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Kentish-Barnes N, Azoulay E, Reignier J, Cariou A, Lafarge A, Huet O, Gargadennec T, Renault A, Souppart V, Clavier P, Dilosquer F, Leroux L, Légé S, Renet A, Brumback LC, Engelberg RA, Pochard F, Resche-Rigon M, Curtis JR. A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients. Intensive Care Med 2024:10.1007/s00134-024-07390-y. [PMID: 38573403 DOI: 10.1007/s00134-024-07390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Suboptimal communication with clinicians, fragmented care and failure to align with patients' preferences are determinants of post intensive care unit (ICU) burden in family members. Our aim was to evaluate the impact of a nurse facilitator on family psychological burden. METHODS We carried out a randomised controlled trial in five ICUs in France comparing standard communication by ICU clinicians to additional communication and support by nurse facilitators. We included patients > 18 years, with expected ICU length of stay > 2 days, chronic life-limiting illness, and their family members. Facilitators were trained to help families to secure care in line with patient's goals, beginning in ICU and continuing for 3 months. Assessments were made at baseline and 1, 3 and 6 months post-randomisation. Primary outcome was the evolution of family symptoms of depression over 6 months using a linear mixed effects model on the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included HADS-Anxiety, Impact of Event Scale-6, goal-concordant care and experience of serious illness (QUAL-E). RESULTS 385 patients and family members were enrolled. Follow-up at 1-, 3- and 6-month was completed by 284 (74%), 264 (68.6%) and 260 (67.5%) family members respectively. The intervention was associated with significantly more formal meetings between the ICU team and the family (1 [1-3] vs 2 [1-4]; p < 0.001). There was no significant difference between the intervention and control groups in evolution of symptoms of depression over 6 months (p = 0.91), nor in symptoms of depression at 6 months [0.53 95% CI (- 0.48; 1.55)]. There were no significant differences in secondary outcomes. CONCLUSION This study does not support the use of facilitators for family members of ICU patients.
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Affiliation(s)
- Nancy Kentish-Barnes
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France.
| | - Elie Azoulay
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
- Paris Cité University, Paris, France
| | - Jean Reignier
- Medical Intensive Care Unit, CHU de Nantes, Nantes, France
- Université de Nantes, Nantes, France
| | - Alain Cariou
- Paris Cité University, Paris, France
- Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France
| | - Antoine Lafarge
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Olivier Huet
- Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France
- Université de Brest, Brest, France
| | - Thomas Gargadennec
- Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France
| | - Anne Renault
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Pamela Clavier
- Medical Intensive Care Unit, CHU de Nantes, Nantes, France
| | | | - Ludivine Leroux
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Sébastien Légé
- Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France
| | - Anne Renet
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Lyndia C Brumback
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - Frédéric Pochard
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Matthieu Resche-Rigon
- Paris Cité University, Paris, France
- Clinical Research Unit, APHP, Saint Louis University Hospital, Paris, France
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
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Vermeersch V, Léon K, Caillard A, Szczesnowski A, Albacete G, Marec N, Tissier F, Gilbert G, Droguet M, Marcorelles P, Giroux-Metges MA, Huet O. Moderate Exercise Modulates Inflammatory Responses and Improves Survival in a Murine Model of Acute Pneumonia. Crit Care Med 2024; 52:e142-e151. [PMID: 38193770 PMCID: PMC10876171 DOI: 10.1097/ccm.0000000000006166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES An association between physical inactivity and worse outcome during infectious disease has been reported. The effect of moderate exercise preconditioning on the immune response during an acute pneumonia in a murine model was evaluated. SETTING Laboratory experiments. SUBJECTS C57BL6/j male mice. INTERVENTIONS Six-week-old C57BL/6J mice were divided in two groups: an exercise group and a control group. In the exercise group, a moderate, progressive, and standardized physical exercise was applied for 8 weeks. It consisted in a daily treadmill training lasting 60 minutes and with an intensity of 65% of the maximal theoretical oxygen uptake. Usual housing recommendation were applied in the control group during the same period. After 8 weeks, pneumonia was induced in both groups by intratracheal instillation of a fixed concentration of a Klebsiella pneumoniae (5 × 103 colony-forming unit) solution. MEASUREMENTS AND MAIN RESULTS Mice preconditioned by physical exercise had a less sever onset of pneumonia as shown by a significant decrease of the Mouse Clinical Assessment Severity Score and had a significantly lower mortality compared with the control group (27% vs. 83%; p = 0.019). In the exercise group, we observed a significantly earlier but transient recruitment of inflammatory immune cells with a significant increase of neutrophils, CD4+ cells and interstitial macrophages counts compared with control group. Lung tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-10 were significantly decreased at 48 hours after pneumonia induction in the exercise group compared with the control group. CONCLUSIONS In our model, preconditioning by moderate physical exercise improves outcome by reducing the severity of acute pneumonia with an increased but transient activation of the innate immune response.
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Affiliation(s)
- Veronique Vermeersch
- Department of Anesthesia and Intensive Care Unit, Brest Teaching Hospital, Brest, France
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
| | - Karelle Léon
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
| | - Anais Caillard
- Department of Anesthesia and Intensive Care Unit, Brest Teaching Hospital, Brest, France
| | | | - Gaëlle Albacete
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
| | - Nadege Marec
- LBAI, Inserm UMR1227, Université de Bretagne Occidentale, Brest, France
| | - Florine Tissier
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
| | | | - Mickael Droguet
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
| | | | - Marie-Agnes Giroux-Metges
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
- Explorations Fonctionnelles Respiratoires, Brest Teaching Hospital, Brest, France
| | - Olivier Huet
- Department of Anesthesia and Intensive Care Unit, Brest Teaching Hospital, Brest, France
- ORPHY, EA4324, Université de Bretagne Occidentale, Brest, France
- Australian and New Zealand Intensive Care research Center, Monash University, Melbourne, VIC, Australia
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Huet O, Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Bouglé A, Kerforne T, Lasocki S, Eljezi V, Dessertaine G, Amour J, Chapalain X. Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial. Crit Care 2024; 28:64. [PMID: 38419119 PMCID: PMC10902989 DOI: 10.1186/s13054-024-04842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND After cardiac surgery, post-operative delirium (PoD) is acknowledged to have a significant negative impact on patient outcome. To date, there is no valuable and specific treatment for PoD. Critically ill patients often suffer from poor sleep condition. There is an association between delirium and sleep quality after cardiac surgery. This study aimed to establish whether promoting sleep using an overnight infusion of dexmedetomidine reduces the incidence of delirium after cardiac surgery. METHODS Randomized, pragmatic, multicentre, double-blind, placebo controlled trial from January 2019 to July 2021. All adult patients aged 65 years or older requiring elective cardiac surgery were randomly assigned 1:1 either to the dexmedetomidine group or the placebo group on the day of surgery. Dexmedetomidine or matched placebo infusion was started the night after surgery from 8 pm to 8 am and administered every night while the patient remained in ICU, or for a maximum of 7 days. Primary outcome was the occurrence of postoperative delirium (PoD) within the 7 days after surgery. RESULTS A total of 348 patients provided informed consent, of whom 333 were randomized: 331 patients underwent surgery and were analysed (165 assigned to dexmedetomidine and 166 assigned to placebo). The incidence of PoD was not significantly different between the two groups (12.6% vs. 12.4%, p = 0.97). Patients treated with dexmedetomidine had significantly more hypotensive events (7.3% vs 0.6%; p < 0.01). At 3 months, functional outcomes (Short-form 36, Cognitive failure questionnaire, PCL-5) were comparable between the two groups. CONCLUSION In patients recovering from an elective cardiac surgery, an overnight infusion of dexmedetomidine did not decrease postoperative delirium. Trial registration This trial was registered on ClinicalTrials.gov (number: NCT03477344; date: 26th March 2018).
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Affiliation(s)
- Olivier Huet
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France.
| | - Thomas Gargadennec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Jean-Ferréol Oilleau
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Bertrand Rozec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
| | - Nicolas Nesseler
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, University Hospital of Rennes, Rennes, France
| | - Adrien Bouglé
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Thomas Kerforne
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine CHU de POITIERS, Poitiers, France
| | - Sigismond Lasocki
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, CHU de ANGERS, I, Angers, France
| | - Vedat Eljezi
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Géraldine Dessertaine
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Amour
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Privé Jacques Cartier, Massy, France
| | - Xavier Chapalain
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
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Aries P, Ognard J, Cadieu A, Degos V, Huet O. Secondary Neurologic Deterioration After Moderate Traumatic Brain Injury: Development of a Multivariable Prediction Model and Proposition of a Simple Triage Score. Anesth Analg 2024; 138:171-179. [PMID: 37097898 PMCID: PMC10699506 DOI: 10.1213/ane.0000000000006460] [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] [Accepted: 02/06/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Identifying patients at risk of secondary neurologic deterioration (SND) after moderate traumatic brain injury (moTBI) is a challenge, as such patients will need specific care. No simple scoring system has been evaluated to date. This study aimed to determine clinical and radiological factors associated with SND after moTBI and to propose a triage score. METHODS All adults admitted in our academic trauma center between January 2016 and January 2019 for moTBI (Glasgow Coma Scale [GCS] score, 9-13) were eligible. SND during the first week was defined either by a decrease in GCS score of >2 points from the admission GCS in the absence of pharmacologic sedation or by a deterioration in neurologic status associated with an intervention, such as mechanical ventilation, sedation, osmotherapy, transfer to the intensive care unit (ICU), or neurosurgical intervention (for intracranial mass lesions or depressed skull fracture). Clinical, biological, and radiological independent predictors of SND were identified by logistic regression (LR). An internal validation was performed using a bootstrap technique. A weighted score was defined based on beta (β) coefficients of the LR. RESULTS A total of 142 patients were included. Forty-six patients (32%) showed SND, and 14-day mortality rate was 18.4%. Independent variables associated with SND were age above 60 years (odds ratio [OR], 3.45 [95% confidence interval {CI}, 1.45-8.48]; P = .005), brain frontal contusion (OR, 3.22 [95% CI, 1.31-8.49]; P = .01), prehospital or admission arterial hypotension (OR, 4.86 [95% CI, 2.03-12.60]; P = .006), and a Marshall computed tomography (CT) score of 6 (OR, 3.25 [95% CI, 1.31-8.20]; P = .01). The SND score was defined with a range from 0 to 10. The score included the following variables: age >60 years (3 points), prehospital or admission arterial hypotension (3 points), frontal contusion (2 points), and Marshall CT score of 6 (2 points). The score was able to detect patients at risk of SND, with an area under the receiver operating characteristic curve (AUC) of 0.73 (95% CI, 0.65-0.82). A score of 3 had a sensitivity of 85%, a specificity of 50%, a VPN of 87%, and a VPP of 44 % to predict SND. CONCLUSIONS In this study, we demonstrate that moTBI patients have a significant risk of SND. A simple weighted score at hospital admission could be able to detect patients at risk of SND. The use of the score may enable optimization of care resources for these patients.
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Affiliation(s)
- Philippe Aries
- From the Department of Anesthesia and Surgical Intensive Care, Military Teaching Hospital “Clermont-Tonnerre”, Brest, France
- Military Teaching Hospital “Clermont-Tonnerre,” Brest, France
- French Military Health Service Academy, École du Val-de-Grâce, Paris, France
| | - Julien Ognard
- French Military Health Service Academy, École du Val-de-Grâce, Paris, France
- Division of Interventional Neuroradiology, Department of Radiology, University Hospital of Brest, Brest, France
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, Brest, France
| | - Amandine Cadieu
- From the Department of Anesthesia and Surgical Intensive Care, Military Teaching Hospital “Clermont-Tonnerre”, Brest, France
| | - Vincent Degos
- APHP, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Clinical Research Group ARPE, Sorbonne University, Paris, France
- INSERM UMR 1141, PROTECT, Paris, France
| | - Olivier Huet
- From the Department of Anesthesia and Surgical Intensive Care, Military Teaching Hospital “Clermont-Tonnerre”, Brest, France
- UFR de Medecine de Brest, Université de Bretagne Occidentale, Brest, France
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Cinotti R, Chopin A, Moyer JD, Huet O, Lasocki S, Cohen B, Dahyot-Fizelier C, Chalard K, Seguin P, Martin FP, Lerebourg C, Guitteny M, Chenet A, Perrouin-Verbe B, Asehnoune K, Feuillet F, Sébille V, Roquilly A. Anxiety and depression symptoms in relatives of moderate-to-severe traumatic brain injury survivors - A multicentre cohort. Anaesth Crit Care Pain Med 2023; 42:101232. [PMID: 37054915 DOI: 10.1016/j.accpm.2023.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION The prevalence and risk factors of anxiety and depression symptoms in relatives of moderate to severe traumatic brain injury (TBI) survivors have not been thoroughly investigated. METHODS Ancillary study of a multicentric prospective randomized-controlled trial in nine university hospitals in 370 moderate-to-severe TBI patients. TBI survivor-relative dyads were included in the 6th month of follow-up. Relatives responded to the Hospital Anxiety and Depression Scale (HADS). The primary endpoints were the prevalence of severe symptoms of anxiety (HADS-Anxiety ≥ 11) and depression (HADS-Depression ≥ 11) in relatives. We explored the risk factors of severe anxiety and depression symptoms. RESULTS Relatives were predominantly women (80.7%), spouse-husband (47.7%), or parents (39%). Out of the 171 dyads included, 83 (50.6%) and 59 (34.9%) relatives displayed severe symptoms of anxiety and depression, respectively. Severe anxiety symptoms in relatives were independently associated with the patient's discharge at home (OR 2.57, 95%CI [1.04-6.37]) and the patient's higher SF-36 Mental Health domain scores (OR 1.03 95%CI [1.01-1.05]). Severe depression symptoms were independently associated with a lower SF-36 Mental Health domain score (OR = 0.98 95%CI [0.96-1.00]). No ICU organization characteristics were associated with psychological symptoms in relatives. DISCUSSION There is a high prevalence of anxiety and depression symptoms among relatives of moderate-to-severe TBI survivors at 6 months. Anxiety and depression were inversely correlated with the patient's mental health status at 6 months. CONCLUSIONS Long-term follow-up must provide psychological care to relatives after TBI.
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Affiliation(s)
- Raphaël Cinotti
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093 France; Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research (SPHERE), F-44000 Nantes, France.
| | - Alice Chopin
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093 France
| | - Jean Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Paris, France
| | - Olivier Huet
- Centre Hospitalier Universitaire De Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Sigismond Lasocki
- Centre Hospitalier Universitaire d'Angers, Anesthesia and Intensive Care Unit, Angers, France
| | - Benjamin Cohen
- Centre Hospitalier Universitaire De Tours, Anesthesia and Intensive Care Unit, Tours, France
| | - Claire Dahyot-Fizelier
- Centre Hospitalier Universitaire De Potiers, Anesthesia and Intensive Care Unit, Poitiers, France
| | - Kevin Chalard
- Centre Hospitalier Universitaire De Montpellier, Anesthesia and Intensive Care Unit, Montpellier, France
| | - Philippe Seguin
- Centre Hospitalier Universitaire De Rennes, Anesthesia and Intensive Care Unit, Rennes, France
| | - Florian Pierre Martin
- CRT2I Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, F-44000, France
| | - Céline Lerebourg
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093 France
| | - Marie Guitteny
- Nantes Université, CHU Nantes, Department of Addictology and Liaison Psychiatry, Consultation-Liaison Psychiatry Unit, Hôtel Dieu, Nantes, F-44093, France
| | - Amandine Chenet
- Nantes Université, CHU Nantes, Médecine Physique et Réadaptation Neurologique, Hôpital Saint-Jacques, Nantes, F-44093, France
| | - Brigitte Perrouin-Verbe
- Nantes Université, CHU Nantes, Médecine Physique et Réadaptation Neurologique, Hôpital Saint-Jacques, Nantes, F-44093, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093 France
| | - Fanny Feuillet
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research (SPHERE), F-44000 Nantes, France; Nantes Université, CHU Nantes, Plateforme de Méthodologie et Biostatistique, Direction Recherche et Innovation, Nantes, F-44000, France
| | - Véronique Sébille
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research (SPHERE), F-44000 Nantes, France; Nantes Université, CHU Nantes, Plateforme de Méthodologie et Biostatistique, Direction Recherche et Innovation, Nantes, F-44000, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093 France; Nantes Université, CHU Nantes, Médecine Physique et Réadaptation Neurologique, Hôpital Saint-Jacques, Nantes, F-44093, France
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Reizine F, Le Marec S, Le Meur A, Consigny M, Berteau F, Bodenes L, Geslain M, McQuilten Z, Le Niger C, Huntzinger J, Seguin P, Thibert JB, Simon D, Reignier J, Egreteau PY, Tadié JM, Huet O, Asfar P, Ehrmann S, Aubron C. Prophylactic platelet transfusion response in critically ill patients: a prospective multicentre observational study. Crit Care 2023; 27:373. [PMID: 37759268 PMCID: PMC10537531 DOI: 10.1186/s13054-023-04650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Response to prophylactic platelet transfusion is suspected to be inconsistent in critically ill patients questioning how to optimize transfusion practices. This study aimed to describe prophylactic platelet transfusion response, to identify factors associated with a suboptimal response, to analyse the correlation between corrected count increment and platelet count increment and to determine the association between poor platelet transfusion response and clinical outcomes. METHODS This prospective multicentre observational study recruited patients who received at least one prophylactic platelet transfusion in one of the nine participating intensive care units for a period up to 16 months. Poor platelet transfusion response was defined as a corrected count increment (CCI) that adjusts for platelet dose and body surface area, less than 7 at 18-24 h after platelet transfusion. Factors associated with poor platelet transfusion response were assessed in a mixed-effect model. Sensitivity analyses were conducted in patients with and without haematology malignancy and chemotherapy. RESULTS Poor platelet transfusion response occurred in 349 of the 472 (73.9%) prophylactic platelet transfusions and in 141/181 (77.9%) patients. The mixed-effect model identified haemoglobin at ICU admission (odds ratio (OR): 0.79 [95% confidence interval (CI) 0.7-0.89]) and body mass index (BMI) (OR: 0.93 [0.89-0.98]) being positively and independently associated with platelet transfusion response, while a haematological malignancy (OR 1.93 [1.09-3.43]), sepsis as primary ICU admission diagnosis (OR: 2.81 [1.57-5.03]), SOFA score (OR 1.10 [1.03; 1.17]) and maximum storage duration of platelet (OR: 1.24 [1.02-1.52]) were independently associated with a suboptimal platelet increment. Clinical outcomes did not differ between groups, nor the requirement for red blood cells. Poor platelet transfusion response was found in 93.5% of patients with haematology malignancy and chemotherapy. CONCLUSIONS In this study of critically ill patients, of whom more than half had bone marrow failure, almost three quarters of prophylactic platelet transfusions led to suboptimal platelet increment measured 18 to 24 h following platelet transfusion. Platelet storage duration was the only factor associated with poor platelet response that may be accessible to intervention. Trial registration in October 2017: ClinicalTrials.gov: NCT03325140.
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Affiliation(s)
- Florian Reizine
- Maladies Infectieuses Et Réanimation Médicale, CHU de Rennes, Rennes, France
- Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
| | - Sarah Le Marec
- Service de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Site La Cavale Blanche, Bvd Tanguy Prigent, 29609, Brest Cedex, France
| | - Anthony Le Meur
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | | | - Florian Berteau
- Service de Réanimation Polyvalente, CH de Morlaix, Morlaix, France
| | - Laetitia Bodenes
- Service de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Site La Cavale Blanche, Bvd Tanguy Prigent, 29609, Brest Cedex, France
| | - Marie Geslain
- Département d'anesthésie-Réanimation, Université de Bretagne Occidentale, CHU de Brest, Brest, France
| | - Zoe McQuilten
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
| | | | | | - Philippe Seguin
- Service de Réanimation Chirurgicale, CHU de Rennes, Rennes, France
| | | | - David Simon
- Service de Biostatistiques, CHU de Brest, Brest, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | | | - Jean-Marc Tadié
- Maladies Infectieuses Et Réanimation Médicale, CHU de Rennes, Rennes, France
| | - Olivier Huet
- Département d'anesthésie-Réanimation, Université de Bretagne Occidentale, CHU de Brest, Brest, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, CHU d'Angers, Angers, France
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CHRU de Tours INSERM CIC 1415, CRICS-TriggerSEP F-CRIN Research Network, INSERM U1100, Université de Tours FR, Tours, France
| | - Cécile Aubron
- Service de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Site La Cavale Blanche, Bvd Tanguy Prigent, 29609, Brest Cedex, France.
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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Bourdiol A, Legros V, Vardon-Bounes F, Rimmele T, Abraham P, Hoffmann C, Dahyot-Fizelier C, Jonas M, Bouju P, Cirenei C, Launey Y, Le Gac G, Boubeche S, Lamarche E, Huet O, Bezu L, Darrieussecq J, Szczot M, Delbove A, Schmitt J, Lasocki S, Auchabie J, Petit L, Kuhn-Bougouin E, Asehnoune K, Ingles H, Roquilly A, Cinotti R. Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study. Crit Care 2023; 27:199. [PMID: 37226261 DOI: 10.1186/s13054-023-04491-w] [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: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. METHODS We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. RESULTS Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. CONCLUSIONS Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. TRIAL REGISTRATION NCT04817696. Registered March 26, 2021.
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Affiliation(s)
- Alexandre Bourdiol
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Vincent Legros
- Service d'Anesthésie-Réanimation, Hôpital Maison Blanche, CHU de Reims, 51100, Reims, France
| | - Fanny Vardon-Bounes
- Service d'Anesthésie-Réanimation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Thomas Rimmele
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- EA7426 Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France
| | - Paul Abraham
- Service de médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Clément Hoffmann
- Burn Center, Percy Military Training Hospital, 101, Avenue Henri Barbusse - BP 406, 92141, Clamart, France
| | - Claire Dahyot-Fizelier
- Intensive Care and Anesthesia Department, University Hospital of Poitiers, University of Poitiers, Poitiers, France
- INSERM U1770, University of Poitiers, Poitiers, France
| | - Maud Jonas
- Service de Réanimation, Hôpital de Saint-Nazaire, Saint-Nazaire, France
| | - Pierre Bouju
- Service de Réanimation Polyvalente, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Cédric Cirenei
- Hôpital Claude Huriez, Pôle Anesthésie-Réanimation, médecine périopératoire et douleur, CHU Lille, 59000, Lille, France
| | - Yoann Launey
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Gregoire Le Gac
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- UMR_S 1242, Chemistry Oncogenesis Stress Signaling, University of Rennes, 35000, Rennes, France
| | - Samia Boubeche
- Service d'Anesthésie-Réanimation, CHU de Rouen, Rouen, France
| | - Edouard Lamarche
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 37000, Tours, France
| | - Olivier Huet
- Department of Anaesthesia and Critical Care, University Hospital of Brest, 29000, Brest, France
| | - Lucillia Bezu
- Service de Réanimation Polyvalente, Gustave Roussy, 94805, Villejuif, France
- Metabolomics and Cell Biology Platforms, Université Paris Saclay, Université de Paris, Sorbonne Université, Inserm UMR1138, Villejuif, France
| | - Julie Darrieussecq
- CH Aubagne, Pôle CARK, Service d'Anesthésie-Réanimation chirurgicale, Edmond Garcin, 179 Av. des soeurs Gastine, 13400, Aubagne, France
| | - Magdalena Szczot
- Service d'Anesthésie-Réanimation, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Johan Schmitt
- Hôpital d'Instruction des Armées Clermont Tonnerre, Rue Colonel Fonferrier, 29240, Brest, France
| | - Sigismond Lasocki
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 49100, Angers, France
| | - Johann Auchabie
- Service de Réanimation, centre hospitalier de Cholet, Cholet, France
| | - Ludivine Petit
- CHU Saint-Etienne, Service d'Anesthésie-Réanimation, Saint-Étienne, France
| | - Emmanuelle Kuhn-Bougouin
- Centre d'Etude et de Traitement de la Douleur, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Karim Asehnoune
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Hugo Ingles
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Antoine Roquilly
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
- UMR 1064, Center for Research in Transplantation and Translational Immunology, INSERM, Nantes Université, 44000, Nantes, France
| | - Raphaël Cinotti
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France.
- MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, INSERM, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, 44000, Nantes, France.
- Department of Anesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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Chapalain X, Lasocki S, Gargadennec T, Consigny M, Campfort M, Cadic A, Léger M, Dias P, Le Niger C, Sparrow RL, Huet O, Aubron C. Postoperative transfusion hemoglobin threshold and functional recovery after high-risk oncologic surgery: A randomized controlled pilot study. Transfusion 2023. [PMID: 37102357 DOI: 10.1111/trf.17367] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Robust evidence to inform best transfusion management after major oncologic surgery, where postoperative recovery might impact treatment regimens for cancer, is lacking. We conducted a study to validate the feasibility of a larger trial comparing liberal versus restrictive red blood cells (RBC) transfusion strategies after major oncologic surgery. STUDY DESIGN AND METHODS This was a two-center, randomized, controlled, study of patients admitted to the intensive care unit after major oncologic surgery. Patients whose hemoglobin level dropped below 9.5 g/dL, were randomly assigned to immediately receive a 1-unit RBC transfusion (liberal) or delayed until the hemoglobin level dropped below 7.5 g/dL (restrictive). The primary outcome was the median hemoglobin level between randomization to day 30 post-surgery. Disability-free survival was evaluated by the WHODAS 2.0 questionnaire. RESULTS 30 patients were randomized (15 patients/group) in 15 months with a mean recruitment rate of 1.8 patients per month. The median hemoglobin level was significantly higher in the liberal group than in the restrictive group: 10.1 g/dL (IQR 9.6-10.5) versus 8.8 g/dL (IQR 8.3-9.4), p < .001, and RBC transfusion rates were 100% versus 66.7%, p = .04. The disability-free survival was similar between groups: 26.7% versus 20%, p = 1. DISCUSSION Our results support the feasibility of a phase 3 randomized controlled trial comparing the impact of liberal versus restrictive transfusion strategies on the functional recovery of critically ill patients following major oncologic surgery.
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Affiliation(s)
- Xavier Chapalain
- Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | | | - Thomas Gargadennec
- Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Maëlys Consigny
- Centre d'Investigation Clinique CIC INSERM 1412, CHRU Brest - Morvan, Brest, France
| | - Maeva Campfort
- Département Anesthésie Réanimation, CHU Angers, Angers, France
| | - Anna Cadic
- Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Maxime Léger
- Département Anesthésie Réanimation, CHU Angers, Angers, France
| | - Patricia Dias
- Centre d'Investigation Clinique CIC INSERM 1412, CHRU Brest - Morvan, Brest, France
| | | | - Rosemary L Sparrow
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Olivier Huet
- Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Cécile Aubron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Département de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalier Universitaire de Brest, Brest, France
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Roquilly A, Francois B, Huet O, Launey Y, Lasocki S, Weiss E, Petrier M, Hourmant Y, Bouras M, Lakhal K, Le Bel C, Flattres Duchaussoy D, Fernández-Barat L, Ceccato A, Flet L, Jobert A, Poschmann J, Sebille V, Feuillet F, Koulenti D, Torres A. Interferon gamma-1b for the prevention of hospital-acquired pneumonia in critically ill patients: a phase 2, placebo-controlled randomized clinical trial. Intensive Care Med 2023; 49:530-544. [PMID: 37072597 PMCID: PMC10112824 DOI: 10.1007/s00134-023-07065-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE We aimed to determine whether interferon gamma-1b prevents hospital-acquired pneumonia in mechanically ventilated patients. METHODS In a multicenter, placebo-controlled, randomized trial conducted in 11 European hospitals, we randomly assigned critically ill adults, with one or more acute organ failures, under mechanical ventilation to receive interferon gamma-1b (100 µg every 48 h from day 1 to 9) or placebo (following the same regimen). The primary outcome was a composite of hospital-acquired pneumonia or all-cause mortality on day 28. The planned sample size was 200 with interim safety analyses after enrolling 50 and 100 patients. RESULTS The study was discontinued after the second safety analysis for potential harm with interferon gamma-1b, and the follow-up was completed in June 2022. Among 109 randomized patients (median age, 57 (41-66) years; 37 (33.9%) women; all included in France), 108 (99%) completed the trial. Twenty-eight days after inclusion, 26 of 55 participants (47.3%) in the interferon-gamma group and 16 of 53 (30.2%) in the placebo group had hospital-acquired pneumonia or died (adjusted hazard ratio (HR) 1.76, 95% confidence interval (CI) 0.94-3.29; P = 0.08). Serious adverse events were reported in 24 of 55 participants (43.6%) in the interferon-gamma group and 17 of 54 (31.5%) in the placebo group (P = 0.19). In an exploratory analysis, we found that hospital-acquired pneumonia developed in a subgroup of patients with decreased CCL17 response to interferon-gamma treatment. CONCLUSIONS Among mechanically ventilated patients with acute organ failure, treatment with interferon gamma-1b compared with placebo did not significantly reduce the incidence of hospital-acquired pneumonia or death on day 28. Furthermore, the trial was discontinued early due to safety concerns about interferon gamma-1b treatment.
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Affiliation(s)
- Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France.
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France.
| | - Bruno Francois
- ICU Department and Inserm CIC 1435 & UMR 1092, University Hospital of Limoges, Limoges, France
| | - Olivier Huet
- Département d'anesthésie réanimation et medecine peri-operatoire, CHRU de Brest, Université de Bretagne Occidentale, 29000, Brest, France
| | - Yoann Launey
- Department of Anaesthesia, Critical Care and Perioperative Medicine, Univ Rennes, CHU Rennes, 35000, Rennes, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Angers, 49000, Angers, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Université Paris Cité, INSERM UMR_S1149, and AP-HP Nord, Hôpital Beaujon, Clichy, France
| | - Melanie Petrier
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Yannick Hourmant
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Karim Lakhal
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | - Cecilia Le Bel
- Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 1413, 44000, Nantes, France
| | | | - Laia Fernández-Barat
- CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
| | - Adrian Ceccato
- Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, CIBERES, Icrea, IDIBAPS, Barcelona, Spain
| | - Laurent Flet
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
| | - Alexandra Jobert
- Nantes Université, CHU Nantes, DRI, Département promotion, cellule vigilances recherche, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Jeremie Poschmann
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 44000, Nantes, France
| | - Veronique Sebille
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Fanny Feuillet
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, 44000, Nantes, France
- Nantes Université, Université de Tours, CHU Nantes, CHU Tours, INSERM, SPHERE U1246, 44000, Nantes, France
| | - Despoina Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Antoni Torres
- CELLEX research laboratories, CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Huet O, Chapalain X, Vermeersch V, Moyer JD, Lasocki S, Cohen B, Dahyot-Fizelier C, Chalard K, Seguin P, Hourmant Y, Asehnoune K, Roquilly A. Impact of continuous hypertonic (NaCl 20%) saline solution on renal outcomes after traumatic brain injury (TBI): a post hoc analysis of the COBI trial. Crit Care 2023; 27:42. [PMID: 36707841 PMCID: PMC9881296 DOI: 10.1186/s13054-023-04311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/07/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To evaluate if the increase in chloride intake during a continuous infusion of 20% hypertonic saline solution (HSS) is associated with an increase in the incidence of acute kidney injury (AKI) compared to standard of care in traumatic brain injury patients. METHODS In this post hoc analysis of the COBI trial, 370 patients admitted for a moderate-to-severe TBI in the 9 participating ICUs were enrolled. The intervention consisted in a continuous infusion of HSS to maintain a blood sodium level between 150 and 155 mmol/L for at least 48 h. Patients enrolled in the control arm were treated as recommended by the latest Brain Trauma foundation guidelines. The primary outcome of this study was the occurrence of AKI within 28 days after enrollment. AKI was defined by stages 2 or 3 according to KDIGO criteria. RESULTS After exclusion of missing data, 322 patients were included in this post hoc analysis. The patients randomized in the intervention arm received a significantly higher amount of chloride during the first 4 days (intervention group: 97.3 ± 31.6 g vs. control group: 61.3 ± 38.1 g; p < 0.001) and had higher blood chloride levels at day 4 (117.9 ± 10.7 mmol/L vs. 111.6 ± 9 mmol/L, respectively, p < 0.001). The incidence of AKI was not statistically different between the intervention and the control group (24.5% vs. 28.9%, respectively; p = 0.45). CONCLUSIONS Despite a significant increase in chloride intake, a continuous infusion of HSS was not associated with AKI in moderate-to-severe TBI patients. Our study does not confirm the potentially detrimental effect of chloride load on kidney function in ICU patients. TRIAL REGISTRATION The COBI trial was registered on clinicaltrial.gov (Trial registration number: NCT03143751, date of registration: 8 May 2017).
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Affiliation(s)
- Olivier Huet
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Boulevard Tanguy Prigent, 29609, Brest, France.
| | - Xavier Chapalain
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Boulevard Tanguy Prigent, 29609, Brest, France
| | - Véronique Vermeersch
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Boulevard Tanguy Prigent, 29609, Brest, France
| | - Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France
| | - Sigismond Lasocki
- Department of Anesthesia and Intensive Care Unit, Angers Hospital, Angers, France
| | - Benjamin Cohen
- Department of Anesthesia and Intensive Care Unit, Tours Hospital, Tours, France
| | | | - Kevin Chalard
- Department of Anesthesia and Intensive Care Unit, Montpellier Hospital, Montpellier, France
| | - P Seguin
- Department of Anesthesia and Intensive Care Unit, Rennes Hospital, Rennes, France
| | - Y Hourmant
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de Nantes, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de Nantes, CHU Nantes, Nantes, France
| | - Antoine Roquilly
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de Nantes, CHU Nantes, Nantes, France
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12
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Landais M, Nay MA, Auchabie J, Hubert N, Frerou A, Yehia A, Mercat A, Jonas M, Martino F, Moriconi M, Courte A, Robert-Edan V, Conia A, Bavozet F, Egreteau PY, Bruel C, Renault A, Huet O, Feller M, Chudeau N, Ferrandiere M, Rebion A, Robert A, Giraudeau B, Reignier J, Thille AW, Tavernier E, Ehrmann S, DEMISELLE J, SASSI T, DELALE C, GROUILLE J, DE TINTENIAC A, GESLAIN M, FLOCH H, BAILLY P, BODENES L, PRAT G, KALFON P, BADRE G, JOURDAIN C, MAZZONI T, LE MEUR A, FAYOLLE PM, HERON A, MAILLET O, LEDOUX N, ROLLE A, RICHARD R, VALETTE M, AZAIS MA, POUPLET C, BACHOUMAS K, CALLAHAN JC, GUITTON C, DARREAU C, LEFEVRE M, LELOUP G, BERTEL M, DAUVERGNE J, PACAUD L, LAKHAL K, MARTIN M, GARRET C, LASCARROU JB, BOULAIN T, MATHONNET A, MULLER G, PHILIPPART F, TRAN M, FOURNIER J, FRAT JP, COUDROY R, CHATELLIER D, HALLEY G, GACOUIN A, HOFF J, VASTAL S, TELLIER AC, BARBAZ M, SALMON GANDONNIERE C, MERCIER E, DARWICHE W. Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trial. Lancet Respir Med 2023; 11:319-328. [PMID: 36693402 DOI: 10.1016/s2213-2600(22)00413-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fasting is frequently imposed before extubation in patients in intensive care units, with the aim to reduce risk of aspiration. This unevaluated practice might delay extubation, increase workload, and reduce caloric intake. We aimed to compare continued enteral nutrition until extubation with fasting before extubation in patients in the intensive care unit. METHODS We conducted an open-label, cluster-randomised, parallel-group, non-inferiority trial in 22 intensive care units in France. Patients aged 18 years or older were eligible for enrolment if they had received invasive mechanical ventilation for at least 48 h in the intensive care unit and received prepyloric enteral nutrition for at least 24 h at the time of extubation decision. Centres were randomly assigned (1:1) to continued enteral nutrition until extubation or 6-h fasting with concomitant gastric suctioning before extubation, to be applied for all patients within the unit. Masking was not possible because of the nature of the trial. The primary outcome was extubation failure (composite criteria of reintubation or death) within 7 days after extubation, assessed in both the intention-to-treat and per-protocol populations. The non-inferiority margin was set at 10%. Pneumonia within 14 days of extubation was a key secondary endpoint. This trial is now complete and is registered with ClinicalTrials.gov, NCT03335345. FINDINGS Between April 1, 2018, and Oct 31, 2019, 7056 patients receiving enteral nutrition and mechanical ventilation were admitted to the intensive care units and 4198 were assessed for eligibility. 1130 patients were enrolled and included in the intention-to-treat population and 1008 were included in the per-protocol population. In the intention-to-treat population, extubation failure occurred in 106 (17·2%) of 617 patients assigned to receive continued enteral nutrition until extubation versus 90 (17·5%) of 513 assigned to fasting, meeting the a priori defined non-inferiority criterion (absolute difference -0·4%, 95% CI -5·2 to 4·5). In the per-protocol population, extubation failure occurred in 101 (17·0%) of 595 patients assigned to receive continued enteral nutrition versus 74 (17·9%) of 413 assigned to fasting (absolute difference -0·9%, 95% CI -5·6 to 3·7). Pneumonia within 14 days of extubation occurred in ten (1·6%) patients assigned to receive continued enteral nutrition and 13 (2·5%) assigned to fasting (rate ratio 0·77, 95% CI 0·22 to 2·69). INTERPRETATION Continued enteral nutrition until extubation in critically ill patients in the intensive care unit was non-inferior to a 6-h fasting maximum gastric vacuity strategy comprising continuous gastric tube suctioning, in terms of extubation failure within 7 days (a patient-centred outcome), and thus represents a potential alternative in this population. FUNDING French Ministry of Health. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Mickaël Landais
- Réanimation Polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | - Mai-Anh Nay
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans Cedex 2, France
| | | | - Noemie Hubert
- Réanimation de Chirurgie Cardiaque, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Aurélien Frerou
- Médecine Intensive Réanimation et Maladies Infectieuses, CHU de Rennes, Rennes, France
| | - Aihem Yehia
- Médecine Intensive Réanimation, CHD Vendée, La Roche sur Yon, France
| | - Alain Mercat
- Médecine Intensive Réanimation, CHU Angers, France
| | - Maud Jonas
- Médecine Intensive Réanimation, CH de Saint-Nazaire, Saint-Nazaire, France
| | | | | | - Anne Courte
- Réanimation, CH de Saint-Brieuc, Saint-Brieuc, France
| | | | | | | | | | - Cédric Bruel
- Médecine Intensive Réanimation, Hôpital Saint Joseph, Paris, France
| | - Anne Renault
- Médecine Intensive Réanimation, CHU de Brest, Brest, France
| | - Olivier Huet
- Réanimation Chirurgicale, CHU de Brest, Brest, France
| | - Marc Feller
- Réanimation Médico-Chirurgicale, CH de Blois, Blois, France
| | - Nicolas Chudeau
- Réanimation Polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | | | - Anne Rebion
- Clinical Investigation Centre, INSERM 1415, CHRU Tours, Tours, France
| | - Alain Robert
- Réanimation Polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | - Bruno Giraudeau
- Universities of Tours and Nantes, INSERM 1246-SPHERE, Tours, France; Clinical Investigation Centre, INSERM 1415, CHRU Tours, Tours, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, INSERM CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Elsa Tavernier
- Universities of Tours and Nantes, INSERM 1246-SPHERE, Tours, France; Clinical Investigation Centre, INSERM 1415, CHRU Tours, Tours, France
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CHRU Tours, CIC INSERM 1415, CRICS-TriggerSep F-CRIN Research Network, Tours, France; INSERM, Centre d'Etude des Pathologies Respiratoires, U1100, Tours, France; Université de Tours, Tours, France.
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Cinotti R, Roquilly A, Chopin A, Martin FP, Morato Y, Lerebourg C, Moyer JD, Huet O, Lasocki S, Cohen B, Dahyot-Fizelier C, Chalard K, Seguin P, Chenet A, Perrouin-Verbe B, Sinha D, Asehnoune K, Feuillet F, Sébille V. Relationship between health-related quality-of-life and functional outcome 6 months after moderate to severe TBI. Ann Phys Rehabil Med 2023; 66:101715. [PMID: 36652785 DOI: 10.1016/j.rehab.2022.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Raphaël Cinotti
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France; UMR 1246 SPHERE "MethodS in Patients-centered outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200 Nantes, France.
| | - Antoine Roquilly
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
| | - Alice Chopin
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France
| | - Florian Pierre Martin
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
| | - Yoanna Morato
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France
| | - Céline Lerebourg
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France
| | - Jean Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris
| | - Olivier Huet
- Centre Hospitalier Universitaire de Brest, Anaesthesia and Intensive Care Unit, Brest, France
| | - Sigismond Lasocki
- Centre Hospitalier Universitaire d'Angers, Anaesthesia and Intensive Care Unit, Angers, France
| | - Benjamin Cohen
- Centre Hospitalier Universitaire de Tours, Anaesthesia and Intensive Care Unit, Tours, France
| | - Claire Dahyot-Fizelier
- Centre Hospitalier Universitaire de Potiers, Anaesthesia and Intensive Care Unit, Poitiers, France
| | - Kevin Chalard
- Centre Hospitalier Universitaire de Montpellier, Anaesthesia and Intensive Care Unit, Montpellier, France
| | - Philippe Seguin
- Centre Hospitalier Universitaire de Rennes, Anaesthesia and Intensive Care Unit, Rennes, France
| | - Amandine Chenet
- CHU Nantes, Nantes Université, Department of Rehabilitation, Hôpital Saint-Jacques, F-44000 Nantes, France
| | - Brigitte Perrouin-Verbe
- CHU Nantes, Nantes Université, Department of Rehabilitation, Hôpital Saint-Jacques, F-44000 Nantes, France
| | - Debajyoti Sinha
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
| | - Karim Asehnoune
- CHU Nantes, Nantes Université, Department of Anaesthesia and critical care, Hôtel Dieu, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
| | - Fanny Feuillet
- UMR 1246 SPHERE "MethodS in Patients-centered outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200 Nantes, France; Plateforme de Méthodologie et Biostatistique, Direction Recherche et Innovation, CHU Nantes, France
| | - Véronique Sébille
- UMR 1246 SPHERE "MethodS in Patients-centered outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
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14
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Grillot N, Lebuffe G, Huet O, Lasocki S, Pichon X, Oudot M, Bruneau N, David JS, Bouzat P, Jobert A, Tching-Sin M, Feuillet F, Cinotti R, Asehnoune K, Roquilly A. Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. JAMA 2023; 329:28-38. [PMID: 36594947 PMCID: PMC9856823 DOI: 10.1001/jama.2022.23550] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE It is uncertain whether a rapid-onset opioid is noninferior to a rapid-onset neuromuscular blocker during rapid sequence intubation when used in conjunction with a hypnotic agent. OBJECTIVE To determine whether remifentanil is noninferior to rapid-onset neuromuscular blockers for rapid sequence intubation. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, open-label, noninferiority trial among 1150 adults at risk of aspiration (fasting for <6 hours, bowel occlusion, recent trauma, or severe gastroesophageal reflux) who underwent tracheal intubation in the operating room at 15 hospitals in France from October 2019 to April 2021. Follow-up was completed on May 15, 2021. INTERVENTIONS Patients were randomized to receive neuromuscular blockers (1 mg/kg of succinylcholine or rocuronium; n = 575) or remifentanil (3 to 4 μg/kg; n = 575) immediately after injection of a hypnotic. MAIN OUTCOMES AND MEASURES The primary outcome was assessed in all randomized patients (as-randomized population) and in all eligible patients who received assigned treatment (per-protocol population). The primary outcome was successful tracheal intubation on the first attempt without major complications, defined as lung aspiration of digestive content, oxygen desaturation, major hemodynamic instability, sustained arrhythmia, cardiac arrest, and severe anaphylactic reaction. The prespecified noninferiority margin was 7.0%. RESULTS Among 1150 randomized patients (mean age, 50.7 [SD, 17.4] years; 573 [50%] women), 1130 (98.3%) completed the trial. In the as-randomized population, tracheal intubation on the first attempt without major complications occurred in 374 of 575 patients (66.1%) in the remifentanil group and 408 of 575 (71.6%) in the neuromuscular blocker group (between-group difference adjusted for randomization strata and center, -6.1%; 95% CI, -11.6% to -0.5%; P = .37 for noninferiority), demonstrating inferiority. In the per-protocol population, 374 of 565 patients (66.2%) in the remifentanil group and 403 of 565 (71.3%) in the neuromuscular blocker group had successful intubation without major complications (adjusted difference, -5.7%; 2-sided 95% CI, -11.3% to -0.1%; P = .32 for noninferiority). An adverse event of hemodynamic instability was recorded in 19 of 575 patients (3.3%) with remifentanil and 3 of 575 (0.5%) with neuromuscular blockers (adjusted difference, 2.8%; 95% CI, 1.2%-4.4%). CONCLUSIONS AND RELEVANCE Among adults at risk of aspiration during rapid sequence intubation in the operating room, remifentanil, compared with neuromuscular blockers, did not meet the criterion for noninferiority with regard to successful intubation on first attempt without major complications. Although remifentanil was statistically inferior to neuromuscular blockers, the wide confidence interval around the effect estimate remains compatible with noninferiority and limits conclusions about the clinical relevance of the difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03960801.
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Affiliation(s)
- Nicolas Grillot
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Gilles Lebuffe
- Université Lille, CHU Lille, ULR 7354–GRITA Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Pôle Anesthésie Réanimation, Lille, France
| | - Olivier Huet
- Département d’Anesthésie Réanimation et Médecine Péri-opératoire, CHRU Brest, Université de Bretagne occidentale, Brest, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Angers, Angers, France
| | - Xavier Pichon
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, University Toulouse III–Paul–Sabatier, Toulouse, France
| | - Mathieu Oudot
- Department of Anesthesiology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Nathalie Bruneau
- Université Lille, CHU Lille, Hopital Salengro, Pôle Anesthésie Réanimation, Lille, France
| | - Jean-Stéphane David
- Service d’Anesthésie Réanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | - Pierre Bouzat
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Alexandra Jobert
- Nantes Université, CHU Nantes, DRCI, Departement Promotion, Nantes, France
- Nantes Université, Univerisité Tours, CHU Nantes, CHU Tours, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes, France
| | - Martine Tching-Sin
- Nantes Université, CHU Nantes, Service de Pharmacie, Hôtel Dieu, Nantes, France
| | - Fanny Feuillet
- Nantes Université, Univerisité Tours, CHU Nantes, CHU Tours, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes, France
- Nantes Université, CHU Nantes, Service de Pharmacie, Hôtel Dieu, Nantes, France
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Raphael Cinotti
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
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15
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Launey Y, Coquet A, Lasocki S, Dahyot-Fizelier C, Huet O, Le Pabic E, Roquilly A, Seguin P. Factors associated with an unfavourable outcome in elderly intensive care traumatic brain injury patients. a retrospective multicentre study. BMC Geriatr 2022; 22:1004. [PMID: 36585608 PMCID: PMC9801582 DOI: 10.1186/s12877-022-03651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/24/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Changes in the epidemiology of traumatic brain injury (TBI) in older patients have received attention, but limited data are available on the outcome of these patients after admission to intensive care units (ICUs). The aim of this study was to evaluate the outcomes of patients over 65 years of age who were admitted to an ICU for TBI. METHODS This was a multicentre, retrospective, observational study conducted from January 2013 to February 2019 in the surgical ICUs of 5 level 1 trauma centres in France. Patients aged ≥ 65 years who were hospitalized in the ICU for TBI with or without extracranial injuries were included. The main objective was to determine the risk factors for unfavourable neurological outcome at 3 months defined as an Extended Glasgow Outcome Scale (GOSE) score < 5. RESULTS Among the 349 intensive care patients analysed, the GOSE score at 3 months was ≤ 4 and ≥ 5 in 233 (67%) and 116 (33%) patients, respectively. The mortality rate at 3 months was 157/233 (67%), and only 7 patients (2%) fully recovered or had minor symptoms. Withdrawal or withholding of life-sustaining therapies in the ICU was identified in 140 patients (40.1%). Multivariate analysis showed that age (OR 1.09, CI 95% 1.04-1.14), male sex (OR 2.94, CI95% 1.70-5.11), baseline Glasgow Coma Scale score (OR 1.20, CI95% 1.13-1.29), injury severity score (ISS; OR 1.04, CI95% 1.02-1.06) and use of osmotherapy (OR 2.42, CI95% 1.26-4.65) were associated with unfavourable outcomes (AUC = 0.79, CI 95% [0.74-0.84]). According to multivariate analysis, the variables providing the best sensitivity and specificity were age ≥ 77 years, Glasgow Coma Scale score ≤ 9 and ISS ≥ 25 (AUC = 0.79, CI 95% [0.74-0.84]). CONCLUSIONS Among intensive care patients aged ≥ 65 years suffering from TBI, age (≥ 77 years), male sex, baseline Glasgow coma scale score (≤ 9), ISS (≥ 25) and use of osmotherapy were predictors of unfavourable neurological outcome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04651803. Registered 03/12/2020. Retrospectively registered.
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Affiliation(s)
- Y Launey
- grid.414271.5Service de Réanimation Chirurgicale. CHU de Rennes. Hôpital Pontchaillou. 2, Rue Henri Le Guilloux, 35033 Rennes Cedex, France
| | - A Coquet
- grid.414271.5Service de Réanimation Chirurgicale. CHU de Rennes. Hôpital Pontchaillou. 2, Rue Henri Le Guilloux, 35033 Rennes Cedex, France
| | - S Lasocki
- grid.411147.60000 0004 0472 0283Département d’Anesthésie Réanimation, CHU de Angers, Angers, France
| | - C Dahyot-Fizelier
- grid.411162.10000 0000 9336 4276Département d’Anesthésie Réanimation, CHU de Poitiers, Poitiers, France
| | - O Huet
- grid.411766.30000 0004 0472 3249Département d’Anesthésie Réanimation, CHU de Brest, Brest, France
| | - E Le Pabic
- grid.411154.40000 0001 2175 0984Centre d’Investigation Clinique, CHU de Rennes, 2 Rue Henri Le Guilloux, 35000 Rennes, France
| | - A Roquilly
- grid.277151.70000 0004 0472 0371Département d’Anesthésie Réanimation, CHU de Nantes, Nantes, France
| | - P Seguin
- grid.414271.5Service de Réanimation Chirurgicale. CHU de Rennes. Hôpital Pontchaillou. 2, Rue Henri Le Guilloux, 35033 Rennes Cedex, France
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Aries P, Huet O, Balicchi J, Mathais Q, Estagnasie C, Martin-Lecamp G, Simon O, Morvan AC, Puech B, Subiros M, Blonde R, Boue Y. Characteristics and outcomes of SARS-COV 2 critically ill patients after emergence of the variant of concern 20H/501Y.V2: A comparative cohort study. Medicine (Baltimore) 2022; 101:e30816. [PMID: 36181037 PMCID: PMC9524525 DOI: 10.1097/md.0000000000030816] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There are currently no data regarding characteristics of critically ill patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variant of concern (VOC) 20H/501Y.V2. We therefore aimed to describe changes of characteristics in critically ill patients with Covid-19 between the first and the second wave when viral genome sequencing indicated that VOC was largely dominant in Mayotte Island (Indian Ocean). Consecutive patients with Covid-19 and over 18 years admitted in the unique intensive care unit (ICU) of Mayotte during wave 2 were compared with an historical cohort of patients admitted during wave 1. We performed a LR comparing wave 1 and wave 2 as outcomes. To complete analysis, we built a Random Forest model (RF), that is, a machine learning classification tool- using the same variable set as that of the LR. We included 156 patients, 41 (26.3%) and 115 (73.7%) belonging to the first and second waves respectively. Univariate analysis did not find difference in demographic data or in mortality. Our multivariate LR found that patients in wave 2 had less fever (absence of fever aOR 5.23, 95% confidence interval (CI) 1.89-14.48, p = .001) and a lower simplified acute physiology score (SAPS II) (aOR 0.95, 95% CI 0.91-0.99, p = .007) at admission; at 24 hours, the need of invasive mechanical ventilation was higher (aOR 3.49, 95% CI 0.98-12.51, p = .055) and pO2/FiO2 ratio was lower (aOR 0.99, 95 % CI 0.98-0.99, p = .03). Patients in wave 2 had also an increased risk of ventilator-associated pneumonia (VAP) (aOR 4.64, 95% CI 1.54-13.93, p = .006). Occurrence of VAP was also a key variable to classify patients between wave 1 and wave 2 in the variable importance plot of the RF model. Our data suggested that VOC 20H/501Y.V2 could be associated with a higher severity of respiratory failure at admission and a higher risk for developing VAP. We hypothesized that the expected gain in survival brought by recent improvements in critical care management could have been mitigated by increased transmissibility of the new lineage leading to admission of more severe patients. The immunological role of VOC 20H/501Y.V2 in the propensity for VAP requires further investigations.
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Affiliation(s)
- Philippe Aries
- Clermont-Tonnerre Military Teaching Hospital, Brest, France
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
- UFR of Medicine, University of Western Brittany, Brest, France
- *Correspondence: Philippe Aries, Clermont-Tonnerre Military Teaching Hospital, Brest, France (e-mail: )
| | - Olivier Huet
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
- UFR of Medicine, University of Western Brittany, Brest, France
| | - Julien Balicchi
- Regional Health Agency, Centre Kinga, Mamoudzou, Mayotte, France
| | - Quentin Mathais
- Department of Anesthesiology and Intensive Care, Military Hospital Sainte Anne, Toulon, France
| | | | | | - Olivier Simon
- Intensive Care Unit, Hospital of Southern Réunion, University Teaching Hospital of La Réunion, Saint-Pierre, Reunion Island, France
| | - Anne-Cécile Morvan
- Intensive Care Unit, Hospital of Western Réunion, Saint-Paul, Reunion Island, France
| | - Bérénice Puech
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, Reunion Island, France
| | - Marion Subiros
- French Public Health Agency in the Indian Ocean Region, Mamoudzou, Mayotte, France
| | - Renaud Blonde
- Intensive Care Unit, Mayotte Hospital, Mamoudzou, Mayotte, France
| | - Yvonnick Boue
- Intensive Care Unit, Mayotte Hospital, Mamoudzou, Mayotte, France
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17
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Godon A, Gabin M, Levy JH, Huet O, Chapalain X, David JS, Tacquard C, Sattler L, Minville V, Mémier V, Blanié A, Godet T, Leone M, De Maistre E, Gruel Y, Roullet S, Vermorel C, Samama CM, Bosson JL, Albaladejo P. Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis. Thromb Res 2022; 216:106-112. [DOI: 10.1016/j.thromres.2022.06.005] [Citation(s) in RCA: 1] [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] [Received: 02/23/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 01/21/2023]
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Chapalain X, Oilleau JF, Henaff L, Lorillon PharmD P, Saout DL, Kha P, Pluchon K, Bezon E, Huet O. Short acting intravenous beta-blocker as a first line of treatment for atrial fibrillation after cardiac surgery: a prospective observational study. Eur Heart J Suppl 2022; 24:D34-D42. [PMID: 35706899 PMCID: PMC9190753 DOI: 10.1093/eurheartjsupp/suac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Post-operative atrial fibrillation (POAF) defined as a new-onset of atrial fibrillation (AF) following surgery occurs frequently after cardiac surgery. For non-symptomatic patients, rate control strategy seems to be as effective as rhythm control one in surgical patients. Landiolol is a new highly cardio-selective beta-blocker agent with interesting pharmacological properties that may have some interest in this clinical situation. This is a prospective, monocentric, observational study. All consecutive adult patients (age >18 years old) admitted in the intensive care unit following cardiac surgery with a diagnosed episode of AF were eligible. Success of landiolol administration was defined by a definitive rate control from the beginning of infusion to the 72th h. We also evaluated rhythm control following landiolol infusion. Safety analysis was focused on haemodynamic, renal and respiratory side effects. From 1 January 2020 to 30 June 2021, we included 54 consecutive patients. A sustainable rate control was obtained for 49 patients (90.7%). Median time until a sustainable rate control was 4 h (1, 22). Median infusion rate of landiolol needed for a sustainable rate control was 10 µg/kg/min (6, 19). Following landiolol infusion, median time until pharmacological cardioversion was 24 h. During landiolol infusion, maintenance of mean arterial pressure target requires a concomitant very low dose of norepinephrine. We did not find any other side effects. Low dose of landiolol used for POAF treatment was effective and safe for a rapid and sustainable rate and rhythm control after cardiac surgery.
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Affiliation(s)
- X Chapalain
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - J F Oilleau
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - L Henaff
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - P Lorillon PharmD
- Department of Pharmacy, Brest University Hospital, 29200 Brest, France
| | - D Le Saout
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - P Kha
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - K Pluchon
- Department of Cardiovascular and Thoracic Surgery, Brest University Hospital, 29200 Brest, France
| | - E Bezon
- Department of Cardiovascular and Thoracic Surgery, Brest University Hospital, 29200 Brest, France
| | - O Huet
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
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19
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Matejovic M, Huet O, Dams K, Elke G, Vaquerizo Alonso C, Csomos A, Krzych ŁJ, Tetamo R, Puthucheary Z, Rooyackers O, Tjäder I, Kuechenhoff H, Hartl WH, Hiesmayr M. Medical nutrition therapy and clinical outcomes in critically ill adults: a European multinational, prospective observational cohort study (EuroPN). Crit Care 2022; 26:143. [PMID: 35585554 PMCID: PMC9115983 DOI: 10.1186/s13054-022-03997-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/25/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Medical nutrition therapy may be associated with clinical outcomes in critically ill patients with prolonged intensive care unit (ICU) stay. We wanted to assess nutrition practices in European intensive care units (ICU) and their importance for clinical outcomes. METHODS Prospective multinational cohort study in patients staying in ICU ≥ 5 days with outcome recorded until day 90. Macronutrient intake from enteral and parenteral nutrition and non-nutritional sources during the first 15 days after ICU admission was compared with targets recommended by ESPEN guidelines. We modeled associations between three categories of daily calorie and protein intake (low: < 10 kcal/kg, < 0.8 g/kg; moderate: 10-20 kcal/kg, 0.8-1.2 g/kg, high: > 20 kcal/kg; > 1.2 g/kg) and the time-varying hazard rates of 90-day mortality or successful weaning from invasive mechanical ventilation (IMV). RESULTS A total of 1172 patients with median [Q1;Q3] APACHE II score of 18.5 [13.0;26.0] were included, and 24% died within 90 days. Median length of ICU stay was 10.0 [7.0;16.0] days, and 74% of patients could be weaned from invasive mechanical ventilation. Patients reached on average 83% [59;107] and 65% [41;91] of ESPEN calorie and protein recommended targets, respectively. Whereas specific reasons for ICU admission (especially respiratory diseases requiring IMV) were associated with higher intakes (estimate 2.43 [95% CI: 1.60;3.25] for calorie intake, 0.14 [0.09;0.20] for protein intake), a lack of nutrition on the preceding day was associated with lower calorie and protein intakes (- 2.74 [- 3.28; - 2.21] and - 0.12 [- 0.15; - 0.09], respectively). Compared to a lower intake, a daily moderate intake was associated with higher probability of successful weaning (for calories: maximum HR 4.59 [95% CI: 1.5;14.09] on day 12; for protein: maximum HR 2.60 [1.09;6.23] on day 12), and with a lower hazard of death (for calories only: minimum HR 0.15, [0.05;0.39] on day 19). There was no evidence that a high calorie or protein intake was associated with further outcome improvements. CONCLUSIONS Calorie intake was mainly provided according to the targets recommended by the active ESPEN guideline, but protein intake was lower. In patients staying in ICU ≥ 5 days, early moderate daily calorie and protein intakes were associated with improved clinical outcomes. Trial registration NCT04143503 , registered on October 25, 2019.
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Affiliation(s)
- Martin Matejovic
- First Medical Department, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Pilsen, Czech Republic
| | | | - Karolien Dams
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Clara Vaquerizo Alonso
- Department of Intensive Care Medicine, Fuenlabrada University Hospital (Hospital Universitario de Fuenlabrada), Madrid, Spain
| | | | - Łukasz J Krzych
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | | | - Zudin Puthucheary
- Barts Health (Royal London) and Queen Mary University of London, London, England, UK
| | - Olav Rooyackers
- Division of Anesthesiology and Intensive Care, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Inga Tjäder
- Karolinska University Hospital, Perioperative Medicine and Intensive Care, Huddinge, Stockholm, Sweden
| | - Helmut Kuechenhoff
- Statistisches Beratungslabor, Institut für Statistik Ludwig-Maximilians-Universität München, Munich, Germany
| | - Wolfgang H Hartl
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Klinikum der Universität, Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.
| | - Michael Hiesmayr
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, and Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Spitalgasse 23, Vienna, Austria.
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Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Lasocki S, Futier E, Amour J, Durand M, Bougle A, Kerforne T, Consigny M, Eddi D, Huet O. Dexmedetomidine after Cardiac Surgery for Prevention of Delirium (EXACTUM) trial protocol: a multicentre randomised, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e058968. [PMID: 35396310 PMCID: PMC8996049 DOI: 10.1136/bmjopen-2021-058968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Incidence of delirium after cardiac surgery remains high and delirium has a significant burden on short-term and long-term outcomes. Multiple causes can trigger delirium occurence, and it has been hypothesised that sleep disturbances can be one of them. Preserving the circadian rhythm with overnight infusion of low-dose dexmedetomidine has been shown to lower the occurrence of delirium in older patients after non-cardiac surgery. However, these results remain controversial. The aim of this study was to demonstrate the usefulness of sleep induction by overnight infusion of dexmedetomidine to prevent delirium after cardiac surgery. METHODS AND ANALYSIS Dexmedetomidine after Cardiac Surgery for Prevention of Delirium is an investigator-initiated, randomised, placebo-controlled, parallel, multicentre, double-blinded trial. Nine centres in France will participate in the study. Patients aged 65 years or older and undergoing cardiac surgery will be enrolled in the study. The intervention starts on day 0 (the day of surgery) until intensive care unit (ICU) discharge; the treatment is administered from 20:00 to 08:00 on the next day. Infusion rate is modified by the treating nurse or the clinician with an objective of Richmond Agitation and Sedation Scale score from -1 to +1. The primary outcome is delirium occurrence evaluated with confusion assessment method for the ICU two times per day during 7 days following surgery. Secondary outcomes include incidence of agitation related events, self-evaluated quality of sleep, cognitive evaluation 3 months after surgery and quality of life 3 months after surgery. The sample size is 348. ETHICS AND DISSEMINATION The study was approved for all participating centers by the French Central Ethics Committee (Comité de Protection des Personnes Ile de France VI, registration number 2018-000850-22). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03477344.
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Affiliation(s)
- Thomas Gargadennec
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
| | - Jean-Ferréol Oilleau
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
| | - Bertrand Rozec
- Intensive Care Unit, Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
- CNRS, INSERM, l'institut du thorax, Université de Nantes, Nantes, France
| | - Nicolas Nesseler
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, Angers, France
- Université Angers Faculté des Sciences, Angers, France
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie Réanimation, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
- CNRS, Inserm U-1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiothoracic Surgery (IPRA), Jacques Cartier Private Hospital, Massy, France
| | - Michel Durand
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Adrien Bougle
- Sorbonne Universite, Paris, France
- Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, GRC 29, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Thomas Kerforne
- Faculté de Médecine, INSERM U1082, Ischémie Reperfusion en Transplantation Modélisation et Innovations Thérapeutiques, Université de Poitiers, Poitiers, France
- Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU Poitiers, Poitiers, France
| | - Maëlys Consigny
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Dauphou Eddi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Olivier Huet
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
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21
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Brulé N, Canet E, Péré M, Feuillet F, Hourmant M, Asehnoune K, Rozec B, Duveau A, Dube L, Pierrot M, Humbert S, Tirot P, Boyer JM, Martin-Lefevre L, Labadie F, Robert R, Benard T, Kerforne T, Thierry A, Lesieur O, Vincent JF, Lesouhaitier M, Larmet R, Vigneau C, Goepp A, Bouju P, Quentin C, Egreteau PY, Huet O, Renault A, Le Meur Y, Venhard JC, Buchler M, Michel O, Voellmy MH, Herve F, Schnell D, Courte A, Glotz D, Amrouche L, Hazzan M, Kamar N, Moal V, Bourenne J, Le Quintrec-Donnette M, Morelon E, Boulain T, Grimbert P, Heng AE, Merville P, Garin A, Hiesse C, Fermier B, Mousson C, Guyot-Colosio C, Bouvier N, Rerolle JP, Durrbach A, Drouin S, Caillard S, Frimat L, Girerd S, Albano L, Rostaing L, Bertrand D, Hertig A, Westeel PF, Montini F, Delpierre E, Dorez D, Alamartine E, Ouisse C, Sebille V, Reignier J. Impact of targeted hypothermia in expanded-criteria organ donors on recipient kidney-graft function: study protocol for a multicentre randomised controlled trial (HYPOREME). BMJ Open 2022; 12:e052845. [PMID: 35351701 PMCID: PMC8961135 DOI: 10.1136/bmjopen-2021-052845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Expanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and mortality. HYPOREME will be a multicentre randomised controlled trial (RCT) comparing targeted hypothermia to normothermia in ECDs, in a country where the use of machine perfusion for organ storage is the standard of care. We hypothesise that hypothermia will decrease the incidence of DGF. METHODS AND ANALYSIS HYPOREME is a multicentre RCT comparing the effect on kidney function in recipients of targeted hypothermia (34°C-35°C) and normothermia (36.5°C-37.5°C) in the ECDs. The temperature intervention starts from randomisation and is maintained until aortic clamping in the operating room. We aim to enrol 289 ECDs in order to analyse the kidney function of 516 recipients in the 53 participating centres. The primary outcome is the occurrence of DGF in kidney recipients, defined as a requirement for renal replacement therapy within 7 days after transplantation (not counting a single session for hyperkalemia during the first 24 hours). Secondary outcomes include the proportion of patients with individual organs transplanted in each group; the number of organs transplanted from each ECD and the vital status and kidney function of the recipients 7 days, 28 days, 3 months and 1 year after transplantation. An interim analysis is planned after the enrolment of 258 kidney recipients. ETHICS AND DISSEMINATION The trial was approved by the ethics committee of the French Intensive Care Society (CE-SRLF-16-07) on 26 April 2016 and by the competent French authorities on 20 April 2016 (Comité de Protection des Personnes-TOURS-Région Centre-Ouest 1, registration #2016-S3). Findings will be published in peer-reviewed journals and presented during national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT03098706.
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Affiliation(s)
- Noëlle Brulé
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Morgane Péré
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Fanny Feuillet
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- INSERM SPHERE U1246 Methods for Patient-centered Outcomes and Health Research, Université de Nantes, Université de Tours, Nantes, PAYS-DE-LA-LOIRE, France
| | - Maryvonne Hourmant
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karim Asehnoune
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Rozec
- Service de Réanimation en Chirurgie Cardio-thoracique et Vasculaire, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Agnes Duveau
- Service de Néphrologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Laurent Dube
- Service de Coordination des prélèvements d'organe, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc Pierrot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Stanislas Humbert
- Service de Réanimation Polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
| | - Jean-Marc Boyer
- Service de Réanimation, Centre Hospitalier de Laval, Laval, France
| | - Laurent Martin-Lefevre
- Service de Médecine Intensive Réanimation, Centre Hospitalier Departemental Les Oudairies, La Roche-sur-Yon, Pays de la Loire, France
| | - François Labadie
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Nazaire, Saint Nazaire, Pays de la Loire, France
| | - René Robert
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ALIVE Research Group, INSERM, University of Poitiers, Poitiers, Poitou-Charentes, France
| | - Thierry Benard
- Service de Réanimation Neurochirurgicale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Kerforne
- Service d'Anesthésie-Réanimation Cardio-Thoracique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Antoine Thierry
- Service de Néphrologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Lesieur
- Service de Réanimation, Centre Hospitalier de la Rochelle, La Rochelle, Nouvelle-Aquitaine, France
| | - Jean-François Vincent
- Service de Réanimation, Centre Hospitalier de Saintes, Saintes, Poitou-Charentes, France
| | - Mathieu Lesouhaitier
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Raphaelle Larmet
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Cecile Vigneau
- Service de Néphrologie, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Angelique Goepp
- Service de Réanimation, Centre Hospitalier Bretagne Atlantique de Vannes, Vannes, France
| | - Pierre Bouju
- Service de Réanimation, Centre Hospitalier de Bretagne Sud, Lorient, Lorient, France
| | - Charlotte Quentin
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint-Malo, Saint-Malo, Bretagne, France
| | - Pierre-Yves Egreteau
- Service de Réanimation Polyvalente, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Olivier Huet
- Service de Réanimation Chirurgicale, Hôpital La Cavale Blanche, CHU de Brest, Brest, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHRU de Brest, Brest, Bretagne, France
| | - Yannick Le Meur
- Service de Néphrologie, Hôpital La Cavale Blanche, CHU de Brest, Brest, France
| | - Jean-Christophe Venhard
- Coordination des prélèvements d'organes et de tissus, Pôle Anesthésie Réanimations, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Mathias Buchler
- Service de Néphrologie, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Olivier Michel
- Service de Réanimation Polyvalente, Centre Hospitalier Jacques Cœur, Bourges, Centre-Val de Loire, France
| | - Marie-Hélène Voellmy
- Service de Coordination des prélèvements, Centre Hospitalier Jacques Cœur, Bourges, Centre-Val de Loire, France
| | - Fabien Herve
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France
| | - David Schnell
- Service de Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angouleme, France
| | - Anne Courte
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, Bretagne, France
| | - Denis Glotz
- Service de Néphrologie, Hôpital Saint-Louis, Université de Paris, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Lucile Amrouche
- Service de Néphrologie, Hôpital Necker, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Hazzan
- University of Lille, Inserm, CHU Lille, U1286-Infinite-Institute for Translational Research in Inflammation, CHRU de Lille, Lille, Hauts-de-France, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'organes, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043- CNRS 5282, Toulouse, France, Toulouse, Midi-Pyrénées, France
| | - Valerie Moal
- Centre de Néphrologie et Transplantation Rénale, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Conception, Marseille, France
| | - Jeremy Bourenne
- Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, CHU La Timone 2, Marseille, France
| | - Moglie Le Quintrec-Donnette
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Emmanuel Morelon
- Service d'Urologie et de Chirurgie de la Transplantation, Pôle Chirurgie, Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Thierry Boulain
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans Hôpital de La Source, Orléans, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, Créteil, France
| | - Anne Elisabeth Heng
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Merville
- Service de Nephrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine-Limousin-Poitou, France
| | - Aude Garin
- Service de Réanimation Polyvalente, Centre Hospitalier de Dreux, Dreux, France
| | - Christian Hiesse
- Service de Néphrologie, Hôpital Foch, Suresnes, Suresnes, France
| | - Brice Fermier
- Service de Réanimation, Centre Hospitalier de Blois, Blois, Centre-Val de Loire, France
| | - Christiane Mousson
- Service de Néphrologie, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Charlotte Guyot-Colosio
- Service de Néphrologie, Centre Hospitalier Universitaire de Reims, Reims, Champagne-Ardenne, France
| | - Nicolas Bouvier
- Service de Néphrologie, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Jean-Philippe Rerolle
- Service de Néphrologie, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Antoine Durrbach
- Service de Néphrologie, Hôpital Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Sarah Drouin
- Service Médico-Chirurgical de Transplantation Rénale, APHP Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Sophie Caillard
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, Alsace, France
| | - Luc Frimat
- Nephrology Department, CHRU Nancy, Université de Lorraine, Nancy, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation, Hôpital Brabois, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Laetitia Albano
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Dominique Bertrand
- Service de Néphrologie, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Alexandre Hertig
- Service de Néphrologie, Hôpital Tenon, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Florent Montini
- Service de Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Eric Delpierre
- Service de Réanimation, Grand Hôpital de l'Est Francilien, Marne La vallée, France
| | - Dider Dorez
- Service de Réanimation Polyvalente, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Eric Alamartine
- Service de Néphrologie Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Rhône-Alpes, France
| | - Carole Ouisse
- Service de Médecine Intensive Réanimation, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Veronique Sebille
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- INSERM SPHERE U1246 Methods for Patient-centered Outcomes and Health Research, Université de Nantes, Université de Tours, Nantes, PAYS-DE-LA-LOIRE, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
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22
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Gaudriot B, Oilleau JF, Kerforne T, Ecoffey C, Huet O, Mansour A, Verhoye JP, Massart N, Nesseler N. The impact of iron store on red blood cell transfusion: a multicentre prospective cohort study in cardiac surgery. BMC Anesthesiol 2022; 22:74. [PMID: 35313823 PMCID: PMC8935744 DOI: 10.1186/s12871-022-01616-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Anaemia is common prior to cardiac surgery and contributes to perioperative morbidity. Iron deficiency is the main cause of anaemia but its impact remains controversial in the surgical setting. We aimed to estimate the impact of iron deficiency on in-hospital perioperative red blood cell transfusion for patients undergoing elective and urgent cardiac surgery. Secondary objectives were to identify risk factors associated with in-hospital red blood cell transfusion. Methods We conducted a prospective multicentre observational study in three university hospitals performing cardiac surgery. We determined iron status prior to surgery and collected all transfusion data to compare iron-deficient and iron-replete patients during hospital stay. We performed a multivariable logistic regression to compare transfusion among groups. Results Five hundred and two patients were included. A trend of low haemoglobin levels associated with iron deficiency persisted until discharge. Red blood cell transfusion was significantly higher in the group of iron deficient patients during surgery (22% vs 13%, p = 0.017), however the incidence during the whole hospital stay was 31% in the iron-deficient group, not significantly different with the non-deficient group (26%, p = 0.28). Iron deficiency was not independently associated with in-hospital red blood cell transfusion (adjusted OR = 0.85 [0.53–1.36], p = 0.49). Conclusions In-hospital red blood cell transfusion was not significantly higher in iron-deficient patients and iron deficiency was not associated with in-hospital red blood cell transfusion in patients undergoing elective and urgent cardiac surgery. Iron deficiency was the main cause of anaemia and anaemia was a strong driver of red blood cell transfusion. Further studies should identify sub-population of iron-deficient patients which may benefit from preoperative iron deficiency management and explore the long-term impact of lower haemoglobin levels at discharge in the iron deficient population.
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Affiliation(s)
- Baptiste Gaudriot
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France. .,Service d'Anesthésie-Réanimation CTCV, Centre Cardio-Pneumologique, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Cedex 9, Rennes, France.
| | - Jean-Ferreol Oilleau
- Department of Anaesthesia and Critical Care, Brest University Hospital, 29000, Brest, France
| | - Thomas Kerforne
- Department of Anaesthesia and Critical Care, INSERM U-1082, Poitiers University Hospital, 86000, Poitiers, France
| | - Claude Ecoffey
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France.,Univ Rennes, CHU de Rennes, 35000, Rennes, France
| | - Olivier Huet
- Department of Anaesthesia and Critical Care, Brest University Hospital, 29000, Brest, France.,Brest University, 29000, Brest, France
| | - Alexandre Mansour
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France.,Univ Rennes, CHU de Rennes, 35000, Rennes, France
| | - Jean-Philippe Verhoye
- Univ Rennes, CHU de Rennes, 35000, Rennes, France.,Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Univ Rennes 1, 35000, Rennes, France
| | - Nicolas Massart
- Intensive Care Unit, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France
| | - Nicolas Nesseler
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France.,Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, F-35000, Rennes, France
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23
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Gargadennec T, Ferraro G, Chapusette R, Chapalain X, Bogossian E, Van Wettere M, Peluso L, Creteur J, Huet O, Sadeghi N, Taccone FS. Detection of cerebral hypoperfusion with a dynamic hyperoxia test using brain oxygenation pressure monitoring. Crit Care 2022; 26:35. [PMID: 35130953 PMCID: PMC8822803 DOI: 10.1186/s13054-022-03918-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Brain multimodal monitoring including intracranial pressure (ICP) and brain tissue oxygen pressure (PbtO2) is more accurate than ICP alone in detecting cerebral hypoperfusion after traumatic brain injury (TBI). No data are available for the predictive role of a dynamic hyperoxia test in brain-injured patients from diverse etiology.
Aim
To examine the accuracy of ICP, PbtO2 and the oxygen ratio (OxR) in detecting regional cerebral hypoperfusion, assessed using perfusion cerebral computed tomography (CTP) in patients with acute brain injury.
Methods
Single-center study including patients with TBI, subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH) undergoing cerebral blood flow (CBF) measurements using CTP, concomitantly to ICP and PbtO2 monitoring. Before CTP, FiO2 was increased directly from baseline to 100% for a period of 20 min under stable conditions to test the PbtO2 catheter, as a standard of care. Cerebral monitoring data were recorded and samples were taken, allowing the measurement of arterial oxygen pressure (PaO2) and PbtO2 at FiO2 100% as well as calculation of OxR (= ΔPbtO2/ΔPaO2). Regional CBF (rCBF) was measured using CTP in the tissue area around intracranial monitoring by an independent radiologist, who was blind to the PbtO2 values. The accuracy of different monitoring tools to predict cerebral hypoperfusion (i.e., CBF < 35 mL/100 g × min) was assessed using area under the receiver-operating characteristic curves (AUCs).
Results
Eighty-seven CTPs were performed in 53 patients (median age 52 [41–63] years—TBI, n = 17; SAH, n = 29; ICH, n = 7). Cerebral hypoperfusion was observed in 56 (64%) CTPs: ICP, PbtO2 and OxR were significantly different between CTP with and without hypoperfusion. Also, rCBF was correlated with ICP (r = − 0.27; p = 0.01), PbtO2 (r = 0.36; p < 0.01) and OxR (r = 0.57; p < 0.01). Compared with ICP alone (AUC = 0.65 [95% CI, 0.53–0.76]), monitoring ICP + PbO2 (AUC = 0.78 [0.68–0.87]) or ICP + PbtO2 + OxR (AUC = 0.80 (0.70–0.91) was significantly more accurate in predicting cerebral hypoperfusion. The accuracy was not significantly different among different etiologies of brain injury.
Conclusions
The combination of ICP and PbtO2 monitoring provides a better detection of cerebral hypoperfusion than ICP alone in patients with acute brain injury. The use of dynamic hyperoxia test could not significantly increase the diagnostic accuracy.
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24
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Chapalain X, Huet O. Slower vs Faster Intravenous Fluid Bolus Rates and Mortality in Critically Ill Patients. JAMA 2021; 326:2331-2332. [PMID: 34905037 DOI: 10.1001/jama.2021.18542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Xavier Chapalain
- Department of Anesthesiology and Intensive Care Medicine, Brest University Hospital, Brest, France
| | - Olivier Huet
- Department of Anesthesiology and Intensive Care Medicine, Brest University Hospital, Brest, France
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25
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Sánchez van Kammen M, Aguiar de Sousa D, Poli S, Cordonnier C, Heldner MR, van de Munckhof A, Krzywicka K, van Haaps T, Ciccone A, Middeldorp S, Levi MM, Kremer Hovinga JA, Silvis S, Hiltunen S, Mansour M, Arauz A, Barboza MA, Field TS, Tsivgoulis G, Nagel S, Lindgren E, Tatlisumak T, Jood K, Putaala J, Ferro JM, Arnold M, Coutinho JM, Sharma AR, Elkady A, Negro A, Günther A, Gutschalk A, Schönenberger S, Buture A, Murphy S, Paiva Nunes A, Tiede A, Puthuppallil Philip A, Mengel A, Medina A, Hellström Vogel Å, Tawa A, Aujayeb A, Casolla B, Buck B, Zanferrari C, Garcia-Esperon C, Vayne C, Legault C, Pfrepper C, Tracol C, Soriano C, Guisado-Alonso D, Bougon D, Zimatore DS, Michalski D, Blacquiere D, Johansson E, Cuadrado-Godia E, De Maistre E, Carrera E, Vuillier F, Bonneville F, Giammello F, Bode FJ, Zimmerman J, d'Onofrio F, Grillo F, Cotton F, Caparros F, Puy L, Maier F, Gulli G, Frisullo G, Polkinghorne G, Franchineau G, Cangür H, Katzberg H, Sibon I, Baharoglu I, Brar J, Payen JF, Burrow J, Fernandes J, Schouten J, Althaus K, Garambois K, Derex L, Humbertjean L, Lebrato Hernandez L, Kellermair L, Morin Martin M, Petruzzellis M, Cotelli M, Dubois MC, Carvalho M, Wittstock M, Miranda M, Skjelland M, Bandettini di Poggio M, Scholz MJ, Raposo N, Kahnis R, Kruyt N, Huet O, Sharma P, Candelaresi P, Reiner P, Vieira R, Acampora R, Kern R, Leker R, Coutts S, Bal S, Sharma SS, Susen S, Cox T, Geeraerts T, Gattringer T, Bartsch T, Kleinig TJ, Dizonno V, Arslan Y. Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. JAMA Neurol 2021; 78:1314-1323. [PMID: 34581763 DOI: 10.1001/jamaneurol.2021.3619] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). Objective To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. Design, Setting, and Participants This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. Exposures Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. Main Outcomes and Measures Clinical characteristics and mortality rate. Results Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. Conclusions and Relevance In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
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Affiliation(s)
- Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal
| | - Sven Poli
- Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany.,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Charlotte Cordonnier
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs van Haaps
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel M Levi
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzanne Silvis
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maryam Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Antonio Arauz
- National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr R.A. Calderón Guardia, San José, Costa Rica
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Georgios Tsivgoulis
- Second Department of Neurology in National, Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jose M Ferro
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Aarti R Sharma
- Imperial College London School of Medicine, Imperial College London, London, United Kingdom
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Gutschalk
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Alina Buture
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland.,School of Medicine, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ana Paiva Nunes
- Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Andreas Tiede
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany
| | - Antonio Medina
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Audrey Tawa
- Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | - Barbara Casolla
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom.,Stroke Unit, Hôpital Pasteur 2, URRIS - UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy
| | | | - Caroline Vayne
- Department of Hematology and Hemostasis, Tours University Hospital, Tours, France
| | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian Pfrepper
- Division of Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | | | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain
| | | | - David Bougon
- Department of Critical Care, Annecy Genevois Hospital, Annecy, France
| | | | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Dylan Blacquiere
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden
| | | | | | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Julian Zimmerman
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Francois Cotton
- Department of Radiology, Lyon University Hospital, Lyon, France
| | - François Caparros
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Laurent Puy
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany
| | - Giosue Gulli
- Department of Medicine, Ashford and St Peters Hospital NHS Foundation Trust, Surrey, United Kingdom
| | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Guillaume Franchineau
- Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France
| | - Hakan Cangür
- Department of Neurology, Hospital of the City of Wolfsburg, Wolfsburg, Germany
| | - Hans Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Irem Baharoglu
- Department of Neurology, Haga Hospital, The Hague, the Netherlands
| | - Jaskiran Brar
- Department of Neurology, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | | | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia
| | - João Fernandes
- Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | | | - Katia Garambois
- Stroke Unit, University Hospital of Grenoble, Grenoble, France
| | - Laurent Derex
- Department of Neurology, Hospices Civils de Lyon, Lyon, France
| | | | | | - Lukas Kellermair
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Maria Cotelli
- Department of Neurology, ASL Vallecamonica-Sebino, Breno, Italy
| | - Marie-Cécile Dubois
- Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Marta Carvalho
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Moritz J Scholz
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Robert Kahnis
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Nyika Kruyt
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Olivier Huet
- UFR de Bio-médecine, Hospital de la Cavale Blanche, CHRU de Brest, Brest, France
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, London, United Kingdom
| | - Paolo Candelaresi
- Department of Neurology and Stroke, Cardarelli Hospital, Naples, Italy
| | - Peggy Reiner
- Department of Neurology, Lariboisière Hospital, Paris, France
| | - Ricardo Vieira
- Department of Hematology, Universidade Federal do Cariri, Juazeiro do Norte, Brazil
| | | | - Rolf Kern
- Department of Neurology, Kempten Hospital, Kempten, Germany
| | - Ronen Leker
- Department of Neurology, Hadassah University Medical Center, Jerusalem, Israel
| | - Shelagh Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simerpreet Bal
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Shyam S Sharma
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Sophie Susen
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | | | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Vanessa Dizonno
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Yildiz Arslan
- Neurology Clinic, Medicana İzmir International Hospital, Izmir, Turkey
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26
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Chapalain X, Huet O, Balzer T, Delbove A, Martino F, Jacquier S, Egreteau PY, Darreau C, Saint-Martin M, Lerolle N, Aubron C. Does Chloride Intake at the Early Phase of Septic Shock Resuscitation Impact on Renal Outcome? Shock 2021; 56:425-432. [PMID: 33606477 DOI: 10.1097/shk.0000000000001757] [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: 10/22/2022]
Abstract
INTRODUCTION Fluid administration is one of the first lines of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings. METHODS This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition, were eligible. A "high-dose" of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of cumulative chloride infusion within the first 48 h of septic shock resuscitation on acute kidney injury (AKI). RESULTS Two hundred thirty-nine patients with septic shock were included. Patients who received a "high-dose" of chloride had significantly higher Sequential Organ Failure Assessment score at the time of enrolment (P < 0.001). Cumulative chloride load was higher in patients requiring renal replacement therapy (RRT) (31.1 vs. 25.2 g/48 h; P < 0.005). Propensity score-weighted regression did not find any association between "high-dose" of chloride and AKI requiring RRT (OR: 0.97 [0.88-1.1]; P = 0.69). There was no association between "high-dose" of chloride and worsening kidney function at H48 (OR: 0.94 [0.83-1.1]; P = 0.42). There was also no association between "high-dose" of chloride and ICU length of stay (P = 0.61), 28-day mortality (P = 0.83), or hospital mortality (P = 0.89). CONCLUSION At the early stage of resuscitation of critically ill patients with septic shock, administration of "high-dose" of chloride (> 18 g/48 h) was not associated with renal prognosis.
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Affiliation(s)
- Xavier Chapalain
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Olivier Huet
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Brest, France
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thibault Balzer
- Department of Anesthesiology and Surgical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Agathe Delbove
- Medical and Surgical Intensive Care Unit, Vannes Hospital, Vannes, France
| | - Frédéric Martino
- Medical and Surgical Intensive Care Unit, Guadeloupe University Hospital, Les Abymes, Guadeloupe, France
| | - Sophie Jacquier
- Medical and Surgical Intensive Care Unit, Orleans Hospital, Orleans, France
| | | | - Cédric Darreau
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | | | - Nicolas Lerolle
- Medical Intensive Care Unit, Angers University Hospital and Angers University, Angers, France
| | - Cécile Aubron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
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27
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Vayne C, Rollin J, Gruel Y, Pouplard C, Galinat H, Huet O, Mémier V, Geeraerts T, Marlu R, Pernod G, Mourey G, Fournel A, Cordonnier C, Susen S. PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia. N Engl J Med 2021; 385:376-378. [PMID: 34010527 PMCID: PMC8174029 DOI: 10.1056/nejmc2106383] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Yves Gruel
- Tours University Hospital, Tours, France
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28
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Roquilly A, Moyer JD, Huet O, Lasocki S, Cohen B, Dahyot-Fizelier C, Chalard K, Seguin P, Jeantrelle C, Vermeersch V, Gaillard T, Cinotti R, Demeure dit Latte D, Mahe PJ, Vourc’h M, Martin FP, Chopin A, Lerebourg C, Flet L, Chiffoleau A, Feuillet F, Asehnoune K. Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury: The COBI Randomized Clinical Trial. JAMA 2021; 325:2056-2066. [PMID: 34032829 PMCID: PMC8150692 DOI: 10.1001/jama.2021.5561] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Fluid therapy is an important component of care for patients with traumatic brain injury, but whether it modulates clinical outcomes remains unclear. OBJECTIVE To determine whether continuous infusion of hypertonic saline solution improves neurological outcome at 6 months in patients with traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial conducted in 9 intensive care units in France, including 370 patients with moderate to severe traumatic brain injury who were recruited from October 2017 to August 2019. Follow-up was completed in February 2020. INTERVENTIONS Adult patients with moderate to severe traumatic brain injury were randomly assigned to receive continuous infusion of 20% hypertonic saline solution plus standard care (n = 185) or standard care alone (controls; n = 185). The 20% hypertonic saline solution was administered for 48 hours or longer if patients remained at risk of intracranial hypertension. MAIN OUTCOMES AND MEASURES The primary outcome was Extended Glasgow Outcome Scale (GOS-E) score (range, 1-8, with lower scores indicating worse functional outcome) at 6 months, obtained centrally by blinded assessors and analyzed with ordinal logistic regression adjusted for prespecified prognostic factors (with a common odds ratio [OR] >1.0 favoring intervention). There were 12 secondary outcomes measured at multiple time points, including development of intracranial hypertension and 6-month mortality. RESULTS Among 370 patients who were randomized (median age, 44 [interquartile range, 27-59] years; 77 [20.2%] women), 359 (97%) completed the trial. The adjusted common OR for the GOS-E score at 6 months was 1.02 (95% CI, 0.71-1.47; P = .92). Of the 12 secondary outcomes, 10 were not significantly different. Intracranial hypertension developed in 62 (33.7%) patients in the intervention group and 66 (36.3%) patients in the control group (absolute difference, -2.6% [95% CI, -12.3% to 7.2%]; OR, 0.80 [95% CI, 0.51-1.26]). There was no significant difference in 6-month mortality (29 [15.9%] in the intervention group vs 37 [20.8%] in the control group; absolute difference, -4.9% [95% CI, -12.8% to 3.1%]; hazard ratio, 0.79 [95% CI, 0.48-1.28]). CONCLUSIONS AND RELEVANCE Among patients with moderate to severe traumatic brain injury, treatment with continuous infusion of 20% hypertonic saline compared with standard care did not result in a significantly better neurological status at 6 months. However, confidence intervals for the findings were wide, and the study may have had limited power to detect a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03143751.
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Affiliation(s)
- Antoine Roquilly
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Jean Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France
| | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | | | - Benjamin Cohen
- CHU de Tours, Anesthesia and Intensive Care Unit, Tours, France
| | | | - Kevin Chalard
- CHU de Montpellier, Anesthesia and Intensive Care Unit, Montpellier, France
| | - Philippe Seguin
- CHU de Rennes, Anesthesia and Intensive Care Unit, Rennes, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France
| | | | - Thomas Gaillard
- CHU d’Angers, Anesthesia and Intensive Care Unit, Angers, France
| | - Raphael Cinotti
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Dominique Demeure dit Latte
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Pierre Joachim Mahe
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Mickael Vourc’h
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Florian Pierre Martin
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Alice Chopin
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Celine Lerebourg
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Laurent Flet
- CHU de Nantes, Service de pharmacie, Hôtel Dieu, Nantes, France
| | - Anne Chiffoleau
- DRCI, Departement promotion, cellule vigilances, CHU Nantes, Nantes, France
| | - Fanny Feuillet
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France
| | - Karim Asehnoune
- Université de Nantes, CHU Nantes, Pôle anesthésie réanimations, Service d’Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes, France
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29
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Fellahi JL, Futier E, Vaisse C, Collange O, Huet O, Loriau J, Gayat E, Tavernier B, Biais M, Asehnoune K, Cholley B, Longrois D. Perioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper. Ann Intensive Care 2021; 11:58. [PMID: 33852124 PMCID: PMC8046882 DOI: 10.1186/s13613-021-00845-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.
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Affiliation(s)
- Jean-Luc Fellahi
- Service D'Anesthésie-Réanimation, Hôpital Louis Pradel, 59 boulevard Pinel, 69500, Hospices Civils de Lyon, Lyon, France. .,Laboratoire CarMeN, Université Claude Bernard Lyon 1, Inserm U1060, Lyon, France.
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie-Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS; Inserm U1103, 63000, Clermont-Ferrand, France
| | - Camille Vaisse
- Service D'Anesthésie-Réanimation, Hôpital Timone, AP-HM, Marseille, France
| | - Olivier Collange
- Service D'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Université de Strasbourg, Strasbourg, France
| | - Olivier Huet
- Département D'Anesthésie-Réanimation, CHRU de La Cavale Blanche, Brest, France.,Université de Bretagne Occidentale, Brest, France
| | - Jerôme Loriau
- Service de Chirurgie Digestive, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation, Hôpital Lariboisière, DMU PARABOL, AP-HP Nord et Université de Paris, Paris, France.,UMR-S 942, Inserm, Paris, France
| | - Benoit Tavernier
- Pôle d'Anesthésie-Réanimation, CHU Lille, Univ. Lille, ULR 2694-METRICS, Lille, France
| | - Matthieu Biais
- Pôle d'Anesthésie-Réanimation, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.,Université de Bordeaux, France, Inserm 1034, Pessac, France
| | - Karim Asehnoune
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie Réanimations, Hôtel-Dieu, CHU de Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - Bernard Cholley
- Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Université de Paris, Paris, France.,Inserm UMR S1140, Paris, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP Nord, Paris, France.,Université de Paris, Paris, France
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30
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Skrifvars MB, Bailey M, Moore E, Mårtensson J, French C, Presneill J, Nichol A, Little L, Duranteau J, Huet O, Haddad S, Arabi YM, McArthur C, Cooper DJ, Bendel S, Bellomo R. A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study-Associations With Acute Kidney Injury and Mortality. Crit Care Med 2021; 49:e394-e403. [PMID: 33566466 PMCID: PMC7963441 DOI: 10.1097/ccm.0000000000004853] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Mannitol and hypertonic saline are used to treat raised intracerebral pressure in patients with traumatic brain injury, but their possible effects on kidney function and mortality are unknown. DESIGN A post hoc analysis of the erythropoietin trial in traumatic brain injury (ClinicalTrials.gov NCT00987454) including daily data on mannitol and hypertonic saline use. SETTING Twenty-nine university-affiliated teaching hospitals in seven countries. PATIENTS A total of 568 patients treated in the ICU for 48 hours without acute kidney injury of whom 43 (7%) received mannitol and 170 (29%) hypertonic saline. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We categorized acute kidney injury stage according to the Kidney Disease Improving Global Outcome classification and defined acute kidney injury as any Kidney Disease Improving Global Outcome stage-based changes from the admission creatinine. We tested associations between early (first 2 d) mannitol and hypertonic saline and time to acute kidney injury up to ICU discharge and death up to 180 days with Cox regression analysis. Subsequently, acute kidney injury developed more often in patients receiving mannitol (35% vs 10%; p < 0.001) and hypertonic saline (23% vs 10%; p < 0.001). On competing risk analysis including factors associated with acute kidney injury, mannitol (hazard ratio, 2.3; 95% CI, 1.2-4.3; p = 0.01), but not hypertonic saline (hazard ratio, 1.6; 95% CI, 0.9-2.8; p = 0.08), was independently associated with time to acute kidney injury. In a Cox model for predicting time to death, both the use of mannitol (hazard ratio, 2.1; 95% CI, 1.1-4.1; p = 0.03) and hypertonic saline (hazard ratio, 1.8; 95% CI, 1.02-3.2; p = 0.04) were associated with time to death. CONCLUSIONS In this post hoc analysis of a randomized controlled trial, the early use of mannitol, but not hypertonic saline, was independently associated with an increase in acute kidney injury. Our findings suggest the need to further evaluate the use and choice of osmotherapy in traumatic brain injury.
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Affiliation(s)
- Markus B Skrifvars
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- St. Vincent's University Hospital, Dublin, Ireland
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
- Department of Anaesthesia and Intensive Care, Hôpitaux universitaires Paris Sud (HUPS), Université Paris Sud XI, Paris, France
- Departement d'anesthésie-réanimation, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, CHRU de Brest, Univeristé de Bretagne Occidental, Brest, France
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Jeffrey Presneill
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux universitaires Paris Sud (HUPS), Université Paris Sud XI, Paris, France
| | - Olivier Huet
- Departement d'anesthésie-réanimation, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, CHRU de Brest, Univeristé de Bretagne Occidental, Brest, France
| | - Samir Haddad
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - David James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
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31
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Grillot N, Garot M, Lasocki S, Huet O, Bouzat P, Le Moal C, Oudot M, Chatel-Josse N, El Amine Y, Danguy des Déserts M, Bruneau N, Cinotti R, David JS, Langeron O, Minville V, Tching-Sin M, Faurel-Paul E, Lerebourg C, Flattres-Duchaussoy D, Jobert A, Asehnoune K, Feuillet F, Roquilly A. Assessment of remifentanil for rapid sequence induction and intubation in patients at risk of pulmonary aspiration of gastric contents compared to rapid-onset paralytic agents: study protocol for a non-inferiority simple blind randomized controlled trial (the REMICRUSH study). Trials 2021; 22:237. [PMID: 33785069 PMCID: PMC8009075 DOI: 10.1186/s13063-021-05192-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background Rapid-onset paralytic agents are recommended to achieve muscle relaxation and facilitate tracheal intubation during rapid sequence induction in patients at risk of pulmonary aspiration of gastric contents. However, opioids are frequently used in this setting. The study’s objective is to demonstrate the non-inferiority of remifentanil compared to rapid-onset paralytic agents, in association with an hypnotic drug, for tracheal intubation in patients undergoing procedure under general anesthesia and at risk of pulmonary aspiration of gastric contents. Methods The REMICRUSH (Remifentanil for Rapid Sequence Induction of Anaesthesia) study is a multicenter, single-blinded, non-inferiority randomized controlled trial comparing remifentanil (3 to 4 μg/kg) with rapid-onset paralytic agents (succinylcholine or rocuronium 1 mg/kg) for rapid sequence induction in 1150 adult surgical patients requiring tracheal intubation during general anesthesia. Enrolment started in October 2019 in 15 French anesthesia units. The expected date of the final follow-up is October 2021. The primary outcome is the proportion of successful tracheal intubation without major complications. A non-inferiority margin of 7% was chosen. Analyses of the intent-to-treat and per-protocol populations are planned. Discussion The REMICRUSH trial protocol has been approved by the ethics committee of The Comité de Protection des Personnes Sud-Ouest et Outre-Mer II and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals. The REMICRUSH trial is the first randomized controlled trial powered to investigate whether remifentanil with hypnotics is non-inferior to rapid-onset paralytic agents with hypnotic in rapid sequence induction of anesthesia for full stomach patients considering successful tracheal intubation without major complication. Trial registration ClinicalTrials.gov NCT03960801. Registered on May 23, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05192-x.
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Affiliation(s)
- Nicolas Grillot
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France.
| | - Matthias Garot
- CHU de Lille, Pole Anesthésie Réanimation, Hôpital Claude Huriez, Lille, France
| | - Sigismond Lasocki
- Université d'Angers, CHU d'Angers, Département Anesthésie Réanimation, Angers, F-49933, France
| | - Olivier Huet
- Anaesthesia, and Intensive Care Unit, Brest Regional University Hospital, Brest, France
| | - Pierre Bouzat
- Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France
| | - Charlène Le Moal
- Anaesthesia and Intensive Care Unit, Le Mans Public Hospital, Le Mans, France
| | - Mathieu Oudot
- Anaesthesia Unit, Vendée District Hospital Center, La Roche-sur-Yon, France
| | | | - Younes El Amine
- Anaesthesia Unit, Valenciennes Public Hospital, Valenciennes, France
| | | | - Nathalie Bruneau
- Anaesthesia and Intensive Care Unit, Lille Regional University Hospital, Lille, France
| | - Raphael Cinotti
- CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Guillaume et René Laennec, Université de Nantes, Saint-Herblain, 44800, France
| | - Jean-Stéphane David
- Hospices Civils de Lyon, Lyon Sud Regional University Hospital, Anaesthesia and Intensive Care Unit, Lyon, France
| | - Olivier Langeron
- Anaesthesia and Intensive Care Unit, Henri-Mondor University Hospital (AP-HP), Créteil, France
| | - Vincent Minville
- Anaesthesia and Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | | | - Elodie Faurel-Paul
- Department of Clinical Research, Nantes University Hospital, Nantes, France
| | - Céline Lerebourg
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
| | - Delphine Flattres-Duchaussoy
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
| | - Alexandra Jobert
- Department of Clinical Research, Nantes University Hospital, Nantes, France
| | - Karim Asehnoune
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
| | - Fanny Feuillet
- Nantes University Hospital, Methodology and Biostatistics Platform, Department of Clinical Research, Nantes, France.,Nantes University, INSERM, SPHERE U1246, Nantes, France
| | - Antoine Roquilly
- Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France
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32
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Michell DL, Shihata WA, Andrews KL, Abidin NAZ, Jefferis AM, Sampson AK, Lumsden NG, Huet O, Parat MO, Jennings GL, Parton RG, Woollard KJ, Kaye DM, Chin-Dusting JPF, Murphy AJ. High intraluminal pressure promotes vascular inflammation via caveolin-1. Sci Rep 2021; 11:5894. [PMID: 33723357 PMCID: PMC7960707 DOI: 10.1038/s41598-021-85476-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/19/2021] [Indexed: 01/18/2023] Open
Abstract
The aetiology and progression of hypertension involves various endogenous systems, such as the renin angiotensin system, the sympathetic nervous system, and endothelial dysfunction. Recent data suggest that vascular inflammation may also play a key role in the pathogenesis of hypertension. This study sought to determine whether high intraluminal pressure results in vascular inflammation. Leukocyte adhesion was assessed in rat carotid arteries exposed to 1 h of high intraluminal pressure. The effect of intraluminal pressure on signaling mechanisms including reactive oxygen species production (ROS), arginase expression, and NFĸB translocation was monitored. 1 h exposure to high intraluminal pressure (120 mmHg) resulted in increased leukocyte adhesion and inflammatory gene expression in rat carotid arteries. High intraluminal pressure also resulted in a downstream signaling cascade of ROS production, arginase expression, and NFĸB translocation. This process was found to be angiotensin II-independent and mediated by the mechanosensor caveolae, as caveolin-1 (Cav1)-deficient endothelial cells and mice were protected from pressure-induced vascular inflammatory signaling and leukocyte adhesion. Cav1 deficiency also resulted in a reduction in pressure-induced glomerular macrophage infiltration in vivo. These findings demonstrate Cav1 is an important mechanosensor in pressure-induced vascular and renal inflammation.
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Affiliation(s)
- Danielle L Michell
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Waled A Shihata
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Medicine, Monash University, Clayton, VIC, Australia.
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia.
| | - Karen L Andrews
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | - Nurul Aisha Zainal Abidin
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | | | | | | | - Olivier Huet
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Marie-Odile Parat
- School of Pharmacy, University of Queensland, St Lucia, QLD, Australia
| | | | - Robert G Parton
- Institute for Molecular Bioscience and Centre for Microscopy and Microanalysis, University of Queensland, St Lucia, QLD, Australia
| | - Kevin J Woollard
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Jaye P F Chin-Dusting
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | - Andrew J Murphy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Bailly P, Egreteau PY, Ehrmann S, Thille AW, Guitton C, Grillet G, Reizine F, Huet O, Jaber S, Nowak E, L'her E. Inased (inhaled sedation in ICU) trial protocol: a multicentre randomised open-label trial. BMJ Open 2021; 11:e042284. [PMID: 33608400 PMCID: PMC7896597 DOI: 10.1136/bmjopen-2020-042284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The use of sedation in intensive care units (ICUs) is necessary and ubiquitous. The impact of sedation strategy on outcome, particularly when delivered early after initiation of mechanical ventilation, is unknown. Evidence is increasing that volatile anaesthetic agents could be associated with better outcome. Their use in delirium prevention is unknown. METHODS AND ANALYSIS This study is an investigator-initiated, prospective, multicentre, two-arm, randomised, control, open-trial comparing inhaled sedation strategy versus intravenous sedation strategy in mechanically ventilated patients in ICU. Two hundred and fifty patients will be randomly assigned to the intravenous sedation group or inhaled sedation group, with a 1:1 ratio in two groups according to the sedation strategy. The primary outcome is the occurrence of delirium assessed using two times a day confusion assessment method for the ICU (CAM-ICU). Secondary outcomes include cognitive and functional outcomes at 3 and 12 months. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethics Committee (CPP Ouest) and national authorities (ANSM). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04341350.
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Affiliation(s)
- Pierre Bailly
- Médecine Intensive et Réanimation, CHRU de Brest, Brest, Bretagne, France
| | - Pierre-Yves Egreteau
- Réanimation polyvalente, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Stephan Ehrmann
- Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Arnaud W Thille
- Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France
- INSERM CIC 1402 Alive Research Group, Université de Poitiers, Poitiers, Poitou-Charentes, France
| | - Christophe Guitton
- Service de Réanimation Médico- Chirurgicale & USC, Centre Hospitalier de Mans, Le Mans, France
| | - Guillaume Grillet
- Réanimation polyvalente, Centre Hospitalier de Lorient, Lorient, Bretagne, France
| | - Florian Reizine
- Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Olivier Huet
- Réanimation chirurgicale, Centre Hospitalier Régional et Universitaire de Brest, Brest, Bretagne, France
| | - S Jaber
- Anesthesia and Critical Care, Montpellier Univ Hosp, Montpellier, France
| | | | - Erwan L'her
- Médecine Intensive et Réanimation, CHRU de Brest, Brest, NA, France
- LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, NA, France
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Hiesmayr M, Csomos A, Dams K, Elke G, Hartl W, Huet O, Krzych LJ, Kuechenhoff H, Matejovic M, Puthucheary ZA, Rooyackers O, Tetamo R, Tjäder I, Vaquerizo C. Protocol for a prospective cohort study on the use of clinical nutrition and assessment of long-term clinical and functional outcomes in critically ill adult patients. Clin Nutr ESPEN 2021; 43:104-110. [PMID: 34024501 DOI: 10.1016/j.clnesp.2021.01.048] [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] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Limited data are available on the impact of clinical nutrition over the course of critical illness and post-discharge outcomes. The present study aims to characterize the use of nutrition support in patients admitted to European intensive care units (ICUs), and its impact on clinical outcomes. Here we present the procedures of data collection and evaluation. METHODS Around 100 medical, surgical, or trauma ICUs in 11 countries (Austria, Belgium, Czech Republic, Germany, France, Hungary, Italy, Poland, Spain, Sweden, United Kingdom) participate in the study. In defined months between November 2019 and April 2020, approximately 1250 patients are enrolled if staying in ICU for at least five consecutive days. Data from ICU day 1-4 are collected retrospectively, followed by a prospective observation period from day 5-90 after ICU admission. Data collection includes patient characteristics, nutrition parameters, complications, ICU and hospital length of stay, discharge status, and functional outcomes. For data analysis, the target is 1000 patients with complete data. Statistical analyses will be descriptive, with multivariate analyses adjusted for potential confounders to explore associations between nutritional balance and change in functional status, time-to-weaning from invasive mechanical ventilation, time to first clinical complication, and overall 15, 30 and 90-day survival. ETHICS AND DISSEMINATION This non-interventional study was reviewed and approved by the ethics committee of the Medical University Vienna, Vienna, Austria (approval number 1678/2019), and the respective ethical committees from participating sites at country and/or local level, as required. Results will be shared with investigators on a country level, and a publication and results presentation at the 2021 ESPEN Congress is planned. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04143503.
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Affiliation(s)
- M Hiesmayr
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, and Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Spitalgasse 23, Vienna, Austria.
| | - A Csomos
- MH EK Honvedkorhaz, Budapest, Hungary.
| | - K Dams
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
| | - G Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - W Hartl
- Klinik Fuer Allgemeine, Viszeral-, und Transplantationschirurgie, Klinikum der Universitaet, Campus Grosshadern, Ludwig-Maximilians-Universität Muenchen, Munich, Germany.
| | - O Huet
- CHRU la Cavale Blanche, Brest, France.
| | - L J Krzych
- Medical University of Silesia, Katowice, Poland.
| | - H Kuechenhoff
- Statistisches Beratungslabor, Institut Fuer Statistik Ludwig-Maximilians-Universitaet Muenchen, Germany.
| | - M Matejovic
- First Medical Department, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Czech Republic.
| | - Z A Puthucheary
- Barts Health (Royal London) & Queen Mary University of London, London, England, UK.
| | - O Rooyackers
- Klinisk Vetenskap, Intervention Och Teknik, Anestesi, Karolinska Institut, Stockholm, Sweden.
| | - R Tetamo
- Ospedale Civile di Guastalla (Reggio Emilia), Italy.
| | - I Tjäder
- Karolinska University Hospital, PMI Huddinge, Stockholm, Sweden.
| | - C Vaquerizo
- Department of Intensive Care Medicine, Fuenlabrada University Hospital (Hospital Universitario de Fuenlabrada), Madrid, Spain.
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Chapalain X, Ozier Y, Le Niger C, McQuilten Z, Huet O, Aubron C. Is there an optimal trade-off between anaemia and red blood cell transfusion in surgical critically ill patients after oncologic surgery? Vox Sang 2021; 116:808-820. [PMID: 33493382 DOI: 10.1111/vox.13068] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Equipoise remains on the optimal transfusion strategy in surgical oncologic patients. The primary objective of our study was to determine the impact of anaemia and red blood cells (RBCs) transfusion on severe postoperative complications in surgical oncologic critically ill patients. MATERIALS AND METHODS Retrospective single-centre study. Adults admitted to intensive care unit after major oncologic surgery were eligible. Analyses to determine the independent risk factors, including anaemia or RBC transfusion, for postoperative complications and/or hospital mortality were performed. RESULTS Of the 283 patients included, 246 patients (86.9%) had anaemia. Fifty-five patients (19·4%) were transfused. Patients exposed to moderate-to-severe anaemia or RBC transfusion had more often severe complications, especially acute kidney injury and infectious complications. Multivariate analysis found an independent association between moderate and severe anaemia and severe postoperative complications (moderate anaemia: OR 14·02 [2·52-264]; severe anaemia: OR 16·25 [2·62-318·5]; P < 0·05). Elderly, obese patients and patients operated from abdominal surgery appeared to be more vulnerable to anaemia than other patients. Transfusion was also an independent risk factor for postoperative complications (OR 4·19 [2·12-8·39]; P < 0·001). When considering moderate-to-severe anaemic patients, RBC transfusion was no longer associated with postoperative complications. CONCLUSIONS Anaemia was associated with severe postoperative complications, and this association was stronger in elderly, obese patients and after abdominal surgery. RBC transfusion also negatively impacts on patients' prognosis. However, this association was not found in case of moderate-to-severe anaemia exposure (haemoglobin < 10 g/dl).
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Affiliation(s)
- Xavier Chapalain
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Brest, France
| | - Yves Ozier
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Brest, France
| | - Catherine Le Niger
- Haemovigilance Unit, Centre Hospitalier et Universitaire de Brest, Brest, France
| | - Zoe McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Olivier Huet
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Brest, France
| | - Cécile Aubron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Medical Intensive Care Unit, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Brest, France
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Padelli M, Aubron C, Huet O, Héry-Arnaud G, Vermeersch V, Hoffmann C, Bettacchioli É, Maguet H, Carré JL, Leven C. Is hypophosphataemia an independent predictor of mortality in critically ill patients with bloodstream infection? A multicenter retrospective cohort study. Aust Crit Care 2021; 34:47-54. [DOI: 10.1016/j.aucc.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
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Fasquel C, Huet O, Ozier Y, Quesnel C, Garnier M. Effects of intraoperative high versus low inspiratory oxygen fraction (FiO2) on patient's outcome: A systematic review of evidence from the last 20 years. Anaesth Crit Care Pain Med 2020; 39:847-858. [DOI: 10.1016/j.accpm.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022]
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Lasocki S, Pène F, Ait-Oufella H, Aubron C, Ausset S, Buffet P, Huet O, Launey Y, Legrand M, Lescot T, Mekontso Dessap A, Piagnerelli M, Quintard H, Velly L, Kimmoun A, Chanques G. Management and prevention of anemia (acute bleeding excluded) in adult critical care patients. Ann Intensive Care 2020; 10:97. [PMID: 32700082 PMCID: PMC7374293 DOI: 10.1186/s13613-020-00711-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Anemia is very common in critical care patients, on admission (affecting about two-thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay. Methods A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SFAR–SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anaemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).
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Affiliation(s)
- Sigismond Lasocki
- Département d'anesthésie-réanimation, Pôle ASUR, CHU Angers, UMR INSERM 1084, CNRS 6214, Université d'Angers, 49000, Angers, France.
| | - Frédéric Pène
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie Paris, Paris, France
| | - Cécile Aubron
- Médecine Intensive Réanimation, CHRU de Brest, Université de Bretagne Occidentale, 29200, Brest, France
| | - Sylvain Ausset
- Ecoles Militaires de Santé de Lyon-Bron, 69500, Bron, France
| | - Pierre Buffet
- Université de Paris, UMRS 1134, Inserm, 75015, Paris, France.,Laboratory of Excellence GREx, 75015, Paris, France
| | - Olivier Huet
- Département d'Anesthésie Réanimation, Hôpital de la Cavale-Blanche, CHRU de Brest, 29200, Brest, France.,UFR de Médecine de Brest, Université de Bretagne Occidentale, 29200, Brest, France
| | - Yoann Launey
- Critical Care Unit, Department of Anaesthesia, Critical Care Medicine and Perioperative Medicine, Rennes University Hospital, 2, Rue Henri-Le-Guilloux, 35033, Rennes, France
| | - Matthieu Legrand
- Department of Anaesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Lescot
- Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri-Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France
| | - Michael Piagnerelli
- Intensive Care, CHU-Charleroi Marie-Curie, Experimental Medicine Laboratory, Université Libre de Bruxelles, (ULB 222) Unit, 140, Chaussée de Bruxelles, 6042, Charleroi, Belgium
| | - Hervé Quintard
- Réanimation Médico-Chirurgicale, Hôpital Pasteur 2, CHU Nice, 30, Voie Romaine, Nice, France
| | - Lionel Velly
- AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005, Marseille, France.,Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation Brabois, Université de Lorraine, CHRU de Nancy, Inserm U1116, Nancy, France
| | - Gérald Chanques
- Department of Anaesthesia and Intensive Care, Montpellier University Saint-Eloi Hospital, and PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
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Abstract
Bowel dysfunction, especially ileus, has been increasingly recognized in critically ill patients. Ileus is commonly associated to constipation, however abnormal motility can also concern the upper digestive tract, therefore impaired gastrointestinal transit (IGT) seems to be a more appropriate term. IGT, especially constipation, is common among patients under mechanical ventilation, occurring in up to 80% of the patients during the first week, and has been associated with worse outcome in intensive care unit (ICU). It is acknowledged that the most relevant definition for constipation in ICU is the absence of stool for the first six days after admission. Concerning the upper digestive intolerance (UDI), the diagnosis should rely only on vomiting and the systematic gastric residual volume (GRV) monitoring should be avoided. IGT results from a complex pathophysiology in which both the critical illness and its specific treatments may have a deleterious role. Both observational and experimental studies have shown the deleterious effect of sepsis, multiorgan failure, sedation (especially opioids) and mechanical ventilation on gut function. To date few studies have reported effect of treatment on IGT and the level of evidence is low. However, cholinesterase inhibitors seem safe and could probably be used in case of constipation but remains poorly prescribed. Prevention with bowel management protocol using osmotic laxatives appears to be safe but did not demonstrate its effectiveness. For patients treated with high posology of opioids during sedation, enteral opioid antagonists may be a promising strategy.
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Affiliation(s)
- Philippe Ariès
- Clermont-Tonnerre Military Teaching Hospital, Brest, France.,Val-de-Grâce French Military Health Service Academy, Paris, France.,Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
| | - Olivier Huet
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France - .,UFR of Medicine, University of Western Brittany, Brest, France
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Futier E, Garot M, Godet T, Biais M, Verzilli D, Ouattara A, Huet O, Lescot T, Lebuffe G, Dewitte A, Cadic A, Restoux A, Asehnoune K, Paugam-Burtz C, Cuvillon P, Faucher M, Vaisse C, El Amine Y, Beloeil H, Leone M, Noll E, Piriou V, Lasocki S, Bazin JE, Pereira B, Jaber S. Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery: The FLASH Randomized Clinical Trial. JAMA 2020; 323:225-236. [PMID: 31961418 PMCID: PMC6990683 DOI: 10.1001/jama.2019.20833] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 12/15/2022]
Abstract
IMPORTANCE It is not known if use of colloid solutions containing hydroxyethyl starch (HES) to correct for intravascular deficits in high-risk surgical patients is either effective or safe. OBJECTIVE To evaluate the effect of HES 130/0.4 compared with 0.9% saline for intravascular volume expansion on mortality and postoperative complications after major abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, parallel-group, randomized clinical trial of 775 adult patients at increased risk of postoperative kidney injury undergoing major abdominal surgery at 20 university hospitals in France from February 2016 to July 2018; final follow-up was in October 2018. INTERVENTIONS Patients were randomized to receive fluid containing either 6% HES 130/0.4 diluted in 0.9% saline (n = 389) or 0.9% saline alone (n = 386) in 250-mL boluses using an individualized hemodynamic algorithm during surgery and for up to 24 hours on the first postoperative day, defined as ending at 7:59 am the following day. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or major postoperative complications at 14 days after surgery. Secondary outcomes included predefined postoperative complications within 14 days after surgery, durations of intensive care unit and hospital stays, and all-cause mortality at postoperative days 28 and 90. RESULTS Among 826 patients enrolled (mean age, 68 [SD, 7] years; 91 women [12%]), 775 (94%) completed the trial. The primary outcome occurred in 139 of 389 patients (36%) in the HES group and 125 of 386 patients (32%) in the saline group (difference, 3.3% [95% CI, -3.3% to 10.0%]; relative risk, 1.10 [95% CI, 0.91-1.34]; P = .33). Among 12 prespecified secondary outcomes reported, 11 showed no significant difference, but a statistically significant difference was found in median volume of study fluid administered on day 1: 1250 mL (interquartile range, 750-2000 mL) in the HES group and 1500 mL (interquartile range, 750-2150 mL) in the saline group (median difference, 250 mL [95% CI, 83-417 mL]; P = .006). At 28 days after surgery, 4.1% and 2.3% of patients had died in the HES and saline groups, respectively (difference, 1.8% [95% CI, -0.7% to 4.3%]; relative risk, 1.76 [95% CI, 0.79-3.94]; P = .17). CONCLUSIONS AND RELEVANCE Among patients at risk of postoperative kidney injury undergoing major abdominal surgery, use of HES for volume replacement therapy compared with 0.9% saline resulted in no significant difference in a composite outcome of death or major postoperative complications within 14 days after surgery. These findings do not support the use of HES for volume replacement therapy in such patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02502773.
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Affiliation(s)
- Emmanuel Futier
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Matthias Garot
- CHU de Lille, Pôle Anesthésie Réanimation, Hôpital Claude Huriez, Lille, France
| | - Thomas Godet
- CHU de Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France
| | - Matthieu Biais
- CHU de Bordeaux, Département Anesthésie et Réanimation, Hôpital Pellegrin, Bordeaux, France
| | - Daniel Verzilli
- CHU Montpellier, Département Anesthésie et Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Montpellier, France
| | - Alexandre Ouattara
- CHU de Bordeaux, Service Anesthésie et Réanimation, Centre Medico-chirugical Magellan, Bordeaux, France
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Olivier Huet
- CHU de Brest, Département Anesthésie et Réanimation, Hôpital La cavale Blanche, Brest, France
| | | | - Gilles Lebuffe
- CHU de Lille, Pôle Anesthésie Réanimation, Hôpital Claude Huriez, Lille, France
| | - Antoine Dewitte
- CHU de Bordeaux, Service Anesthésie et Réanimation, Centre Medico-chirugical Magellan, Bordeaux, France
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Anna Cadic
- CHU de Brest, Département Anesthésie et Réanimation, Hôpital La cavale Blanche, Brest, France
| | - Aymeric Restoux
- AP-HP, Département Anesthésie et Réanimation, Hôpital Beaujon, Clichy, Paris, France
| | - Karim Asehnoune
- CHU de Nantes, Département Anesthésie et Réanimation, Hôpital Hôtel Dieu, Nantes, France
| | | | - Philippe Cuvillon
- CHU de Nîmes, Section d’Anesthésie, Département Anesthésie et Réanimation, Nîmes, France
| | - Marion Faucher
- Institut Paoli Calmettes, Département Anesthésie et Réanimation, Marseille, France
| | - Camille Vaisse
- Assistance Publique Hôpitaux de Marseille (AP-HM), Service Anesthésie et Réanimation, Hôpital Timone, Marseille, France
| | - Younes El Amine
- Centre Hospitalier de Valenciennes, Département Anesthésie et Réanimation, Valenciennes, France
| | - Hélène Beloeil
- Université de Rennes, Inserm, INRA, CHU Rennes, CIC 1414, Numecan, Pôle Anesthésie et Réanimation, Rennes, France
| | - Marc Leone
- AP-HM, Service Anesthésie et Réanimation, Hôpital Nord, Université Aix Marseille, Marseille, France
| | - Eric Noll
- Hôpitaux Universitaires de Strasbourg, Service d’Anesthésie Réanimation Chirurgicale, Hôpital Hautepierre, Strasbourg, France
| | - Vincent Piriou
- Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Service d’Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Lyon, France
| | | | - Jean-Etienne Bazin
- CHU de Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Samir Jaber
- CHU Montpellier, Département Anesthésie et Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Montpellier, France
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Le Niger C, Vadam C, Grayo CM, Le Roy J, Huet O, Bodenes L, Aubron C, Huiban B, Nguyen V, Oilleau JF, Couturier MA, Guillerm G, Le Guen P, Galinat H, Carré JL, Coutté MB, Ozier Y. Gestion personnalisée du sang (GPS) : expérience du CHRU de Brest. Transfus Clin Biol 2019. [DOI: 10.1016/j.tracli.2019.06.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chapalain X, Vermeersch V, Egreteau PY, Prat G, Alavi Z, Vicaut E, Huet O. Association between fluid overload and SOFA score kinetics in septic shock patients: a retrospective multicenter study. J Intensive Care 2019; 7:42. [PMID: 31417678 PMCID: PMC6688320 DOI: 10.1186/s40560-019-0394-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background Fluid infusion represents one of the cornerstones of resuscitation therapies in order to increase oxygen delivery during septic shock. Fluid overload as a consequence of excessive fluid administration seems to be linked to worse long-term outcome. However, its immediate effect on patient’s clinical state is poorly described. The goal of this study was to assess the impact of FO on SOFA score kinetics as a surrogate marker of organ dysfunction from day 0 to day 5. Material and methods Retrospective, multicenter, investigator-initiated study. All adult patients (> 18 years old) admitted from January 2012 to April 2017 in one of the three ICUs for septic shock, secondary to peritonitis or pulmonary infection and mechanically ventilated, were included. Univariate analysis was performed with Student’s t and chi-square test, for continuous and categorical variables, respectively. A multivariate linear regression model evaluated the impact of FO on delta SOFA score from day 0 to day 5. Secondly, a multivariate mixed-model accounting for repeated measures analyzed the impact of FO on SOFA score kinetics. Results One hundred twenty-nine patients met the inclusion criteria and were assigned into FO and no FO groups. FO occurred in 39% of the patients. The difference between SOFA score at day 0 and day 5 was more than twofold higher in the no FO group than in the FO group with a difference of 2.37 between the two groups (4.52 vs. 2.15; p = 0.001). Cumulative fluid intake at day 5 was higher in the FO group (2738 vs. 8715 ml, p < 0.001). In multivariate analysis, FO was associated with delta SOFA score: aRR = 0.15 (95% CI 0.03–0.63; p = 0.009). In mixed model, the regression coefficient for fluid overload status (r2 = 1.16; p = 0.014) indicated that the slope for SOFA score kinetic was less pronounced for patients with FO than for patients without FO. Conclusions FO patients had a more prolonged multi-organ failure according to SOFA score kinetics during septic shock from resuscitation phase to day 5. Electronic supplementary material The online version of this article (10.1186/s40560-019-0394-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xavier Chapalain
- 1Department of anesthesiology and intensive care unit, CHRU de Brest Hopital La cavale Blanche, Boulevard Tanguy Prigent, Brest, France.,ATLANREA Clinical Trial Group, https://www.atlanrea.org/.,7Université de Bretagne Occidentale, UFR de Médecine, Brest, France
| | - Véronique Vermeersch
- 1Department of anesthesiology and intensive care unit, CHRU de Brest Hopital La cavale Blanche, Boulevard Tanguy Prigent, Brest, France.,ATLANREA Clinical Trial Group, https://www.atlanrea.org/.,7Université de Bretagne Occidentale, UFR de Médecine, Brest, France
| | - Pierre-Yves Egreteau
- Department of Intensive Care Medicine, CH de Morlaix, Rue de Kersaint Gilly, Morlaix, France
| | - Gwenael Prat
- 3Department of Medical ICU, CHRU de Brest, Boulevard Tanguy Prigent, Paris, France
| | - Zarrin Alavi
- 5INSERM CIC 1412, CHRU de Brest, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, Paris, France
| | - Eric Vicaut
- 2APHP, Unité de recherche clinique, Hôpital Fernand Widal, Université Paris Diderot, Paris, France
| | - Olivier Huet
- 1Department of anesthesiology and intensive care unit, CHRU de Brest Hopital La cavale Blanche, Boulevard Tanguy Prigent, Brest, France.,ATLANREA Clinical Trial Group, https://www.atlanrea.org/.,7Université de Bretagne Occidentale, UFR de Médecine, Brest, France
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43
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Knott RJ, Harris A, Higgins A, Nichol A, French C, Little L, Haddad S, Presneill J, Arabi Y, Bailey M, Cooper DJ, Duranteau J, Huet O, Mak A, McArthur C, Pettilä V, Skrifvars MB, Vallance S, Varma D, Wills J, Bellomo R. Cost-Effectiveness of Erythropoietin in Traumatic Brain Injury: A Multinational Trial-Based Economic Analysis. J Neurotrauma 2019; 36:2541-2548. [PMID: 30907230 DOI: 10.1089/neu.2018.6229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The EPO-TBI multi-national randomized controlled trial found that erythropoietin (EPO), when compared to placebo, did not affect 6-month neurological outcome, but reduced illness severity-adjusted mortality in patients with traumatic brain injury (TBI), making the cost-effectiveness of EPO in TBI uncertain. The current study uses patient-level data from the EPO-TBI trial to evaluate the cost-effectiveness of EPO in patients with moderate or severe TBI from the healthcare payers' perspective. We addressed the issue of transferability in multi-national trials by estimating costs and effects for specific geographical regions of the study (Australia/New Zealand, Europe, and Saudi Arabia). Unadjusted mean quality-adjusted life-years (QALYs; 95% confidence interval [CI]) at 6 months were 0.027 (0.020-0.034; p < 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000-0.028; p = 0.04). Mean unadjusted costs (95% CI) were $US5668 (-9191 to -2144; p = 0.002) lower in the treatment group; controlling for baseline IMPACT-TBI score and regional heterogeneity reduced this difference to $2377 (-12,446 to 7693; p = 0.64). For a willingness-to-pay threshold of $US50,000 per QALY, 71.8% of replications were considered cost-effective. Therefore, we did not find evidence that EPO was significantly cost-effective in the treatment of moderate or severe TBI at 6-month follow-up.
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Affiliation(s)
- Rachel J Knott
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Alisa Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred, Melbourne, Victoria, Australia.,University College Dublin-Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Craig French
- Western Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Samir Haddad
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Jeffrey Presneill
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred, Melbourne, Victoria, Australia.,University of Queensland and Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Yaseen Arabi
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center Riyadh, Kingdom of Saudi Arabia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred, Melbourne, Victoria, Australia
| | - Jacques Duranteau
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris, France
| | - Olivier Huet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesiology and Intensive Care Medicine, CHU La Cavale Blanche, Brest, France
| | - Anne Mak
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred, Melbourne, Victoria, Australia
| | - Colin McArthur
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Auckland City Hospital, Auckland, New Zealand
| | - Ville Pettilä
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Shirley Vallance
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred, Melbourne, Victoria, Australia
| | | | - Judy Wills
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Alfred, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Western Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Austin Hospital, Melbourne, Victoria, Australia
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Vermeersch V, Huet O. Prophylactic hypothermia for traumatic brain injury patients: It is not cool to be cooled. Anaesth Crit Care Pain Med 2019; 38:97-98. [PMID: 30763725 DOI: 10.1016/j.accpm.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Véronique Vermeersch
- Department of anaesthesia and intensive care medicine, CHRU La Cavale Blanche, Brest, France; UFR de médecine, Université de Bretagne occidentale, Brest, France
| | - Olivier Huet
- Department of anaesthesia and intensive care medicine, CHRU La Cavale Blanche, Brest, France; UFR de médecine, Université de Bretagne occidentale, Brest, France; ANZIC research centre, Monash University, Melbourne, Victoria, Australia.
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45
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Skrifvars MB, Moore E, Mårtensson J, Bailey M, French C, Presneill J, Nichol A, Little L, Duranteau J, Huet O, Haddad S, Arabi Y, McArthur C, Cooper DJ, Bellomo R. Erythropoietin in traumatic brain injury associated acute kidney injury: A randomized controlled trial. Acta Anaesthesiol Scand 2019; 63:200-207. [PMID: 30132785 DOI: 10.1111/aas.13244] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). METHODS Pre-planned analysis of patients included in the EPO-TBI (ClinicalTrials.gov NCT00987454) trial who were randomized to weekly EPO (40 000 units) or placebo (0.9% sodium chloride) subcutaneously up to three doses or until intensive care unit (ICU) discharge. Creatinine levels and urinary output (up to 7 days) were categorized according to the Kidney Disease Improving Global Outcome (KDIGO) classification. Severity of TBI was categorized with the International Mission for Prognosis and Analysis of Clinical Trials in TBI. RESULTS Of 3348 screened patients, 606 were randomized and 603 were analyzed. Of these, 82 (14%) patients developed AKI according to KDIGO (60 [10%] with KDIGO 1, 11 [2%] patients with KDIGO 2, and 11 [2%] patients with KDIGO 3). Male gender (hazard ratio [HR] 4.0 95% confidence interval [CI] 1.4-11.2, P = 0.008) and severity of TBI (HR 1.3 95% CI 1.1-1.4, P < 0.001 for each 10% increase in risk of poor 6 month outcome) predicted time to AKI. KDIGO stage 1 (HR 8.8 95% CI 4.5-17, P < 0.001), KDIGO stage 2 (HR 13.2 95% CI 3.9-45.2, P < 0.001) and KDIGO stage 3 (HR 11.7 95% CI 3.5-39.7, P < 0.005) predicted time to mortality. EPO did not influence time to AKI (HR 1.08 95% CI 0.7-1.67, P = 0.73) or creatinine levels during ICU stay (P = 0.09). CONCLUSIONS Acute kidney injury is more common in male patients and those with severe compared to moderate TBI and appears associated with worse outcome. EPO does not prevent AKI after TBI.
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Affiliation(s)
- Markus B. Skrifvars
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Division of Intensive Care; Department of Anaesthesiology, Intensive Care and Pain Medicine; Helsinki University Hospital and University of Helsinki; Helsinki Finland
- Department of Emergency Medicine and Services; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Elizabeth Moore
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Johan Mårtensson
- Department of Physiology and Pharmacology; Section of Anaesthesia and Intensive Care; Karolinska Institutet; Stockholm Sweden
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Craig French
- Department of Intensive Care; Western Health; Melbourne Victoria Australia
| | - Jeffrey Presneill
- Department of Intensive Care; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
- St Vincent's University Hospital; Dublin Ireland
- Department of Intensive Care and Hyperbaric Medicine; The Alfred; Melbourne Victoria Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care; Hôpitaux universitaires Paris Sud (HUPS); Université Paris Sud XI; Orsay France
| | - Olivier Huet
- Departement d'anesthésie-réanimation; Hopital de la Cavale Blanche; Boulevard Tanguy Prigent; CHRU de Brest; Univeristé de Bretagne Occidental; Brest France
| | - Samir Haddad
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center; Riyadh Saudi Arabia
- G&S Medical Associates; Urgent Care; Paterson New Jersey
| | - Yaseen Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center; Riyadh Saudi Arabia
| | - Colin McArthur
- Department of Critical Care Medicine; Auckland City Hospital; Auckland New Zealand
| | - David J. Cooper
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Intensive Care and Hyperbaric Medicine; The Alfred; Melbourne Victoria Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Intensive Care; Austin Health; Melbourne Victoria Australia
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46
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Pickering RJ, Tikellis C, Rosado CJ, Tsorotes D, Dimitropoulos A, Smith M, Huet O, Seeber RM, Abhayawardana R, Johnstone EK, Golledge J, Wang Y, Jandeleit-Dahm KA, Cooper ME, Pfleger KD, Thomas MC. Transactivation of RAGE mediates angiotensin-induced inflammation and atherogenesis. J Clin Invest 2018; 129:406-421. [PMID: 30530993 DOI: 10.1172/jci99987] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022] Open
Abstract
Activation of the type 1 angiotensin II receptor (AT1) triggers proinflammatory signaling through pathways independent of classical Gq signaling that regulate vascular homeostasis. Here, we report that the AT1 receptor preformed a heteromeric complex with the receptor for advanced glycation endproducts (RAGE). Activation of the AT1 receptor by angiotensin II (Ang II) triggered transactivation of the cytosolic tail of RAGE and NF-κB-driven proinflammatory gene expression independently of the liberation of RAGE ligands or the ligand-binding ectodomain of RAGE. The importance of this transactivation pathway was demonstrated by our finding that adverse proinflammatory signaling events induced by AT1 receptor activation were attenuated when RAGE was deleted or transactivation of its cytosolic tail was inhibited. At the same time, classical homeostatic Gq signaling pathways were unaffected by RAGE deletion or inhibition. These data position RAGE transactivation by the AT1 receptor as a target for vasculoprotective interventions. As proof of concept, we showed that treatment with the mutant RAGE peptide S391A-RAGE362-404 was able to inhibit transactivation of RAGE and attenuate Ang II-dependent inflammation and atherogenesis. Furthermore, treatment with WT RAGE362-404 restored Ang II-dependent atherogenesis in Ager/Apoe-KO mice, without restoring ligand-mediated signaling via RAGE, suggesting that the major effector of RAGE activation was its transactivation.
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Affiliation(s)
- Raelene J Pickering
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Christos Tikellis
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Carlos J Rosado
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | - Monique Smith
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Olivier Huet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,Department of Anaesthesia and Intensive Care, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Université de Bretagne Ouest, Brest, France
| | - Ruth M Seeber
- Molecular Endocrinology and Pharmacology, Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Nedlands, Australia
| | - Rekhati Abhayawardana
- Molecular Endocrinology and Pharmacology, Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Nedlands, Australia
| | - Elizabeth Km Johnstone
- Molecular Endocrinology and Pharmacology, Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Nedlands, Australia
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia
| | - Yutang Wang
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Australia
| | - Karin A Jandeleit-Dahm
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Kevin Dg Pfleger
- Molecular Endocrinology and Pharmacology, Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Nedlands, Australia.,Dimerix Limited, Nedlands, Western Australia, Australia
| | - Merlin C Thomas
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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47
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Cooper DJ, Nichol AD, Bailey M, Bernard S, Cameron PA, Pili-Floury S, Forbes A, Gantner D, Higgins AM, Huet O, Kasza J, Murray L, Newby L, Presneill JJ, Rashford S, Rosenfeld JV, Stephenson M, Vallance S, Varma D, Webb SAR, Trapani T, McArthur C. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. JAMA 2018; 320:2211-2220. [PMID: 30357266 PMCID: PMC6583488 DOI: 10.1001/jama.2018.17075] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [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: 12/12/2022]
Abstract
IMPORTANCE After severe traumatic brain injury, induction of prophylactic hypothermia has been suggested to be neuroprotective and improve long-term neurologic outcomes. OBJECTIVE To determine the effectiveness of early prophylactic hypothermia compared with normothermic management of patients after severe traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS The Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury-Randomized Clinical Trial (POLAR-RCT) was a multicenter randomized trial in 6 countries that recruited 511 patients both out-of-hospital and in emergency departments after severe traumatic brain injury. The first patient was enrolled on December 5, 2010, and the last on November 10, 2017. The final date of follow-up was May 15, 2018. INTERVENTIONS There were 266 patients randomized to the prophylactic hypothermia group and 245 to normothermic management. Prophylactic hypothermia targeted the early induction of hypothermia (33°C-35°C) for at least 72 hours and up to 7 days if intracranial pressures were elevated, followed by gradual rewarming. Normothermia targeted 37°C, using surface-cooling wraps when required. Temperature was managed in both groups for 7 days. All other care was at the discretion of the treating physician. MAIN OUTCOMES AND MEASURES The primary outcome was favorable neurologic outcomes or independent living (Glasgow Outcome Scale-Extended score, 5-8 [scale range, 1-8]) obtained by blinded assessors 6 months after injury. RESULTS Among 511 patients who were randomized, 500 provided ongoing consent (mean age, 34.5 years [SD, 13.4]; 402 men [80.2%]) and 466 completed the primary outcome evaluation. Hypothermia was initiated rapidly after injury (median, 1.8 hours [IQR, 1.0-2.7 hours]) and rewarming occurred slowly (median, 22.5 hours [IQR, 16-27 hours]). Favorable outcomes (Glasgow Outcome Scale-Extended score, 5-8) at 6 months occurred in 117 patients (48.8%) in the hypothermia group and 111 (49.1%) in the normothermia group (risk difference, 0.4% [95% CI, -9.4% to 8.7%]; relative risk with hypothermia, 0.99 [95% CI, 0.82-1.19]; P = .94). In the hypothermia and normothermia groups, the rates of pneumonia were 55.0% vs 51.3%, respectively, and rates of increased intracranial bleeding were 18.1% vs 15.4%, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe traumatic brain injury, early prophylactic hypothermia compared with normothermia did not improve neurologic outcomes at 6 months. These findings do not support the use of early prophylactic hypothermia for patients with severe traumatic brain injury. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00987688; Anzctr.org.au Identifier: ACTRN12609000764235.
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Affiliation(s)
- D. James Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Departments of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Departments of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Irish Critical Care Clinical Trials Network, University College Dublin-Clinical Research Centre at St Vincent’s University Hospital, Dublin, Ireland
- Department of Anaesthesia and Intensive Care Medicine, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Departments of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre of Excellence in Traumatic Brain Injury Research, Monash University, Melbourne, Victoria, Australia
- Emergency Medicine, Hamad Medical Corporation, Dhueta, Qatar
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sébastien Pili-Floury
- Service de Réanimation Chirurgicale, Pôle d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besancon, Besançon, France
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dashiell Gantner
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Departments of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
- Centre of Excellence in Traumatic Brain Injury Research, Monash University, Melbourne, Victoria, Australia
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Olivier Huet
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de La Cavale Blanche, CHRU de Brest, Brest, France
- UFR de médecine et des sciences de la santé, Université de Bretagne Occidenta, Brest, France
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lynne Murray
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Lynette Newby
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Jeffrey J. Presneill
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jeffrey V. Rosenfeld
- Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Michael Stephenson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Shirley Vallance
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Departments of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Dinesh Varma
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Steven A. R. Webb
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Departments of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Colin McArthur
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
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48
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Rossignol Y, Huet O, Chapalain X, Le Maguet P, Sparrow R, L'Her E, Le Niger C, Ozier Y, Aubron C. Compliance with the European trauma guidelines: An observational single centre study. Transfus Clin Biol 2018; 26:18-26. [PMID: 29936040 DOI: 10.1016/j.tracli.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The European trauma guidelines were developed to assist clinicians in the early phase of trauma management to diagnose and treat coagulopathy and bleeding. This study aimed to determine compliance with these European trauma guidelines in a French referral trauma centre. METHODS Medical charts of trauma patients with an injury severity score≥16 admitted between January 2013 and December 2014 were reviewed. Compliance with 21 recommendations in the first 24-hours of patient management was assessed. RESULTS There were 145 patients with median ISS of 34 [IQR 25-41]. A good level of compliance (i.e. applied in≥80% of patients) was identified for nine recommendations, inconsistent compliance (i.e. applied in 50 to 79% of patients) for six recommendations, including fibrinogen levels at hospital admission and achievement of a target mean arterial blood pressure (MAP)>80mmHg in patients with major bleeding and TBI (55.5%), and poor compliance (i.e. applied in<50% of patients) for another six recommendations. Poorly applied recommendations included early measurement of lactate or base deficit (32%), early administration of tranexamic acid (18%), and achievement of normocapnia in patients with TBI undergoing invasive ventilation (3%). CONCLUSIONS In a referral trauma centre, nine of the 21 evaluable recommendations in the European trauma guidelines were applied in≥80% of patients. Early diagnosis and treatment of trauma-related coagulopathy was identified as an area for significant practice improvement. In patients with TBI, efforts should be made to achieve the targeted MAP and to maintain normocapnia.
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Affiliation(s)
- Y Rossignol
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - O Huet
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - X Chapalain
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - P Le Maguet
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - R Sparrow
- Department of Epidemiology and Preventive Medicine, Monash University, 3004 Melbourne, Australia
| | - E L'Her
- Emergency Department, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France; Medical Intensive Care Unit, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - C Le Niger
- Haemovigilance Unit, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - Y Ozier
- Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France
| | - C Aubron
- Medical Intensive Care Unit, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France; Department of Epidemiology and Preventive Medicine, Monash University, 3004 Melbourne, Australia.
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49
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Presneill J, Gantner D, Nichol A, McArthur C, Forbes A, Kasza J, Trapani T, Murray L, Bernard S, Cameron P, Capellier G, Huet O, Newby L, Rashford S, Rosenfeld JV, Smith T, Stephenson M, Varma D, Vallance S, Walker T, Webb S, James Cooper D. Statistical analysis plan for the POLAR-RCT: The Prophylactic hypOthermia trial to Lessen trAumatic bRain injury-Randomised Controlled Trial. Trials 2018; 19:259. [PMID: 29703266 PMCID: PMC5923032 DOI: 10.1186/s13063-018-2610-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/27/2018] [Indexed: 01/10/2023] Open
Abstract
Background The Prophylactic hypOthermia to Lessen trAumatic bRain injury-Randomised Controlled Trial (POLAR-RCT) will evaluate whether early and sustained prophylactic hypothermia delivered to patients with severe traumatic brain injury improves patient-centred outcomes. Methods The POLAR-RCT is a multicentre, randomised, parallel group, phase III trial of early, prophylactic cooling in critically ill patients with severe traumatic brain injury, conducted in Australia, New Zealand, France, Switzerland, Saudi Arabia and Qatar. A total of 511 patients aged 18–60 years have been enrolled with severe acute traumatic brain injury. The trial intervention of early and sustained prophylactic hypothermia to 33 °C for 72 h will be compared to standard normothermia maintained at a core temperature of 37 °C. The primary outcome is the proportion of favourable neurological outcomes, comprising good recovery or moderate disability, observed at six months following randomisation utilising a midpoint dichotomisation of the Extended Glasgow Outcome Scale (GOSE). Secondary outcomes, also assessed at six months following randomisation, include the probability of an equal or greater GOSE level, mortality, the proportions of patients with haemorrhage or infection, as well as assessment of quality of life and health economic outcomes. The planned sample size will allow 80% power to detect a 30% relative risk increase from 50% to 65% (equivalent to a 15% absolute risk increase) in favourable neurological outcome at a two-sided alpha of 0.05. Discussion Consistent with international guidelines, a detailed and prospective analysis plan has been developed for the POLAR-RCT. This plan specifies the statistical models for evaluation of primary and secondary outcomes, as well as defining covariates for adjusted analyses and methods for exploratory analyses. Application of this statistical analysis plan to the forthcoming POLAR-RCT trial will facilitate unbiased analyses of these important clinical data. Trial registration ClinicalTrials.gov, NCT00987688 (first posted 1 October 2009); Australian New Zealand Clinical Trials Registry, ACTRN12609000764235. Registered on 3 September 2009. Electronic supplementary material The online version of this article (10.1186/s13063-018-2610-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey Presneill
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Dashiell Gantner
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia.,Department of Anaesthesia and Intensive Care Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College, Dublin, Ireland
| | - Colin McArthur
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Forbes
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia
| | - Jessica Kasza
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia
| | - Lynnette Murray
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia
| | - Stephen Bernard
- Department of Intensive Care, The Alfred, Melbourne, Australia.,Ambulance Victoria, Melbourne, Australia
| | - Peter Cameron
- Centre of Excellence in Traumatic Brain Injury Research, The Alfred, Monash University, Melbourne, Australia.,Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gilles Capellier
- Réanimation médicale CHRU Jean Minjoz, Besançon, France.,Université de Franche - Comte, 1 Rue Claude Goudimel, Besançon, 25030, France
| | - Olivier Huet
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Anaesthesia and Intensive Care Medicine, Hôpital de La Cavale Blanche, CHRU de Brest, Brest, France.,UFR de médecine et des sciences de la santé, Université de Bretagne Occidental, Brest, France
| | - Lynette Newby
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Melbourne, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences (USUHS), Bethesda, MD, USA
| | - Tony Smith
- St John New Zealand, Auckland, New Zealand.,Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Michael Stephenson
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Ambulance Victoria, Melbourne, Australia
| | - Dinesh Varma
- Department of Radiology, The Alfred Hospital, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Shirley Vallance
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Department of Intensive Care, The Alfred, Melbourne, Australia
| | | | - Steve Webb
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia.,Intensive Care Unit, Royal Perth Hospital, Perth, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, 99 Commercial Road, Melbourne, 3004, Australia. .,Department of Intensive Care, The Alfred, Melbourne, Australia.
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50
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Skrifvars MB, French C, Bailey M, Presneill J, Nichol A, Little L, Durantea J, Huet O, Haddad S, Arabi Y, McArthur C, Cooper DJ, Bellomo R, for the EPO-TBI Investigators and t. Cause and Timing of Death and Subgroup Differential Effects of Erythropoietin in the EPO-TBI Study. J Neurotrauma 2018; 35:333-340. [DOI: 10.1089/neu.2017.5135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Markus B. Skrifvars
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
- North West Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Presneill
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Lorraine Little
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacques Durantea
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris, France
| | - Olivier Huet
- Department of Anaesthesiology and Intensive Care Medicine, CHU La Cavale Blanche, Brest, France
| | - Samir Haddad
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - D. James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
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