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Brohan O, Chenouard A, Gaultier A, Tonna JE, Rycus P, Pezzato S, Moscatelli A, Liet JM, Bourgoin P, Rozé JC, Léger PL, Rambaud J, Joram N. Pao2 and Mortality in Neonatal Extracorporeal Membrane Oxygenation: Retrospective Analysis of the Extracorporeal Life Support Organization Registry, 2015-2020. Pediatr Crit Care Med 2024:00130478-990000000-00326. [PMID: 38511990 DOI: 10.1097/pcc.0000000000003508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Extracorporeal life support can lead to rapid reversal of hypoxemia but the benefits and harms of different oxygenation targets in severely ill patients are unclear. Our primary objective was to investigate the association between the Pao2 after extracorporeal membrane oxygenation (ECMO) initiation and mortality in neonates treated for respiratory failure. DESIGN Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry data, 2015-2020. PATIENTS Newborns supported by ECMO for respiratory indication were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Pao2 24 hours after ECMO initiation (H24 Pao2) was reported. The primary outcome was 28-day mortality. We identified 3533 newborns (median age 1 d [interquartile range (IQR), 1-3]; median weight 3.2 kg [IQR, 2.8-3.6]) from 198 ELSO centers, who were placed on ECMO. By 28 days of life, 731 (20.7%) had died. The median H24 Pao2 was 85 mm Hg (IQR, 60-142). We found that both hypoxia (Pao2 < 60 mm Hg) and moderate hyperoxia (Pao2 201-300 mm Hg) were associated with greater adjusted odds ratio (aOR [95% CI]) of 28-day mortality, respectively: aOR 1.44 (95% CI, 1.08-1.93), p = 0.016, and aOR 1.49 (95% CI, 1.01-2.19), p value equals to 0.045. CONCLUSIONS Early hypoxia or moderate hyperoxia after ECMO initiation are each associated with greater odds of 28-day mortality among neonates requiring ECMO for respiratory failure.
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Affiliation(s)
- Orlane Brohan
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Aurélie Gaultier
- Nantes Université, CHU Nantes, Direction de la Recherche et de l'innovation, Plateforme de méthodologie et biostatistique, Nantes, France
| | - Joseph E Tonna
- Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI
| | - Peter Rycus
- Extracorporeal Life Support Organization (ELSO), Ann Arbor, MI
| | - Stefano Pezzato
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Jean-Michel Liet
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
- Clinical Investigation Center (CIC) 1413, INSERM, Public Health, Clinic of the Data, University Hospital of Nantes, Nantes, France
| | - Pierre-Louis Léger
- Pediatric Intensive Care Unit, Trousseau University Hospital, Paris, France
- INSERM U955-ENVA, University Paris 12, Paris, France
| | - Jérôme Rambaud
- Pediatric Intensive Care Unit, Trousseau University Hospital, Paris, France
- INSERM U955-ENVA, University Paris 12, Paris, France
| | - Nicolas Joram
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
- INSERM U955-ENVA, University Paris 12, Paris, France
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Portefaix A, Dhelens C, Recher M, Cour-Andlauer F, Naudin J, Mortamet G, Joram N, Tissières P, Ginhoux T, Kassai B, Boutitie F, Maucort-Boulch D, Javouhey E. High-dose intravenous immunoglobulin versus albumin 4% in paediatric toxic shock syndrome: a randomised controlled feasibility study. Arch Dis Child 2024:archdischild-2022-325274. [PMID: 38360044 DOI: 10.1136/archdischild-2022-325274] [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: 01/18/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Toxic shock syndrome (TSS) is a rare disease responsible for significant morbidity and mortality. Intravenous immunoglobulin (IG) therapy in paediatric TSS could improve shock and organ failure, but more consistent efficacy and safety data are needed. Our objective was to determine whether a randomised clinical trial (RCT) assessing intravenous IG in TSS in children is feasible. METHODS We performed a multicentre, feasibility, double-blind RCT assessing efficacy of high-dose intravenous IG versus albumin 4% (control group) within the first 12 hours of shock onset. Included patients were aged above 1 month and below 18 years with suspected TSS and septic shock. Feasibility was assessed by measuring inclusion rate, protocol compliance and missing data regarding death and the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score. Other secondary clinical outcomes were evaluated during hospital stay, at 60 day and 1 year. RESULTS 28 patients, admitted in 6 paediatric intensive care units during 36 consecutive months and followed for 1 year, received the allocated treatment: 13 in intravenous IG group, 15 in control group. The median age was 10.6 years and the sex ratio was 1. Inclusion rate was above 50%, protocol deviations were below 30% and missing data regarding death and PELOD-2 Score below 10%. No difference concerning secondary clinical outcomes between groups was observed, and more adverse events were reported in the control group. CONCLUSION It seems to be feasible to conduct an RCT assessing intravenous IG efficacy and safety in paediatric TSS but must be realised internationally, with choice of a clinically relevant endpoint and a specific design in order to be realistic. TRIAL REGISTRATION NUMBER NCT02219165.
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Affiliation(s)
- Aurélie Portefaix
- Clinical Investigation Center, Hospices Civils de Lyon, Lyon Bron, France
- EMET LBBE, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Carole Dhelens
- Pharmacie FRIPHARM, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Morgan Recher
- Services de Réanimation Pédiatrique, CHU Lille, F59000-Lille, France
- METRICS, Universite Lille Nord de France, Villeneuve-d'Ascq, Hauts-de-France, France
| | - Fleur Cour-Andlauer
- Réanimation Pédiatrique, Centre Hospitalier Universitaire de Lyon, Bron, France
| | - Jérôme Naudin
- Service de Réanimation Pédiatrique, Hôpital Universitaire Robert-Debré, Paris, Île-de-France, France
| | | | - Nicolas Joram
- Réanimation Pédiatrique, CHU Nantes, Nantes, Pays de la Loire, France
| | - Pierre Tissières
- Paediatric Intensive Care Unit, Hospital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
- Institute for Integrative Cell Biology, Gif-sur-Yvette, Île-de-France, France
| | - Tiphanie Ginhoux
- Clinical Investigation Center, Hospices Civils de Lyon, Lyon Bron, France
| | - Behrouz Kassai
- Clinical Investigation Center, Hospices Civils de Lyon, Lyon Bron, France
- Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Florent Boutitie
- Biostatistics, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | | | - Etienne Javouhey
- Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
- EA 7426 Joint Research Unit HCL-bioMérieux, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
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3
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Tabone L, El-Tannoury J, Levy M, Sauthier M, Joram N, Du Pont-Thibodeau G, Bourgoin P, Al-Omar S, Poirier N, Emeriaud G, Thibault C. Determining Optimal Mean Arterial Blood Pressure Based on Cerebral Autoregulation in Children after Cardiac Surgery. Pediatr Cardiol 2024; 45:81-91. [PMID: 37945783 DOI: 10.1007/s00246-023-03326-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
To evaluate the feasibility of continuous determination of the optimal mean arterial blood pressure (opt-MAP) according to cerebral autoregulation and to describe the opt-MAP, the autoregulation limits, and the time spent outside these limits in children within 48 h of cardiac surgery. Cerebral autoregulation was assessed using the correlation coefficient (COx) between cerebral oxygenation and MAP in children following cardiac surgery. Plots depicting the COx according to the MAP were used to determine the opt-MAP using weighted multiple time windows. For each patient, we estimated (1) the time spent with MAP outside the autoregulation limits and (2) the burden of deviation, defined as the area between the MAP curve and the autoregulation limits when the MAP was outside these limits. Fifty-one patients with a median age of 7.1 (IQR 0.7-52.0) months old were included. The opt-MAP was calculated for 94% (IQR 90-96) of the monitored time. The opt-MAP was significantly lower in neonates < 1 month old. The patients spent 24% (18-31) of the time outside of the autoregulation limits, with no significant differences between age groups. Continuous determination of the opt-MAP is feasible in children within the first 48 h following cardiac surgery.
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Affiliation(s)
- Laurence Tabone
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Pediatric Intensive Care Unit and Pediatric Emergency Department, CHU Clocheville, Tours, France
| | - Jihad El-Tannoury
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert Debré, Paris, France
| | - Michael Sauthier
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nicolas Joram
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
| | - Geneviève Du Pont-Thibodeau
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
| | - Sally Al-Omar
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nancy Poirier
- Department of Cardiac Surgery, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Emeriaud
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Céline Thibault
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
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Brohan O, Liet JM, Dejoie T, Jegard J, Gaultier A, Bourgoin P, Joram N, Chenouard A. Evolution of Carboxyhemoglobin in Children Supported by Extracorporeal Membrane Oxygenation: An Observational Single-Center Study. ASAIO J 2023; 69:879-884. [PMID: 37527636 DOI: 10.1097/mat.0000000000001983] [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] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Carboxyhemoglobin (COHb) is potentially a novel marker of hemolysis on extracorporeal membrane oxygenation (ECMO) and may be useful as an indicator for circuit-related complication in adults, but little is known about COHb levels in children. An observational single-center study was performed between January 2018 and December 2021. Fifty-eight children were included and COHb levels were obtained along with routine blood gas analysis before, during, and after ECMO support. From the 6th hour of ECMO support, the COHb level increased relative to the pre-ECMO level, with an adjusted mean difference of 0.44 (95% confidence interval [CI], 0.26-0.62; p < 0.001) and remained higher during ECMO run and within 6 hours after weaning ( p < 0.001). Among the 18 children (31%) who experienced at least one circuit-related complication leading to a circuit change, we observed a significant decrease in COHb levels within 24 hours after the circuit change, compared with the 24 hours before (adjusted mean difference, 0.54%; 95% CI, 0.27-0.80; p < 0.001). The maximal daily COHb level was able to predict circuit-related complications within 24 hours following COHb measurement with an area under the receiver operating characteristic (ROC) curve of 0.85 (95% CI, 0.77-0.92; p < 0.001).
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Affiliation(s)
- Orlane Brohan
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Jean-Michel Liet
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Thomas Dejoie
- Laboratoire de Biochimie, CHU Nantes, Nantes Université, Nantes, France
| | - Julien Jegard
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Aurélie Gaultier
- Direction de la Recherche et de l'innovation, Plateforme de méthodologie et biostatistique, CHU Nantes, Nantes Université, Nantes, France
| | - Pierre Bourgoin
- CHU Nantes, Nantes Université, Département d'Anesthésie, Nantes, France
| | - Nicolas Joram
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Alexis Chenouard
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
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5
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Joram N, Beqiri E, Pezzato S, Moscatelli A, Robba C, Liet JM, Chenouard A, Bourgoin P, Czosnyka M, Léger PL, Smielewski P. Correction: Continuous Monitoring of Cerebral Autoregulation in Children Supported by Extracorporeal Membrane Oxygenation: A Pilot Study. Neurocrit Care 2023:10.1007/s12028-023-01727-z. [PMID: 37131091 DOI: 10.1007/s12028-023-01727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Nicolas Joram
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.
- INSERM U955-ENVA, University Paris 12, Paris, France.
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Physiology and Transplantation, Milan University, Milan, Italy
| | - Stefano Pezzato
- Neonatal and Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Chiara Robba
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jean-Michel Liet
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Pierre-Louis Léger
- Pediatric Intensive Care Unit, Trousseau University Hospital, Paris, France
- INSERM U955-ENVA, University Paris 12, Paris, France
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Chahine A, Chenouard A, Joram N, Berthomieu L, Du Pont-Thibodeau G, Leclere B, Liet JM, Maminirina P, Leclair-Visonneau L, Breinig S, Bourgoin P. Continuous Amplitude-Integrated Electroencephalography During Neonatal and Pediatric Extracorporeal Membrane Oxygenation. J Clin Neurophysiol 2023; 40:317-324. [PMID: 34387276 DOI: 10.1097/wnp.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Early prognostication of neurologic outcome in neonates and children supported with extra-corporeal membrane oxygenation (ECMO) is challenging. Amplitude-integrated EEG (aEEG) offers the advantages of continuous monitoring and 24-hours availability at the bedside for intensive care unit providers. The objective of this study was to describe the early electrophysiological background patterns of neonates and children undergoing ECMO and their association with neurologic outcomes. METHODS This was a retrospective review of neonates and children undergoing ECMO and monitored with aEEG. Amplitude-integrated EEG was summarized as an aEEG background score determined within the first 24 hours of ECMO and divided in 3-hour periods. Screening for electrical seizures was performed throughout the full ECMO duration. Neurologic outcome was defined by the Pediatric Cerebral Performance Category score at hospital discharge. RESULTS Seventy-three patients (median age 79 days [8-660], median weight 4.78 kg [3.24-10.02]) were included in the analysis. Thirty-two patients had a favorable neurologic outcome and 41 had an unfavorable neurologic outcome group at hospital discharge. A 24-hour aEEG background score >17 was associated with an unfavorable outcome with a sensitivity of 44%, a specificity of 97%, a positive predictive value of 95%, and a negative predictive value of 57%. In multivariate analysis, 24-hour aEEG background score was associated with unfavorable outcome (hazard ratio, 6.1; p = 0.001; 95% confidence interval, 2.31-16.24). The presence of seizures was not associated with neurologic outcome at hospital discharge. CONCLUSIONS Continuous aEEG provides accurate neurologic prognostication in neonates and children supported with ECMO. Early aEEG monitoring may help intensive care unit providers to guide clinical care and family counseling.
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Affiliation(s)
- Adela Chahine
- Pediatric Intensive Care Unit, University Hospital, Toulouse, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | - Nicolas Joram
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | - Lionel Berthomieu
- Pediatric Intensive Care Unit, University Hospital, Toulouse, France
| | | | - Brice Leclere
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
| | - Jean-Michel Liet
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | | | | | - Sophie Breinig
- Pediatric Intensive Care Unit, University Hospital, Toulouse, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit and Pediatric Cardiac Anesthesia, University Hospital, Nantes, France
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Joram N, Beqiri E, Pezzato S, Moscatelli A, Robba C, Liet JM, Chenouard A, Bourgoin P, Czosnyka M, Léger PL, Smielewski P. Correction to: Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral Autoregulation Monitoring Among Children Supported by ECMO. Neurocrit Care 2023:10.1007/s12028-023-01728-y. [PMID: 37100979 DOI: 10.1007/s12028-023-01728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Nicolas Joram
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.
- Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France.
- INSERM U955‑ENVA, University Paris 12, Paris, France.
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Physiology and Transplantation, Milan University, Milan, Italy
| | - Stefano Pezzato
- Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Andrea Moscatelli
- Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Chiara Robba
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Policlinico San Martino IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Jean-Michel Liet
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
- Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
- Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
- Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Pierre-Louis Léger
- INSERM U955‑ENVA, University Paris 12, Paris, France
- Pediatric Intensive Care Unit, Trousseau University Hospital, Paris, France
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Bourgoin P, Jegard J, Joram N, Fox S, Biard M, Fernandez M, Baruteau AE, Dejoie T, Ferdynus C, Chenouard A. Effectiveness of intraoperative use of dexmedetomidine in reducing the incidence of tachyarrhythmia after congenital cardiac surgery in neonates and infants: a doubly robust method estimation analysis. Eur J Cardiothorac Surg 2023; 63:7067747. [PMID: 36864617 DOI: 10.1093/ejcts/ezad076] [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: 12/07/2022] [Revised: 02/03/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVES The antiarrhythmic effects of dexmedetomidine (DEX) have been suggested, but there are controversial reports on the effectiveness of intraoperative use of DEX to reduce the incidence of post operative tachyarrhythmia (POT). METHODS From a local ECHSA database, we included patients operated for congenital heart diseases (CHD) under cardiopulmonary bypass within a five-year period (2017-2021), during which intraoperative use of high dose of DEX (1-1.4 µg/kg/h) was implemented. A doubly robust matching estimation of the causal effect of DEX on the incidence of POT was conducted. We combined a multimodal estimation model in patients not exposed to DEX (Disease Risk Score) as well as a regression analysis in a matched cohort for patients exposured to DEX. RESULTS From a cohort of 593 surgeries (514 patients) occurring during the study period, doubly matched analysis consisted of the analysis of 426 surgeries conducted under DEX or not (213 per group). The probability of developing POT in patients exposed to DEX was 6.6% (95% CI 0.032-0.099) versus 14.5% (95% CI 0.098-0.193) in the group of patients not exposed to DEX. The doubly robust matched estimation method showed a mean reduction of 8.8% (95% CI -0.137 to -0.023)) of POT when DEX is used for intraoperative anaesthesia. CONCLUSION The use of high doses of DEX during anaesthesia for congenital heart surgery in neonates and infants is associated with a moderate but significant reduction of POT.
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Affiliation(s)
- Pierre Bourgoin
- Departement of Anesthesiology, University Hospital, Nantes, France.,Department of Pediatric Intensive Care, University Hospital, Nantes, France
| | - Julien Jegard
- Department of Pediatric Intensive Care, University Hospital, Nantes, France
| | - Nicolas Joram
- Department of Pediatric Intensive Care, University Hospital, Nantes, France
| | - Sylvain Fox
- Department of Cardiovascular Anaesthesia, University Hospital, La Réunion, France
| | - Marc Biard
- Departement of Anesthesiology, University Hospital, Nantes, France
| | | | - Alban Elouen Baruteau
- Department of congenital and pediatric cardiology, University Hospital, Nantes, France
| | - Thomas Dejoie
- Department of Biochemistry, University Hospital, Nantes, France
| | - Cyril Ferdynus
- Department of Biostatistics, Universtiy Hospital, La Réunion, France
| | - Alexis Chenouard
- Department of Pediatric Intensive Care, University Hospital, Nantes, France
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9
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Bourgoin P, Lecomte J, Oualha M, Berthomieu L, Pereira T, Davril E, Lamoureux F, Joram N, Chenouard A, Duflot T. Population Pharmacokinetics of Levosimendan and its Metabolites in Critically Ill Neonates and Children Supported or Not by Extracorporeal Membrane Oxygenation. Clin Pharmacokinet 2023; 62:335-348. [PMID: 36631687 DOI: 10.1007/s40262-022-01199-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Levosimendan (LVSMD) is a calcium-sensitizer inotropic and vasodilator agent whose use might have a beneficial effect on the weaning of venoarterial extracorporeal membrane oxygenation (VA-ECMO). In light of LVSMD pharmacological characteristics, we hypothesized that ECMO may induce major pharmacokinetic (PK) modifications for LVSMD and its metabolites. OBJECTIVE The aim of this study was to investigate the PK of LVSMD and its metabolites, and to assess the effects of ECMO on PK parameters. METHODS We conducted a multicentric, prospective study (NCT03681379). Twenty-seven infusions of LVSMD were performed, allowing for the collection of 255 blood samples. Non-linear mixed-effects modeling software (MONOLIX®) was used to develop a parent-metabolite PK model of LVSMD and its metabolites. RESULTS Most patients received a 0.2 µg/kg/min infusion of LVSMD over 24 h. After elimination of non-reliable samples or concentrations below the limit of quantification, 166, 101 and 85 samples were considered for LVSMD, OR-1855 and OR-1896, respectively, of which 81, 53 and 41, respectively, were drawn under ECMO conditions. Parent-metabolite PK modeling revealed that a two-compartment model with first-order elimination best described LVSMD PK. Use of a transit compartment allowed for an explanation of the delayed appearance of circulating OR-1855 and OR-1896, with the latter following a first-order elimination. Patient weight influenced the central volume of distribution and elimination of LVSMD. ECMO support increased the elimination rate of LVSMD by 78%, and ECMO also slowed down the metabolite formation rate by 85% for OR-1855, which in turn is converted to the active metabolite OR-1896, 14% slower than without ECMO. Simulated data revealed that standard dosing may not be appropriate for patients under ECMO, with a decrease in the steady-state concentration of LVSMD and lower exposure to the active metabolite OR-1896. CONCLUSIONS ECMO altered PK parameters for LVSMD and its metabolites. An infusion of LVSMD over 48 h, instead of 24 h, with a slightly higher dose may promote synthesis of the active metabolite OR-1896, which is responsible for the long-term efficacy of LVSMD. Further trials evaluating ECMO effects using a PK/pharmacodynamic approach may be of interest. REGISTRATION ClinicalTrials.gov identifier number NCT03681379.
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Affiliation(s)
- Pierre Bourgoin
- Pediatric Intensive Care Unit, CHU Nantes, 44093, Nantes, France. .,Department of Anesthesiology, CHU Nantes, 44093, Nantes, France.
| | - Jules Lecomte
- Department of Anesthesiology, CHU Nantes, 44093, Nantes, France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit, CHU Necker Enfants Malades, 75015, Paris, France
| | - Lionel Berthomieu
- Pediatric Intensive Care Unit, CHU Toulouse, 31059, Toulouse, France
| | - Tony Pereira
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Emeline Davril
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Fabien Lamoureux
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France.,Department of Pharmacology, CHU Rouen, 76000, Rouen, France
| | - Nicolas Joram
- Pediatric Intensive Care Unit, CHU Nantes, 44093, Nantes, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, CHU Nantes, 44093, Nantes, France
| | - Thomas Duflot
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France.,Department of Pharmacology, CHU Rouen, 76000, Rouen, France.,CHU Rouen, CIC-CRB U1404, 76000, Rouen, France
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10
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Bourgoin P, Lecomte J, Oualha M, Berthomieu L, Pereira T, Davril E, Lamoureux F, Joram N, Chenouard A, Duflot T. Correction to: Population Pharmacokinetics of Levosimendan and its Metabolites in Critically Ill Neonates and Children Supported or Not by Extracorporeal Membrane Oxygenation. Clin Pharmacokinet 2023; 62:349. [PMID: 36752992 DOI: 10.1007/s40262-023-01218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Pierre Bourgoin
- Pediatric Intensive Care Unit, CHU Nantes, 44093, Nantes, France. .,Department of Anesthesiology, CHU Nantes, 44093, Nantes, France.
| | - Jules Lecomte
- Department of Anesthesiology, CHU Nantes, 44093, Nantes, France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit, CHU Necker Enfants Malades, 75015, Paris, France
| | - Lionel Berthomieu
- Pediatric Intensive Care Unit, CHU Toulouse, 31059, Toulouse, France
| | - Tony Pereira
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Emeline Davril
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Fabien Lamoureux
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France.,Department of Pharmacology, CHU Rouen, 76000, Rouen, France
| | - Nicolas Joram
- Pediatric Intensive Care Unit, CHU Nantes, 44093, Nantes, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, CHU Nantes, 44093, Nantes, France
| | - Thomas Duflot
- INSERM U1096, UNIROUEN, Normandie University, 76000, Rouen, France.,Department of Pharmacology, CHU Rouen, 76000, Rouen, France.,CHU Rouen, CIC-CRB U1404, 76000, Rouen, France
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11
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Liet JM, Baleine J, Demaret P, Mounier S, Porcheret F, Joram N, Chenouard A. Semiautomated Regional Citrate Anticoagulation for Continuous Kidney Replacement Therapy: An Observational Study in Young Children. Pediatr Crit Care Med 2022; 23:e429-e433. [PMID: 35583226 DOI: 10.1097/pcc.0000000000002993] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To review use of semiautomated regional citrate anticoagulation (saRCA) for continuous kidney replacement therapy (CKRT) in young children. DESIGN Retrospective cohort study. SETTING Three independent PICUs. PATIENTS All consecutive children weighing less than 11 kg who received CKRT with saRCA from January 2015 to June 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-one children weighing less than 11 kg underwent CKRT with saRCA. The total duration of the CKRT was 2,014 hours, with a total of 64 CKRT sessions. Citrate intoxication occurred in four of 64 CKRT sessions (6%). Citrate intoxication was consistently observed in the few CKRT sessions where the initial lactate concentration was greater than 4 mmol/L or the ratio of replacement fluid flow to citrate flow less than 50%. The rate of unscheduled interruptions of CKRT sessions was 25% (16/64). CONCLUSIONS We have used saRCA for CKRT in children weighing less than 11 kg. A strict protocol and intensive training are required to minimize complications.
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Affiliation(s)
- Jean-Michel Liet
- Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, University Hospital of Nantes, Nantes, France
| | - Julien Baleine
- Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Pierre Demaret
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Chrétien, Liège, Belgium
| | - Sophie Mounier
- Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Florence Porcheret
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospital of Nantes, Nantes, France
| | - Nicolas Joram
- Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, University Hospital of Nantes, Nantes, France
| | - Alexis Chenouard
- Division of Pediatric Critical Care Medicine, Department of Neonatal Medicine and Pediatric Intensive Care, University Hospital of Nantes, Nantes, France
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12
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SMR SDMR, Federici L, Lesieur O, Sement A, Chagnon JL, Rigaud JP, Diehl JL, Dreyfuss D, Guiot P, Joram N, Outin H, Sevens C, Thévenin D, Touati S, Annane D, Terzi N. Evolution du capacitaire et des ressources humaines en réanimation après la première vague de la pandémie COVID-19 : une enquête du Syndicat des Médecins Réanimateurs. Méd Intensive Réa 2022. [DOI: 10.37051/mir-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
La France a connu au printemps 2020 une crise sanitaire sans précédent sur les plans sanitaire et sociétal due à la pandémie de COVID-19. Lors de cette première vague les hôpitaux ont fait face à un afflux important de patients dans les secteurs de Réanimation. Des mesures exceptionnelles ont été mises en place, pour permettre au système de soins de tenir. Au sortir de cette première vague des propositions ont été faites afin d’optimiser l’organisation des Soins Critiques. Dans ce contexte, nous avons mené une enquête auprès des services de Réanimation français en Janvier 2021, destinée à produire un état des lieux. L’objectif principal de cette enquête était de déterminer si les mesures revendiquées par les soignants et affichées par l’exécutif étaient effectives.
Nous avons mené une enquête déclarative visant à établir l’état des lieux des lits de Réanimation et des effectifs soignants avant et après la première vague de la pandémie à COVID-19 en France. Nous avons ainsi pu démontré qu’aucun des lits supplémentaires ouverts pendant la première vague épidémique n’a été pérennisé. Plus inquiétant, 13% des 114 services répondeurs soulignent que le ratio d’une infirmière pour 2,5 patients n’est pas respecté par manque de personnels formés et disponibles. Ces éléments confirment qu’à l’heure actuelle, aucune mesure n’a été prise pour améliorer un capacitaire historiquement et conjoncturellement déficitaire. Cette indispensable correction ne pourra s’opérer qu’avec le recrutement, la formation et la stabilisation d’équipes soignantes spécialisées, médicales et paramédicales.
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13
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Chenouard A, Liet JM, Maminirina P, Denis M, Tonna J, Rycus P, Joram N, Bourgoin P. Neurological Outcome According to the Site of Cannulation in Septic Children Supported by Venoarterial Extracorporeal Membrane Oxygenation. ASAIO J 2021; 67:1349-1355. [PMID: 34264870 DOI: 10.1097/mat.0000000000001532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72-2.65; P = 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34-5.49; P = 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37-4.82; P = 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population.
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Affiliation(s)
| | | | | | | | - Joseph Tonna
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Uttah
| | - Peter Rycus
- Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan
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14
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Bourgoin P, Aubert L, Joram N, Launay E, Beuchee A, Roue JM, Baruteau A, Fernandez M, Pavy C, Baron O, Flamant C, Liet JM, Ozanne B, Chenouard A. Frequency of Extracorporeal Membrane Oxygenation Support and Outcomes After Implementation of a Structured PICU Network in Neonates and Children: A Prospective Population-Based Study in the West of France. Pediatr Crit Care Med 2021; 22:e558-e570. [PMID: 33950889 DOI: 10.1097/pcc.0000000000002748] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the frequency and outcomes on the use of extracorporeal membrane oxygenation (ECMO) among critically ill neonates and children within a structured pediatric critical care network in the West of France. To assess the optimality of decision-making process for patients primarily admitted in non-ECMO centers. DESIGN Observational prospective population-based study from January 2015 to December 2019. PATIENTS Neonates over 34 weeks of gestational age, weighing more than 2,000 g and children under 15 years and 3 months old admitted in one of the 10 units belonging to a Regional Pediatric Critical Care Network. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eight-thousand one hundred eighty-nine children and 3,947 newborns were admitted within one of the 10 units of the network over the study period. Sixty-five children (8.1% [95% CI, 6.2-10‰]) and 35 newborns (9.4% [95% CI, 6.4-12%]) required ECMO support. Of these patients, 31 were first admitted to a non-ECMO center, where 20 were cannulated in situ (outside the regional ECMO center) and 11 after transfer to the ECMO regional center. Cardiogenic shock, highest serum lactate level, and cardiac arrest prior to first phone call with the regional ECMO center were associated with higher rate of in situ cannulation. During the study period, most of the patients were cannulated for underlying cardiac issue (42/100), postoperative cardiac surgery instability (38/100), and pediatric (10/100) and neonatal (10/100) respiratory distress syndrome. Patients primarily admitted in non-ECMO centers or not had similar 28-day post-ICU survival rates compared with those admitted in the referral ECMO center (58% vs 51%; p = 0.332). Pre-ECMO cardiac arrest, ECMO, and lower pH at ECMO onset were associated with lower 28-day post-ICU survival. CONCLUSIONS Our local results suggest that a structured referral network for neonatal and pediatric ECMO in the region of Western France facilitated escalation of care with noninferior (or similar) early mortality outcome. Our data support establishing referral networks in other equivalent regions.
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Affiliation(s)
- Pierre Bourgoin
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
- Department of Anesthesiology, University Hospital, Nantes, France
| | - Lucie Aubert
- Department of Pediatrics, University Hospital, Rennes, France
| | - Nicolas Joram
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | - Elise Launay
- Department of Pediatrics, University Hospital, Nantes, France
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre of Research in Epidemiology and StatisticS (CRESS), University of Paris, Paris, France
| | - Alain Beuchee
- Department of Pediatrics, Neonatal Intensive Care Unit, University Hospital, Rennes, France
| | - Jean Michel Roue
- Neonatal and Pediatric Intensive Care Unit, University Hospital, Brest, France
| | - Alban Baruteau
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Modesto Fernandez
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
- Department of Anesthesiology, University Hospital, Nantes, France
| | - Carine Pavy
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Olivier Baron
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Cyril Flamant
- Department of Pediatrics, Neonatal Intensive Care Unit, University Hospital, Nantes, France
| | - Jean Michel Liet
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | - Bruno Ozanne
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital, Rennes, France
| | - Alexis Chenouard
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital, Nantes, France
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15
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Joram N, Beqiri E, Pezzato S, Andrea M, Robba C, Liet JM, Chenouard A, Bourgoin P, Czosnyka M, Léger PL, Smielewski P. Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral Autoregulation Monitoring Among Children Supported by ECMO. Neurocrit Care 2021; 35:480-490. [PMID: 33686559 DOI: 10.1007/s12028-021-01201-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/29/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cerebral autoregulation (CA) impairment is associated with neurological complications among children supported by extracorporeal membrane oxygenation (ECMO). Severe variations of arterial CO2 (PaCO2) and O2 (PaO2) tension after ECMO onset are common and associate with mortality and poor neurological outcome. The impact of gas exchange on CA among critically ill patients is poorly studied. METHODS Retrospective analysis of data collected prospectively from 30 children treated with veno-arterial or veno-venous ECMO in the PICU of Nantes University Hospital, France. A correlation coefficient between the variations of regional cerebral oxygen saturation (rSO2) and the variations of mean arterial blood pressure (MAP) was calculated as an index of CA (cerebral oxygenation reactivity index, COx). Cox-MAP plots were investigated allowing determining lower limit of autoregulation (LLA) and upper limit of autoregulation (ULA) limits of autoregulation. Age-based normal blood pressure was used to adjust the MAP, LLA, and ULA data from each patient and then reported as percentage (nMAP, nLLA, and nULA, respectively). RSO2, COx, nMAP, nLLA, and nULA values were averaged over one hour before each arterial blood gas (ABG) sample during ECMO run. RESULTS Thirty children (median age 4.8 months [Interquartile range (IQR) 0.7-39.1], median weight 5 kg [IQR 4-15]) experiencing 31 ECMO runs were included in the study. Three hundred and ninety ABGs were analyzed. The highest values of COx were observed on day 1 (D1) of ECMO. The relationship between COx and PaCO2 was nonlinear, but COx values tended to be lower in case of hypercapnia compared to normocapnia. During the whole ECMO run, a weak but significant correlation between PaCO2 and nULA was observed (R = 0.432, p = 0.02). On D1 of ECMO, this correlation was stronger (R = 0.85, p = 0.03) and a positive correlation between nLLA and PaCO2 was also found (R = 0.726, p < 0.001). A very weak negative correlation between PaO2 and nULA was observed within the whole ECMO run and on D1 of ECMO (R = -0.07 p = 0.04 and R = -0.135 p = <0.001, respectively). The difference between nULA and nLLA representing the span of the autoregulation plateau was positively correlated with PaCO2 and negatively correlated with PaO2 (R = 0.224, p = 0.01 and R = -0.051, p = 0.004, respectively). CONCLUSIONS We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.
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Affiliation(s)
- Nicolas Joram
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France. .,Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France. .,INSERM U955-ENVA, University Paris 12, Paris, France.
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Physiology and Transplantation, Milan University, Milan, Italy
| | - Stefano Pezzato
- Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Moscatelli Andrea
- Pediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Chiara Robba
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Jean-Michel Liet
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France
| | - Alexis Chenouard
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.,Clinical Investigation Center (CIC) 1413, University Hospital of Nantes, Nantes, France
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Pierre-Louis Léger
- INSERM U955-ENVA, University Paris 12, Paris, France.,Pediatric Intensive Care Unit, Trousseau University Hospital, Paris, France
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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16
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Denamur S, Chenouard A, Lefort B, Baron O, Neville P, Baruteau A, Joram N, Chantreuil J, Bourgoin P. Outcome analysis of a conservative approach to diaphragmatic paralysis following congenital cardiac surgery in neonates and infants: a bicentric retrospective study. Interact Cardiovasc Thorac Surg 2021; 33:597-604. [PMID: 34000037 DOI: 10.1093/icvts/ivab123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Diaphragmatic paralysis following congenital cardiac surgery is associated with significant morbidity and mortality. Spontaneous recovery of diaphragmatic function has been described, contrasting with centres providing early diaphragmatic plication. We aimed to describe the outcomes of a conservative approach, as well as to identify factors associated with a failure of the strategy. METHODS This is a retrospective study of patients admitted after cardiac surgery and suffering unilateral diaphragmatic paralysis within 2 French Paediatric Cardiac Surgery Centers. The conservative approach, defined by the prolonged use of ventilation until successful weaning from respiratory support, was the primary strategy adopted in both centres. In case of unsuccessful evolution, a diaphragmatic plication was scheduled. Total ventilation time included invasive and non-invasive ventilation. Diaphragm asymmetry was defined by the number of posterior rib segments counted between the 2 hemi-diaphragms on the chest X-ray after cardiac surgery. RESULTS Fifty-one neonates and infants were included in the analysis. Patients' median age was 12.0 days at cardiac surgery (5.0-82.0), and median weight was 3.5 kg (2.8-4.9). The conservative approach was successful for 32/51 patients (63%), whereas 19/51 patients (37%) needed diaphragm plication. There was no difference in patients' characteristics between groups. Respiratory support prolonged for 21 days or more and diaphragm asymmetry more than 2 rib segments were independently associated with the failure of the conservative strategy [odds ratio (OR) 6.9 (1.29-37.3); P = 0.024 and OR 6.0 (1.4-24.7); P = 0.013, respectively]. CONCLUSIONS The conservative approach was successful for 63% of the patients. We identified risk factors associated with the strategy's failure.
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Affiliation(s)
- Sophie Denamur
- Department of Pediatrics, Pediatric Pneumology, University Hospital, Tours, France
| | - Alexis Chenouard
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Bruno Lefort
- Department of Pediatric Cardiology, University Hospital, Tours, France
| | - Olivier Baron
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Paul Neville
- Department of Congenital Cardiac Surgery, University Hospital, Tours, France
| | - Alban Baruteau
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Nicolas Joram
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France
| | - Julie Chantreuil
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital, Tours, France
| | - Pierre Bourgoin
- Department of Pediatric Cardiology and Congenital Cardiac Surgery, University Hospital, Nantes, France.,Department of Anesthesiology, University Hospital, Nantes, France
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17
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Chenouard A, Rimbert M, Joram N, Braudeau C, Roquilly A, Bourgoin P, Asehnoune K. Monocytic Human Leukocyte Antigen DR Expression in Young Infants Undergoing Cardiopulmonary Bypass. Ann Thorac Surg 2021; 111:1636-1642. [PMID: 32652073 DOI: 10.1016/j.athoracsur.2020.05.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/20/2019] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Monocytic human leukocyte antigen DR (mHLA-DR) expression levels have been reported to be a marker of immunosuppression and a predictor of sepsis and mortality. There are, however, scant data regarding mHLA-DR monitoring in young infants after cardiopulmonary bypass. Our objectives were to investigate the kinetics of mHLA-DR expression and to determine whether mHLA-DR levels are associated with healthcare-associated infection (HAI) after cardiopulmonary bypass in young infants. METHODS mHLA-DR levels were analyzed by flow cytometry using a standardized method in 49 infants (<3 months old) with congenital heart disease before and after cardiopulmonary bypass. Results are expressed as the number of anti-HLA-DR antibodies per cell (AB/c). RESULTS Postoperative mHLA-DR expression was reduced in all infants. Eleven patients (22%) developed HAI, and 4 patients (8%) died during the 30-day follow-up. mHLA-DR expression was significantly lower on postoperative day 4 in the HAI group compared with those who without HAI (3768 AB/c [range, 1938-6144] vs 13,230 AB/c [range, 6152-19,130], P = .014). Although mHLA-DR expression was associated with postoperative severity, mHLA-DR ≤4500 AB/c in the first 72 hours among patients with higher postoperative severity (extracorporeal membrane oxygenation and/or corticoids and/or delayed closure of sternum) was associated with occurrence of HAI in the univariate analysis (odds ratio, 6.3; 95% confidence interval, 1.0-38.7; P = .037). CONCLUSIONS Cardiopulmonary bypass induces a profound decrease in mHLA-DR expression in young infants. Among patients with higher postoperative severity, low level of mHLA-DR in the early postoperative period is associated with the development of HAI.
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Affiliation(s)
| | - Marie Rimbert
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Nicolas Joram
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Cécile Braudeau
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Antoine Roquilly
- CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - Pierre Bourgoin
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Karim Asehnoune
- CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
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18
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Annane D, Federici L, Chagnon JL, Diehl JL, Dreyfuss D, Guiot P, Javouhey E, Joram N, Lesieur O, Rigaud JP, Outin H, Sement A, Sevens C, Thévenin D, Touati S, Terzi N. Intensive care units, the Achilles heel of France in the COVID-19 battle. Lancet Reg Health Eur 2021; 2:100046. [PMID: 34173634 PMCID: PMC7844353 DOI: 10.1016/j.lanepe.2021.100046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Djillali Annane
- General Intensive Care Unit, Hôpital Raymond Poincaré (APHP), Université de Versailles SQY and Université Paris Saclay, 104 boulevard Raymond Poincaré, 92380 Garches, France
| | - Laura Federici
- Intensive Care Unit, CH Sud Francilien, 116, Boulevard Jean Jaurès 91106 CORBEIL-ESSONNES, France
| | - Jean-Luc Chagnon
- General Intensive Care Unit, Centre hospitalier de Valencienne, Valencienne, France
| | - Jean Luc Diehl
- Service de médecine intensive, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | | | - Philippe Guiot
- General Intensive Care Unit, GHR Mulhouse Sud Alsace, Mulhouse, France
| | - Etienne Javouhey
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Nicolas Joram
- Service de réanimation Pédiatrique, CHU Nantes, France
| | - Olivier Lesieur
- Intensive Care Unit, Saint Louis Hospital, La Rochelle, France
| | | | - Hervé Outin
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy - Saint-Germain-en-Laye 10 rue du Champ Gaillard, BP 3082 - 78303 Poissy Cedex, France
| | - Arnaud Sement
- Réanimation Polyvalente, Centre Hospitalier Mont de Marsan, Urrugne, Nouvelle-Aquitaine, France
| | - Chantal Sevens
- Union Trade of Intensive Care Physicians, Maison de la Réanimation, 50 Avenue Claude Vellefaux, Paris, France
| | - Didier Thévenin
- Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Samia Touati
- Réanimation medico-chirurgicale, Groupement hospitalier public du sud de l'Oise, Creil, France
| | - Nicolas Terzi
- INSERM U1042, University Grenoble Alpes, Medical Intensive Care Unit, Grenoble, France
| | - Trade Union of Intensive Care Physicians
- General Intensive Care Unit, Hôpital Raymond Poincaré (APHP), Université de Versailles SQY and Université Paris Saclay, 104 boulevard Raymond Poincaré, 92380 Garches, France
- General Intensive Care Unit, Centre hospitalier de Valencienne, Valencienne, France
- Service de médecine intensive, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
- Université de Paris, INSERM UMR S1155, Paris, France
- Intensive Care Unit, CH Sud Francilien, 116, Boulevard Jean Jaurès 91106 CORBEIL-ESSONNES, France
- General Intensive Care Unit, GHR Mulhouse Sud Alsace, Mulhouse, France
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
- Service de réanimation Pédiatrique, CHU Nantes, France
- Intensive Care Unit, Saint Louis Hospital, La Rochelle, France
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy - Saint-Germain-en-Laye 10 rue du Champ Gaillard, BP 3082 - 78303 Poissy Cedex, France
- Intensive Care Unit, Dieppe General Hospital, Dieppe, France
- Réanimation Polyvalente, Centre Hospitalier Mont de Marsan, Urrugne, Nouvelle-Aquitaine, France
- Union Trade of Intensive Care Physicians, Maison de la Réanimation, 50 Avenue Claude Vellefaux, Paris, France
- Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
- Réanimation medico-chirurgicale, Groupement hospitalier public du sud de l'Oise, Creil, France
- INSERM U1042, University Grenoble Alpes, Medical Intensive Care Unit, Grenoble, France
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19
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Chenouard A, Toulgoat F, Rolland A, Liet JM, Maminirina P, Joram N, Bourgoin P. Right watershed cerebral infarction following neck cannulation for veno-arterial extracorporeal membrane oxygenation in pediatric septic shock: a case series. Perfusion 2020; 36:293-298. [PMID: 32755274 DOI: 10.1177/0267659120946724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Children supported by extracorporeal membrane oxygenation present a high risk of neurological complications. Although carotid cannulation is known to be associated with neurologic injury, conflicting data exist with regard to the predominance of right- or left-sided lesions. We describe here two infants requiring veno-arterial extracorporeal membrane oxygenation for septic shock who encountered right watershed infarction ipsilateral to carotid artery cannulation. Hemodynamic failure seems to be the most probable underlying mechanism. The asymmetry of transcranial Doppler metrics in one case and the low right regional cerebral oxygen saturation value observed soon after right cannulation in both cases suggest an insufficient cerebral collateral flow compensation. The risk of ipsilateral watershed injury should be considered before cervical cannulation, notably in the context of sepsis and an evaluation of the cerebral collateral blood flow before and just after cannulation may be interesting in order to identify infants with higher risk of ipsilateral ischemic lesions.
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Affiliation(s)
- Alexis Chenouard
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | | | - Anne Rolland
- Department of Neurology, University Hospital, Nantes, France
| | - Jean-Michel Liet
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | | | - Nicolas Joram
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, University Hospital, Nantes, France
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20
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Gillet B, Joram N, Bacchi VF, Thomas C, Béné MC, Wuillème S. Neisseria meningitidis inside neutrophils, revealing properdin deficiency. Int J Infect Dis 2020; 99:117-118. [PMID: 32717395 DOI: 10.1016/j.ijid.2020.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Benjamin Gillet
- Service d'Hématologie Biologique, Centre Hospitalier Universitaire, Nantes, France
| | - Nicolas Joram
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire, Nantes, France
| | | | - Caroline Thomas
- Service d'Hématologie et Immunologie Pédiatrique, Centre Hospitalier Universitaire, Nantes, France
| | - Marie C Béné
- Service d'Hématologie Biologique, Centre Hospitalier Universitaire, Nantes, France
| | - Soraya Wuillème
- Service d'Hématologie Biologique, Centre Hospitalier Universitaire, Nantes, France.
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21
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Bourgoin P, Savary M, Leger PL, Mauriat P, Demaret P, Joram N, Alacoque X. Neonatal and pediatric ECMO organization in France: A national survey. Arch Pediatr 2020; 26:342-346. [PMID: 31500921 DOI: 10.1016/j.arcped.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/02/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) in France has increased since the H1N1 pandemic in 2009. By contrast, neonatal and pediatric ECMO support in France was known to be limited to a few centers offering congenital cardiac surgery. The purpose of this survey conducted in 2017 was to identify the neonatal and pediatric ECMO centers in France as well as networks existing between ECMO and non-ECMO centers. RESULTS Seventy-two neonatal or pediatric intensive care unit medical directors answered the survey (84% of the centers surveyed). Twenty were identified as ECMO centers, defined as a unit able to start ECMO with its own resources. ECMO centers ranged from 470,000 to 1,180,000 inhabitants (neonates or children under 18). Thirteen of them (65%) reported that they were affiliated with a congenital cardiac surgery department. A total of 187 patients were supported with ECMO in these centers in 2016. Only six of these centers estimated an activity greater than 15 cases per year over the last 5 years. Nearly 30% of ECMO runs were indicated before or after congenital heart surgery. Four of the ECMO centers offered off-site facilities (mobile team). Non-ECMO centers are likely to be neonatal intensive care units. Nine of them (18.7%) declared knowing an ECMO center that provided mobile care with predefined organization, 11 (22.9%) reported knowing an ECMO center providing a mobile activity without predefined organization, nine (18.%), and 18 (37.5%) ICUs declared they knew of the existence of an ECMO program but did not report any possibility of mobile care or any procedure for transfer. CONCLUSIONS Of the centers reporting the highest case volumes, four offered mobile ECMO abilities. Well-organized networks for the most severe neonates and children were not identified in France.
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Affiliation(s)
- P Bourgoin
- Pediatric Intensive Care Unit, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
| | - M Savary
- Pediatric Intensive Care Unit, CHU La Martinique, Fort-de-France, Martinique
| | - P-L Leger
- Pediatric and Neonatal Intensive Care Unit, CHU Trousseau, 75012 Paris, France
| | - P Mauriat
- Cardiace Intensive Care Unit, CHU Pessac Bordeaux, 33600 Pessac, France
| | | | - N Joram
- Pediatric Intensive Care Unit, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France
| | - X Alacoque
- Department of Anesthesiology, CHU Toulouse, 31300 Toulouse, France
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22
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Pedersen DV, Gadeberg TAF, Thomas C, Wang Y, Joram N, Jensen RK, Mazarakis SMM, Revel M, El Sissy C, Petersen SV, Lindorff-Larsen K, Thiel S, Laursen NS, Fremeaux-Bacchi V, Andersen GR. Structural Basis for Properdin Oligomerization and Convertase Stimulation in the Human Complement System. Front Immunol 2019; 10:2007. [PMID: 31507604 PMCID: PMC6713926 DOI: 10.3389/fimmu.2019.02007] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 12/05/2022] Open
Abstract
Properdin (FP) is a positive regulator of the immune system stimulating the activity of the proteolytically active C3 convertase C3bBb in the alternative pathway of the complement system. Here we present two crystal structures of FP and two structures of convertase bound FP. A structural core formed by three thrombospondin repeats (TSRs) and a TB domain harbors the convertase binding site in FP that mainly interacts with C3b. Stabilization of the interaction between the C3b C-terminus and the MIDAS bound Mg2+ in the Bb protease by FP TSR5 is proposed to underlie FP convertase stabilization. Intermolecular contacts between FP and the convertase subunits suggested by the structure were confirmed by binding experiments. FP is shown to inhibit C3b degradation by FI due to a direct competition for a common binding site on C3b. FP oligomers are held together by two sets of intermolecular contacts, where the first is formed by the TB domain from one FP molecule and TSR4 from another. The second and largest interface is formed by TSR1 and TSR6 from the same two FP molecules. Flexibility at four hinges between thrombospondin repeats is suggested to enable the oligomeric, polydisperse, and extended architecture of FP. Our structures rationalize the effects of mutations associated with FP deficiencies and provide a structural basis for the analysis of FP function in convertases and its possible role in pattern recognition.
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Affiliation(s)
- Dennis V. Pedersen
- Department of Molecular Biology and Genetics, Center for Structural Biology, Aarhus University, Aarhus, Denmark
| | - Trine A. F. Gadeberg
- Department of Molecular Biology and Genetics, Center for Structural Biology, Aarhus University, Aarhus, Denmark
| | - Caroline Thomas
- Service d'Oncologie Pédiatrique, CHU Nantes, Hôpital Mère Enfant, Nantes, France
| | - Yong Wang
- Department of Biology, Linderstrøm-Lang Centre for Protein Science, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Joram
- Service de Réanimation Pédiatrique, CHU Nantes, Nantes, France
| | - Rasmus K. Jensen
- Department of Molecular Biology and Genetics, Center for Structural Biology, Aarhus University, Aarhus, Denmark
| | - Sofia M. M. Mazarakis
- Department of Molecular Biology and Genetics, Center for Structural Biology, Aarhus University, Aarhus, Denmark
| | - Margot Revel
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Carine El Sissy
- Service d'Immunologie Biologique, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Kresten Lindorff-Larsen
- Department of Biology, Linderstrøm-Lang Centre for Protein Science, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Nick S. Laursen
- Department of Molecular Biology and Genetics, Center for Structural Biology, Aarhus University, Aarhus, Denmark
| | - Véronique Fremeaux-Bacchi
- Service d'Immunologie Biologique, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Gregers R. Andersen
- Department of Molecular Biology and Genetics, Center for Structural Biology, Aarhus University, Aarhus, Denmark
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23
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Karolak JA, Vincent M, Deutsch G, Gambin T, Cogné B, Pichon O, Vetrini F, Mefford HC, Dines JN, Golden-Grant K, Dipple K, Freed AS, Leppig KA, Dishop M, Mowat D, Bennetts B, Gifford AJ, Weber MA, Lee AF, Boerkoel CF, Bartell TM, Ward-Melver C, Besnard T, Petit F, Bache I, Tümer Z, Denis-Musquer M, Joubert M, Martinovic J, Bénéteau C, Molin A, Carles D, André G, Bieth E, Chassaing N, Devisme L, Chalabreysse L, Pasquier L, Secq V, Don M, Orsaria M, Missirian C, Mortreux J, Sanlaville D, Pons L, Küry S, Bézieau S, Liet JM, Joram N, Bihouée T, Scott DA, Brown CW, Scaglia F, Tsai ACH, Grange DK, Phillips JA, Pfotenhauer JP, Jhangiani SN, Gonzaga-Jauregui CG, Chung WK, Schauer GM, Lipson MH, Mercer CL, van Haeringen A, Liu Q, Popek E, Coban Akdemir ZH, Lupski JR, Szafranski P, Isidor B, Le Caignec C, Stankiewicz P. Complex Compound Inheritance of Lethal Lung Developmental Disorders Due to Disruption of the TBX-FGF Pathway. Am J Hum Genet 2019; 104:213-228. [PMID: 30639323 DOI: 10.1016/j.ajhg.2018.12.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/13/2018] [Indexed: 12/24/2022] Open
Abstract
Primary defects in lung branching morphogenesis, resulting in neonatal lethal pulmonary hypoplasias, are incompletely understood. To elucidate the pathogenetics of human lung development, we studied a unique collection of samples obtained from deceased individuals with clinically and histopathologically diagnosed interstitial neonatal lung disorders: acinar dysplasia (n = 14), congenital alveolar dysplasia (n = 2), and other lethal lung hypoplasias (n = 10). We identified rare heterozygous copy-number variant deletions or single-nucleotide variants (SNVs) involving TBX4 (n = 8 and n = 2, respectively) or FGF10 (n = 2 and n = 2, respectively) in 16/26 (61%) individuals. In addition to TBX4, the overlapping ∼2 Mb recurrent and nonrecurrent deletions at 17q23.1q23.2 identified in seven individuals with lung hypoplasia also remove a lung-specific enhancer region. Individuals with coding variants involving either TBX4 or FGF10 also harbored at least one non-coding SNV in the predicted lung-specific enhancer region, which was absent in 13 control individuals with the overlapping deletions but without any structural lung anomalies. The occurrence of rare coding variants involving TBX4 or FGF10 with the putative hypomorphic non-coding SNVs implies a complex compound inheritance of these pulmonary hypoplasias. Moreover, they support the importance of TBX4-FGF10-FGFR2 epithelial-mesenchymal signaling in human lung organogenesis and help to explain the histopathological continuum observed in these rare lethal developmental disorders of the lung.
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MESH Headings
- DNA Copy Number Variations/genetics
- Female
- Fibroblast Growth Factor 10/genetics
- Fibroblast Growth Factor 10/metabolism
- Gene Expression Regulation
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/mortality
- Infant, Newborn, Diseases/pathology
- Lung/embryology
- Lung/growth & development
- Lung Diseases/genetics
- Lung Diseases/metabolism
- Lung Diseases/mortality
- Lung Diseases/pathology
- Male
- Maternal Inheritance
- Organogenesis
- Paternal Inheritance
- Pedigree
- Polymorphism, Single Nucleotide/genetics
- Receptor, Fibroblast Growth Factor, Type 2/metabolism
- Signal Transduction/genetics
- T-Box Domain Proteins/genetics
- T-Box Domain Proteins/metabolism
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Affiliation(s)
- Justyna A Karolak
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Marie Vincent
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | - Gail Deutsch
- Department of Pathology, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Tomasz Gambin
- Department of Medical Genetics, Institute of Mother and Child, 01-211 Warsaw, Poland; Institute of Computer Science, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - Benjamin Cogné
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | - Olivier Pichon
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France
| | | | - Heather C Mefford
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jennifer N Dines
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Katie Golden-Grant
- Division of Genetic Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Katrina Dipple
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA; Division of Genetic Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Amanda S Freed
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Kathleen A Leppig
- Genetic Services Kaiser Permanente of Washington, Seattle, WA 98112, USA
| | - Megan Dishop
- Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick Sydney, NSW 2031 Australia; School of Women's and Children's Health, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Bruce Bennetts
- Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Molecular Genetics Department, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Andrew J Gifford
- School of Women's and Children's Health, The University of New South Wales, Sydney, NSW 2052, Australia; Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Martin A Weber
- Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anna F Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Cornelius F Boerkoel
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Tina M Bartell
- Department of Genetics, Kaiser Permanente Sacramento Medical Center, Sacramento, CA 95815, USA
| | | | - Thomas Besnard
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | - Florence Petit
- Service de Génétique Clinique, CHU Lille, 59000 Lille, France
| | - Iben Bache
- Department of Cellular and Molecular Medicine, University of Copenhagen, 2200 N Copenhagen, Denmark; Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, 2100 Ø Copenhagen, Denmark
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Copenhagen, Denmark; Deparment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 N, Copenhagen, Denmark
| | | | | | - Jelena Martinovic
- Unit of Fetal Pathology, AP-HP, Antoine Beclere Hospital, 75000 Paris, France
| | - Claire Bénéteau
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | - Arnaud Molin
- Service de Génétique Médicale, CHU Caen, 14000 Caen, France
| | - Dominique Carles
- Service d'anatomo-pathologie, CHU Bordeaux, 33000 Bordeaux, France
| | - Gwenaelle André
- Service d'anatomo-pathologie, CHU Bordeaux, 33000 Bordeaux, France
| | - Eric Bieth
- Service de génétique médicale, CHU Toulouse, France and UDEAR, UMR 1056 Inserm - Université de Toulouse, 31000 Toulouse, France
| | - Nicolas Chassaing
- Service de génétique médicale, CHU Toulouse, France and UDEAR, UMR 1056 Inserm - Université de Toulouse, 31000 Toulouse, France
| | | | | | | | - Véronique Secq
- Aix Marseille Univ, APHM, Hôpital Nord, Service d'anatomo-pathologie, 13000 Marseille, France
| | - Massimiliano Don
- Sant'Antonio General Hospital, Pediatric Care Unit, San Daniele del Friuli, 33100 Udine, Italy
| | - Maria Orsaria
- Department of Medical and Biological Sciences, Pathology Unit, University of Udine, Udine, Italy
| | - Chantal Missirian
- Aix Marseille Univ, APHM, INSERM, MMG, Marseille, Timone Hospital, 13000 Marseille, France
| | - Jérémie Mortreux
- Aix Marseille Univ, APHM, INSERM, MMG, Marseille, Timone Hospital, 13000 Marseille, France
| | - Damien Sanlaville
- Hospices Civils de Lyon, GHE, Genetics department, and Lyon University, 69000 Lyon, France
| | - Linda Pons
- Hospices Civils de Lyon, GHE, Genetics department, and Lyon University, 69000 Lyon, France
| | - Sébastien Küry
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | - Stéphane Bézieau
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | - Jean-Michel Liet
- Service de réanimation pédiatrique, CHU Nantes, 44000 Nantes, France
| | - Nicolas Joram
- Service de réanimation pédiatrique, CHU Nantes, 44000 Nantes, France
| | | | - Daryl A Scott
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chester W Brown
- Department of Pediatrics, Genetics Division, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Fernando Scaglia
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA; Joint BCM-CUHK Center of Medical Genetics, Prince of Wales Hospital, ShaTin, New Territories, Hong Kong SAR
| | - Anne Chun-Hui Tsai
- Department of Pediatrics, The Children's Hospital, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Dorothy K Grange
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - John A Phillips
- Department of Pediatrics, Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jean P Pfotenhauer
- Department of Pediatrics, Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY 10032, USA
| | - Galen M Schauer
- Department of Pathology, Kaiser Permanente Oakland Medical Center, Oakland, CA 94611, USA
| | - Mark H Lipson
- Department of Genetics, Kaiser Permanente Sacramento Medical Center, Sacramento, CA 95815, USA
| | - Catherine L Mercer
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton SO16 5YA, UK
| | - Arie van Haeringen
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Qian Liu
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Edwina Popek
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zeynep H Coban Akdemir
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - James R Lupski
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Przemyslaw Szafranski
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bertrand Isidor
- Service de Génétique Médicale, CHU de Nantes, 44000 Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, 44000 Nantes, France
| | | | - Paweł Stankiewicz
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Baylor Genetics, Houston, TX 77021, USA; Institute of Mother and Child, 01-211 Warsaw, Poland.
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Recher M, Bertrac C, Guillot C, Baudelet JB, Karaca‐Altintas Y, Hubert H, Leclerc F, Leteurtre S, Devictor D, Chevret L, Javouhey E, Vanel B, Valla F, Cambonie G, Milesi C, Liet J, Joram N, Hubert P, Dupic L, Ozanne B, Tirel O, Dauger S, Desprez P, Chantreuil J. Enhance quality care performance: Determination of the variables for establishing a common database in French paediatric critical care units. J Eval Clin Pract 2018; 24:767-771. [PMID: 29987866 PMCID: PMC6174952 DOI: 10.1111/jep.12984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
Selected variables for the French Paediatric Intensive Care registry. RATIONALE, AIMS, AND OBJECTIVES Providing quality care requires follow-up in regard to clinical and economic activities. Over the past decade, medical databases and patient registries have expanded considerably, particularly in paediatric critical care medicine (eg, the Paediatric Intensive Care Audit Network (PICANet) in the UK, the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry in Australia and New Zealand, and the Virtual Paediatric Intensive Care Unit Performance System (VPS) in the USA). Such a registry is not yet available in France. The aim of this study was to determine variables that ought to be included in a French paediatric critical care registry. METHODS Variables, items, and subitems from 3 foreign registries and 2 French local databases were used. Items described each variable, and subitems described items. The Delphi method was used to evaluate and rate 65 variables, 90 items, and 17 subitems taking into account importance or relevance based on input from 28 French physicians affiliated with the French Paediatric Critical Care Group. Two ratings were used between January and May 2013. RESULTS Fifteen files from 10 paediatric intensive care units were included. Out of 65 potential variables, 48 (74%) were considered to be indispensable, 16 (25%) were considered to be optional, and 1 (2%) was considered to be irrelevant. Out of 90 potential items, 62 (69%) were considered to be relevant, 23 (26%) were considered to be of little relevance, and 5 (6%) were considered to be irrelevant. Out of 17 potential subitems, 9 (53%) were considered to be relevant, 6 (35%) were considered to be of little relevance, and 2 (12%) were considered to be irrelevant. CONCLUSIONS The necessary variables that ought to be included in a French paediatric critical care registry were identified. The challenge now is to develop the French registry for paediatric intensive care units.
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Affiliation(s)
- Morgan Recher
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
| | | | | | - Jean Benoit Baudelet
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
| | | | - Hervé Hubert
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
- French National Out‐of‐Hospital Cardiac Arrest Registry (RéAC)LilleFrance
| | - Francis Leclerc
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
| | - Stéphane Leteurtre
- CHU Lille, Réanimation PédiatriqueF‐59000LilleFrance
- Univ. LilleEA 2694—Santé Publique: épidémiologie et qualité des soinsF‐59000LilleFrance
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25
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Chenouard A, Braudeau C, Cottron N, Bourgoin P, Salabert N, Roquilly A, Josien R, Joram N, Asehnoune K. HLA-DR expression in neonates after cardiac surgery under cardiopulmonary bypass: a pilot study. Intensive Care Med Exp 2018; 6:1. [PMID: 29327145 PMCID: PMC5764905 DOI: 10.1186/s40635-017-0166-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/14/2017] [Indexed: 08/30/2023] Open
Abstract
Monocyte HLA-DR expression has been reported as a marker of immunosuppression and a predictor of sepsis development. However, to date, there is no report on monocyte HLA-DR monitoring exclusively in neonates (< 28 days of life) who underwent cardiac surgery under cardiopulmonary bypass (CPB), which have a high risk of nosocomial infection. In this pilot study, we studied nine neonates with a diagnosis of congenital heart disease requiring surgery under CPB. There was a significant reduction in monocyte HLA-DR expression for the first two postoperative days, as compared to preoperatively (p = 0.004). Moreover, neonates who displayed an episode of NI had a dramatically lower HLA-DR expression at day 4, as compared to neonates without NI (4257 AB/c [2220–5895] vs 14,947 AB/c [9858–16,960]; p = 0.04). Our preliminary results could indicate that HLA-DR expression may be a useful biomarker of immunosuppression-induced secondary infection after CPB in neonates.
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Affiliation(s)
| | - Cécile Braudeau
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Nicolas Cottron
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Pierre Bourgoin
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Nina Salabert
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Antoine Roquilly
- CHU Nantes, Pôle anesthésie réanimations, Service d'anesthésie réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Régis Josien
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Nicolas Joram
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Karim Asehnoune
- CHU Nantes, Pôle anesthésie réanimations, Service d'anesthésie réanimation chirurgicale, Hôtel Dieu, Nantes, France
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26
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Liet JM, Barrière F, Gaillard-Le Roux B, Bourgoin P, Legrand A, Joram N. Physiological effects of invasive ventilation with neurally adjusted ventilatory assist (NAVA) in a crossover study. BMC Pediatr 2016; 16:180. [PMID: 27821162 PMCID: PMC5100099 DOI: 10.1186/s12887-016-0717-4] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 10/25/2016] [Indexed: 12/19/2022] Open
Abstract
Background Neurally Adjusted Ventilatory Assist (NAVA) is a mode of assisted mechanical ventilation that delivers inspiratory pressure proportionally to the electrical activity of the diaphragm. To date, no pediatric study has focused on the effects of NAVA on hemodynamic parameters. This physiologic study with a randomized cross-over design compared hemodynamic parameters when NAVA or conventional ventilation (CV) was applied. Methods After a baseline period, infants received NAVA and CV in a randomized order during two consecutive 30-min periods. During the last 10 min of each period, respiratory and hemodynamic parameters were collected. No changes in PEEP, FiO2, sedation or inotropic doses were allowed during these two periods. The challenge was to keep minute volumes constant, with no changes in blood CO2 levels and in pH that may affect the results. Results Six infants who had undergone cardiac surgery (mean age 7.8 ± 4.1 months) were studied after parental consent. Four of them had low central venous oxygen saturation (ScvO2 < 65 %). The ventilatory settings resulted in similar minute volumes (1.7 ± 0.4 vs. 1.6 ± 0.6 ml/kg, P = 0.67) and in similar tidal volumes respectively with NAVA and with CV. There were no statistically significant differences on blood pH levels between the two modes of ventilation (7.32 ± 0.02 vs. 7.32 ± 0.04, P = 0.34). Ventilation with NAVA delivered lower peak inspiratory pressures than with CV: -32.7 % (95 % CI: -48.2 to –17.1 %, P = 0.04). With regard to hemodynamics, systolic arterial pressures were higher using NAVA: +8.4 % (95 % CI: +3.3 to +13.6 %, P = 0.03). There were no statistically significant differences on cardiac index between the two modes of ventilation. However, all children with a low baseline ScvO2 (<65 %) tended to increase their cardiac index with NAVA compared to CV: 2.03 ± 0.30 vs. 1.91 ± 0.39 L/min.m2 (median ± interquartile, P = 0.07). Conclusions This pilot study raises the hypothesis that NAVA could have beneficial effects on hemodynamics in children when compared to a conventional ventilatory mode that delivered identical PEEP and similar minute volumes. Trial registration ClinicalTrials.gov Identifier: NCT01490710. Date of registration: December 7, 2011.
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Affiliation(s)
- Jean-Michel Liet
- Pediatric Intensive Care Unit, Hôpital Femme-Enfant-Adolescent, the University Hospital Center of Nantes (CHU), 38 bd Jean-Monnet, 44093, Nantes, France.
| | - François Barrière
- Pediatric Intensive Care Unit, Hôpital Femme-Enfant-Adolescent, the University Hospital Center of Nantes (CHU), 38 bd Jean-Monnet, 44093, Nantes, France
| | - Bénédicte Gaillard-Le Roux
- Pediatric Intensive Care Unit, Hôpital Femme-Enfant-Adolescent, the University Hospital Center of Nantes (CHU), 38 bd Jean-Monnet, 44093, Nantes, France
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, Hôpital Femme-Enfant-Adolescent, the University Hospital Center of Nantes (CHU), 38 bd Jean-Monnet, 44093, Nantes, France
| | - Arnaud Legrand
- Pediatric Intensive Care Unit, Hôpital Femme-Enfant-Adolescent, the University Hospital Center of Nantes (CHU), 38 bd Jean-Monnet, 44093, Nantes, France.,CIC-INSERM 1413, University of Nantes, Nantes, France
| | - Nicolas Joram
- Pediatric Intensive Care Unit, Hôpital Femme-Enfant-Adolescent, the University Hospital Center of Nantes (CHU), 38 bd Jean-Monnet, 44093, Nantes, France
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Le Gloan L, Hauet Q, David A, Hanna N, Arfeuille C, Arnaud P, Boileau C, Romefort B, Benbrik N, Gournay V, Joram N, Baron O, Isidor B. Neonatal Marfan Syndrome: Report of a Case with an Inherited Splicing Mutation outside the Neonatal Domain. Mol Syndromol 2016; 6:281-6. [PMID: 27022329 DOI: 10.1159/000443867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2015] [Indexed: 11/19/2022] Open
Abstract
We report a child and her mother affected by Marfan syndrome. The child presented with a phenotype of neonatal Marfan syndrome, revealed by acute and refractory heart failure, finally leading to death within the first 4 months of life. Her mother had a common clinical presentation. Genetic analysis revealed an inherited FBN1 mutation. This intronic mutation (c.6163+3_6163+6del), undescribed to date, leads to exon 49 skipping, corresponding to in-frame deletion of 42 amino acids (p.Ile2014_Asp2055del). FBN1 next-generation sequencing did not show any argument for mosaicism. Association in the same family of severe neonatal and classical Marfan syndrome illustrates the intrafamilial phenotype variability.
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Affiliation(s)
- Laurianne Le Gloan
- Cardiologie Pédiatrique et Congénitale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Quentin Hauet
- Cardiologie Pédiatrique et Congénitale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Albert David
- Génétique Médicale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Nadine Hanna
- Département de Génétique Moléculaire, Centre National de Référence pour le Syndrome de Marfan et Apparentés, INSERM LVTS U1148, Faculté Paris Diderot, AP-HP Hopital Bichat, Paris, France
| | - Chloé Arfeuille
- Département de Génétique Moléculaire, Centre National de Référence pour le Syndrome de Marfan et Apparentés, INSERM LVTS U1148, Faculté Paris Diderot, AP-HP Hopital Bichat, Paris, France
| | - Pauline Arnaud
- Département de Génétique Moléculaire, Centre National de Référence pour le Syndrome de Marfan et Apparentés, INSERM LVTS U1148, Faculté Paris Diderot, AP-HP Hopital Bichat, Paris, France
| | - Catherine Boileau
- Département de Génétique Moléculaire, Centre National de Référence pour le Syndrome de Marfan et Apparentés, INSERM LVTS U1148, Faculté Paris Diderot, AP-HP Hopital Bichat, Paris, France
| | - Bénédicte Romefort
- Cardiologie Pédiatrique et Congénitale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Nadir Benbrik
- Cardiologie Pédiatrique et Congénitale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Véronique Gournay
- Cardiologie Pédiatrique et Congénitale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Nicolas Joram
- Réanimation Pédiatrique, CHU de Nantes, Université de Nantes, Nantes, France
| | - Olivier Baron
- Cardiologie Pédiatrique et Congénitale, CHU de Nantes, Université de Nantes, Nantes, France
| | - Bertrand Isidor
- Génétique Médicale, CHU de Nantes, Université de Nantes, Nantes, France
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Hauet Q, Gloan LL, Benbrik N, Romefort B, Lachaud M, Joram N, Guerin P, Gournay V. 0346: Neonatal arterial switch operation: the sooner the better! Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hubert G, Liet JM, Barrière F, Joram N. Hypernatrémie majeure par intoxication à l’eau de mer chez un enfant. Arch Pediatr 2015; 22:39-42. [DOI: 10.1016/j.arcped.2014.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/25/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
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30
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Liet JM, Allain-Launay E, Gaillard-LeRoux B, Barrière F, Chenouard A, Dejode JM, Joram N. Regional citrate anticoagulation for pediatric CRRT using integrated citrate software and physiological sodium concentration solutions. Pediatr Nephrol 2014; 29:1625-31. [PMID: 24526097 DOI: 10.1007/s00467-014-2770-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/07/2014] [Accepted: 01/22/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND In continuous renal replacement therapy (CRRT), regional citrate anticoagulation offers an attractive alternative to heparinization, especially for children with a high bleeding risk. METHODS We report on a new management approach to CRRT using integrated citrate software and physiological sodium concentration solutions. Convective filtration was performed with pre-filter citrate anticoagulation using an 18 mmol/L citrate solution and a post-filter replacement fluid. The citrate flow rate was automatically adjusted to the blood flow rate by means of integrated citrate software. Similarly, calcium was automatically infused into children to maintain their blood calcium levels within normal range. RESULTS Eleven CRRT sessions were performed (330 h) in seven critically ill children aged 3-15 years (extreme values 15-66 kg). Disease categories included sepsis with multiorgan dysfunction (n = 2) and hemolytic uremic syndrome (n = 5). Median effluent dose was 2.1 (extreme values 1.7-3.3) L/h/1.73 m2. No session had to be stopped because of metabolic complications. Calcium levels, both in the circuits and in the circulating blood of the children, remained stable and secure. CONCLUSIONS Regional citrate anticoagulation can be used in children with a body weight of >15 kg using integrated citrate software and commercially available solutions with physiological sodium concentrations in a safe, effective and convenient procedure.
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Affiliation(s)
- Jean-Michel Liet
- Unité de Réanimation Pédiatrique, Pôle Femme-Enfant-Adolescent, Centre hospitalier universitaire (CHU) de Nantes, 38 Boulevard Jean-Monnet, 44093, Nantes, France,
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Joram N, Gaillard Le Roux B, Barrière F, Liet JM. Place des protocoles de sédation en réanimation pédiatrique. Réanimation 2014. [DOI: 10.1007/s13546-013-0818-4] [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: 10/26/2022]
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32
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Joram N, Benbrik N, De Windt A, Colas H, Liet JM. [Severe shock after protamine infusion in a neonate undergoing cardio pulmonary bypass]. ACTA ACUST UNITED AC 2013; 32:876-8. [PMID: 24210577 DOI: 10.1016/j.annfar.2013.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/02/2013] [Indexed: 11/19/2022]
Abstract
Shock after protamine infusion are rare. We report here the case of a 6-day-old boy having presented severe and recurring hypotensions after protamine infusions during cardiac surgery under cardio pulmonary bypass. The physiopathology of these reactions is complex and, in the presented case, involved mechanism may not be anaphylactic.
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Affiliation(s)
- N Joram
- Unité de réanimation pédiatrique, pôle Femme-Enfant-Adolescent, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France.
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Joram N, Macher J, Liet JM, Gaillard Le Roux B, Baron O, Gournay V, Romefort B, Gras Le Guen C. Preoperative Staphylococcus aureus carriage and risk of surgical site infection after cardiac surgery in children: A pilot cohort study. Arch Cardiovasc Dis 2013. [DOI: 10.1016/j.acvd.2013.06.044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liet JM, Dejode JM, Joram N, Gaillard Le Roux B, Péréon Y. Bedside diagnosis of bilateral diaphragmatic paralysis. Intensive Care Med 2012; 39:335. [DOI: 10.1007/s00134-012-2729-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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35
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Homer L, Launay E, Joram N, Jacqueline C, Jarreau PH, Caillon J, Moyon T, Branger B, Potel G, Roze JC, Méhats C, Gras-Leguen C. Antenatal phosphodiesterase 4 inhibition restores postnatal growth and pulmonary development in a model of chorioamnionitis in rabbits. J Pharmacol Exp Ther 2011; 340:620-8. [PMID: 22160266 DOI: 10.1124/jpet.111.179085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Chorioamnionitis is implicated in the pathophysiology of bronchopulmonary disease, and the associated inflammatory response is responsible for adverse effects on alveolar development. The aim of this work was to analyze the effects of a phosphodiesterase 4 (PDE4)-selective inhibitor, rolipram (a modulator of the inflammatory response), in an experimental model of chorioamnionitis on pulmonary development and on the processes of infection and inflammation. Rabbit mothers were assigned to four groups: 1) saline serum inoculation (controls); 2) Escherichia coli intrauterine inoculation (C+); 3) rolipram infusion (R+); and 4) E. coli inoculation + rolipram infusion (C+R+). High rates of morbility and mortality were noticed in mothers and pups (5 of 13 pregnant rabbits in groups with rolipram). Alveolar development, inflammation, and infection were analyzed in pups at day 0 and day 5. At day 0, in the context of chorioamnionitis, rolipram significantly decreased birth weight (p < 0.01) relative to that of controls (p < 0.05). At day 5, weight normalized in group C+R+ but not in group C+ relative to controls (p < 0.001); moreover, alveolar airspace volume was preserved in group C+R+ but not in group C+ (p < 0.05). Interstitial volume decreased in group C+ versus controls (p < 0.05) but was preserved in group C+R+. Specific alveolar area was not significantly modified by rolipram. No significant difference was found concerning bronchoalveolar lavage cellularity, and all blood cultures remained sterile. In this model of impaired alveologenesis, rolipram significantly preserved specific alveolar density. However, PDE4 inhibition induced antenatal fetal demise and growth retardation.
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Affiliation(s)
- L Homer
- Centre Hospitalier Universitaire Brest, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Brest, France
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Liet JM, Dejode JM, Joram N, Gaillard-Le Roux B, Bétrémieux P, Rozé JC. Respiratory support by neurally adjusted ventilatory assist (NAVA) in severe RSV-related bronchiolitis: a case series report. BMC Pediatr 2011; 11:92. [PMID: 22014152 PMCID: PMC3207882 DOI: 10.1186/1471-2431-11-92] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/20/2011] [Indexed: 11/10/2022] Open
Abstract
Background Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation controlled by diaphragmatic electrical signals. The electrical signals allow synchronization of ventilation to spontaneous breathing efforts of a child, as well as permitting pressure assistance proportional to the electrical signal. NAVA provides equally fine synchronization of respiratory support and pressure assistance varying with the needs of the child. NAVA has mainly been studied in children who underwent cardiac surgery during the period of weaning from a respirator. Case presentation We report here a series of 3 children (1 month, 3 years, and 28 days old) with severe respiratory distress due to RSV-related bronchiolitis requiring invasive mechanical ventilation with a high level of oxygen (FiO2 ≥50%) for whom NAVA facilitated respiratory support. One of these children had diagnosis criteria for acute lung injury, another for acute respiratory distress syndrome. Establishment of NAVA provided synchronization of mechanical ventilatory support with the breathing efforts of the children. Respiratory rate and inspiratory pressure became extremely variable, varying at each cycle, while children were breathing easily and smoothly. All three children demonstrated less oxygen requirements after introducing NAVA (57 ± 6% to 42 ± 18%). This improvement was observed while peak airway pressure decreased (28 ± 3 to 15 ± 5 cm H2O). In one child, NAVA facilitated the management of acute respiratory distress syndrome with extensive subcutaneous emphysema. Conclusions Our findings highlight the feasibility and benefit of NAVA in children with severe RSV-related bronchiolitis. NAVA provides a less aggressive ventilation requiring lower inspiratory pressures with good results for oxygenation and more comfort for the children.
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Affiliation(s)
- Jean-Michel Liet
- Unité de Réanimation Pédiatrique, Hôpital Mère-Enfant Faïencerie, CHU de Nantes, 38 Boulevard Jean-Monnet, 44093 Nantes, France
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Joram N, Launay E, Roze JC, Caillon J, Franco-Montoya ML, Bourbon J, Jarreau PH, Gras-Le Guen C. Betamethasone worsens chorioamnionitis-related lung development impairment in rabbits. Am J Perinatol 2011; 28:605-12. [PMID: 21494996 DOI: 10.1055/s-0031-1276734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although chorioamnionitis and glucocorticoids (GC) are both known to have potential adverse effects on alveolar development, the use of GC is generalized because of their demonstrated benefits in premature newborns. The objective of this study was to analyze the cumulative effects of GC and chorioamnionitis on lung development and infectious process. In a model of ESCHERICHIA COLI chorioamnionitis controlled by antibiotics, pregnant rabbits were randomized among five groups: (1) E. COLI infection alone, (2) infection plus one betamethasone injection (0.1 mg.kg(-1)), (3) infection plus two betamethasone injections, (4) betamethasone alone, (5) control. Lung morphometric analysis, bronchoalveolar lavage, and bacteriologic tissue cultures were performed after spontaneous delivery. In the context of chorioamnionitis, one betamethasone treatment significantly decreased birth weight and lung volume versus controls (30 ± 1.40 versus 52.40 ± 2.54 g, and 1.92 ± 0.67 versus 2.15 ± 0.74 cm(3), respectively, p < 0.05). Two betamethasone treatments significantly decreased specific alveolar area (279.8 ± 46 cm(2)/100 g versus 510.90 ± 54.1 cm(2)/100 g), specific interstitium volume (0.98 ± 0.09 cm(3)/100 g versus 1.78 ± 0.16 cm(3)/100 g), and specific elastin fiber length (57.4 ± 10.5 versus 183.6 ± 8.1 cm/100 g). These results suggest that glucocorticoid treatment might represent an additional risk factor for lung development in the instance of prenatal infection.
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Affiliation(s)
- Nicolas Joram
- CIC mère-enfant, Children's Hospital, CHU Nantes, Creteil, France.
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Joram N. Étude de l’effet cumulé de la corticothérapie anténatale et de la chorioamniotite sur le développement pulmonaire fœtal à partir dans un modèle expérimental chez le lapin. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Recent studies have shown that genetic variants, responsible for the different human response when facing an infectious risk, concerned the genes of proteins involved in either recognition of the infectious agent, in the inflammatory cascade, or in the coagulation process. For example, some studies clearly demonstrated that if a twin was affected by an infectious disease, the risk of infection by the same agent for the other twin was significantly higher in homozygote than in heterozygote twins. In Caucasians, a punctual mutation of the TLR2 cytosol was proved to block the response to bacterial lipoproteins and to some Gram positive bacteria and could be responsible for a greater susceptibility to septic shock. Several polymorphisms of the tlr4 gene have been involved in the onset of septic shock in postsurgery infection due to Gram(-) bacilli. Paradoxically, these variants seemed to protect against legionellosis. In pediatrics, polymorphisms of tlr4 were also clearly identified as risk factors for meningococcemia of severe bronchiolitis due to the respiratory syncytial virus (RSV) in children under 2 years of age. A polymorphism of the TLR5 receptor gene, which creates a stop codon and which is responsible for a nonfunctionality of the receptor was associated with the onset of severe legionellosis. Analysing the functions of these genetic polymorphisms in the onset of sepsis will open the way to a lot of research on specific treatments focused on genetic abnormalities.
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Affiliation(s)
- N Joram
- Service de réanimation médicale, hôpital Cochin-Port-Royal, 27 rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Joram N, Boscher C, Denizot S, Loubersac V, Winer N, Roze JC, Gras-Le Guen C. Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection. Arch Dis Child Fetal Neonatal Ed 2006; 91:F65-6. [PMID: 16371391 PMCID: PMC2672656 DOI: 10.1136/adc.2005.074245] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [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] [Indexed: 11/04/2022]
Abstract
Procalcitonin (PCT) and C reactive protein (CRP) concentrations in umbilical cord blood of 197 neonates were measured to evaluate their value as markers of infection. Sixteen of the neonates were infected. The sensitivity, specificity, and negative and positive predictive values were respectively 87.5%, 98.7%, 87.5%, and 98.7% for PCT and 50%, 97%, 67%, and 94% for CRP. Serum PCT in cord blood seems to be a useful and early marker of antenatal infection.
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Affiliation(s)
- N Joram
- Département de Périnatologie, Hôpital Mère Enfant, Nantes, France
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