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Conreur C, Coureau M, Grimaldi D, Simonet O, Vallot F, Ndjekembo Shango D. A 16-year-old man with leptospirosis and atypical disseminated intravascular coagulation: a case report. J Med Case Rep 2023; 17:493. [PMID: 38008733 PMCID: PMC10680241 DOI: 10.1186/s13256-023-04239-8] [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: 11/06/2022] [Accepted: 10/31/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Leptospirosis is known for its pulmonary form characterized by intra-alveolar hemorrhage, exhibiting a high mortality rate. Management by venous-venous extracorporeal membrane oxygenation has been reported in a small number of cases. CASE PRESENTATION We report herein the case of a 16-year-old Caucasian male who was admitted with rapidly deteriorating respiratory and digestive complaints. He developed severe acute respiratory distress syndrome secondary to disseminated intravascular coagulation and intra-alveolar hemorrhage, requiring initiation of venous-venous extracorporeal membrane oxygenation. Initial infectious and immunological assessments were inconclusive, but repeat serology on the tenth day of admission confirmed a diagnosis of leptospirosis. The patient received multiple transfusions, and upon favorable response to treatment with corticosteroids and antibiotics, he was successfully weaned off venous-venous extracorporeal membrane oxygenation, which was discontinued after 12 days. CONCLUSION Leptospirosis is a rare cause of severe acute respiratory failure following pulmonary hemorrhage. It is typically diagnosed by serology, with detectable IgM antibodies 5-7 days after the onset of symptoms. We report that early support with respiratory extracorporeal membrane oxygenation favors timely clearance of endobronchial clotting, parenchymal recovery, and prevention of ventilator-induced lung injury. Major hypofibrinogenemia, which did not seem to worsen during extracorporeal membrane oxygenation application, was managed by repeated transfusions. Further studies investigating the pathogenesis of this coagulopathy are required to further optimize the management of this rare and severe complication.
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Affiliation(s)
- Charlotte Conreur
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium.
| | - Michelle Coureau
- Department of Intensive Care, Erasme Hospital, Route de Lennik, 808, 1700, Brussels, Belgium
| | - David Grimaldi
- Department of Intensive Care, Erasme Hospital, Route de Lennik, 808, 1700, Brussels, Belgium
| | - Olivier Simonet
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium
| | - Frédéric Vallot
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium
| | - Didier Ndjekembo Shango
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium
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Gouvêa Bogossian E, Taleb C, Aspide R, Badenes R, Battaglini D, Bilotta F, Blandino Ortiz A, Caricato A, Castioni CA, Citerio G, Ferraro G, Martino C, Melchionda I, Montanaro F, Monleon Lopez B, Nato CG, Piagnerelli M, Picetti E, Robba C, Simonet O, Thooft A, Taccone FS. Cerebro-spinal fluid glucose and lactate concentrations changes in response to therapies in patIents with primary brain injury: the START-TRIP study. Crit Care 2023; 27:130. [PMID: 37004053 PMCID: PMC10067218 DOI: 10.1186/s13054-023-04409-6] [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: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Altered levels of cerebrospinal fluid (CSF) glucose and lactate concentrations are associated with poor outcomes in acute brain injury patients. However, no data on changes in such metabolites consequently to therapeutic interventions are available. The aim of the study was to assess CSF glucose-to-lactate ratio (CGLR) changes related to therapies aimed at reducing intracranial pressure (ICP). METHODS A multicentric prospective cohort study was conducted in 12 intensive care units (ICUs) from September 2017 to March 2022. Adult (> 18 years) patients admitted after an acute brain injury were included if an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring was inserted within 24 h of admission. During the first 48-72 h from admission, CGLR was measured before and 2 h after any intervention aiming to reduce ICP ("intervention"). Patients with normal ICP were also sampled at the same time points and served as the "control" group. RESULTS A total of 219 patients were included. In the intervention group (n = 115, 53%), ICP significantly decreased and CPP increased. After 2 h from the intervention, CGLR rose in both the intervention and control groups, although the magnitude was higher in the intervention than in the control group (20.2% vs 1.6%; p = 0.001). In a linear regression model adjusted for several confounders, therapies to manage ICP were independently associated with changes in CGLR. There was a weak inverse correlation between changes in ICP and CGRL in the intervention group. CONCLUSIONS In this study, CGLR significantly changed over time, regardless of the study group. However, these effects were more significant in those patients receiving interventions to reduce ICP.
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Affiliation(s)
- Elisa Gouvêa Bogossian
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Chahnez Taleb
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - Denise Battaglini
- Department of Surgical Science and Integrated Diagnostic, University of Genoa, Genoa, Italy
- IRRCS Policlinico San Martino, Genoa, Italy
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico Di Roma, Rome, Italy
| | - Aaron Blandino Ortiz
- Department of Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Anselmo Caricato
- Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, Gemelli Hospital, Sacro Cuore Catholic University, Rome, Italy
| | - Carlo Alberto Castioni
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, Italy
| | - Giuseppe Citerio
- Scuola di Medicina e Chirurgia, Azienda Socio Sanitaria Territoriale Monza, Università Milano Bicocca, Monza, Italy
| | - Gioconda Ferraro
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Costanza Martino
- Anesthesia and Intensive Care Unit, Azienda Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Isabella Melchionda
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico Di Roma, Rome, Italy
| | - Federica Montanaro
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Berta Monleon Lopez
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - Consolato Gianluca Nato
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico Di Roma, Rome, Italy
| | - Michael Piagnerelli
- Department of Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, Charleroi, Belgium
- Experimental Medicine Laboratory, CHU-Charleroi, Montigny-Le-Tilleul, Belgium
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Chiara Robba
- Department of Surgical Science and Integrated Diagnostic, University of Genoa, Genoa, Italy
- IRRCS Policlinico San Martino, Genoa, Italy
| | - Olivier Simonet
- Department of Anaesthesia and Intensive Care, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Aurelie Thooft
- Department of Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, Charleroi, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
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Talpoș MT, Rasson A, De Terwangne C, Simonet O, Taccone FS, Vallot F. Early Prediction of High-Flow Oxygen Therapy Failure in COVID-19 Acute Hypoxemic Respiratory Failure: A Retrospective Study of Scores and Thresholds. Cureus 2022; 14:e32087. [DOI: 10.7759/cureus.32087] [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] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
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van Minnen O, Oude Lansink-Hartgring A, van den Boogaard B, van den Brule J, Bulpa P, Bunge JJH, Delnoij TSR, Elzo Kraemer CV, Kuijpers M, Lambermont B, Maas JJ, de Metz J, Michaux I, van de Pol I, van de Poll M, Raasveld SJ, Raes M, Dos Reis Miranda D, Scholten E, Simonet O, Taccone FS, Vallot F, Vlaar APJ, van den Bergh WM. Reduced anticoagulation targets in extracorporeal life support (RATE): study protocol for a randomized controlled trial. Trials 2022; 23:405. [PMID: 35578271 PMCID: PMC9108348 DOI: 10.1186/s13063-022-06367-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although life-saving in selected patients, ECMO treatment still has high mortality which for a large part is due to treatment-related complications. A feared complication is ischemic stroke for which heparin is routinely administered for which the dosage is usually guided by activated partial thromboplastin time (aPTT). However, there is no relation between aPTT and the rare occurrence of ischemic stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome. METHODS We will conduct a three-arm non-inferiority randomized controlled trial, in adult patients treated with ECMO. Participants will be randomized between heparin administration with a target of 2-2.5 times baseline aPTT, 1.5-2 times baseline aPTT, or low molecular weight heparin guided by weight and renal function. Apart from anticoagulation targets, treatment will be according to standard care. The primary outcome parameter is a combined endpoint consisting of major bleeding including hemorrhagic stroke, severe thromboembolic complications including ischemic stroke, and mortality at 6 months. DISCUSSION We hypothesize that with lower anticoagulation targets or anticoagulation with LMWH during ECMO therapy, patients will have fewer hemorrhagic complications without an increase in thromboembolic complication or a negative effect on their outcome. If our hypothesis is confirmed, this study could lead to a change in anticoagulation protocols and a better outcome for patients treated with ECMO. TRIAL REGISTRATION ClinicalTrials.gov NCT04536272 . Registered on 2 September 2020. Netherlands Trial Register NL7969.
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Affiliation(s)
- Olivier van Minnen
- Department of Critical Care, University Medical Center Groningen, Room R3.904, PO BOX 30001, 9700, RB, Groningen, The Netherlands.
| | - Annemieke Oude Lansink-Hartgring
- Department of Critical Care, University Medical Center Groningen, Room R3.904, PO BOX 30001, 9700, RB, Groningen, The Netherlands
| | | | - Judith van den Brule
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre Bulpa
- Department of Intensive Care, CHU UCL Namur site Mont-Godinne, Yvoir, Belgium
| | - Jeroen J H Bunge
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Thijs S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carlos V Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijn Kuijpers
- Department of Intensive Care Medicine, Isala Clinics, Zwolle, The Netherlands
| | | | - Jacinta J Maas
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesse de Metz
- Department of Intensive Care, OLVG, Amsterdam, The Netherlands
| | - Isabelle Michaux
- Department of Intensive Care, CHU UCL Namur site Mont-Godinne, Yvoir, Belgium
| | - Ineke van de Pol
- Department of Intensive Care Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marcel van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Jorinde Raasveld
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Matthias Raes
- Department of Intensive Care, University Hospital Brussels, Brussels, Belgium
| | - Dinis Dos Reis Miranda
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik Scholten
- Department of Intensive Care Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Olivier Simonet
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde (CHwapi), Tournai, Belgium
| | - Fabio S Taccone
- Department of Intensive Care, Hôpital Erasme Bruxelles, Brussels, Belgium
| | - Frederic Vallot
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde (CHwapi), Tournai, Belgium
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, Room R3.904, PO BOX 30001, 9700, RB, Groningen, The Netherlands
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Natile M, Simonet O, Vallot F, De Kock M. Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review. Acta Anaest Belg 2021. [DOI: 10.56126/72.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP.
Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods.
Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.
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6
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Forget P, Lacroix S, Deflandre EP, Pirson A, Hustinx N, Simonet O, Wandji F, von Montigny S, Amraoui J. Pleth variability index and fluid management practices: a multicenter service evaluation. BMC Res Notes 2021; 14:293. [PMID: 34321083 PMCID: PMC8317350 DOI: 10.1186/s13104-021-05705-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The introduction of a new technology has the potential to modify clinical practices, especially if easy to use, reliable and non-invasive. This observational before/after multicenter service evaluation compares fluid management practices during surgery (with fluids volumes as primary outcome), and clinical outcomes (secondary outcomes) before and after the introduction of the Pleth Variability Index (PVI), a non-invasive fluid responsiveness monitoring. RESULTS In five centers, 23 anesthesiologists participated during a 2-years period. Eighty-eight procedures were included. Median fluid volumes infused during surgery were similar before and after PVI introduction (respectively, 1000 ml [interquartile range 25-75 [750-1700] and 1000 ml [750-2000]). The follow-up was complete for 60 from these and outcomes were similar. No detectable change in the fluid management was observed after the introduction of a new technology in low to moderate risk surgery. These results suggest that the introduction of a new technology should be associated with an implementation strategy if it is intended to be associated with changes in clinical practice.
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Affiliation(s)
- Patrice Forget
- Institute of Applied Health Sciences, Epidemiology group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, NHS Grampian, Department of Anaesthesia, Aberdeen, UK.
| | - Simon Lacroix
- Clinique Saint-Luc of Bouge, Department of Anaesthesia, Extracorporeal Circulation Team, Namur, Belgium
| | - Eric P Deflandre
- Clinique Saint-Luc of Bouge, Department of Anaesthesia, Extracorporeal Circulation Team, Namur, Belgium.,Clinique Saint-Luc of Bouge, Department of Anaesthesia, Namur, Belgium.,Cabinet Medical ASTES, Jambes, Belgium.,University of Liege, Liege, Belgium
| | - Anne Pirson
- Grand Hopital de Charleroi, Charleroi, Belgium
| | | | - Olivier Simonet
- Centre Hospitalier de Wallonie Picarde, Department of Anaesthesia, Tournai, Belgium
| | - Fabrice Wandji
- Centre Hospitalier de Wallonie Picarde, Department of Anaesthesia, Tournai, Belgium
| | - Serge von Montigny
- Centre Hospitalier Mons-Warquignies, Department of Anaesthesia, Mons, Belgium
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7
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Longrois D, Petitjeans F, Simonet O, de Kock M, Belliveau M, Pichot C, Lieutaud T, Ghignone M, Quintin L. How should dexmedetomidine and clonidine be prescribed in the critical care setting? Rev Bras Ter Intensiva 2021; 33:600-615. [PMID: 35081245 PMCID: PMC8889603 DOI: 10.5935/0103-507x.20210087] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
Cardiac, ventilatory and kidney management in the critical care setting has been optimized over the past decades. Cognition and sedation represent one of the last remaning challenges. As conventional sedation is suboptimal and as the sedation evoked by alpha-2 adrenergic agonists ("cooperative" sedation with dexmedetomidine, clonidine or guanfacine) represents a valuable alternative, this manuscript covers three practical topics for which evidence-based medicine is lacking: a) Switching from conventional to cooperative sedation ("switching"): the short answer is the abrupt withdrawal of conventional sedation, immediate implementation of alpha-2 agonist infusion and the use of "rescue sedation" (midazolam bolus[es]) or "breakthrough sedation" (haloperidol bolus[es]) to stabilize cooperative sedation. b) Switching from conventional to cooperative sedation in unstable patients (e.g., refractory delirium tremens, septic shock, acute respiratory distress syndrome, etc.): to avoid hypotension and bradycardia evoked by sympathetic deactivation, the short answer is to maintain the stroke volume through volume loading, vasopressors and inotropes. c) To avoid these switches and associated difficulties, alpha-2 agonists may be considered first-line sedatives. The short answer is to administer alpha-2 agonists slowly from admission or endotracheal intubation up to stabilized cooperative sedation. The "take home" message is as follows: a) alpha-2 agonists are jointly sympathetic deactivators and sedative agents; b) sympathetic deactivation implies maintaining the stroke volume and iterative assessment of volemia. Evidence-based medicine should document our propositions.
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Affiliation(s)
| | | | | | - Marc de Kock
- Centre Hospitalier de Wallonie Picarde - Tournai,
Belgique
| | | | | | | | - Marco Ghignone
- JF Kennedy Hospital North Campus - West Palm Beach, Fl,
United States
| | - Luc Quintin
- Hôpital d’Instruction des Armées Desgenettes - Lyon,
France.,Corresponding author: Luc Quintin, 120 Rue de la
Pagere, 69500 Lyon-Bron, France, E-mail:
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Longrois D, Petitjeans F, Simonet O, de Kock M, Belliveau M, Pichot C, Lieutaud T, Ghignone M, Quintin L. Clinical Practice: Should we Radically Alter our Sedation of Critical Care Patients, Especially Given the COVID-19 Pandemics? Rom J Anaesth Intensive Care 2020; 27:43-76. [PMID: 34056133 PMCID: PMC8158317 DOI: 10.2478/rjaic-2020-0018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. Depth of sedation has evolved over the last 40 years (no-sedation, deep sedation, daily emergence, minimal sedation, etc.). Most guidelines now recommend determining the depth of sedation and minimizing the use of benzodiazepines and opioids. The broader use of alpha-2 adrenergic agonists ('alpha-2 agonists') led to sedation regimens beginning at admission to the CCU that contrast with hypnotics+opioids ("conventional" sedation), with major consequences for cognition, ventilation and circulatory performance. The same doses of alpha-2 agonists used for 'cooperative' sedation (ataraxia, analgognosia) elicit no respiratory depression but modify the autonomic nervous system (cardiac parasympathetic activation, attenuation of excessive cardiac and vasomotor sympathetic activity). Alpha-2 agonists should be selected only in patients who benefit from their effects ('personalized' indications, as opposed to a 'one size fits all' approach). Then, titration to effect is required, especially in the setting of systemic hypotension and/or hypovolemia. Since no general guidelines exist for the use of alpha-2 agonists for CCU sedation, our clinical experience is summarized for the benefit of physicians in clinical situations in which a recommendation might never exist (refractory delirium tremens; unstable, hypovolemic, hypotensive patients, etc.). Because the physiology of alpha-2 receptors and the pharmacology of alpha-2 agonists lead to personalized indications, some details are offered. Since interactions between conventional sedatives and alpha-2 agonists have received little attention, these interactions are addressed. Within the existing guidelines for CCU sedation, this article could facilitate the use of alpha-2 agonists as effective and safe sedation while awaiting large, multicentre trials and more evidence-based medicine.
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Affiliation(s)
- D Longrois
- Départements d’Anesthésie-Réanimation, Université Paris-Diderot and Paris VII Sorbonne-Paris-Cité, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris and UMR 5698, Paris, France
| | - F Petitjeans
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
| | - O Simonet
- Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - M de Kock
- Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - M Belliveau
- Hôpital de St Jerome, St Jérôme, Québec, Canada
| | - C Pichot
- Hôpital Louis Pasteur, Dole, France
| | - Th Lieutaud
- Hôpital de Bourg en BresseBourg-en-BresseFrance
- Centre de Recherche en Neurosciences(TIGER,UMR CRNS 5192-INSERM 1098), Lyon-Bron, France
| | - M Ghignone
- J.F. Kennedy Hospital North Campus, West Palm Beach, Florida, USA
| | - L Quintin
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
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9
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Ndjekembo Shango D, Simonet O, Vallot F, Defendi F, De Kock M. [ACE-inhibition and bradykinin-mediated angioedema]. Rev Med Liege 2020; 75:151-153. [PMID: 32157838] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Angiotensin converting enzyme inhibitors (ACE-i) are the most common cause of bradykininin angioedema. These bradykinin-mediated angioedemas are sometimes confused with histamine-induced angioedema, which may cause a late diagnosis and hence poor initial management, deleterious to the patient. This report describes a patient with a bradykinin-mediated angioedema soon after the initiation of perindopril, with laryngeal involvement requiring orotracheal intubation in emergency. The diagnosis was confirmed later and the assay of the activity of the enzymes involved in the catabolism of kinins - aminopeptidase P (APP), carboxypeptidase N (CPN) and Angiotensin-Converting Enzyme (ACE) - demonstrated a decrease of activity of both APP and ACE. As the diagnosis was not made initially, the specific treatments - concentrate of C1 inhibitor or antagonist of the B2 receptor of bradykinin (Icatibant) - were not administered. Any angioedema occurring during a treatment with ACE-i should be considered as a bradykinin-mediated angioedema.
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Affiliation(s)
- D Ndjekembo Shango
- Service d'Anesthésie et Soins Intensifs, Centre Hospitalier de Wallonie-Picarde (CHwapi), Tournai, Belgique
| | - O Simonet
- Service d'Anesthésie et Soins Intensifs, Centre Hospitalier de Wallonie-Picarde (CHwapi), Tournai, Belgique
| | - F Vallot
- Service d'Anesthésie et Soins Intensifs, Centre Hospitalier de Wallonie-Picarde (CHwapi), Tournai, Belgique
| | - F Defendi
- Laboratoire d'Immunologie, CHU Grenoble, France
| | - M De Kock
- Service d'Anesthésie et Soins Intensifs, Centre Hospitalier de Wallonie-Picarde (CHwapi), Tournai, Belgique
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10
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Samouri G, Stouffs A, Essen LV, Simonet O, De Kock M, Forget P. What Can We Learn from Sarcopenia with Curarisation in the Context of Cancer Surgery? A Review of the Literature. Curr Pharm Des 2019; 25:3005-3010. [PMID: 31298155 DOI: 10.2174/1381612825666190705185033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/23/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The monitoring of the curarisation is a unique opportunity to investigate the function of the neuromuscular junction (NMJ) during cancer surgery, especially in frailty-induced and age-related sarcopenia. METHOD We conducted a comprehensive literature review in PubMed, without any limit of time related to frailty, sarcopenia, age and response to neuromuscular blockers in the context of cancer surgery. RESULTS Several modifications appear with age: changes in cardiac output, a decrease in muscle mass and increase in body fat, the deterioration in renal and hepatic function, the plasma clearance and the volume of distribution in elderly are smaller. These changes can be exacerbated in cancer patients. We also find modifications of the NMJ: dysfunctional mitochondria, modifications in the innervation of muscle fibers and motor units, uncoupling of the excitation-contraction of muscle fibers, inflammation. Neuromuscular blocking agents (NMBAs) compete with acetylcholine and prevent it from fixing itself on its receptor. Many publications reported guidelines for using NMBAs in the elderly, based on studies comparing old people with young people. No one screened frailty before, and thus, no studies compared frail elderly and non-frail elderly undergoing cancer surgery. CONCLUSION Despite many studies about curarisation in the specific populations, and many arguments for a potential interest for investigation, no studies investigated specifically the response to NMBAs in regard of the frailty-induced and age-related sarcopenia.
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Affiliation(s)
- Georges Samouri
- Department of Anesthesiology, Clinique Saint Pierre, Ottignies, Belgium
| | - Alexandre Stouffs
- Department of Anesthesiology, Cliniques universitaires, Saint-Luc, Brussels, Belgium
| | - Lionel V Essen
- Department of Anesthesiology, Clinique Saint Pierre, Ottignies, Belgium
| | - Olivier Simonet
- Department of Anesthesiology, Centre Hospitalier Wallonie-Picarde, Tournai, B-7500, Belgium
| | - Marc De Kock
- Department of Anesthesiology, Centre Hospitalier Wallonie-Picarde, Tournai, B-7500, Belgium
| | - Patrice Forget
- Department of Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Faidherbe C, De Kock M, Simonet O, Vallot F, Ndjekembo Shango D. Pulmonary lobectomy in two multitrauma patients under extracorporeal circulation placed preoperatively in an intensive care unit: A case report. Clin Case Rep 2019; 7:1297-1301. [PMID: 31360470 PMCID: PMC6637334 DOI: 10.1002/ccr3.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/23/2019] [Accepted: 04/22/2019] [Indexed: 11/13/2022] Open
Abstract
The clinical course of our two patients highlights the feasibility of using venovenous extracorporeal membrane oxygenation (ECMO) with heparin for multitraumatic patients needing thoracic surgery. Further research is required to determine if surgery can be performed with totally heparin-free vv-ECMO. All ICU teams should become familiar with this technique.
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Affiliation(s)
- Clément Faidherbe
- Department of Intensive CareCentre Hospitalier de Wallonie Picarde (CHwapi)TournaiBelgium
| | - Marc De Kock
- Department of Intensive CareCentre Hospitalier de Wallonie Picarde (CHwapi)TournaiBelgium
| | - Olivier Simonet
- Department of Intensive CareCentre Hospitalier de Wallonie Picarde (CHwapi)TournaiBelgium
| | - Frédéric Vallot
- Department of Intensive CareCentre Hospitalier de Wallonie Picarde (CHwapi)TournaiBelgium
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12
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Bissot M, Henin PY, Aunac S, Colinet B, Barvais L, Simonet O, De Kock M. Preoperative frailty assessment: a review. Acta Anaesthesiol Belg 2016; 67:157-173. [PMID: 29873986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Elderly surgical population is growing faster than the rate of population ageing. The risk of postoperative complication is higher in this population, the type of complication and the risk indicators are different from younger patients. There is also a huge heterogeneity in the elderly population. The concept of frailty-emerges to explain these specific aspects and to risk stratify older patients. The present work intends to help the anaesthesiologist to take into account the concept of frailty at the preoperative visit. We reviewed, in the light of surgical context, the physiopathology of ageing, the definitions of frailty concept,the current existing strategies for peri-operational optimisation and the different frailty assessment tools. Our conclusions are that preoperative frailty assessment is essential in modern perioperative medicine practice and that the Edmonton Frail Scale stands out from other tools even though it cannot yet be considered as a gold standard.
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13
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Forget P, Simonet O, De Kock M. Cancer surgery induces inflammation, immunosuppression and neo-angiogenesis, but is it influenced by analgesics? F1000Res 2013; 2:102. [PMID: 24358839 PMCID: PMC3752648 DOI: 10.12688/f1000research.2-102.v1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 12/12/2022] Open
Abstract
Surgery remains a main part of the treatment of most solid tumors. Paradoxically, rapid disease progression may be a consequence of surgery in patients presenting with a dysregulated inflammatory response, and increased angiogenesis consequent to a suppressed antitumoral immune response. Physicians taking care of cancer patients should be aware of the important findings that indicate that analgesic techniques could play a role in these phenomena.
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Affiliation(s)
- Patrice Forget
- Departments of Anesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Olivier Simonet
- Department of Anesthesiology, Centre Hospitalier Wallonie-Picarde, Tournai, B-7500, Belgium
| | - Marc De Kock
- Departments of Anesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Abstract
The effect of post-operative epidural morphine analgesia on pulmonary function was assessed after abdominal surgery and compared to conventional analgesia. In a control group, ten patients received a parenteral analgesic, non-narcotic drug. In a second group of 11 patients, epidural morphine was injected after the operation and continuous analgesia was prolonged until the 3rd post-operative day by means of repeated injections through an epidural catheter. Analgesia was tested on a visual pain scale. Pulmonary function was evaluated by measurements of blood gases, pulmonary volumes (vital capacity, by spirometry, and functional residual capacity by helium dilution technique) and forced expiratory volume in one second. Measurements were performed on the day before the operation and on the first, third and sixth post-operative days. Pain scoring documented a better analgesia in the epidural group during the post-operative period. By contrast, epidural morphine was unable significantly to improve VC, FEV1 and FRC during the post-operative course. The results suggest that pain is not an important factor of decreased post-operative pulmonary function.
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