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Schmidt M, Hajage D, Lebreton G, Dres M, Guervilly C, Richard JC, Sonneville R, Winiszewski H, Muller G, Beduneau G, Mercier E, Roze H, Lesouhaitier M, Terzi N, Thille AW, Laurent I, Kimmoun A, Combes A. Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS: The PRONECMO Randomized Clinical Trial. JAMA 2023; 330:2343-2353. [PMID: 38038395 PMCID: PMC10692949 DOI: 10.1001/jama.2023.24491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
Importance Prone positioning may improve outcomes in patients with severe acute respiratory distress syndrome (ARDS), but it is unknown whether prone positioning improves clinical outcomes among patients with ARDS who are undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO) compared with supine positioning. Objective To test whether prone positioning vs supine positioning decreases the time to successful ECMO weaning in patients with severe ARDS supported by VV-ECMO. Design, Setting, and Participants Randomized clinical trial of patients with severe ARDS undergoing VV-ECMO for less than 48 hours at 14 intensive care units (ICUs) in France between March 3, 2021, and December 7, 2021. Interventions Patients were randomized 1:1 to prone positioning (at least 4 sessions of 16 hours) (n = 86) or to supine positioning (n = 84). Main Outcomes and Measures The primary outcome was time to successful ECMO weaning within 60 days following randomization. Secondary outcomes included ECMO and mechanical ventilation-free days, ICU and hospital length of stay, skin pressure injury, serious adverse events, and all-cause mortality at 90-day follow-up. Results Among 170 randomized patients (median age, 51 [IQR, 43-59] years; n = 60 women [35%]), median respiratory system compliance was 15.0 (IQR, 10.7-20.6) mL/cm H2O; 159 patients (94%) had COVID-19-related ARDS; and 164 (96%) were in prone position before ECMO initiation. Within 60 days of enrollment, 38 of 86 patients (44%) had successful ECMO weaning in the prone ECMO group compared with 37 of 84 (44%) in the supine ECMO group (risk difference, 0.1% [95% CI, -14.9% to 15.2%]; subdistribution hazard ratio, 1.11 [95% CI, 0.71-1.75]; P = .64). Within 90 days, no significant difference was observed in ECMO duration (28 vs 32 days; difference, -4.9 [95% CI, -11.2 to 1.5] days; P = .13), ICU length of stay, or 90-day mortality (51% vs 48%; risk difference, 2.4% [95% CI, -13.9% to 18.6%]; P = .62). No serious adverse events were reported during the prone position procedure. Conclusions and Relevance Among patients with severe ARDS supported by VV-ECMO, prone positioning compared with supine positioning did not significantly reduce time to successful weaning of ECMO. Trial Registration ClinicalTrials.gov Identifier: NCT04607551.
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Affiliation(s)
- Matthieu Schmidt
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
- GRC 30 RESPIRE, Sorbonne Université, Paris, France
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière–Charles Foix, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Assistance Publique–Hôpitaux de Paris, Thoracic and Cardiovascular Department, Hôpital Pitié-Salpêtrière, Paris France
| | - Martin Dres
- GRC 30 RESPIRE, Sorbonne Université, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), et Sorbonne Université, INSERM, UMRS-1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christophe Guervilly
- Médecine Intensive Réanimation, Hôpital Nord, AP-HM, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France
| | - Jean Christophe Richard
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Romain Sonneville
- Université Paris Cité, INSERM U1137, F-75018 Paris, APHP Nord, Service de Médecine Intensive Réanimation, Hôpital Bichat–Claude Bernard, Paris, France
| | | | - Gregoire Muller
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Gaëtan Beduneau
- Université Rouen Normandie, Normandie Université, GRHVN UR 3830, Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network, Tours, France
| | - Hadrien Roze
- Service d’Anesthésie Réanimation Thoraco-Abdominale, CMC Magellan, Hôpital, Haut Leveque, CHU de Bordeaux, INSERM 1045: Centre de Recherche Cardio-Thoracique, Université de Bordeaux, Pessac, France
| | - Mathieu Lesouhaitier
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Inserm U1042, Grenoble, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Isaura Laurent
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière–Charles Foix, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
- GRC 30 RESPIRE, Sorbonne Université, Paris, France
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Huang F, Ammirati E, Ponnaiah M, Montero S, Raimbault V, Abrams D, Lebreton G, Pellegrino V, Ihle J, Bottiroli M, Persichini R, Barrionuevo-Sánchez MI, Ariza-Solé A, Ng PY, Sin SWC, Ayer R, Buscher H, Belaid S, Delmas C, Ferreira R, Roncon-Albuquerque R, Lόpez-Sobrino T, Bunge JJH, Fisser C, Franchineau G, McCanny J, Ohshimo S, Sionis A, Hernández-Pérez FJ, Barge-Caballero E, Balik M, Muglia H, Park S, Donker DW, Porral B, Aïssaoui N, Mekontso Dessap A, Burgos V, Lesouhaitier M, Fried J, Jung JS, Rosillo S, Scherrer V, Nseir S, Winszewski H, Jorge-Pérez P, Kimmoun A, Diaz R, Combes A, Schmidt M. Fulminant myocarditis proven by early biopsy and outcomes. Eur Heart J 2023; 44:5110-5124. [PMID: 37941449 DOI: 10.1093/eurheartj/ehad707] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.
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Affiliation(s)
- Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Maharajah Ponnaiah
- ICAN Intelligence and Omics, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Departament de Medicina, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Victor Raimbault
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital and Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris Cedex 13, France
| | | | - Joshua Ihle
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Maurizio Bottiroli
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, France
| | - Marisa Isabel Barrionuevo-Sánchez
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pauline Yeung Ng
- Adult Intensive Care Unit, Queen Mary Hospital, Hong-Kong, China
| | - Simon Wai Ching Sin
- Department of Anaesthesiology, The University of Hong Kong, Hong-Kong, China
| | - Raj Ayer
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Hergen Buscher
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Slimane Belaid
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Rita Ferreira
- Intensive Care Unit, Saint João Hospital, Porto, Portugal
| | | | | | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christoph Fisser
- Intensive Care Unit, University Medical Centre Regensburg, Regensburg, Germany
| | - Guillaume Franchineau
- Department of Intensive Care Medicine and Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Sorbonne Université, Paris Cedex 18, France
| | - Jamie McCanny
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust Hospital, London, UK
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco José Hernández-Pérez
- Advanced Heart Failure and Transplant Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Eduardo Barge-Caballero
- Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, A Coruña, Spain
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, General University Hospital, Prague, Czech Republic
| | | | - Sunghoon Park
- Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Beatriz Porral
- Intensive Care Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Nadia Aïssaoui
- Intensive Care Unit, Cochin Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris Cedex 5, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Mondor Hospital, Créteil, France
| | - Virginia Burgos
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Mathieu Lesouhaitier
- Departement of Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, Rennes 35200, France
| | - Justin Fried
- Department of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Sandra Rosillo
- Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Vincent Scherrer
- Department of Anesthesiology and Critical Care, CHU Rouen, Rouen F-76000, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, CHU de Lille, University Lille, Lille, France
| | | | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias Nuestra Señora de Candelaria, Canary Islands, Tenerife, Spain
| | - Antoine Kimmoun
- CHRU de NANCY, Service de Médecine Intensive et Réanimation, Inserm U1116, Université de Lorraine, Nancy, France
| | - Rodrigo Diaz
- Department of Cardiology, Clínica Las Condes, Las Condes, Chile
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
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3
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Tadié JM, Locher C, Maamar A, Reignier J, Asfar P, Commereuc M, Lesouhaitier M, Gregoire M, Le Pabic E, Bendavid C, Moreau C, Diehl JL, Gey A, Tartour E, Le Tulzo Y, Thibault R, Terzi N, Gacouin A, Roussel M, Delclaux C, Tarte K, Cynober L. Enteral citrulline supplementation versus placebo on SOFA score on day 7 in mechanically ventilated critically ill patients: the IMMUNOCITRE randomized clinical trial. Crit Care 2023; 27:381. [PMID: 37784110 PMCID: PMC10546668 DOI: 10.1186/s13054-023-04651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Restoring plasma arginine levels through enteral administration of L-citrulline in critically ill patients may improve outcomes. We aimed to evaluate whether enteral L-citrulline administration reduced organ dysfunction based on the Sequential Organ Failure Assessment (SOFA) score and affected selected immune parameters in mechanically ventilated medical intensive care unit (ICU) patients. METHODS A randomized, double-blind, multicenter clinical trial of enteral administration of L-citrulline versus placebo for critically ill adult patients under invasive mechanical ventilation without sepsis or septic shock was conducted in four ICUs in France between September 2016 and February 2019. Patients were randomly assigned to receive enteral L-citrulline (5 g) every 12 h for 5 days or isonitrogenous, isocaloric placebo. The primary outcome was the SOFA score on day 7. Secondary outcomes included SOFA score improvement (defined as a decrease in total SOFA score by 2 points or more between day 1 and day 7), secondary infection acquisition, ICU length of stay, plasma amino acid levels, and immune biomarkers on day 3 and day 7 (HLA-DR expression on monocytes and interleukin-6). RESULTS Of 120 randomized patients (mean age, 60 ± 17 years; 44 [36.7%] women; ICU stay 10 days [IQR, 7-16]; incidence of secondary infections 25 patients (20.8%)), 60 were allocated to L-citrulline and 60 were allocated to placebo. Overall, there was no significant difference in organ dysfunction as assessed by the SOFA score on day 7 after enrollment (4 [IQR, 2-6] in the L-citrulline group vs. 4 [IQR, 2-7] in the placebo group; Mann‒Whitney U test, p = 0.9). Plasma arginine was significantly increased on day 3 in the treatment group, while immune parameters remained unaffected. CONCLUSION Among mechanically ventilated ICU patients without sepsis or septic shock, enteral L-citrulline administration did not result in a significant difference in SOFA score on day 7 compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02864017 (date of registration: 11 August 2016).
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Affiliation(s)
- Jean-Marc Tadié
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France.
- SITI Laboratory, CHU Rennes, Rennes, France.
- Réanimation Médicale, CHU Rennes, Rennes, France.
- Centre d'investigation clinique de Rennes (CIC1414), CHU Rennes, Rennes, France.
- Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France.
- Hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guillloux, 35033, Rennes Cedex, France.
| | - Clara Locher
- Inserm, Centre d'investigation clinique de Rennes (CIC1414), service de pharmacologie clinique, Institut de recherche en santé, environnement et travail (Irset), UMR S 1085, EHESP, Univ Rennes, CHU Rennes, 35000, Rennes, France
| | - Adel Maamar
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
| | - Jean Reignier
- MIP, UR 4334, Médecine Intensive Réanimation, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Pierre Asfar
- Département de Médecine Intensive - Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, Angers, France
| | - Morgane Commereuc
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Mathieu Lesouhaitier
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
- Réanimation Médicale, CHU Rennes, Rennes, France
- Centre d'investigation clinique de Rennes (CIC1414), CHU Rennes, Rennes, France
| | - Murielle Gregoire
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Estelle Le Pabic
- Inserm, Centre d'investigation clinique de Rennes (CIC1414), service de pharmacologie clinique, Institut de recherche en santé, environnement et travail (Irset), UMR S 1085, EHESP, Univ Rennes, CHU Rennes, 35000, Rennes, France
| | - Claude Bendavid
- Laboratoire de Biochimie-Métabolique, CHU Rennes, Rennes, France
| | - Caroline Moreau
- Laboratoire de Biochimie-Métabolique, CHU Rennes, Rennes, France
| | - Jean-Luc Diehl
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Gey
- INSERM U970, Université Paris Cité, Paris, France
- Hôpital européen Georges Pompidou, Service d'Immunologie biologique, 20, Rue Leblanc, 75015, Paris, France
| | - Eric Tartour
- INSERM U970, Université Paris Cité, Paris, France
- Hôpital européen Georges Pompidou, Service d'Immunologie biologique, 20, Rue Leblanc, 75015, Paris, France
| | - Yves Le Tulzo
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
- Réanimation Médicale, CHU Rennes, Rennes, France
| | - Ronan Thibault
- INSERM, INRAE, Nutrition Métabolismes et Cancer, NuMeCan, Univ Rennes, CHU Rennes, Service d'endocrinologie-Diabétologie-Nutrition, Rennes, France
| | - Nicolas Terzi
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
| | - Arnaud Gacouin
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
| | - Mikael Roussel
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Christophe Delclaux
- AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, Université de Paris, 75019, Paris, France
| | - Karin Tarte
- UMR 1236, Univ Rennes, INSERM, Établissement Français du Sang, LabexIGO, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Luc Cynober
- Faculty of Pharmacy, Paris Cité University, Paris, France
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Guillot P, Delamaire F, Gacouin A, Painvin B, Piau C, Reizine F, Lesouhaitier M, Tadié JM, Maamar A. Early discontinuation of combination antibiotic therapy in severe community-acquired pneumonia: a retrospective cohort study. BMC Infect Dis 2023; 23:611. [PMID: 37723456 PMCID: PMC10506273 DOI: 10.1186/s12879-023-08493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is commonly treated with an empiric combination therapy, including a macrolide, or a quinolone and a β-lactam. However, the risk of Legionella pneumonia may lead to a prolonged combination therapy even after negative urinary antigen tests (UAT). METHODS We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality. RESULTS Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis. CONCLUSION Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia.
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Affiliation(s)
- Pauline Guillot
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Flora Delamaire
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Arnaud Gacouin
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
- Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Benoit Painvin
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Caroline Piau
- CHU Rennes, Service de Bactériologie, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Florian Reizine
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Mathieu Lesouhaitier
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Jean-Marc Tadié
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
- Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Adel Maamar
- CHU Rennes, Service de Maladies Infectieuses Et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
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Vaidie J, Peju E, Jandeaux LM, Lesouhaitier M, Lacherade JC, Guillon A, Wittebole X, Asfar P, Evrard B, Daix T, Vignon P, François B. Long-term immunosuppressive treatment is not associated with worse outcome in patients hospitalized in the intensive care unit for septic shock: the PACIFIC study. Crit Care 2023; 27:340. [PMID: 37660107 PMCID: PMC10475175 DOI: 10.1186/s13054-023-04626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Except in a few retrospective studies mainly including patients under chemotherapy, information regarding the impact of immunosuppressive therapy on the prognosis of patients admitted to the intensive care unit (ICU) for septic shock is scarce. Accordingly, the PACIFIC study aimed to asses if immunosuppressive therapy is associated with an increased mortality in patients admitted to the ICU for septic shock. METHODS This was a retrospective epidemiological multicentre study. Eight high enroller centres in septic shock randomised controlled trials (RCTs) participated in the study. Patients in the "exposed" group were selected from the screen failure logs of seven recent RCTs and excluded because of immunosuppressive treatment. The "non-exposed" patients were those included in the placebo arm of the same RCTs. A multivariate logistic regression model was used to estimate the risk of death. RESULTS Among the 433 patients enrolled, 103 were included in the "exposed" group and 330 in the "non-exposed" group. Reason for immunosuppressive therapy included organ transplantation (n = 45 [44%]) or systemic disease (n = 58 [56%]). ICU mortality rate was 24% in the "exposed" group and 25% in the "non-exposed" group (p = 0.9). Neither in univariate nor in multivariate analysis immunosuppressive therapy was associated with a higher ICU mortality (OR: 0.95; [95% CI 0.56-1.58]: p = 0.86 and 1.13 [95% CI 0.61-2.05]: p = 0.69, respectively) or 3-month mortality (OR: 1.13; [95% CI 0.69-1.82]: p = 0.62 and OR: 1.36 [95% CI 0.78-2.37]: p = 0.28, respectively). CONCLUSIONS In this study, long-term immunosuppressive therapy excluding chemotherapy was not associated with significantly higher or lower ICU and 3-month mortality in patients admitted to the ICU for septic shock.
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Affiliation(s)
- Julien Vaidie
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - Edwige Peju
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise-Marie Jandeaux
- Médecine Intensive et Réanimation, Nouvel Hôpital Civil, CHRU de Strasbourg, Strasbourg, France
| | - Mathieu Lesouhaitier
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
| | | | - Antoine Guillon
- Médecine Intensive - Réanimation, CHRU Bretonneau, Tours, France
- Inserm UMR 1100, UFR de Médecine, Tours, France
| | - Xavier Wittebole
- Service de Soins Intensifs, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Pierre Asfar
- Médecine Intensive - Réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - Bruno Evrard
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
- Inserm CIC 1435, CHU Dupuytren, Limoges, France
| | - Thomas Daix
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
- Inserm CIC 1435, CHU Dupuytren, Limoges, France
- Inserm UMR 1092, CHU Dupuytren, Limoges, France
| | - Philippe Vignon
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France
- Inserm CIC 1435, CHU Dupuytren, Limoges, France
- Inserm UMR 1092, CHU Dupuytren, Limoges, France
| | - Bruno François
- Réanimation Polyvalente, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.
- Inserm CIC 1435, CHU Dupuytren, Limoges, France.
- Inserm UMR 1092, CHU Dupuytren, Limoges, France.
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6
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Belicard F, Pinceaux K, Le Pabic E, Coirier V, Delamaire F, Painvin B, Lesouhaitier M, Maamar A, Guillot P, Quelven Q, Houssel P, Boudjema K, Reizine F, Camus C. Bacterial and fungal infections: a frequent and deadly complication among critically ill acute liver failure patients. Infect Dis (Lond) 2023:1-10. [PMID: 37211670 DOI: 10.1080/23744235.2023.2213326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Acute liver failure (ALF) is a rare but life-threatening condition mostly requiring intensive care unit (ICU) admission. ALF induces immune disorders and may promote infection acquisition. However, the clinical spectrum and impact on patients' prognosis remain poorly explored. METHODS We conducted a retrospective single-centre study on patients admitted for ALF to the ICU of a referral University Hospital from 2000 to 2021. Baseline characteristics and outcomes according to the presence of infection until day 28 were analysed. Risk factors for infection were determined using logistic regression. The impact of infection on 28-day survival was assessed using the proportional hazard Cox model. RESULTS Of the 194 patients enrolled, 79 (40.7%) underwent infection: community-acquired, hospital-acquired before ICU and ICU-acquired before/without and after transplant in 26, 23, 23 and 14 patients, respectively. Most infections were pneumonia (41.4%) and bloodstream infection (38.8%). Of a total of 130 microorganisms identified, 55 were Gram-negative bacilli (42.3%), 48 Gram-positive cocci (36.9%) and 21 were fungi (16.2%). Obesity (OR 3.77 [95% CI 1.18-14.40]; p = .03) and initial mechanical ventilation (OR 2.26 [95% CI 1.25-4.12]; p = .007) were independent factors associated with overall infection. SAPSII > 37 (OR 3.67 [95% CI 1.82-7.76], p < .001) and paracetamol aetiology (OR 2.10 [95% CI 1.06-4.22], p = .03) were independently associated with infection at admission to ICU. On the opposite, paracetamol aetiology was associated with lower risk of ICU-acquired infection (OR 0.37 [95% CI 0.16-0.81], p = .02). Patients with any type of infection had lower day 28 survival rates (57% versus 73%; HR 1.65 [1.01-2.68], p = .04). The presence of infection at ICU admission (p = .04), but not ICU-acquired infection, was associated with decreased survival. CONCLUSIONS The prevalence of infection is high in ALF patients which is associated with a higher risk of death. Further studies assessing the use of early antimicrobial therapy are needed.
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Affiliation(s)
- Félicie Belicard
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Kieran Pinceaux
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | | | - Valentin Coirier
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Flora Delamaire
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Benoît Painvin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | | | - Adel Maamar
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Pauline Guillot
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Quentin Quelven
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | | | - Karim Boudjema
- CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | - Florian Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- CH Vannes, Service de Réanimation Polyvalente, Vannes, France
| | - Christophe Camus
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
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7
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Maamar A, Delamaire F, Reizine F, Lesouhaitier M, Painvin B, Quelven Q, Coirier V, Guillot P, Tulzo YL, Tadié JM, Gacouin A. Impact of Arterial CO 2 Retention in Patients With Moderate or Severe ARDS. Respir Care 2023; 68:582-591. [PMID: 36977590 PMCID: PMC10171350 DOI: 10.4187/respcare.10507] [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] [Indexed: 03/30/2023]
Abstract
BACKGROUND Lung-protective ventilation (reduced tidal volume and limited plateau pressure) may lead to CO2 retention. Data about the impact of hypercapnia in patients with ARDS are scarce and conflicting. METHODS We performed a non-interventional cohort study with subjects with ARDS admitted from 2006 to 2021 and with PaO2 /FIO2 ≤ 150 mm Hg. We examined the association between severe hypercapnia (PaCO2 ≥ 50 mm Hg) on the first 5 days after the diagnosis of ARDS and death in ICU for 930 subjects. All the subjects received lung-protective ventilation. RESULTS Severe hypercapnia was noted in 552 subjects (59%) on the first day of ARDS (day 1); 323/930 (34.7%) died in the ICU. Severe hypercapnia on day 1 was associated with mortality in the unadjusted (odds ratio 1.54, 95% CI 1.16-1.63; P = .003) and adjusted (odds ratio 1.47, 95% CI 1.08-2.43; P = .004) models. In the Bayesian analysis, the posterior probability that severe hypercapnia was associated with ICU death was > 90% in 4 different priors, including a septic prior for this association. Sustained severe hypercapnia on day 5, defined as severe hypercapnia present from day 1 to day 5, was noted in 93 subjects (12%). After propensity score matching, severe hypercapnia on day 5 remained associated with ICU mortality (odds ratio 1.73, 95% CI 1.02-2.97; P = .047). CONCLUSIONS Severe hypercapnia was associated with mortality in subjects with ARDS who received lung-protective ventilation. Our results deserve further evaluation of the strategies and treatments that aim to control CO2 retention.
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Affiliation(s)
- Adel Maamar
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
| | - Flora Delamaire
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
| | - Florian Reizine
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France
| | - Mathieu Lesouhaitier
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France
| | - Benoit Painvin
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
| | - Quentin Quelven
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
| | - Valentin Coirier
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
| | - Pauline Guillot
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
| | - Yves Le Tulzo
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France
| | - Jean Marc Tadié
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France
| | - Arnaud Gacouin
- Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France.
- Université Rennes1, Faculté de Médecine, Biosit, Rennes, France
- Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France
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8
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Gauthier J, Grégoire M, Reizine F, Lesouhaitier M, Desvois Y, Ghukasyan G, Moreau C, Amé P, Tarte K, Tadié JM, Delaloy C. Citrulline enteral administration markedly reduces immunosuppressive extrafollicular plasma cell differentiation in a preclinical model of sepsis. Eur J Immunol 2023; 53:e2250154. [PMID: 36564641 DOI: 10.1002/eji.202250154] [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: 08/26/2022] [Revised: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
The sustained immunosuppression associated with severe sepsis favors an increased susceptibility to secondary infections and remains incompletely understood. Plasmablast and plasma cell subsets, whose primary function is to secrete antibodies, have emerged as important suppressive populations that expand during sepsis. In particular, sepsis supports CD39hi plasmablast metabolic reprogramming associated with adenosine-mediated suppressive activity. Arginine deficiency has been linked to an increased risk of secondary infections in sepsis. Overcoming arginine shortage by citrulline administration efficiently improves sepsis-induced immunosuppression and secondary infections in the cecal ligation and puncture murine model. Here, we aimed to determine the impact of citrulline administration on B cell suppressive responses in sepsis. We demonstrate that restoring arginine bioavailability through citrulline administration markedly reduces the dominant extrafollicular B cell response, decreasing the immunosuppressive LAG3+ and CD39+ plasma cell populations, and restoring splenic follicles. At the molecular level, the IRF4/MYC-mediated B cell reprogramming required for extrafollicular plasma cell differentiation is shunted in the splenic B cells of mice fed with citrulline. Our study reveals a prominent impact of nutrition on B cell responses and plasma cell differentiation and further supports the development of citrulline-based clinical studies to prevent sepsis-associated immune dysfunction.
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Affiliation(s)
| | - Murielle Grégoire
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
- CHU Rennes, SITI Laboratory, Pôle Biologie, Rennes, France
| | - Florian Reizine
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
- CHU Rennes, SITI Laboratory, Pôle Biologie, Rennes, France
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Mathieu Lesouhaitier
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
- CHU Rennes, SITI Laboratory, Pôle Biologie, Rennes, France
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Yoni Desvois
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
| | | | - Caroline Moreau
- CHU Rennes, Laboratoire de Biochimie, Pôle Biologie, Rennes, France
- Univ Rennes, INSERM, EHESP, IRSET, UMR S1085, Rennes, France
| | - Patricia Amé
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
- CHU Rennes, SITI Laboratory, Pôle Biologie, Rennes, France
| | - Karin Tarte
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
- CHU Rennes, SITI Laboratory, Pôle Biologie, Rennes, France
| | - Jean-Marc Tadié
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
- CHU Rennes, SITI Laboratory, Pôle Biologie, Rennes, France
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Céline Delaloy
- UMR INSERM S1236, LabEx IGO, Univ Rennes, EFS, Rennes, France
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9
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Maamar A, Guillot P, Joussellin V, Delamaire F, Painvin B, Bichon A, de la Jartre OB, Mauget M, Lesouhaitier M, Tadié JM, Terzi N, Gacouin A. Moderate to severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality. ERJ Open Res 2023; 9:00554-2022. [PMID: 37041986 PMCID: PMC9885245 DOI: 10.1183/23120541.00554-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/21/2022] [Indexed: 01/27/2023] Open
Abstract
BackgroundThis study aimed to compare ventilatory parameters recorded the first days of ARDS, and mortality at day 60 between COVID-19 and influenza ARDS patients with PaO2/FiO2≤150 mmHg.MethodsWe compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure (DP), respiratory system compliance (CRs), ventilator ratio (VR), corrected minute ventilation (VEcorr), and surrogate of mechanical power [index=(4×DP)+respiratory rate] were calculated from day1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed.ResultsOn day 1 of ARDS, COVID-19 patients had significantly higher PaO2/FiO2ratio (median [IQR], 97 mmHg [79–129]versus83 [62.2–114]), p=0.001), and lower DP (13 cmH20 [11–16.0]versus14 [12.0–16.7], p=0.01), VR (2.08 [1.73–2.49versus2.52 [1.97–3.03], p<0.001), VEcorr (12.7 L·mn−1[10.2–14.9]versus14.9 [11.6–18.6], p<0.001), index (80 [70–89]versus84 [75–94], p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5 repeated values of PaO2/FiO2ratio, PaCO2, VR and VEcorr differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29%versus21.7%, p=0.43).ConclusionsVentilation was more impaired in influenza than in COVID-19 ARDS patients the first day of ARDS with important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.
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10
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Aissi James S, Guervilly C, Lesouhaitier M, Coppens A, Haddadi C, Lebreton G, Nizard J, Brechot N, Assouline B, Saura O, Levy D, Lefèvre L, Barhoum P, Chommeloux J, Hékimian G, Luyt CE, Kimmoun A, Combes A, Schmidt M. Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study. Crit Care 2022; 26:312. [PMID: 36253839 PMCID: PMC9574812 DOI: 10.1186/s13054-022-04189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Although rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother’s and child’s conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation.
Methods We included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed.
Results Among 563 women on venovenous ECMO during the study period, 11 were cannulated during an ongoing pregnancy at a median (range) of 25 (21–29) gestational weeks, and 13 after an emergency delivery performed at 32 (17–39) weeks of gestation. Pre-ECMO PaO2/FiO2 ratio was 57 (26–98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported. Conclusion Continuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04189-5.
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Affiliation(s)
- Sarah Aissi James
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Christophe Guervilly
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive-Réanimation, APHM, CHU Hôpital Nord, Marseille, France
| | - Mathieu Lesouhaitier
- grid.411154.40000 0001 2175 0984Service de Maladies Infectieuses Et Réanimation Médicale, CHU de Rennes, Rennes, France
| | - Alexandre Coppens
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Clément Haddadi
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Université de Lorraine, Nancy, France
| | - Guillaume Lebreton
- grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France ,grid.411439.a0000 0001 2150 9058Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Jacky Nizard
- grid.462844.80000 0001 2308 1657Department of Gynaecology and Obstetrics, Groupe Hospitalier Pitié-Salpêtrière, CNRS UMR 7222, INSERM U1150, Sorbonne Universités, Paris, France
| | - Nicolas Brechot
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Benjamin Assouline
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Ouriel Saura
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - David Levy
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Lucie Lefèvre
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Pétra Barhoum
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Juliette Chommeloux
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Guillaume Hékimian
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Charles-Edouard Luyt
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Université de Lorraine, Nancy, France
| | - Alain Combes
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France ,grid.411439.a0000 0001 2150 9058Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France ,grid.411439.a0000 0001 2150 9058Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France ,grid.411439.a0000 0001 2150 9058Service de Medecine Intensive Reanimation, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de La Pitié-Salpêtrière, 47, Bd de L’Hôpital, 75651 Paris Cedex 13, France
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11
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Maamar A, Liard C, Doucet W, Reizine F, Painvin B, Delamaire F, Coirier V, Quelven Q, Guillot P, Lesouhaitier M, Tadié JM, Gacouin A. Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study. Virol J 2022; 19:145. [PMID: 36085163 PMCID: PMC9463051 DOI: 10.1186/s12985-022-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation's incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy. METHODS We included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. RESULTS We included 241 patients (median age 62 years [53-70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37-2.49, p < 0.001). CONCLUSION Agitation in ARDS Covid-19 patients was more frequent than in ARDS influenza patients and was not associated with common risk factors, such as severity of illness or sedation. Systemic hyperinflammation might be responsible for these neurological manifestations, but there is no specific management to our knowledge.
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Affiliation(s)
- Adel Maamar
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
| | - Clémence Liard
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Willelm Doucet
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Florian Reizine
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Benoit Painvin
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Flora Delamaire
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Valentin Coirier
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Quentin Quelven
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Pauline Guillot
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Mathieu Lesouhaitier
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Jean Marc Tadié
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Arnaud Gacouin
- CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
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12
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Petitgas P, Lesouhaitier M, Boukthir S, Cattoir V, Tattevin P, Bénézit F. Correction to: Cerebral nocardiosis in a patient treated with pembrolizumab: a first case report. BMC Infect Dis 2022; 22:371. [PMID: 35413825 PMCID: PMC9006503 DOI: 10.1186/s12879-022-07343-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Paul Petitgas
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France. .,Infectious Diseases and Internal Medicine Unit, Saint-Pierre University Hospital, La Reunion, France.
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Sarrah Boukthir
- Clinical Microbiology Laboratory Unit, Pontchaillou University Hospital, Rennes, France
| | - Vincent Cattoir
- Clinical Microbiology Laboratory Unit, Pontchaillou University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - François Bénézit
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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13
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Petitgas P, Lesouhaitier M, Boukthir S, Cattoir V, Tattevin P, Bénézit F. Cerebral nocardiosis in a patient treated with pembrolizumab: a first case report. BMC Infect Dis 2022; 22:306. [PMID: 35351017 PMCID: PMC8962086 DOI: 10.1186/s12879-022-07288-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Checkpoints inhibitors (CPIs) are increasingly used for the treatment of several malignancies. The most common side effects are Immune Related Adverse Events, while infectious complications are rare, especially cerebral nocardiosis. Case presentation Here, we report the first clinical case of a cerebral nocardiosis revealed after seizure in a patient treated by pembrolizumab for a metastatic lung cancer, in the absence of any additional immunosuppressive therapy or risk factors for cerebral nocardiosis. The extended evaluation including a brain CT-scan did not reveal any lesion before pembrolizumab. Nevertheless, the 3-month delay between the start of Pembrolizumab and the diagnosis of cerebral nocardiosis suggests that the infection occurred prior to the CPI. Unfortunately, the patient died during treatment for cerebral nocardiosis, while the lung cancer tumor mass had decreased by 80% after the sixth cycle of pembrolizumab. Conclusions This case report emphasizes that clinicians should consider diagnoses other than metastasis in a patient with a brain mass and metastatic cancer treated with CPI, such as opportunistic infections or IRAE.
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Affiliation(s)
- Paul Petitgas
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France. .,Infectious Diseases and Internal Medicine Unit, Saint-Pierre University Hospital, La Reunion, France.
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Sarrah Boukthir
- Clinical Microbiology Laboratory Unit, Pontchaillou University Hospital, Rennes, France
| | - Vincent Cattoir
- Clinical Microbiology Laboratory Unit, Pontchaillou University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - François Bénézit
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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14
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Brulé N, Canet E, Péré M, Feuillet F, Hourmant M, Asehnoune K, Rozec B, Duveau A, Dube L, Pierrot M, Humbert S, Tirot P, Boyer JM, Martin-Lefevre L, Labadie F, Robert R, Benard T, Kerforne T, Thierry A, Lesieur O, Vincent JF, Lesouhaitier M, Larmet R, Vigneau C, Goepp A, Bouju P, Quentin C, Egreteau PY, Huet O, Renault A, Le Meur Y, Venhard JC, Buchler M, Michel O, Voellmy MH, Herve F, Schnell D, Courte A, Glotz D, Amrouche L, Hazzan M, Kamar N, Moal V, Bourenne J, Le Quintrec-Donnette M, Morelon E, Boulain T, Grimbert P, Heng AE, Merville P, Garin A, Hiesse C, Fermier B, Mousson C, Guyot-Colosio C, Bouvier N, Rerolle JP, Durrbach A, Drouin S, Caillard S, Frimat L, Girerd S, Albano L, Rostaing L, Bertrand D, Hertig A, Westeel PF, Montini F, Delpierre E, Dorez D, Alamartine E, Ouisse C, Sebille V, Reignier J. Impact of targeted hypothermia in expanded-criteria organ donors on recipient kidney-graft function: study protocol for a multicentre randomised controlled trial (HYPOREME). BMJ Open 2022; 12:e052845. [PMID: 35351701 PMCID: PMC8961135 DOI: 10.1136/bmjopen-2021-052845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Expanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and mortality. HYPOREME will be a multicentre randomised controlled trial (RCT) comparing targeted hypothermia to normothermia in ECDs, in a country where the use of machine perfusion for organ storage is the standard of care. We hypothesise that hypothermia will decrease the incidence of DGF. METHODS AND ANALYSIS HYPOREME is a multicentre RCT comparing the effect on kidney function in recipients of targeted hypothermia (34°C-35°C) and normothermia (36.5°C-37.5°C) in the ECDs. The temperature intervention starts from randomisation and is maintained until aortic clamping in the operating room. We aim to enrol 289 ECDs in order to analyse the kidney function of 516 recipients in the 53 participating centres. The primary outcome is the occurrence of DGF in kidney recipients, defined as a requirement for renal replacement therapy within 7 days after transplantation (not counting a single session for hyperkalemia during the first 24 hours). Secondary outcomes include the proportion of patients with individual organs transplanted in each group; the number of organs transplanted from each ECD and the vital status and kidney function of the recipients 7 days, 28 days, 3 months and 1 year after transplantation. An interim analysis is planned after the enrolment of 258 kidney recipients. ETHICS AND DISSEMINATION The trial was approved by the ethics committee of the French Intensive Care Society (CE-SRLF-16-07) on 26 April 2016 and by the competent French authorities on 20 April 2016 (Comité de Protection des Personnes-TOURS-Région Centre-Ouest 1, registration #2016-S3). Findings will be published in peer-reviewed journals and presented during national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT03098706.
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Affiliation(s)
- Noëlle Brulé
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Morgane Péré
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Fanny Feuillet
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- INSERM SPHERE U1246 Methods for Patient-centered Outcomes and Health Research, Université de Nantes, Université de Tours, Nantes, PAYS-DE-LA-LOIRE, France
| | - Maryvonne Hourmant
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karim Asehnoune
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Rozec
- Service de Réanimation en Chirurgie Cardio-thoracique et Vasculaire, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Agnes Duveau
- Service de Néphrologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Laurent Dube
- Service de Coordination des prélèvements d'organe, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc Pierrot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Stanislas Humbert
- Service de Réanimation Polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
| | - Jean-Marc Boyer
- Service de Réanimation, Centre Hospitalier de Laval, Laval, France
| | - Laurent Martin-Lefevre
- Service de Médecine Intensive Réanimation, Centre Hospitalier Departemental Les Oudairies, La Roche-sur-Yon, Pays de la Loire, France
| | - François Labadie
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Nazaire, Saint Nazaire, Pays de la Loire, France
| | - René Robert
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ALIVE Research Group, INSERM, University of Poitiers, Poitiers, Poitou-Charentes, France
| | - Thierry Benard
- Service de Réanimation Neurochirurgicale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Kerforne
- Service d'Anesthésie-Réanimation Cardio-Thoracique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Antoine Thierry
- Service de Néphrologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Lesieur
- Service de Réanimation, Centre Hospitalier de la Rochelle, La Rochelle, Nouvelle-Aquitaine, France
| | - Jean-François Vincent
- Service de Réanimation, Centre Hospitalier de Saintes, Saintes, Poitou-Charentes, France
| | - Mathieu Lesouhaitier
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Raphaelle Larmet
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Cecile Vigneau
- Service de Néphrologie, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Angelique Goepp
- Service de Réanimation, Centre Hospitalier Bretagne Atlantique de Vannes, Vannes, France
| | - Pierre Bouju
- Service de Réanimation, Centre Hospitalier de Bretagne Sud, Lorient, Lorient, France
| | - Charlotte Quentin
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint-Malo, Saint-Malo, Bretagne, France
| | - Pierre-Yves Egreteau
- Service de Réanimation Polyvalente, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Olivier Huet
- Service de Réanimation Chirurgicale, Hôpital La Cavale Blanche, CHU de Brest, Brest, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHRU de Brest, Brest, Bretagne, France
| | - Yannick Le Meur
- Service de Néphrologie, Hôpital La Cavale Blanche, CHU de Brest, Brest, France
| | - Jean-Christophe Venhard
- Coordination des prélèvements d'organes et de tissus, Pôle Anesthésie Réanimations, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Mathias Buchler
- Service de Néphrologie, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Olivier Michel
- Service de Réanimation Polyvalente, Centre Hospitalier Jacques Cœur, Bourges, Centre-Val de Loire, France
| | - Marie-Hélène Voellmy
- Service de Coordination des prélèvements, Centre Hospitalier Jacques Cœur, Bourges, Centre-Val de Loire, France
| | - Fabien Herve
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France
| | - David Schnell
- Service de Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angouleme, France
| | - Anne Courte
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, Bretagne, France
| | - Denis Glotz
- Service de Néphrologie, Hôpital Saint-Louis, Université de Paris, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Lucile Amrouche
- Service de Néphrologie, Hôpital Necker, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Hazzan
- University of Lille, Inserm, CHU Lille, U1286-Infinite-Institute for Translational Research in Inflammation, CHRU de Lille, Lille, Hauts-de-France, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'organes, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043- CNRS 5282, Toulouse, France, Toulouse, Midi-Pyrénées, France
| | - Valerie Moal
- Centre de Néphrologie et Transplantation Rénale, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Conception, Marseille, France
| | - Jeremy Bourenne
- Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, CHU La Timone 2, Marseille, France
| | - Moglie Le Quintrec-Donnette
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Emmanuel Morelon
- Service d'Urologie et de Chirurgie de la Transplantation, Pôle Chirurgie, Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Thierry Boulain
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans Hôpital de La Source, Orléans, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, Créteil, France
| | - Anne Elisabeth Heng
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Merville
- Service de Nephrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine-Limousin-Poitou, France
| | - Aude Garin
- Service de Réanimation Polyvalente, Centre Hospitalier de Dreux, Dreux, France
| | - Christian Hiesse
- Service de Néphrologie, Hôpital Foch, Suresnes, Suresnes, France
| | - Brice Fermier
- Service de Réanimation, Centre Hospitalier de Blois, Blois, Centre-Val de Loire, France
| | - Christiane Mousson
- Service de Néphrologie, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Charlotte Guyot-Colosio
- Service de Néphrologie, Centre Hospitalier Universitaire de Reims, Reims, Champagne-Ardenne, France
| | - Nicolas Bouvier
- Service de Néphrologie, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Jean-Philippe Rerolle
- Service de Néphrologie, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Antoine Durrbach
- Service de Néphrologie, Hôpital Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Sarah Drouin
- Service Médico-Chirurgical de Transplantation Rénale, APHP Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Sophie Caillard
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, Alsace, France
| | - Luc Frimat
- Nephrology Department, CHRU Nancy, Université de Lorraine, Nancy, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation, Hôpital Brabois, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Laetitia Albano
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Dominique Bertrand
- Service de Néphrologie, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Alexandre Hertig
- Service de Néphrologie, Hôpital Tenon, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Florent Montini
- Service de Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Eric Delpierre
- Service de Réanimation, Grand Hôpital de l'Est Francilien, Marne La vallée, France
| | - Dider Dorez
- Service de Réanimation Polyvalente, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Eric Alamartine
- Service de Néphrologie Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Rhône-Alpes, France
| | - Carole Ouisse
- Service de Médecine Intensive Réanimation, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Veronique Sebille
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- INSERM SPHERE U1246 Methods for Patient-centered Outcomes and Health Research, Université de Nantes, Université de Tours, Nantes, PAYS-DE-LA-LOIRE, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Le Guen Y, Lederlin M, Triquet L, Lesouhaitier M, Le Tulzo Y, Ricordel C. [Pulmonary manifestations induced by osimertinib]. Rev Mal Respir 2021; 39:62-66. [PMID: 34969538 DOI: 10.1016/j.rmr.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The third-generation tyrosine kinase inhibitor (TKI) osimertinib is recommended as a first-line treatment in advanced non-small cell lung cancer harboring an activating mutation of Epidermal Growth Factor Receptor (EGFR). Adverse pulmonary events related to osimertinib exposure have been reported, primarily in Japanese patients. They rarely occur in the Caucasian population. OBSERVATION Herein we report two clinical cases of osimertinib-induced lung toxicities in patients diagnosed with advanced lung adenocarcinoma harboring an EGFR mutation. In the first case, interstitial pneumonia was asymptomatic and evolved favorably after osimertinib discontinuation. The second patient presented a more extensive form of lung injuries and despite systemic corticosteroid therapy, the evolution was fatal. CONCLUSION Osimertinib-related lung toxicities remain exceptional. While most forms are mild, consideration of TKI treatment discontinuation may be necessitated. Introduction of another TKI or rechallenge with osimertinib might be considered along with corticosteroid therapy if necessary. Diffuse alveolar damage is a pejorative prognostic factor.
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Affiliation(s)
- Y Le Guen
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - M Lederlin
- Service de radiologie, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - L Triquet
- Service de pharmacologie, centre régional de pharmacovigilance de pharmaco-épidémiologie et d'information sur le médicament, CHU Pontchaillou, 35033 Rennes, France
| | - M Lesouhaitier
- Service des maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guillloux, 35033 Rennes cedex 9, France
| | - Y Le Tulzo
- Service des maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guillloux, 35033 Rennes cedex 9, France
| | - C Ricordel
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; INSERM U1242, Chemistry Oncogenesis Stress and Signalling, CLCC Eugène Marquis, Rennes, France
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich C, Fritz R, Fry S, Fuentes N, Fukuda M, Gaborieau V, Gaci R, Gagliardi M, Gagnard JC, Gagné N, Gagneux-Brunon A, Gaião S, Gail Skeie L, Gallagher P, Gallego Curto E, Gamble C, Gani Y, Garan A, Garcia R, García Barrio N, Garcia-Diaz J, Garcia-Gallo E, Garimella N, Garot D, Garrait V, Gauli B, Gault N, Gavin A, Gavrylov A, Gaymard A, Gebauer J, Geraud E, Gerbaud Morlaes L, Germano N, ghisulal PK, Ghosn J, Giani M, Giaquinto C, Gibson J, Gigante T, Gilg M, Gilroy E, Giordano G, Girvan M, Gissot V, Gitahi J, Giwangkancana G, Glikman D, Glybochko P, Gnall E, Goco G, Goehringer F, Goepel S, Goffard JC, Goh JY, Golob J, Gomes R, Gomez K, Gómez-Junyent J, Gominet M, Gonzalez A, Gordon P, Gordon A, Gorenne I, Goubert L, Goujard C, Goulenok T, Grable M, Graf J, Grandin EW, Granier P, Grasselli G, Grazioli L, Green CA, Greene C, Greenhalf W, Greffe S, Grieco DL, Griffee M, Griffiths F, Grigoras I, Groenendijk A, Grosse Lordemann A, Gruner H, Gu Y, Guarracino F, Guedj J, Guego M, Guellec D, Guerguerian AM, Guerreiro D, Guery R, Guillaumot A, Guilleminault L, Guimarães de Castro M, Guimard T, Haalboom M, Haber D, Habraken H, Hachemi A, Hadri N, Haidash O, Haider S, Haidri F, Hakak S, Hall A, Hall M, Halpin S, Hamer A, Hamers R, Hamidfar R, Hammond T, Han LY, Haniffa R, Hao KW, Hardwick H, Harrison EM, Harrison J, Harrison SBE, Hartman A, Hashmi J, Hashmi M, Hayat M, Hayes A, Hays L, Heerman J, Heggelund L, Hendry R, Hennessy M, Henriquez A, Hentzien M, Herekar F, Hernandez-Montfort J, Herr D, Hershey A, Hesstvedt L, Hidayah A, Higgins D, Higgins E, HigginsOKeeffe G, Hinchion R, Hinton S, Hiraiwa H, Hitoto H, Ho A, Ho YB, Hoctin A, Hoffmann I, Hoh WH, Hoiting O, Holt R, Holter JC, Horby P, Horcajada JP, Hoshino K, Hoshino K, Houas I, Hough CL, Houltham S, Hsu JMY, Hulot JS, Hussain I, Ijaz S, Illes HG, Imbert P, Imran M, Imran Sikander R, Inácio H, Infante Dominguez C, Ing YS, Iosifidis E, Ippolito M, Isgett S, Ishani PGPI, Isidoro T, Ismail N, Isnard M, Itai J, Ito A, Ivulich D, Jaafar D, Jaafoura S, Jabot J, Jackson C, Jamieson N, Jaquet P, Jassat W, Jaud-Fischer C, Jaureguiberry S, Javidfar J, Jawad I, Jaworsky D, Jayakumar D, Jego F, Jelani AM, Jenum S, Jimbo-Sotomayor R, Job VDP, Joe OY, Jorge García RN, Joseph C, Joseph M, Joshi S, Jourdain M, Jouvet P, June J, Jung A, Jung H, Juzar D, Kafif O, Kaguelidou F, Kaisbain N, Kaleesvran T, Kali S, Kalicinska A, Kalomoiri S, Kamal S, Kamaluddin MAA, Kamaruddin ZAC, Kamarudin N, Kandamby DH, Kandel C, Kang KY, Kant R, Kanwal D, Kanyawati D, Karki B, Karpayah P, Karsies T, Kartsonaki C, Kasugai D, Kataria A, Katz K, Kaur A, Kaur Johal S, Kawasaki T, Kay C, Keane H, Keating S, Kellam P, Kelly A, Kelly A, Kelly C, Kelly N, Kelly S, Kelly Y, Kelsey M, Kennedy R, Kennon K, Kernan M, Kerroumi Y, Keshav S, Kestelyn E, Khalid I, Khalid O, Khalil A, Khan C, Khan I, Khanal S, Kho ME, Khoo D, Khoo R, Khoo S, Khoso N, Kiat KH, Kida Y, Kiiza P, Kildal AB, Kim JB, Kimmoun A, Kindgen-Milles D, King A, Kitamura N, Klenerman P, Klont R, Kloumann Bekken G, Knight S, Kobbe R, Kodippily C, Kohns Vasconcelos M, Koirala S, Komatsu M, Korten V, Kosgei C, Kpangon A, Krawczyk K, Krishnan S, Krishnan V, Kruglova O, Kumar A, Kumar D, Kumar G, Kumar M, Kumar Vecham P, Kuriakose D, Kurtzman E, Kusumastuti NP, Kutsogiannis D, Kutsyna G, Kyriakoulis K, Lachatre M, Lacoste M, Laffey JG, Lagrange M, Laine F, Lairez O, Lakhey S, Lalueza A, Lambert M, Lamontagne F, Langelot-Richard M, Langlois V, Lantang EY, Lanza M, Laouénan C, Laribi S, Lariviere D, Lasry S, Latif N, Launay O, Laureillard D, Lavie-Badie Y, Law A, Lawrence C, Lawrence T, Le M, Le Bihan C, Le Bris C, Le Falher G, Le Fevre L, Le Hingrat Q, Le Maréchal M, Le Mestre S, Le Moal G, Le Moing V, Le Nagard H, Le Turnier P, Leal E, Leal Santos M, Lee BH, Lee HG, Lee J, Lee SH, Lee TC, Lee YL, Leeming G, Lefebvre B, Lefebvre L, Lefevre B, LeGac S, Lelievre JD, Lellouche F, Lemaignen A, Lemee V, Lemeur A, Lemmink G, Lene HS, Lennon J, León R, Leone M, Leone M, Lepiller Q, Lescure FX, Lesens O, Lesouhaitier M, Lester-Grant A, Levy B, Levy Y, Levy-Marchal C, Lewandowska K, L'Her E, Li Bassi G, Liang J, Liaquat A, Liegeon G, Lim KC, Lim WS, Lima C, Lina B, Lina L, Lind A, Lingas G, Lion-Daolio S, Lissauer S, Liu K, Livrozet M, Lizotte P, Loforte A, Lolong N, Loon LC, Lopes D, Lopez-Colon D, Loschner AL, Loubet P, Loufti B, Louis G, Lourenco S, Lovelace-Macon L, Low LL, Lowik M, Loy JS, Lucet JC, Lumbreras Bermejo C, Luna CM, Lungu O, Luong L, Luque N, Luton D, Lwin N, Lyons R, Maasikas O, Mabiala O, MacDonald S, MacDonald S, Machado M, Macheda G, Macias Sanchez J, Madhok J, Maestro de la Calle G, Mahieu R, Mahy S, Maia AR, Maier LS, Maillet M, Maitre T, Malfertheiner M, Malik N, Mallon P, Maltez F, Malvy D, Manda V, Mandei JM, Mandelbrot L, Manetta F, Mangal K, Mankikian J, Manning E, Manuel A, Maria Sant`Ana Malaque C, Marino D, Marino F, Markowicz S, Maroun Eid C, Marques A, Marquis C, Marsh B, Marsh L, Marshal M, Marshall J, Martelli CT, Martin DA, Martin E, Martin-Blondel G, Martinelli A, Martin-Loeches I, Martinot M, Martin-Quiros A, Martins A, Martins J, Martins N, Martins Rego C, Martucci G, Martynenko O, Marwali EM, Marzukie M, Masa Jimenez JF, Maslove D, Maslove D, Mason P, Mason S, Masood S, Masood S, Mat Nor B, Matan M, Mateus Fernandes H, Mathew M, Mathieu D, Mattei M, Matulevics R, Maulin L, Maxwell M, Maynar J, Mazzoni T, Mc Sweeney L, McAndrew L, McArthur C, McCarthy A, McCarthy A, McCloskey C, McConnochie R, McDermott S, McDonald SE, McElroy A, McElwee S, McEneany V, McEvoy N, McGeer A, McKay C, McKeown J, McLean KA, McNally P, McNicholas B, McPartlan E, Meaney E, Mear-Passard C, Mechlin M, Meher M, Mehkri O, Mele F, Melo L, Memon K, Mendes JJ, Menkiti O, Menon K, Mentré F, Mentzer AJ, Mercier E, Mercier N, Merckx A, Mergeay-Fabre M, Mergler B, Merson L, Mesquita A, Metwally O, Meybeck A, Meyer D, Meynert AM, Meysonnier V, Meziane A, Mezidi M, Michelagnoli G, Michelanglei C, Michelet I, Mihelis E, Mihnovit V, Miranda-Maldonado H, Misnan NA, Mohamed NNE, Mohamed TJ, Moin A, Molina D, Molinos E, Molloy B, Mone M, Monteiro A, Montes C, Montrucchio G, Moore S, Moore SC, Morales Cely L, Moro L, Morocho Tutillo DR, Morton B, Motherway C, Motos A, Mouquet H, Mouton Perrot C, Moyet J, Mudara C, Mufti AK, Muh NY, Muhamad D, Mullaert J, Muller F, Müller KE, Munblit D, Muneeb S, Munir N, Munshi L, Murphy A, Murphy A, Murphy L, Murris M, Murthy S, Musaab H, Muyandy G, Myrodia DM, N N, Nagpal D, Nagrebetsky A, Narasimhan M, Narayanan N, Nasim Khan R, Nazerali-Maitland A, Neant N, Neb H, Nekliudov NA, Nelwan E, Neto R, Neumann E, Neves B, Ng PY, Nghi A, Nguyen D, Ni Choileain O, Ni Leathlobhair N, Nichol A, Nitayavardhana P, Nonas S, Noordin NAM, Noret M, Norharizam NFI, Norman L, Notari A, Noursadeghi M, Nowicka K, Nowinski A, Nseir S, Nunez JI, Nurnaningsih N, Nyamankolly E, O Brien F, O'Callaghan A, Occhipinti G, OConnor D, O'Donnell M, Ogston T, Ogura T, Oh TH, O'Halloran S, O'Hearn K, Ohshimo S, Oldakowska A, Oliveira J, Oliveira L, Olliaro PL, O'Neil C, Ong DS, Ong JY, Oosthuyzen W, Opavsky A, Openshaw P, Orakzai S, Orozco-Chamorro CM, Orquera A, Ortoleva J, Osatnik J, O'Shea L, O'Sullivan M, Othman SZ, Ouamara N, Ouissa R, Owyang C, Oziol E, Pabasara HMU, Pagadoy M, Pages J, Palacios A, Palacios M, Palmarini M, Panarello G, Panda PK, Paneru H, Pang LH, Panigada M, Pansu N, Papadopoulos A, Parke R, Parker M, Parra B, Parrini V, Pasha T, Pasquier J, Pastene B, Patauner F, Patel J, Pathmanathan MD, Patrão L, Patricio P, Patrier J, Patterson L, Pattnaik R, Paul C, Paul M, Paulos J, Paxton WA, Payen JF, Peariasamy K, Pedrera Jiménez M, Peek GJ, Peelman F, Peiffer-Smadja N, Peigne V, Pejkovska M, Pelosi P, Peltan ID, Pereira R, Perez D, Periel L, Perpoint T, Pesenti A, Pestre V, Petrou L, Petrov-Sanchez V, Pettersen FO, Peytavin G, Pharand S, Piagnerelli M, Picard W, Picone O, Piero MD, Pierobon C, Piersma D, Pimentel C, Pinto R, Pires C, Pironneau I, Piroth L, Pius R, Piva S, Plantier L, Plotkin D, Png HS, Poissy J, Pokeerbux R, Pokorska-Spiewak M, Poli S, Pollakis G, Ponscarme D, Popielska J, Post AM, Postma DF, Povoa P, Póvoas D, Powis J, Prapa S, Preau S, Prebensen C, Preiser JC, Prinssen A, Pritchard MG, Priyadarshani GDD, Proença L, Pudota S, Puéchal O, Pujo Semedi B, Pulicken M, Puntoni M, Purcell G, Quesada L, Quinones-Cardona V, Quirós González V, Quist-Paulsen E, Quraishi M, Rabaa M, Rabaud C, Rabindrarajan E, Rafael A, Rafiq M, Ragazzo G, Rahman AKHA, Rahman RA, Rahutullah A, Rainieri F, Rajahram GS, Rajapakse N, Ralib A, Ramakrishnan N, Ramanathan K, Ramli AA, Rammaert B, Ramos GV, Rana A, Rangappa R, Ranjan R, Rapp C, Rashan A, Rashan T, Rasheed G, Rasmin M, Rätsep I, Rau C, Ravi T, Raza A, Real A, Rebaudet S, Redl S, Reeve B, Rehan A, Rehman A, Reid L, Reid L, Reikvam DH, Reis R, Rello J, Remppis J, Remy M, Ren H, Renk H, Resende L, Resseguier AS, Revest M, Rewa O, Reyes LF, Reyes T, Ribeiro MI, Richardson D, Richardson D, Richier L, Ridzuan SNAA, Riera J, Rios AL, Rishu A, Rispal P, Risso K, Rivera Nuñez MA, Rizer N, Robb D, Robba C, Roberto A, Roberts S, Robertson DL, Robineau O, Roche-Campo F, Rodari P, Rodeia S, Rodriguez Abreu J, Roessler B, Roger C, Roger PM, Roilides E, Rojek A, Romaru J, Roncon-Albuquerque Jr R, Roriz M, Rosa-Calatrava M, Rose M, Rosenberger D, Rossanese A, Rossetti M, Rossignol B, Rossignol P, Rousset S, Roy C, Roze B, Rusmawatiningtyas D, Russell CD, Ryan M, Ryan M, Ryckaert S, Rygh Holten A, Saba I, Sadaf S, Sadat M, Sahraei V, Saint-Gilles M, Sakiyalak P, Salahuddin N, Salazar L, Saleem J, Saleem J, Sales G, Sallaberry S, Salmon Gandonniere C, Salvator H, Sanchez O, Sánchez Choez X, Sanchez de Oliveira K, Sanchez-Miralles A, Sancho-Shimizu V, Sandhu G, Sandhu Z, Sandrine PF, Sandulescu O, Santos M, Sarfo-Mensah S, Sarmento Banheiro B, Sarmiento ICE, Sarton B, Satyapriya S, Satyawati R, Saviciute E, Savio R, Savvidou P, Saw YT, Schaffer J, Schermer T, Scherpereel A, Schneider M, Schroll S, Schwameis M, Schwartz G, Scott JT, Scott-Brown J, Sedillot N, Seitz T, Selvanayagam J, Selvarajoo M, Semaille C, Semple MG, Senian RB, Senneville E, Sepulveda C, Sequeira F, Sequeira T, Serpa Neto A, Serrano Balazote P, Shadowitz E, Shahidan SA, Shahnaz Hasan M, Shamsah M, Shankar A, Sharjeel S, Sharma P, Shaw CA, Shaw V, Shi H, Shiban N, Shiekh M, Shiga T, Shime N, Shimizu H, Shimizu K, Shimizu N, Shindo N, Shrapnel S, Shum HP, Si Mohammed N, Siang NY, Sibiude J, Siddiqui A, Sigfrid L, Sillaots P, Silva C, Silva MJ, Silva R, Sim Lim Heng B, Sin WC, Singh BC, Singh P, Sitompul PA, Sivam K, Skogen V, Smith S, Smood B, Smyth C, Smyth M, Smyth M, Snacken M, So D, Soh TV, Solis M, Solomon J, Solomon T, Somers E, Sommet A, Song MJ, Song R, Song T, Song Chia J, Sonntagbauer M, Soom AM, Sotto A, Soum E, Sousa AC, Sousa M, Sousa Uva M, Souza-Dantas V, Sperry A, Spinuzza E, Sri Darshana BPSR, Sriskandan S, Stabler S, Staudinger T, Stecher SS, Steinsvik T, Stienstra Y, Stiksrud B, Stolz E, Stone A, Streinu-Cercel A, Streinu-Cercel A, Strudwick S, Stuart A, Stuart D, Subekti D, Suen G, Suen JY, Sukumar P, Sultana A, Summers C, Supic D, Suppiah D, Surovcová M, Suwarti S, Svistunov AA, Syahrin S, Syrigos K, Sztajnbok J, Szuldrzynski K, Tabrizi S, Taccone FS, Tagherset L, Taib SM, Talarek E, Taleb S, Talsma J, Tampubolon ML, Tan KK, Tan LV, Tan YC, Tanaka C, Tanaka H, Tanaka T, Taniguchi H, Tanveer H, Taqdees H, Taqi A, Tardivon C, Tattevin P, Taufik MA, Tawfik H, Tedder RS, Tee TY, Teixeira J, Tejada S, Tellier MC, Teoh SK, Teotonio V, Téoulé F, Terpstra P, Terrier O, Terzi N, Tessier-Grenier H, Tey A, Thabit AAM, Tham ZD, Thangavelu S, Thibault V, Thiberville SD, Thill B, Thirumanickam J, Thompson S, Thomson D, Thomson EC, Thurai SRT, Thuy DB, Thwaites RS, Tierney P, Tieroshyn V, Timashev PS, Timsit JF, Tirupakuzhi Vijayaraghavan BK, Tissot N, Toh JZY, Toki M, Tolppa T, Tonby K, Tonnii SL, Torres A, Torres M, Torres Santos-Olmo RM, Torres-Zevallos H, Towers M, Trapani T, Traynor D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Coirier V, Lesouhaitier M, Reizine F, Painvin B, Quelven Q, Maamar A, Gacouin A, Tadié JM, Le Tulzo Y, Camus C. Tolerance and complications of therapeutic plasma exchange by centrifugation: A single center experience. J Clin Apher 2021; 37:54-64. [PMID: 34786746 DOI: 10.1002/jca.21950] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) constitutes an important therapy for hematological, neurological, immunological, and nephrological diseases. Most studies have focused on efficacy, whereas tolerance and complications during sessions have been less well studied and not recently. MATERIAL AND METHODS We conducted a single center retrospective study of all patients who underwent TPE between 2011 and 2018. TPE sessions using the centrifugation technique were performed by dedicated trained nurses. Specific side effects were identified through surveillance forms completed contemporaneously. The primary outcome was the rate of all-type adverse effects that occurred during the TPE sessions. RESULTS In total, 1895 TPE sessions performed on 185 patients were analyzed. At least one adverse effect was reported for 805 sessions (42.5% [29.9%-70.1%]), corresponding to 171 patients (92.4% [87.6%-95.8%]). Hypotension occurred during 288 sessions (15.2%), was asymptomatic in 95.8% of cases, and more frequent with the use of 4% albumin than fresh frozen plasma (FFP) (19.8 vs 8.9%, P <.0001). Hypocalcemia occurred during 370 sessions (19.6%) and was more frequent with the use of FFP than with the use of albumin alone (FFP alone: 28.0%, albumin + FFP: 26%, albumin alone: 11.7%; P <.0001). Allergic reactions occurred during 56 sessions (3%), exclusively with FFP. Severe adverse effects were reported for 0.3% of sessions and 5.4% of patients. CONCLUSIONS TPE is a safe therapy when performed by a trained team. Adverse effects were frequent but mostly not serious. The replacement fluid was the main determinant of the occurrence of complications. (ClinicalTrials.gov ID: NCT03888417).
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Affiliation(s)
- Valentin Coirier
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Mathieu Lesouhaitier
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Florian Reizine
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Benoît Painvin
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Quentin Quelven
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Adel Maamar
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Arnaud Gacouin
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Jean-Marc Tadié
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Yves Le Tulzo
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Christophe Camus
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
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Gacouin A, Lesouhaitier M, Reizine F, Painvin B, Maamar A, Camus C, Le Tulzo Y, Tadié JM. 1-hour t-piece spontaneous breathing trial vs 1-hour zero pressure support spontaneous breathing trial and reintubation at day 7: A non-inferiority approach. J Crit Care 2021; 67:95-99. [PMID: 34741964 DOI: 10.1016/j.jcrc.2021.10.016] [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: 05/04/2021] [Revised: 09/28/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Physiological data suggest that T-piece and zero pressure support (PS0) ventilation both accurately reflect spontaneous breathing conditions after extubation. These two types of spontaneous breathing trials (SBTs) are used in our Intensive Care Unit to evaluate patients for extubation readiness and success but have rarely been compared in clinical studies. MATERIALS AND METHODS We performed a prospective observational study to confirm the hypothesis that 1-hour T-piece SBT and 1-h PS0 zero PEEP (ZEEP) SBT are associated with similar rates of reintubation at day 7 after extubation. A non-inferiority approach was used for sample size calculation. RESULTS The cohort consisted of 529 subjects invasively ventilated for more than 24 h and extubated after successful 1-hour T-piece SBT (n = 303, 57%) or 1-h PS0 ZEEP SBT (n = 226, 43%). The reintubation rate at day 7 was 14.6% with PS0 ZEEP and 17.5% with T-piece (difference - 2.6% [95% confidence interval, -8.3% to 4.3%]; p = 0.40). The reasons for reintubation did not differ significantly when compared between patients with 1-h PS0 ZEEP SBT and patients with 1-hour T-piece SBT. CONCLUSION Our results suggest that successful 1-hour T-piece and 1-h PSO ZEEP SBTs are associated with similar reintubation rates at day 7.
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Affiliation(s)
- Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France; Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, F-35033 Rennes, France.
| | - Mathieu Lesouhaitier
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France
| | - Florian Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France
| | - Benoit Painvin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France
| | - Adel Maamar
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France
| | - Christophe Camus
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France
| | - Yves Le Tulzo
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France; Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, F-35033 Rennes, France
| | - Jean Marc Tadié
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; Université Rennes1, Faculté de Médecine, Biosit, F-35043 Rennes, France; Inserm-CIC-1414, Faculté de Médecine, Université Rennes I, IFR 140, F-35033 Rennes, France
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Lesouhaitier M, Gregoire M, Gacouin A, Coirier V, Frerou A, Piau C, Cattoir V, Dumontet E, Revest M, Tattevin P, Roisne A, Verhoye JP, Flecher E, Le Tulzo Y, Tarte K, Tadié JM. Neutrophil function and bactericidal activity against Staphylococcus aureus after cardiac surgery with cardiopulmonary bypass. J Leukoc Biol 2021; 111:867-876. [PMID: 34425029 DOI: 10.1002/jlb.5ab1219-737rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Staphylococcus aureus is the main bacterial pathogen encountered in mediastinitis after cardiac surgical procedures; it remains a devastating complication with a high mortality rate. As neutrophils have a primordial role in the defense against staphylococcus infection and cardiopulmonary bypass (CPB) is known to induce immunosuppression, the aim of this study was to investigate CPB impact on neutrophil functions. Patients without known immunosuppression scheduled for cardiac surgery with CPB were included. Bone marrow and blood samples were harvested before, during, and after surgery. Neutrophil phenotypic maturation and functions (migration, adhesion, neutrophil extracellular trap [NET] release, reactive oxygen species (ROS) production, phagocytosis, and bacteria killing) were investigated. Two types of Staphylococcus aureus strains (one from asymptomatic nasal carriage and another from mediastinitis infected tissues) were used to assess in vitro bacterial direct impact on neutrophils. We found that CPB induced a systemic inflammation with an increase in circulating mature neutrophils after surgery. Bone marrow sample analysis did not reveal any modification of neutrophil maturation during CPB. Neutrophil lifespan was significantly increased and functions such as NET release and ROS production were enhanced after CPB whereas bacteria killing and phagocytosis were not impacted. Results were similar with the two different isolates of Staphylococcus aureus. These data suggest that CPB induces a recruitment of mature neutrophils via a demargination process rather than impacting their maturation in the bone marrow. In addition, neutrophils are fully efficient after CPB and do not contribute to postoperative immunosuppression.
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Affiliation(s)
- Mathieu Lesouhaitier
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France.,INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France
| | - Murielle Gregoire
- INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France.,Department of Biology, CHU Rennes, Rennes, France
| | - Arnaud Gacouin
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Valentin Coirier
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Aurélien Frerou
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Caroline Piau
- Department of Bacteriology, CHU Rennes, Rennes, France
| | | | - Erwan Dumontet
- INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France.,Department of Biology, CHU Rennes, Rennes, France
| | - Matthieu Revest
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Pierre Tattevin
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Antoine Roisne
- Department of Anesthesiology Critical Care Medicine and Perioperative Medicine, CHU Rennes, Rennes, France
| | | | - Erwan Flecher
- Department of thoracic and cardiovascular surgery, CHU Rennes, Rennes, France
| | - Yves Le Tulzo
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France.,INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France
| | - Karin Tarte
- INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France.,Department of Biology, CHU Rennes, Rennes, France
| | - Jean-Marc Tadié
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France.,INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France
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Frérou A, Maamar A, Rafi S, Lhommet C, Phelouzat P, Pontis E, Reizine F, Lesouhaitier M, Camus C, Le Tulzo Y, Tadié JM, Gacouin A. Monitoring Transcutaneously Measured Partial Pressure of CO 2 During Intubation in Critically Ill Subjects. Respir Care 2021; 66:1004-1015. [PMID: 33824171 DOI: 10.4187/respcare.08009] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ([Formula: see text]) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal. METHODS In this single-center, prospective, observational study, we recorded [Formula: see text] from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between [Formula: see text] variability and the development of postintubation hypotension. RESULTS A total of 202 subjects were included in the study. The [Formula: see text] values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P < .05). [Formula: see text] variability differed significantly according to the preoxygenation method (P < .001, linear mixed model). A decrease in [Formula: see text] by > 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03-4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation. CONCLUSIONS [Formula: see text] variability during intubation is significant and differs with the method of preoxygenation. A decrease in [Formula: see text] after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.).
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Affiliation(s)
- Aurélien Frérou
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Adel Maamar
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Sonia Rafi
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Claire Lhommet
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Pierre Phelouzat
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Emmanuel Pontis
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Florian Reizine
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Mathieu Lesouhaitier
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Christophe Camus
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Yves Le Tulzo
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Jean-Marc Tadié
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Arnaud Gacouin
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
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21
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Reizine F, Pinceaux K, Lederlin M, Autier B, Guegan H, Gacouin A, Luque-Paz D, Boglione-Kerrien C, Bacle A, Le Daré B, Launey Y, Lesouhaitier M, Painvin B, Camus C, Mansour A, Robert-Gangneux F, Belaz S, Le Tulzo Y, Tadié JM, Maamar A, Gangneux JP. Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different? J Fungi (Basel) 2021; 7:jof7050388. [PMID: 34063556 PMCID: PMC8156373 DOI: 10.3390/jof7050388] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern. Influenza-associated acute respiratory distress syndrome (ARDS) and severe COVID-19 patients are both at risk of developing invasive fungal diseases. We used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological, and radiological aspects of IAPA and CAPA in a monocentric retrospective study. A total of 120 patients were included, 71 with influenza and 49 with COVID-19-associated ARDS. Among them, 27 fulfilled the newly published criteria of IPA: 17/71 IAPA (23.9%) and 10/49 CAPA (20.4%). Kaplan–Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0.032), whereas mortality did not differ between CAPA and IAPA patients. Radiological findings showed differences between IAPA and CAPA, with a higher proportion of features suggestive of IPA during IAPA. Lastly, a wide proportion of IPA patients had low plasma voriconazole concentrations with a higher delay to reach concentrations > 2 mg/L in CAPA vs. IAPA patients (p = 0.045). Severe COVID-19 and influenza patients appeared very similar in terms of prevalence of IPA and outcome. The dramatic consequences on the patients’ prognosis emphasize the need for a better awareness in these particular populations.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
- Correspondence: (F.R.); (J.-P.G.)
| | - Kieran Pinceaux
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Mathieu Lederlin
- CHU Rennes, Service d’Imagerie Médicale, F-35033 Rennes, France;
| | - Brice Autier
- CHU Rennes, Service de Parasitologie-Mycologie, F-35033 Rennes, France; (B.A.); (H.G.); (F.R.-G.); (S.B.)
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, F-35000 Rennes, France;
| | - Hélène Guegan
- CHU Rennes, Service de Parasitologie-Mycologie, F-35033 Rennes, France; (B.A.); (H.G.); (F.R.-G.); (S.B.)
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, F-35000 Rennes, France;
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - David Luque-Paz
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | | | - Astrid Bacle
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, F-35000 Rennes, France;
- CHU Rennes, Service de Pharmacie, F-35033 Rennes, France;
| | | | - Yoann Launey
- CHU Rennes, Service de Réanimation Chirurgicale, F-35033 Rennes, France;
| | - Mathieu Lesouhaitier
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Benoit Painvin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Christophe Camus
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Alexandre Mansour
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Florence Robert-Gangneux
- CHU Rennes, Service de Parasitologie-Mycologie, F-35033 Rennes, France; (B.A.); (H.G.); (F.R.-G.); (S.B.)
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, F-35000 Rennes, France;
| | - Sorya Belaz
- CHU Rennes, Service de Parasitologie-Mycologie, F-35033 Rennes, France; (B.A.); (H.G.); (F.R.-G.); (S.B.)
| | - Yves Le Tulzo
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Adel Maamar
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F-35033 Rennes, France; (K.P.); (A.G.); (D.L.-P.); (M.L.); (B.P.); (C.C.); (A.M.); (Y.L.T.); (J.-M.T.); (A.M.)
| | - Jean-Pierre Gangneux
- CHU Rennes, Service de Parasitologie-Mycologie, F-35033 Rennes, France; (B.A.); (H.G.); (F.R.-G.); (S.B.)
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, F-35000 Rennes, France;
- Correspondence: (F.R.); (J.-P.G.)
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22
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Frerou A, Lesouhaitier M, Gregoire M, Uhel F, Gacouin A, Reizine F, Moreau C, Loirat A, Maamar A, Nesseler N, Anselmi A, Flecher E, Verhoye JP, Le Tulzo Y, Cogné M, Roussel M, Tarte K, Tadié JM. Venoarterial extracorporeal membrane oxygenation induces early immune alterations. Crit Care 2021; 25:9. [PMID: 33407728 PMCID: PMC7788860 DOI: 10.1186/s13054-020-03444-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides heart mechanical support in critically ill patients with cardiogenic shock. Despite important progresses in the management of patients under VA-ECMO, acquired infections remain extremely frequent and increase mortality rate. Since immune dysfunctions have been described in both critically ill patients and after surgery with cardiopulmonary bypass, VA-ECMO initiation may be responsible for immune alterations that may expose patients to nosocomial infections (NI). Therefore, in this prospective study, we aimed to study immune alterations induced within the first days by VA-ECMO initiation. Methods We studied immune alterations induced by VA-ECMO initiation using cytometry analysis to characterize immune cell changes and enzyme-linked immunosorbent assay (ELISA) to explore plasma cytokine levels. To analyze specific changes induced by VA-ECMO initiation, nine patients under VA-ECMO (VA-ECMO patients) were compared to nine patients with cardiogenic shock (control patients). Results Baseline immune parameters were similar between the two groups. VA-ECMO was associated with a significant increase in circulating immature neutrophils with a significant decrease in C5a receptor expression. Furthermore, we found that VA-ECMO initiation was followed by lymphocyte dysfunction along with myeloid-derived suppressor cells (MDSC) expansion. ELISA analysis revealed that VA-ECMO initiation was followed by an increase in pro-inflammatory cytokines such as IL-6, IL-8 and TNF-α along with IL-10, a highly immunosuppressive cytokine. Conclusion VA-ECMO is associated with early immune changes that may be responsible for innate and adaptive immune alterations that could confer an increased risk of infection.
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Affiliation(s)
- Aurélien Frerou
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | - Mathieu Lesouhaitier
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | - Murielle Gregoire
- INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France.,Pôle Biologie, CHU Rennes, 35033, Rennes, France
| | - Fabrice Uhel
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | - Arnaud Gacouin
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | - Florian Reizine
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | | | - Aurélie Loirat
- Service de Cardiologie et maladies vasculaires, CHU de Rennes, 35033, Rennes, France
| | - Adel Maamar
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | | | - Amedeo Anselmi
- Chirurgie Cardio-Thoracique Et Vasculaire, CHU Rennes, 35033, Rennes, France
| | - Erwan Flecher
- Chirurgie Cardio-Thoracique Et Vasculaire, CHU Rennes, 35033, Rennes, France
| | | | - Yves Le Tulzo
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France
| | - Michel Cogné
- INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France.,Pôle Biologie, CHU Rennes, 35033, Rennes, France
| | - Mikael Roussel
- INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France.,Pôle Biologie, CHU Rennes, 35033, Rennes, France
| | - Karin Tarte
- INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France.,Pôle Biologie, CHU Rennes, 35033, Rennes, France
| | - Jean-Marc Tadié
- Maladies Infectieuses Et Réanimation Médicale, CHU Rennes, 35033, Rennes, France. .,INSERM, EFS Bretagne, UMR U1236, Université de Rennes 1, 35000, Rennes, France. .,Pôle Biologie, CHU Rennes, 35033, Rennes, France.
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23
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Reizine F, Lesouhaitier M, Gregoire M, Pinceaux K, Gacouin A, Maamar A, Painvin B, Camus C, Le Tulzo Y, Tattevin P, Revest M, Le Bot A, Ballerie A, Cador-Rousseau B, Lederlin M, Lebouvier T, Launey Y, Latour M, Verdy C, Rossille D, Le Gallou S, Dulong J, Moreau C, Bendavid C, Roussel M, Cogne M, Tarte K, Tadié JM. SARS-CoV-2-Induced ARDS Associates with MDSC Expansion, Lymphocyte Dysfunction, and Arginine Shortage. J Clin Immunol 2021; 41:515-525. [PMID: 33387156 PMCID: PMC7775842 DOI: 10.1007/s10875-020-00920-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
Purpose The SARS-CoV-2 infection can lead to a severe acute respiratory distress syndrome (ARDS) with prolonged mechanical ventilation and high mortality rate. Interestingly, COVID-19-associated ARDS share biological and clinical features with sepsis-associated immunosuppression since lymphopenia and acquired infections associated with late mortality are frequently encountered. Mechanisms responsible for COVID-19-associated lymphopenia need to be explored since they could be responsible for delayed virus clearance and increased mortality rate among intensive care unit (ICU) patients. Methods A series of 26 clinically annotated COVID-19 patients were analyzed by thorough phenotypic and functional investigations at days 0, 4, and 7 after ICU admission. Results We revealed that, in the absence of any difference in demographic parameters nor medical history between the two groups, ARDS patients presented with an increased number of myeloid-derived suppressor cells (MDSC) and a decreased number of CD8pos effector memory cell compared to patients hospitalized for COVID-19 moderate pneumonia. Interestingly, COVID-19-related MDSC expansion was directly correlated to lymphopenia and enhanced arginase activity. Lastly, T cell proliferative capacity in vitro was significantly reduced among COVID-19 patients and could be restored through arginine supplementation. Conclusions The present study reports a critical role for MDSC in COVID-19-associated ARDS. Our findings open the possibility of arginine supplementation as an adjuvant therapy for these ICU patients, aiming to reduce immunosuppression and help virus clearance, thereby decreasing the duration of mechanical ventilation, nosocomial infection acquisition, and mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00920-5.
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Affiliation(s)
- Florian Reizine
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Murielle Gregoire
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Kieran Pinceaux
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Arnaud Gacouin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Adel Maamar
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Benoit Painvin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Christophe Camus
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Yves Le Tulzo
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Audrey Le Bot
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Berengère Cador-Rousseau
- Department of Internal Medicine and Clinical Immunology, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Mathieu Lederlin
- Department of Radiology, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Thomas Lebouvier
- Department of Anesthesia and Critical Care, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Yoann Launey
- Department of Anesthesia and Critical Care, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Maelle Latour
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Clotilde Verdy
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Delphine Rossille
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Simon Le Gallou
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Joelle Dulong
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Caroline Moreau
- Department of Biochemistry, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Claude Bendavid
- Department of Biochemistry, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Mikael Roussel
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Michel Cogne
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Karin Tarte
- SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. .,SITI, Pole de Biologie, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France. .,UMR 1236, University of Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France. .,Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
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24
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Gacouin A, Lesouhaitier M, Reizine F, Pronier C, Grégoire M, Painvin B, Maamar A, Thibault V, Le Tulzo Y, Tadié JM. Short-term survival of acute respiratory distress syndrome patients due to influenza virus infection alone: a cohort study. ERJ Open Res 2020; 6:00587-2020. [PMID: 33263066 PMCID: PMC7682721 DOI: 10.1183/23120541.00587-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 11/07/2022] Open
Abstract
Background Influenza virus (IV)-related pathophysiology suggests that the prognosis of acute respiratory distress syndrome (ARDS) due to IV could be different from the prognosis of ARDS due to other causes. However, the impact of IV infection alone on the prognosis of ARDS patients compared to that of patients with other causes of ARDS has been poorly assessed. Methods We compared the 28-day survival from the diagnosis of ARDS with an arterial oxygen tension/inspiratory oxygen fraction ratio ≤150 mmHg between patients with and without IV infection alone. Data were collected prospectively and analysed retrospectively. We first performed survival analysis on the whole population; second, patients with IV infection alone were compared with matched pairs using propensity score matching. Results The cohort admitted from October 2009 to March 2020 consisted of 572 patients, including 73 patients (13%) with IV alone. On the first 3 days of mechanical ventilation, nonpulmonary Sequential Organ Failure Assessment scores were significantly lower in patients with IV infection than in the other patients. After the adjusted analysis, IV infection alone remained independently associated with lower mortality at day 28 (hazard ratio 0.51, 95% CI 0.26–0.99, p=0.047). Mortality at day 28 was significantly lower in patients with IV infection alone than in other patients when propensity score matching was used (20% versus 38%, p=0.02). Conclusions Our results suggest that patients with ARDS following IV infection alone have a significantly better prognosis at day 28 and less severe nonpulmonary organ dysfunction than do those with ARDS from causes other than IV infection alone. Influenza virus infection alone is associated with a better short-term prognosis than are other causes of ARDShttps://bit.ly/31W2Mh2
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25
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Le Bot A, Lecomte R, Chapplain J, Gazeau P, Lesouhaitier M, Ansart S, Boutoille D, Le berre R, Tattevin P, Revest M. La rifampicine améliore-t-elle le pronostic des endocardites à Staphylococcus sp. sur prothèse ? Une étude rétrospective multicentrique. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.011] [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: 10/23/2022]
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26
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Tattevin P, Fillâtre P, Tchamgoué S, Lesouhaitier M, Nesseler N, Tadié JM. Should we include microorganisms in scores to predict outcome in candidates for cardiac surgery during the acute phase of endocarditis? J Thorac Dis 2019; 11:E158-E162. [PMID: 31737328 DOI: 10.21037/jtd.2019.09.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Pierre Fillâtre
- Intensive Care Unit, Yves Le Foll Hospital, Saint Brieuc, France
| | - Serge Tchamgoué
- Internal Medicine and Infectious Diseases, Robert Boulin Hospital, Libourne, France
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nicolas Nesseler
- Cardiovascular Thoracic Surgery Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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27
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Lesouhaitier M, Dudreuilh C, Tamain M, Kanaan N, Bailly E, Legoupil D, Deltombe C, Perrin P, Houot R, Vigneau C. Utilisation des inhibiteurs de checkpoints chez les greffés rénaux. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.371] [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: 10/28/2022]
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28
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Lesouhaitier M, Legeai C, Savoye E, Cantrelle C, Pipien I, Macher MA, Vigneau C, Dorent R. Impact of donor coronary angiography on kidney transplantation outcomes. Clin Transplant 2018; 32:e13355. [DOI: 10.1111/ctr.13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/09/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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29
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Grégoire M, Uhel F, Lesouhaitier M, Gacouin A, Guirriec M, Mourcin F, Dumontet E, Chalin A, Samson M, Berthelot LL, Tissot A, Kerjouan M, Jouneau S, Le Tulzo Y, Tarte K, Zmijewski JW, Tadié JM. Impaired efferocytosis and neutrophil extracellular trap clearance by macrophages in ARDS. Eur Respir J 2018; 52:13993003.02590-2017. [DOI: 10.1183/13993003.02590-2017] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/11/2018] [Indexed: 12/25/2022]
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30
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Lesouhaitier M, Dudreuilh C, Tamain M, Kanaan N, Bailly E, Legoupil D, Deltombe C, Perrin P, Manson G, Vigneau C, Houot R. Checkpoint blockade after kidney transplantation. Eur J Cancer 2018; 96:111-114. [PMID: 29705511 DOI: 10.1016/j.ejca.2018.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Caroline Dudreuilh
- Department of Nephrology and Renal Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France; DHU (Département Hospitalo-Universitaire), VIC (Virus-Immunité-Cancer), Université Paris-Est-Créteil (UPEC), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Créteil, France
| | - Mathilde Tamain
- Division of Nephrology, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nada Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elodie Bailly
- Department of Nephrology and Kidney Transplantation, University Hospital of Tours, France; Université François Rabelais, Tours, France
| | | | - Clement Deltombe
- Institute for Transplantation, Urology and Nephrology (ITUN), Nantes University Hospital, Nantes, France
| | - Peggy Perrin
- Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | | | - Cécile Vigneau
- CHU Pontchaillou, Division of Nephrology, Rennes, France; Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR 1085, Rennes, France
| | - Roch Houot
- CHU Pontchaillou, Department of Hematology, Rennes, France; INSERM, U1236, Rennes, France.
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31
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Lesouhaitier M, Legeai C, Savoye E, Cantrelle C, Pipien I, Macher M, Vigneau C, Dorent R. Performing Coronary Angiography in High Risk Cardiac Donors Does Not Affect Renal Function in Kidney Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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32
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, 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Lesouhaitier M, Legeai C, Savoye E, Marcher M, Vigneau C, Dorent R. Impact de la coronarographie du donneur sur les résultats de la greffe rénale. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.368] [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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