, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E. Outcome of Manuscripts Rejected From Intensive Care Medicine: An In Silico Study. Intensive Care Med Exp 2015. [PMCID: PMC4796553 DOI: 10.1186/2197-425x-3-s1-a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Guervilly C, Lehingue S, Dizier S, Zieleskiewics L, Hraiech S, D'journo XB, Thomas G, Klazen F, Adda M, Roch A, Forel JM, Thomas P, Leone M, Papazian L. Extra vascular lung water but not lung ultrasound predicts grade 3 pulmonary graft dysfunction and utilization of rescue therapies for severe hypoxemia after lung transplantation. Intensive Care Med Exp 2015. [PMCID: PMC4796213 DOI: 10.1186/2197-425x-3-s1-a233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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21
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Koulenti D, Blot S, Dulhunty JM, Papazian L, Martin-Loeches I, Dimopoulos G, Brun-Buisson C, Nauwynck M, Putensen C, Sole-Violan J, Armaganidis A, Rello J. COPD patients with ventilator-associated pneumonia: implications for management. Eur J Clin Microbiol Infect Dis 2015; 34:2403-11. [PMID: 26407622 DOI: 10.1007/s10096-015-2495-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
Abstract
Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
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Affiliation(s)
- D Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece.,Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - S Blot
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. .,Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - J M Dulhunty
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - L Papazian
- Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord-Assistance Publique-Hôpitaux de Marseille Aix-Marseille Université, Μarseille, France
| | - I Martin-Loeches
- Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain.,Department of Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - G Dimopoulos
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - C Brun-Buisson
- Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris, France
| | - M Nauwynck
- Department of Intensive Care Medicine, St. Jan Hospital, Bruges, Belgium
| | - C Putensen
- Department of Intensive Care Medicine, Bonn University Hospital, Bonn, Germany
| | - J Sole-Violan
- Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria, Spain
| | - A Armaganidis
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - J Rello
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Thomas G, Hraiech S, Loundou A, Truwit J, Kruger P, Mcauley DF, Papazian L, Roch A. Statin therapy in critically-ill patients with severe sepsis: a review and meta-analysis of randomized clinical trials. Minerva Anestesiol 2015; 81:921-930. [PMID: 25690048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED While statins are indicated to reduce blood cholesterol levels, they also have anti-inflammatory and immunomodulatory effects. Several observational cohort studies suggested that statins may improve survival and reduce complications in patients with sepsis. Recent randomized controlled studies in critically ill patients have been conducted and published. In this paper we present a meta-analysis of these randomized trials. METHODS An electronic article search through PubMed was performed. Only randomized controlled trials including critically ill adult patients with severe sepsis were retained. A meta-analysis was performed as detailed in text below. Overall analysis including 1818 patients total from 4 studies showed that there was no difference in 60-day mortality between statins (223/903) and placebo (233/899) [risk ratio, 0.930; 95% CI, 0.722 to 1.198]. Similarly, no difference in 28-day mortality was observed between groups (statins 191/907, placebo 199/911; risk ratio 0.953; 95% CI, 0.715 to 1.271). The results of this meta-analysis confirm that the use of statin therapy should not be recommended in the management of severe sepsis in critically ill patients. Statins should be continued with caution and only if necessary, as one study reported that the statin group had a higher rate of hepatic and renal failure.
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Affiliation(s)
- G Thomas
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères -
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Cassir N, Papazian L, Fournier PE, Raoult D, La Scola B. Insights into bacterial colonization of intensive care patients' skin: the effect of chlorhexidine daily bathing. Eur J Clin Microbiol Infect Dis 2015; 34:999-1004. [PMID: 25604707 DOI: 10.1007/s10096-015-2316-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/07/2015] [Indexed: 01/19/2023]
Abstract
Skin is a major reservoir of bacterial pathogens in intensive care unit (ICU) patients. The aim of this study was to assess the skin bacterial richness and diversity in ICU patients and the effect of CHG daily bathing on skin microbiota. Twenty ICU patients were included during an interventional period with CHG daily bathing (n = 10) and a control period (n = 10). At day seven of hospitalization, eight skin swab samples (nares, axillary vaults, inguinal creases, manubrium and back) were taken from each patient. The bacterial identification was performed by microbial culturomics. We used the Shannon index to compare the diversity. We obtained 5,000 colonies that yielded 61 bacterial species (9.15 ± 3.7 per patient), including 15 (24.5 %) that had never been cultured from non-pathological human skin before, and three (4.9 %) that had never been cultured from human samples before. Notably, Gram-negative bacteria were isolated from all sites. In the water-and-soap group, there was a higher risk of colonization with Gram-negative bacteria (OR = 6.05, 95 % CI [1.67-21.90]; P = 0.006). In the CHG group, we observed more patients colonized by sporulating bacteria (9/10 vs. 3/10; P = 0.019) with a reduced skin bacterial richness (P = 0.004) and lower diversity (0.37, 95 % CI [0.33; 0.42] vs. 0.50, 95 % CI [0.48; 0.52]). Gram-negative bacteria are frequent and disseminated components of the transient skin flora in ICU patients. CHG daily bathing is associated with a reduction in Gram-negative bacteria colonization together with substantial skin microbiota shifts.
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Affiliation(s)
- N Cassir
- Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France
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Timsit JF, Citerio G, Lavilloniere M, Perner A, Smith M, Ruckly S, Bassetti M, Bakker J, Benoit D, Curtis JR, Doig G, Herridge M, Jaber S, Papazian L, Peters M, Singer P, Soares M, Torres A, Viellard-Baron A, Azoulay E. DETERMINANTS OF DOWNLOADS AND CITATIONS FOR ARTICLES PUBLISHED IN INTENSIVE CARE MEDICINE. Intensive Care Med Exp 2015. [PMCID: PMC4796153 DOI: 10.1186/2197-425x-3-s1-a863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cassir N, Hraiech S, Nougairede A, Zandotti C, Fournier PE, Papazian L. Outbreak of adenovirus type 1 severe pneumonia in a French intensive care unit, September-October 2012. ACTA ACUST UNITED AC 2014; 19. [PMID: 25306980 DOI: 10.2807/1560-7917.es2014.19.39.20914] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We herein describe and analyse the first outbreak of severe pneumonia caused by human adenovirus type1 (HAdV C type 1), which included immunocompetent patients in an intensive care unit (ICU) of Marseille, France, and occurred between September and October 2012. Seven successive patients were diagnosed by HAdV specific real-time polymerase chain reaction with a positive bronchoalveolar lavage. After the collection of nasopharyngeal swabs from healthcare workers, three nurses working night shifts tested positive for HAdV C including one that had exhibited respiratory signs while working one week before the outbreak. She was the most likely source of the outbreak. Our findings suggest that HAdV-1 could be considered as a possible cause of severe pneumonia even in immunocompetent patients with a potential to cause outbreaks in ICUs. HAdV rapid identification and typing is needed to curtail the spread of this pathogen. Reinforcing hand hygiene with antiseptics with demonstrated activity against non-enveloped viruses and ensuring that HCWs with febrile respiratory symptoms avoid direct patient contact are critical measures to prevent transmission of HAdV in healthcare settings.
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Affiliation(s)
- N Cassir
- Unite de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63 CNRS 7278, IRD 189, Inserm U1095, IHU Mediterranee-Infection, Aix-Marseille Universite, Marseille, France
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Michel F, Thomas G, Papazian L. Utilité des aspirations trachéales systématiques dans la prise en charge des pneumonies acquises sous ventilation mécanique. Réanimation 2014. [DOI: 10.1007/s13546-014-0885-x] [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: 11/30/2022]
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Guervilly C, Hraiech S, Gariboldi V, Xeridat F, Dizier S, Toesca R, Forel JM, Adda M, Grisoli D, Collart F, Roch A, Papazian L. Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol 2014; 80:307-313. [PMID: 24257150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an effective rescue therapy for improving oxygenation in selected severe acute respiratory distress syndrome (ARDS). Prone position (PP) is usually considered before vvECMO and few data are available on the association of PP during VV-ECMO. Thus, we investigated the effect on oxygenation and the safety of PP during vvECMO. METHODS During a two-year period, 15 patients with severe ARDS were turned into PP during VV-ECMO therapy for at least one of the three following conditions: severe hypoxemia (PaO2/FiO2 ratio below 70) despite maximal oxygenation, injurious ventilation parameters with plateau pressure exceeding 32 cmH2O or failure of attempt to wean ECMO after at least 10 days on ECMO support. RESULTS PP was considered after a median of 9 days of ECMO and applied for a median of 12 hours and an average of 1.4 sessions per patient resulting in a total of 21 procedures. We found significant improvement in PaO2/FiO2 ratio at 6 hours (P=0.03) and 12 hours (P=0.007) after reversal. The improvement in oxygenation has still persisted 1hour (P=0.017) and 6 hours (P=0.013) after back to the supine position. No change in PaCO2, respiratory system (RS) compliance was observed. ECMO flow was maintained constant during the procedure. No complication related to PP was detected. CONCLUSION PP may be considered in selected patients difficult to wean or remaining very hypoxemic despite VV-ECMO support.
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Affiliation(s)
- C Guervilly
- Medical Intensive Care Unit, Respiratory Distress and Severe Infections, North Hospital, URMITE CNRS-UMR 6236, Aix-Marseille University, Assistance Publique HÔpitaux de Marseille, Marseille, France -
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Gomez C, Doddoli C, Coltey B, Dufeu N, Dizier S, Thomas PA, Papazian L, Reynaud M. Prolonged Mechanical Ventilation in Lung Transplant Recipients: Predictive Factors and Outcomes. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bélénotti P, Guervilly C, Grandval P, Benyamine A, Ene N, Serratrice J, Petit P, Laugier R, Papazian L, Weiller PJ. [Ischemic cholangitis in intensive care unit: favourable outcome with ursodesoxycholic acid and fenofibrate]. Rev Med Interne 2012. [PMID: 23200798 DOI: 10.1016/j.revmed.2012.10.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ischemic cholangitis in intensive care unit is a recently reported liver disease in patients who have had a prolonged mechanical ventilation and vasopressive drug support for multiple organ deficiency. Prognosis is usually poor and the only life-saving therapy is liver transplantation despite ursodesoxycholic acid treatment. CASE REPORT We report a 63-year-old man who presented with a sclerosis cholangitis after a month in intensive care unit, effectively treated with fenofibrate and ursodesoxycholic acid. Recent reports underline fenofibrate efficacy in the treatment of primary biliary cirrhosis, especially in association with ursodesoxycholic acid. This treatment has prevented liver transplantation for our patient with a correct quality of life. CONCLUSION The addition of fibrate to ursodesoxycholic acid improves persistent cholestasis in sclerosing cholangitis.
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Affiliation(s)
- P Bélénotti
- Service de médecine interne, hôpital de la Timone, Marseille, France.
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Voillet F, Charmensat O, Castanier M, Roch A, Papazian L. [Porphyromonas causing lung cavitation with empyema]. Ann Fr Anesth Reanim 2012; 31:573. [PMID: 22677062 DOI: 10.1016/j.annfar.2012.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 03/28/2012] [Indexed: 06/01/2023]
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Chiche L, Thomas G, Forel JM, Papazian L. [Ventilator-associated viral pneumonia]. Reanimation 2011; 20:228. [PMID: 32288725 PMCID: PMC7117808 DOI: 10.1007/s13546-011-0255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/21/2011] [Indexed: 11/15/2022]
Abstract
Viral infections (especially respiratory infections) are not rare in critically ill non-immunocompromised patients. Efficient and rapid virologic diagnosis tests such as polymerase chain reaction (PCR) are now widely available. Herpesviridae (herpes simplex virus and cytomegalovirus) are the most frequent viruses detected among non-immunocompromised patients admitted to the intensive care unit (ICU). However, causal relationships between detected viruses and outcomes are still debated, with a variable level of demonstration among the different viruses. The aim of this review was to assess the role of viruses in causing mechanical ventilation-acquired pneumonias in non-immunocompromised ICU adult patients. We also discuss the possible physiopathology of these viral infections, as well as the opportunity for therapeutic interventions.
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Affiliation(s)
- L. Chiche
- Service de réanimation-médicale, URMITE CNRS-UMR 6236, CHU Nord, Assistance publique-Hôpitaux de Marseille, université Aix-Marseille-II, Chemin-des-Bourrely, F-13015 Marseille cedex 20, Marseille, France
| | - G. Thomas
- Service de réanimation-médicale, URMITE CNRS-UMR 6236, CHU Nord, Assistance publique-Hôpitaux de Marseille, université Aix-Marseille-II, Chemin-des-Bourrely, F-13015 Marseille cedex 20, Marseille, France
| | - J. -M. Forel
- Service de réanimation-médicale, URMITE CNRS-UMR 6236, CHU Nord, Assistance publique-Hôpitaux de Marseille, université Aix-Marseille-II, Chemin-des-Bourrely, F-13015 Marseille cedex 20, Marseille, France
| | - L. Papazian
- Service de réanimation-médicale, URMITE CNRS-UMR 6236, CHU Nord, Assistance publique-Hôpitaux de Marseille, université Aix-Marseille-II, Chemin-des-Bourrely, F-13015 Marseille cedex 20, Marseille, France
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Zem GC, Dreyfuss J, Allen J, Kawashima R, Daco E, Kanda Y, Yaghoobian J, Danialian S, Givens W, Baghoomian A, Zograbyan N, Haroutounian S, Bimanand N, Silani S, Khorrami H, Shirazi MH, Keihani K, Tafreshi G, Jahanbakhsh A, Solati A, Balazadeh H, Phan H, Papazian L, Moayer A, Oppenheimer SB. Kinetics of yeast dissociation from lectin beads: I. alpha methyl mannose. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.480.13] [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: 11/11/2022]
Affiliation(s)
- Gregory C. Zem
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - J Dreyfuss
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - J Allen
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - R Kawashima
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - E Daco
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - Y Kanda
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - J Yaghoobian
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - S Danialian
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - W Givens
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - A Baghoomian
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - N Zograbyan
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - S Haroutounian
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - N Bimanand
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - S Silani
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - H Khorrami
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | | | - K Keihani
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - G Tafreshi
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - A Jahanbakhsh
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - A Solati
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - H Balazadeh
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - H Phan
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - L Papazian
- BiologyCalifornia State University, NorthridgeNorthridgeCA
| | - A Moayer
- BiologyCalifornia State University, NorthridgeNorthridgeCA
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Roch A, Guervilly C, Papazian L. Fluid Management in Acute Lung Injury and ARDS. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Belenotti P, Benyamine A, Bensahla H, Ene N, Swiader L, Petit P, Papazian L, Weiller PJ. Cholangite ischémique post-réanimation : utilité d’un traitement par fibrate, à propos d’un cas. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Le Goff C, Jung B, Corne P, Chanques G, Jonquet O, Allaouchiche B, Papazian L, Lefrant J, Jaber S. Buffer therapy in severe metabolic or mixed acidosis. Crit Care 2009. [PMCID: PMC4084338 DOI: 10.1186/cc7616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Michelet P, D'Journo XB, Seinaye F, Forel JM, Papazian L, Thomas P. Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy. Br J Surg 2008; 96:54-60. [DOI: 10.1002/bjs.6307] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The aim of this case–control study was to compare the efficacy of non-invasive positive pressure ventilation (NPPV) with that of conventional treatment in patients who develop postoperative acute respiratory failure (ARF) after oesophagectomy.
Methods
Thirty-six consecutive patients with ARF treated by NPPV were matched for diagnosis, age within 5 years, sex, preoperative radiochemotherapy and Charlson co-morbidity index with 36 patients who received conventional treatment (control group).
Results
NPPV was associated with a lower reintubation rate (nine versus 23 patients; P = 0·008), lower frequency of acute respiratory distress syndrome (eight versus 19 patients; P = 0·015), and a reduction in intensive care stay (mean(s.d.) 14(13) versus 22(18) days; P = 0·034). Anastomotic leakage was less common in patients receiving NPPV (two versus ten; P = 0·027). These patients also showed a greater improvement in gas exchange in the first 3 days after onset of ARF (P = 0·013).
Conclusion
The use of NPPV for the treatment of postoperative ARF may decrease the incidence of endotracheal intubation and related complications, without increasing the risk of anastomotic leakage after oesophagectomy.
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Affiliation(s)
- P Michelet
- Service de Réanimation, Pôle Réanimation - Urgence - Service d'Aide Médicale Urgente - Hyperbarie, Marseilles, France
| | - X B D'Journo
- Service de Chirurgie Thoracique, Pôle Thorax, Hôpital Sainte-Marguerite, Marseilles, France
| | - F Seinaye
- Service de Réanimation, Pôle Réanimation - Urgence - Service d'Aide Médicale Urgente - Hyperbarie, Marseilles, France
| | - J M Forel
- Service de Réanimation, Pôle Réanimation - Urgence - Service d'Aide Médicale Urgente - Hyperbarie, Marseilles, France
| | - L Papazian
- Service de Réanimation, Pôle Réanimation - Urgence - Service d'Aide Médicale Urgente - Hyperbarie, Marseilles, France
| | - P Thomas
- Service de Chirurgie Thoracique, Pôle Thorax, Hôpital Sainte-Marguerite, Marseilles, France
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Donati S, Papazian L. Neumopatías hospitalarias en pacientes con ventilación mecánica. EMC - Anestesia-Reanimación 2008. [PMCID: PMC7158992 DOI: 10.1016/s1280-4703(08)70462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Las neumopatías son la primera causa de infección hospitalaria en reanimación. Las neumopatías hospitalarias en los pacientes con ventilación mecánica (NHPVM) ocurren después de al menos 48 horas de ventilación mecánica invasiva. Su mecanismo es multifactorial, pero la opinión predominante es que obedecen a una inhalación posterior a la colonización orofaríngea, gástrica o traqueal. El retraso en la manifestación permite clasificar las NHPVM en precoces o tardías según se desarrollen antes o después del 5.° día de ventilación mecánica. La clínica puede ayudar al diagnóstico, sobre todo mediante la CPIS (Clinical Pulmonary Infection Score) y también es útil el lavado broncoalveolar (LBA), que parece la mejor prueba para el diagnóstico microbiológico. El diagnóstico diferencial se plantea con una neumopatía no bacteriana o incluso no infecciosa (neoplásica, inflamatoria, fibrosante) en la que siempre debe plantearse la búsqueda de otro foco infeccioso en función de la orientación clínica inicial o del fracaso de la antibioticoterapia. El uso preferente de la ventilación no invasiva, cuando es posible, parece que ayuda a prevenir el desarrollo de la neumopatía hospitalaria. La posición inclinada 30-45° del paciente es la única medida preventiva verdaderamente validada en las NHPVM. El tratamiento curativo de las neumopatías bacterianas descansa por lo general en un tratamiento antibiótico doble, que puede orientarse por los datos de muestras obtenidas con métodos no invasivos como las aspiraciones traqueales efectuadas de forma periódica y sistemática. La duración del tratamiento es discutible, pero los últimos datos apoyan un tratamiento con antibióticos relativamente corto, de 8 días.
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Michelet P, Roch A, D'Journo XB, Blayac D, Barrau K, Papazian L, Thomas P, Auffray JP. Effect of thoracic epidural analgesia on gastric blood flow after oesophagectomy. Acta Anaesthesiol Scand 2007; 51:587-94. [PMID: 17430321 DOI: 10.1111/j.1399-6576.2007.01290.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [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: 12/20/2022]
Abstract
BACKGROUND The oesophagectomy procedure includes the formation of a gastric tube to re-establish the continuity of the gastrointestinal tract. The effect of thoracic epidural analgesia (TEA) on gastric mucosal blood flow (GMBF) remains unknown in clinical practice. The aim of this prospective observational study was to assess the microcirculatory changes induced by TEA in the early post-operative course. METHODS Eighteen consecutive patients who underwent radical oesophagectomy with en-bloc resection and two-field lymphadenectomy for oesophageal cancer, and benefited from TEA during the post-operative course, were studied prospectively, and compared with nine patients who declined the use of TEA in the same period (control group). GMBF was measured using a laser Doppler flowmeter in three consecutive time periods (before and after 1 and 18 h of TEA infusion). Post-operative monitoring also included the measurement of arterial pressure, cardiac output, gas exchange and intrathoracic blood volume index. RESULTS After the first and 18th hour of infusion, TEA induced an increase in GMBF compared with baseline and the control group. The mean arterial pressure and intrathoracic blood volume index decreased after the first hour of TEA infusion with no influence on the cardiac index. CONCLUSIONS This clinical study demonstrates that TEA improves the microcirculation of the gastric tube in the early post-oesophagectomy period. The clinical relevance of TEA in this setting should be validated in larger studies focusing on the clinical outcome following oesophagectomy.
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Affiliation(s)
- P Michelet
- Département d'Anesthésie Réanimation, Hôpitaux Sud, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 9, France.
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de Laitre V, Lefrant JY, Jaber S, Baudot J, Papazian L, Muller L, Mercier G, Fabbro-Péray P, Ripart J, Eledjam JJ, de La Coussaye JE. [General practitioners' and intensivists' relationships: intensivists' point of view from eight French southern regional areas]. ACTA ACUST UNITED AC 2006; 25:493-500. [PMID: 16488102 DOI: 10.1016/j.annfar.2005.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 12/18/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Assessment of relationship between general practitioners and intensivists. STUDY DESIGN Intensivists were questioned by phone from June 14th to September 28th 2004. METHODS 245 out of 264 intensivists from 8 French Southern regional areas were questioned concerning their relationship with critically ill patients' general practitioner. RESULTS Patients were mainly admitted into Intensive care Unit (ICU) from the Emergency Department (55%). An information letter from the general practitioner was reported for 20% of admitted patients but 50% of these letters was assumed as not informative. The informations concerning the patient's medical history, therapies, and disease leading to admission and the patient's status were assessed with 6.5, 7.0, 6.0 and 2.0, respectively (maximal note=10). The intensivists contacted the general practitioner for 30% of admitted patients. During the stay in ICU, 33% general practitioners were reported to request informations by phone or visit in ICU. When the stay in ICU was>10 days, the general practitioner was nearly never regularly informed about patient's status. When the patient was discharged from the ICU, 80% of intensivists used an exhaustive typed report to inform the general practitioner. The overall relationship between the general practitioner and the intensivist was assessed as 5.5/10. Insufficient information in the general practitioner's letter at admission, the lack of request for information during the stay in ICU, the lack of contact with the general practitioner by the intensivist and an intensivist's age between 46 and 55 were associated with a relationship assessment<4/10).
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Affiliation(s)
- V de Laitre
- Fédération d'Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-Universitaire Caremeau, CHU de Nîmes, place du professeur Robert-Debré, 30029 Nîmes cedex 09, France
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Gernez Y, Barlési F, Doddoli C, Chetaille B, Forel JM, Astoul P, Papazian L. [Acute respiratory distress syndrome following inhalation of barium sulfate]. Rev Mal Respir 2006; 22:477-80. [PMID: 16227934 DOI: 10.1016/s0761-8425(05)85576-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Abstract
INTRODUCTION Barium sulfate (BS) is chosen to explore swallowing disorders because of its reduced osmolality allowing no adverse reaction if aspirated in the bronchial tree. CASE REPORT A 66-years old man treated for an advanced stage mesothelioma experienced a BS aspiration during an esophagography. He developed 3 days after an acute respiratory distress syndrome (ARDS) and deceased. The post-mortem examination revealed a diffuse alveolar damage (DAD). CONCLUSION Whereas BS aspiration is generally well tolerated, serious adverse event as a DAD would exceptionally occurs. Thus, a close watch over respiratory symptoms has to be kept after BS administration, especially in debilitated and elderly patients.
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Affiliation(s)
- Y Gernez
- Service de Réanimation Médicale, Hôpital Sainte-Marguerite, Faculté de Médecine, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille, Marseille, France
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Michelet P, Roch A, Brousse D, D'Journo XB, Bregeon F, Lambert D, Perrin G, Papazian L, Thomas P, Carpentier JP, Auffray JP. Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation. Br J Anaesth 2005; 95:267-73. [PMID: 15980044 DOI: 10.1093/bja/aei178] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [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: 11/13/2022] Open
Abstract
BACKGROUND One-lung ventilation-related hypoxaemia (OLV-RH) can occur in patients with healthy lungs. In this case, PEEP frequently improves oxygenation. The aim of this study was to determine, in a healthy lung model of OLV, whether the increase in PEEP improved oxygenation and whether the mechanisms involved include both inspiratory lung recruitment and an end-expiratory lung volume increase. Since inhaled nitric oxide (iNO) may have a synergistic effect on oxygenation in the case of PEEP-induced recruitment, their association was also tested. METHODS Twenty pigs were studied during open-chest, left OLV. Arterial blood gases and haemodynamic variables were measured at different levels of PEEP (0, 5, 10 and 15 cm H(2)O) applied in random order with or without iNO 4 p.p.m. Pressure-volume curves were measured at each level of PEEP. RESULTS PEEP(5) and PEEP(10) improved Pa(O(2))/FI(O(2)) ratio (P<0.005) and shunt (P<0.005) regardless of the presence of iNO. PEEP(15) improved oxygenation and shunt only when it was associated with iNO (P<0.001). Whereas PEEP(5), PEEP(10) and PEEP(15) were associated with a significant increase in end-expiratory volume (P<0.001), only PEEP(5) and PEEP(10) were associated with continuous lung volume recruitment (P<0.01). Moreover, PEEP(15) induced a significant decrease in linear compliance (P<0.001). CONCLUSIONS In a healthy porcine lung model of OLV-RH, moderate PEEP can improve oxygenation. This effect implies both expiratory and inspiratory pulmonary recruitment. Co-administration of 4 p.p.m. iNO was ineffective.
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Affiliation(s)
- P Michelet
- Département d'Anesthésie Réanimation, Hôpitaux Sud, Marseille, France.
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Abadie Y, Bregeon F, Papazian L, Lange F, Chailley-Heu B, Thomas P, Duvaldestin P, Adnot S, Maitre B, Delclaux C. Decreased VEGF concentration in lung tissue and vascular injury during ARDS. Eur Respir J 2005; 25:139-46. [PMID: 15640335 DOI: 10.1183/09031936.04.00065504] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [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: 11/05/2022]
Abstract
Endothelial injury is an important prognostic factor in acute respiratory distress syndrome (ARDS). Decreased production of vascular endothelial growth factor (VEGF) in ARDS may favour vascular lesions, since VEGF promotes endothelial survival by inhibiting apoptosis. This study sought to document low VEGF levels in lung tissue from ARDS patients, to determine whether the cause was injury to alveolar type II cells (the main pulmonary source of VEGF) and to evaluate the vascular consequences. Lung specimens were obtained by open biopsy or autopsy from 29 patients with severe ARDS (two survivors) and five controls. As compared with controls, homogenates of lung tissue from ARDS patients contained less VEGF (median (interquartile range) ARDS 8.2 (4.7-12.2) versus controls 28.4 (9.9-47.1) ng x g(-1) protein). Increased immunostaining with surfactant protein B was seen in ARDS lungs. Extensive cellular apoptosis (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelling staining), including endothelial and alveolar type II cells, was demonstrated, and vascular bed density (CD31 immunostaining) decreased in ARDS lungs as compared with controls. VEGF levels were negatively correlated to apoptotic endothelial cell counts. In conclusion, decreased vascular endothelial growth factor levels in lung tissue may participate in the decrease in lung perfusion in acute respiratory distress syndrome.
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Affiliation(s)
- Y Abadie
- INSERM Unit 492, Paris XII Unversity, France
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Affiliation(s)
- F Chabot
- Service des Maladies Respiratoires et Réanimation respiratoire, CHU Nancy Brabois, Vandoeuvre-les-Nancy, France
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Thomas P, Acri P, Doddoli C, D'journo B, Trousse D, Michelet P, Chetaille B, Papazian L, Giovannini M, Seitz JF, Giudicelli R, Fuentes P. [Surgery for oesophageal cancer: current controversies]. Ann Chir 2003; 128:351-8. [PMID: 12943829 DOI: 10.1016/s0003-3944(03)00122-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Any attempt to define the present role of surgery in the treatment of oesophageal cancer should integrate the dramatic changes that occurred within this disease over the last 2 decades: major shift in the histologic type of tumours, improved staging methods, spectacular reduction of operative risks, standardization of oncologic principles focusing on the completeness of resection, and development of multimodality therapeutic strategies. Surgery has still a pivotal role. Esophagectomy should be performed by trained surgeons in high-volume institutions. Radical surgery with en-bloc resection and 2 fields lymphadenectomy, should be encouraged in low-risk patients with subcarinal tumors. Although multimodality treatment strategy is commonly applied for locally advanced disease, few data support its superiority over surgical resection alone, followed by adjuvant therapy when appropriate. One may thus hypothesize that the risk/benefit ratio of such strategies is probably optimal in case of early stage tumors, and future studies may further clarify this issue. Conversely, locally advanced tumors, particularly those located in the upper mediastinum and the neck, may be managed alternatively without surgery. However, surgery remains an important tool to ensure optimal palliation of dysphagia, to achieve local control, and finally to improve quality of life. In that way, video-assisted techniques and/or trans hiatal approaches aiming to minimize the surgical insult may have a place in the treatment of patients who have substantially responded to induction therapy. Tumors located close to the pharyngo-oesophageal junction are best managed with chemotherapy and radiotherapy. Finally, salvage surgery may be considered in highly selected patients in case of non-response or local relapse without distant metastases.
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Affiliation(s)
- P Thomas
- Service de chirurgie thoracique et des maladies de l'oesophage, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard Sainte-Marguerite, 13274 Marseille 9, France.
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Arnal J, Gainnier M, Grandfond A, Donati S, Papazian L, Sainty J. Crit Care 2002; 6:P26. [DOI: 10.1186/cc1724] [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: 11/10/2022] Open
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Roch A, Papazian L, Bregeon F, Gainnier M, Michelet P, Thirion X, Saux P, Thomas P, Jammes Y, Auffray JP. High or low doses of almitrine bismesylate in ARDS patients responding to inhaled NO and receiving norepinephrine? Intensive Care Med 2001; 27:1737-43. [PMID: 11810116 DOI: 10.1007/s00134-001-1128-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2000] [Accepted: 09/03/2001] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effects on oxygenation and pulmonary haemodynamics of almitrine bismesylate (AB) 5 microg/kg per minute and 16 microg/kg per minute in ARDS patients responding to and receiving inhaled NO (iNO) and presenting septic shock requiring norepinephrine, while no difference was observed in a previous trial including iNO responders and nonresponders. DESIGN Prospective, cohort study. SETTING Adult medico-surgical intensive care unit of a university hospital. PATIENTS Fifteen patients with ARDS receiving and responding to iNO (10 ppm) and presenting septic shock requiring norepinephrine (mean 0.5+/-0.45 microg/kg per minute, range 0.08- 2.08). INTERVENTIONS The protocol consisted of two consecutive phases in a fixed order: continuous intravenous infusion of AB 5 microg/kg per minute for 30 min, and continuous intravenous infusion of AB 16 microg/kg per minute for 30 min. MEASUREMENTS AND MAIN RESULTS AB 5 microg/kg per minute significantly increased PaO2/FiO2 ( P<0.05) compared with iNO alone [160 (range 77-450) mmHg vs 122 (range 70-225) mmHg]. AB 16 microg/kg per minute produced a greater increase of PaO2/FiO2 ( P<0.05) when compared with 5 microg/kg per minute [227 (range 84-501) mmHg]. AB did not improve shunt at any dose regimen. AB produced an increase in mean pulmonary arterial pressure (MPAP) from 22+/-5 to 25+/-4 mmHg ( P<0.03). MPAP did not significantly increase between the two doses. Pulmonary vascular resistances and other haemodynamic and respiratory parameters were not affected by almitrine bismesylate. CONCLUSIONS These results suggest that it is possible to obtain a further improvement in oxygenation by increasing AB infusion rate in ARDS patients iNO responders receiving norepinephrine. Due to the potential deleterious effects of AB, this strategy should be used in the most severely hypoxaemic patients.
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Affiliation(s)
- A Roch
- Service de Réanimation Polyvalente, Hôpitaux Sud, Marseille, France
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48
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Papazian L, Paladini MH, Bregeon F, Huiart L, Thirion X, Saux P, Jammes Y, Auffray JP. Is a short trial of prone positioning sufficient to predict the improvement in oxygenation in patients with acute respiratory distress syndrome? Intensive Care Med 2001; 27:1044-9. [PMID: 11497137 DOI: 10.1007/s001340000799] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [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: 12/16/2022]
Abstract
OBJECTIVE To determine whether a 1-h trial of prone positioning is sufficient to identify responders. DESIGN Prospective clinical cohort study in a medico-surgical ICU in a teaching hospital. PATIENTS 49 patients with acute respiratory distress syndrome. INTERVENTIONS A 6-h period of prone positioning. MEASUREMENTS AND RESULTS Baseline measurements (blood gas analysis and respiratory parameters) were evaluated in supine position just prior to turning the patients prone. Measurements were then repeated 1 h after the beginning of prone positioning (PP1h) and at the end of the 6-h period of prone positioning (PP6h). The last measurements were performed 1 h after repositioning the patients supine. Prone position induced an increase in the PaO2/FIO2 ratio (p < 0.001). A response (increase in PaO2/FIO2 ratio of at least 20 % at PP1h and/or at PP6h) was observed in 37 of 49 patients (76%). Twenty-seven of these patients (73%) were responders at PP1h while 10 (27%) were responders only at PP6h- In all, two-thirds of the patients were considered persistent responders. However, whereas the PaO2/FIO2 ratio decreased significantly 1 h after repositioning the fast responders supine, the PaO2/ FIO2 ratio remained unchanged after repositioning slow responders. CONCLUSIONS A short-term trial of prone positioning does not appear a sufficient method to identify patients who would benefit from the postural treatment.
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Affiliation(s)
- L Papazian
- Service de Réanimation Médicale, Hĵpitaux Sud, Marseille, France.
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49
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Bregeon F, Ciais V, Carret V, Gregoire R, Saux P, Gainnier M, Thirion X, Drancourt M, Auffray JP, Papazian L. Is ventilator-associated pneumonia an independent risk factor for death? Anesthesiology 2001; 94:554-60. [PMID: 11379672 DOI: 10.1097/00000542-200104000-00005] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [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: 11/27/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) has been implicitly accused of increasing mortality. However, it is not certain that pneumonia is responsible for death or whether fatal outcome is caused by other risk factors for death that exist before the onset of pneumonia. The aim of this study was to evaluate the attributable mortality caused by VAP by performing a matched-paired, case-control study between patients who died and patients who were discharged from the intensive care unit after more than 48 h of mechanical ventilation. METHODS During the study period, 135 consecutive deaths were included in the case group. Case-control matching criteria were as follows: (1) diagnosis on admission that corresponded to 1 of 11 predefined diagnostic groups; (2) age difference within 10 yr; (3) sex; (4) admission within 1 yr; (5) APACHE II score within 7 points; (6) ventilation of control patients for at least as long as the cases. Precise clinical, radiologic, and microbiologic definitions were used to identify VAP. RESULTS Analysis was performed on 108 pairs that were matched with 91% of success. There were 39 patients (36.1%) who developed VAP in each group. Multivariate analysis showed that renal failure, bone marrow failure, and treatment with corticosteroids but not VAP were independent risk factors for death. There was no difference observed between cases and controls concerning the clinical and microbiologic diagnostic criteria for pneumonia. CONCLUSION Ventilator-associated pneumonia does not appear to be an independent risk factor for death.
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Affiliation(s)
- F Bregeon
- Laboratoire de Physiopathologie Respiratoire, Université de la Méditerranée, France
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Abstract
STUDY OBJECTIVES To evaluate the rate of arterial thrombosis and catheter-related infection following radial artery or dorsalis pedis artery (DPA) cannulations lasting > or = 4 days. DESIGN Prospective, observational study of two cohorts of ICU patients. SETTING ICU of a university hospital. PATIENTS In a first group of 131 consecutive patients, the DPA was selected for arterial cannulation. In the second group, 134 consecutive patients were considered for radial artery cannulation. MEASUREMENTS AND RESULTS In the DPA group, the overall success rate for catheter placement was 85%. Patients were cannulated for 16 +/- 5 days (mean +/- SD). In the radial artery group, the overall success rate was 97.7% (129 of 132 patients; p < 0.0001 vs DPA group). Patients were cannulated for 13.3 +/- 4.0 days. In both groups, no signs of ischemia were detected at the clinical examination. In the DPA group, no thrombosis was detected at the angiographic examination in 21 patients (38%), a thrombosis without vessel obstruction was observed in 21 patients (31%), and a thrombosis with vessel obstruction was observed in 21 patients (31%). In the radial artery group, no thrombosis was observed in 31 patients (24%; not significant vs DPA group), a partial thrombosis was found in 73 patients (57%), and a total thrombosis with vessel obstruction was found in 25 patients (19%). Two cases of catheter-related infection were observed in the DPA group. In the radial artery group, four cases of catheter-related infection were diagnosed vs DPA group (not significant). CONCLUSIONS The rate of serious complications was similar for both sites of arterial cannulation. Accepting a 12.7% lower rate of successful placement, the DPA route provides a safe and easily available alternative when radial arteries are not accessible.
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Affiliation(s)
- C Martin
- ICU and Anesthesia Department, Marseilles School of Medicine and Hopital Sainte Marguerite, Marseille, France.
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