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Pirracchio R, Annane D, Waschka AK, Lamontagne F, Arabi YM, Bollaert PE, Billot L, Du B, Briegel J, Cohen J, Finfer S, Gordon A, Hammond N, Hyvernat H, Keh D, Li Y, Liu L, Meduri GU, Mirea L, Myburgh JA, Sprung CL, Tilouche N, Tongyoo S, Venkatesh B, Zheng R, Delaney A. Patient-Level Meta-Analysis of Low-Dose Hydrocortisone in Adults with Septic Shock. NEJM Evid 2023; 2:EVIDoa2300034. [PMID: 38320130 DOI: 10.1056/evidoa2300034] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Low-Dose Hydrocortisone and Septic ShockCorticosteroids have been evaluated as a therapy for septic shock for more than 50 years. However, uncertainty persists about their effects on mortality. Pirracchio and colleagues undertake a patient-level meta-analysis to answer this important question.
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Affiliation(s)
- Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital (APHP), Garches, France
- School of Medicine Simone Veil, University Paris Saclay-Campus UVSQ, Paris
- FHU SEPSIS, U1173, University Paris Saclay, INSERM, Paris
| | - Andre K Waschka
- Department of Statistics, University of California Berkeley, Berkeley
- Department of Mathematics, Mercer University, Macon, Georgia
| | - François Lamontagne
- Département de médecine interne, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard-Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Laurent Billot
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
| | - Bin Du
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Beijing
| | - Josef Briegel
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Jeremy Cohen
- Intensive Care Unit, The Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- School of Public Health, Imperial College London, London
| | - Anthony Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London
| | - Naomi Hammond
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- Newtown, NSW, Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Herve Hyvernat
- Intensive Care Unit, Hôpital ARCHET 1-CHU de Nice, Nice, France
| | - Didier Keh
- Klinik für Anästhsiologie m.S. Canpus Virchow-Klinikum, Charite University Berlin, Berlin
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing
- Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Ling Liu
- Department of Critical Medicine, Zhong-Da Hospital, and School of Clinical Medicine, Southeast University, Nanjing, China
| | | | - Liliana Mirea
- Anaesthesia and Intensive Care Clinic, Clinical Emergency Hospital of Bucharest, Carol Davila University of Medicine, Bucharest, Romania
| | - John A Myburgh
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem
| | - Neijla Tilouche
- Intensive Care Unit, University Hospital Taher Sfar Mahdia, University of Monastir, Research Laboratory, Monastir, Tunisia
| | - Surat Tongyoo
- Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- Wesley Hospital, George Institute for Global Health, University of New South Wales, Sydney
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Anthony Delaney
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney
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2
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Sharshar T, Porcher R, Asfar P, Grimaldi L, Jabot J, Argaud L, Lebert C, Bollaert PE, Harlay ML, Chillet P, Maury E, Santoli F, Blanc P, Sonneville R, Vu DC, Rohaut B, Mazeraud A, Alvarez JC, Navarro V, Clair B, Outin H, Azabou E, Beloncle F, Ben-Hadj O, Blanc P, Bollaert PE, Bolgert F, Bouadma L, Chillet P, Clair B, Corne P, Clere-Jehl R, Cour M, Crespel A, Déiler V, Dellamonica J, Demeret S, Harley ML, Henry-Lagarrigue M, Jabot J, Heming N, Hernu R, Kouatchet A, Lebert C, Lerolle N, Maury E, Letrou S, Mazeraud A, Mercat A, Mortaza S, Mourvillier B, Outin H, Paugham-Burtz C, Pierrot M, Provent M, Rohaut B, De La Salle S, Santoli F, Schenk M, Siami S, Souday V, Sharshar T, Sonneville R, Timsit JF, Thuong M, Weiss N. Valproic acid as adjuvant treatment for convulsive status epilepticus: a randomised clinical trial. Crit Care 2023; 27:8. [PMID: 36624526 PMCID: PMC9830759 DOI: 10.1186/s13054-022-04292-7] [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: 09/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Generalised convulsive status epilepticus (GCSE) is a medical emergency. Guidelines recommend a stepwise strategy of benzodiazepines followed by a second-line anti-seizure medicine (ASM). However, GCSE is uncontrolled in 20-40% patients and is associated with protracted hospitalisation, disability, and mortality. The objective was to determine whether valproic acid (VPA) as complementary treatment to the stepwise strategy improves the outcomes of patients with de novo established GCSE. METHODS This was a multicentre, double-blind, randomised controlled trial in 244 adults admitted to intensive care units for GCSE in 16 French hospitals between 2013 and 2018. Patients received standard care of benzodiazepine and a second-line ASM (except VPA). Intervention patients received a 30 mg/kg VPA loading dose, then a 1 mg/kg/h 12 h infusion, whilst the placebo group received an identical intravenous administration of 0.9% saline as a bolus and continuous infusion. Primary outcome was proportion of patients discharged from hospital by day 15. The secondary outcomes were seizure control, adverse events, and cognition at day 90. RESULTS A total of 126 (52%) and 118 (48%) patients were included in the VPA and placebo groups. 224 (93%) and 227 (93%) received a first-line and a second-line ASM before VPA or placebo infusion. There was no between-group difference for patients hospital-discharged at day 15 [VPA, 77 (61%) versus placebo, 72 (61%), adjusted relative risk 1.04; 95% confidence interval (0.89-1.19); p = 0.58]. There were no between-group differences for secondary outcomes. CONCLUSIONS VPA added to the recommended strategy for adult GCSE is well tolerated but did not increase the proportion of patients hospital-discharged by day 15. TRIAL REGISTRATION NO NCT01791868 (ClinicalTrials.gov registry), registered: 15 February 2012.
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Affiliation(s)
- Tarek Sharshar
- grid.508487.60000 0004 7885 7602Neuro-Intensive Care Medicine, Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France
| | - Raphaël Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France ,grid.411394.a0000 0001 2191 1995Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Pierre Asfar
- grid.411147.60000 0004 0472 0283Department of Medical Intensive Care, University Hospital, Angers, France
| | - Lamiae Grimaldi
- grid.50550.350000 0001 2175 4109Clinical Research Unit, Assistance Publique - Hôpitaux de Paris University Paris-Saclay. Faculty of medicine, University of Versailles Saint-Quentin en Yvelines. Inserm U1018 Team Anti-infective evasion and pharmacoepidemiology, Boulogne-Billancourt, France
| | - Julien Jabot
- Medical-Surgical Intensive Care Unit, CHU Felix-Guyon, Saint-Denis, La Réunion, France
| | - Laurent Argaud
- grid.412180.e0000 0001 2198 4166Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Christine Lebert
- grid.477015.00000 0004 1772 6836Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Pierre-Edouard Bollaert
- grid.29172.3f0000 0001 2194 6418CHRU-Nancy, Service de Médecine Intensive Réanimation, Université de Lorraine, 54000 Nancy, France
| | - Marie Line Harlay
- grid.412201.40000 0004 0593 6932Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Patrick Chillet
- Service de Médecine Intensive - Réanimation, Centre hospitalier Léon Bourgeois, Châlons en Champagne, France
| | - Eric Maury
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive et Réanimation Hôpital Saint-Antoine, Paris-Sorbonne Université, Paris, France
| | - Francois Santoli
- grid.414308.a0000 0004 0594 0368Médecine Intensive—Réanimation, Centre Hospitalier Robert Ballanger, Aulnay sous Bois, France
| | - Pascal Blanc
- grid.440383.80000 0004 1765 1969Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France
| | - Romain Sonneville
- Université de Paris Cité, INSERM UMR1137, Paris, France ,grid.411119.d0000 0000 8588 831XAPHP Nord, Médecine Intensive – Réanimation, Hôpital Bichat—Claude Bernard, Paris, France
| | - Dinh Chuyen Vu
- General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Benjamin Rohaut
- grid.462844.80000 0001 2308 1657Department of Neurology, Neuro-ICU & Brain institute - ICM, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Paris, France
| | - Aurelien Mazeraud
- grid.508487.60000 0004 7885 7602Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Perception and Memory Unit, Neurosciences Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jean-Claude Alvarez
- grid.12832.3a0000 0001 2323 0229Department of Pharmacology and Toxicology, Inserm U-1173, Raymond Poincare Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, 104 Boulevard Raymond Poincare, 92380 Garches, France
| | - Vincent Navarro
- grid.425274.20000 0004 0620 5939AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Sorbonne Université, and Paris Brain Institute, Paris, France
| | - Bernard Clair
- grid.12832.3a0000 0001 2323 0229General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Hervé Outin
- grid.418056.e0000 0004 1765 2558Intensive Care Unit Centre Hospitalier Intercommunal, Poissy/Saint-Germain-en-Laye, France
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3
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Kentish-Barnes N, Chevret S, Valade S, Jaber S, Kerhuel L, Guisset O, Martin M, Mazaud A, Papazian L, Argaud L, Demoule A, Schnell D, Lebas E, Ethuin F, Hammad E, Merceron S, Audibert J, Blayau C, Delannoy PY, Lautrette A, Lesieur O, Renault A, Reuter D, Terzi N, Philippon-Jouve B, Fiancette M, Ramakers M, Rigaud JP, Souppart V, Asehnoune K, Champigneulle B, Goldgran-Toledano D, Dubost JL, Bollaert PE, Chouquer R, Pochard F, Cariou A, Azoulay E. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 2022; 399:656-664. [PMID: 35065008 DOI: 10.1016/s0140-6736(21)02176-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes. METHODS We undertook a prospective, multicentre, cluster randomised controlled trial in 34 ICUs in France, to compare standard care with a physician-driven, nurse-aided, three-step support strategy for families throughout the dying process, following a decision to withdraw or withhold life support. Inclusion criteria were relatives of patients older than 18 years with an ICU length of stay 2 days or longer. Participating ICUs were randomly assigned (1:1 ratio) into an intervention cluster and a control cluster. The randomisation scheme was generated centrally by a statistician not otherwise involved in the study, using permutation blocks of non-released size. In the intervention group, three meetings were held with relatives: a family conference to prepare the relatives for the imminent death, an ICU-room visit to provide active support, and a meeting after the patient's death to offer condolences and closure. ICUs randomly assigned to the control group applied their best standard of care in terms of support and communication with relatives of dying patients. The primary endpoint was the proportion of relatives with prolonged grief (measured with PG-13, score ≥30) 6 months after the death. Analysis was by intention to treat, with the bereaved relatives as the unit of observation. The study is registered with ClinicalTrials.gov, NCT02955992. FINDINGS Between Feb 23, 2017, and Oct 8, 2019, we enrolled 484 relatives of ICU patients to the intervention group and 391 to the control group. 379 (78%) relatives in the intervention group and 309 (79%) in the control group completed the 6-month interview to measure the primary endpoint. The intervention significantly reduced the number of relatives with prolonged grief symptoms (66 [21%] vs 57 [15%]; p=0·035) and the median PG-13 score was significantly lower in the intervention group than in the control group (19 [IQR 14-26] vs 21 [15-29], mean difference 2·5, 95% CI 1·04-3·95). INTERPRETATION Among relatives of patients dying in the ICU, a physician-driven, nurse-aided, three-step support strategy significantly reduced prolonged grief symptoms. FUNDING French Ministry of Health.
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Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France.
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, INSERM, Paris University, Saint Louis Hospital, AP-HP, Paris, France
| | - Sandrine Valade
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; AP-HP Centre, Cochin Hospital, Medical Intensive Care, Paris, France
| | - Samir Jaber
- Saint Eloi University Hospital, Department of Anesthesia and Critical Care Medicine, Montpellier and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Lionel Kerhuel
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Olivier Guisset
- Saint André University Hospital, Medical Intensive Care, Bordeaux, France
| | - Maëlle Martin
- Hôtel Dieu University Hospital, Medical Intensive Care, Nantes, France
| | - Amélie Mazaud
- Hospices Civils de Lyon, Edouard Herriot University Hospital, Surgical Intensive Care, Lyon, France
| | - Laurent Papazian
- AP-HM, Hôpital Nord, Medical Intensive Care and Aix-Marseille University, Faculté des Sciences Médicales et Paramédicales, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Edouard Herriot Hospital, Medical Intensive Care, and Université de Lyon, Lyon, France
| | - Alexandre Demoule
- AP-HP Sorbonne Université, La Pitié-Salpêtrière University Hospital, Medical Intensive Care Unit and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - David Schnell
- Angoulême Hospital, Medical and Surgical Intensive Care, Angoulême, France
| | - Eddy Lebas
- Bretagne Atlantique Hospital, Medical and Surgical Intensive Care, Vannes, France
| | - Frédéric Ethuin
- Côte de Nacre University Hospital, Surgical Intensive Care, Caen, France
| | - Emmanuelle Hammad
- AP-HM, Hospital Nord, Anaesthesia and Intensive Care, Marseille, France
| | - Sybille Merceron
- André Mignot Hospital, Medical Intensive Care, Le Chesnay, France
| | - Juliette Audibert
- Louis Pasteur Hospital, Medical and Surgical Intensive Care, Chartres, France
| | - Clarisse Blayau
- AP-HP Sorbonne University, Tenon Hospital, Medical Intensive Care, Paris, France
| | | | - Alexandre Lautrette
- Gabriel Montpied University Hospital, Medical Intensive Care, Clermont Ferrand, France
| | - Olivier Lesieur
- La Rochelle Hospital, Medical and Surgical Intensive Care, La Rochelle, France
| | - Anne Renault
- Cavale Blanche University Hospital, Medical Intensive Care, Brest, France
| | - Danielle Reuter
- Sud Francilien Hospital, Medical and Surgical Intensive Care, Evry, France
| | - Nicolas Terzi
- Grenoble Alpes University Hospital, Medical Intensive Care, Grenoble, France
| | | | - Maud Fiancette
- Les Oudairies Hospital, Medical and Surgical Intensive Care, La Roche-sur-Yon, France
| | - Michel Ramakers
- Saint Lô Hospital, Medical and Surgical Intensive Care, Saint Lô, France
| | | | - Virginie Souppart
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Karim Asehnoune
- Hôtel Dieu University Hospital, Department of Anesthesia and Critical Care, Nantes, France
| | - Benoît Champigneulle
- AP-HP Centre, Hôpital Européen Georges Pompidou, Department of Aaesthesia and Critical Care, Paris, France
| | | | - Jean-Louis Dubost
- René Dubos Hospital, Medical and Surgical Intensive Care, Pontoise, France
| | | | - Renaud Chouquer
- Annecy Hospital, Medical and Surgical Intensive Care, Annecy, France
| | - Frédéric Pochard
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; AP-HP Nord, Fernand Widal Hospital, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Alain Cariou
- AP-HP Centre, Cochin Hospital, Medical Intensive Care, Paris, France; Paris University, Paris, France
| | - Elie Azoulay
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, INSERM, Paris University, Saint Louis Hospital, AP-HP, Paris, France
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4
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Boissier F, Seegers V, Seguin A, Legriel S, Cariou A, Jaber S, Lefrant JY, Rimmelé T, Renault A, Vinatier I, Mathonnet A, Reuter D, Guisset O, Cracco C, Durand-Gasselin J, Éon B, Thirion M, Rigaud JP, Philippon-Jouve B, Argaud L, Chouquer R, Papazian L, Dedrie C, Georges H, Lebas E, Rolin N, Bollaert PE, Lecuyer L, Viquesnel G, Leone M, Chalumeau-Lemoine L, Garrouste-Orgeas M, Azoulay E, Kentish-Barnes N. Assessing physicians' and nurses' experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments. Crit Care 2020; 24:521. [PMID: 32843097 PMCID: PMC7448438 DOI: 10.1186/s13054-020-03191-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. Conclusion We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.
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Affiliation(s)
- Florence Boissier
- Medical Intensive Care, University Hospital of Poitiers, Poitiers, France.,INSERM CIC 1402 (ALIVE group), Poitiers University, Poitiers, France
| | - Valérie Seegers
- Data Management Research Department DRCI, Angers Hospital and SFR ICAT, University of Angers, Angers, France
| | - Amélie Seguin
- Medical Intensive Care, Caen University Hospital, Caen, France
| | | | - Alain Cariou
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Cochin University Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Samir Jaber
- Saint Eloi Hospital, Centre Hospitalier Universitaire Montpellier, Anesthesia and Critical Care Department B, Montpellier, France.,PhyMedExp, University of Montpellier, Montpellier, France.,INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Jean-Yves Lefrant
- Anesthesia and Intensive Care, Carémeau University Hospital, Nîmes, France.,Nîmes University, Nîmes, France
| | - Thomas Rimmelé
- Anaesthesia and Intensive Care Medicine, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Anne Renault
- Medical Intensive Care, Cavale Blanche University Hospital, Brest, France
| | - Isabelle Vinatier
- Medical Intensive Care, Les Oudairies Hospital, La Roche Sur Yon, France
| | | | - Danielle Reuter
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France
| | - Olivier Guisset
- Medical Intensive Care, Saint André University Hospital, Bordeaux, France
| | | | | | - Béatrice Éon
- Anaesthesia and Intensive Care, La Timone University Hospital, Marseille, France
| | - Marina Thirion
- Medical Intensive Care, Victor Dupouy Hospital, Argenteuil, France
| | | | | | - Laurent Argaud
- Medical Intensive Care, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.,Lyon Est University, Lyon, France
| | | | - Laurent Papazian
- Medical Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
| | | | | | - Eddy Lebas
- Intensive Care, Bretagne Atlantique Hospital, Vannes, France
| | - Nathalie Rolin
- Medical Intensive Care, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Pierre-Edouard Bollaert
- Medical Intensive Care, Nancy University Hospital, Nancy, France.,Lorraine University, Nancy, France
| | - Lucien Lecuyer
- Medical Intensive Care, Sud Francilien Hospital, Evry, France
| | | | - Marc Leone
- Aix-Marseille University, Marseille, France.,Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | | | | | - Elie Azoulay
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France.,Biostatistics and Clinical Epidemiology Research Team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Nancy Kentish-Barnes
- Biostatistics and Clinical Epidemiology Research Team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France. .,Famiréa Research Group, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France. .,Medical ICU, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
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5
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Lesny M, Conrad M, Latarche C, Sylvestre A, Gaujard E, Dubois V, Quignard C, Citro V, Thomas JC, Bridey C, Weber AM, Simon C, Klein S, Gibot S, Bollaert PE. Adverse events during nursing care procedure in intensive care unit: The PREVENIR study. Intensive Crit Care Nurs 2020; 60:102881. [PMID: 32499089 DOI: 10.1016/j.iccn.2020.102881] [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: 12/06/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE. DESIGN This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients' baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses. RESULTS 5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP. CONCLUSION AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02881645.
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Affiliation(s)
- M Lesny
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - M Conrad
- Réanimation médicale, Hôpital central, CHU Nancy, France.
| | - C Latarche
- Qualité Gestion des risques, CHU Nancy, France
| | | | - E Gaujard
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - V Dubois
- Réanimation neurochirurgicale, Hôpital central, CHU Nancy, France
| | - C Quignard
- Réanimation chirurgicale, Hôpital central, CHU Nancy, France
| | - V Citro
- Réanimation, CHR Metz, France
| | - J C Thomas
- Réanimation chirurgicale Cardiovasculaire, Hôpitaux de Brabois, CHU Nancy, France
| | - C Bridey
- Réanimation médicale, Hôpitaux de Brabois, CHU Nancy, France
| | - A M Weber
- Réanimation médicale, CHU Strasbourg, France
| | - C Simon
- Réanimation chirurgicale, Hôpitaux de Brabois, CHU Nancy, France
| | - S Klein
- CIC-EC INSERM, CHU Nancy, France
| | - S Gibot
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - P E Bollaert
- Réanimation médicale, Hôpital central, CHU Nancy, France
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6
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Lemarié J, Maigrat CH, Kimmoun A, Dumont N, Bollaert PE, Selton-Suty C, Gibot S, Huttin O. Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study. Ann Intensive Care 2020; 10:24. [PMID: 32056017 PMCID: PMC7018922 DOI: 10.1186/s13613-020-0636-2] [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: 10/01/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients. RESULTS Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S', RV FAC). A RV global LSS value > - 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters. CONCLUSIONS Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT.
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Affiliation(s)
- Jérémie Lemarié
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France.
| | - Charles-Henri Maigrat
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Nathalie Dumont
- Plateforme d'Aide à la Recherche Clinique, Bâtiment Recherche, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Christine Selton-Suty
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
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7
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Quenot JP, Helms J, Labro G, Dargent A, Meunier-Beillard N, Ksiazek E, Bollaert PE, Louis G, Large A, Andreu P, Bein C, Rigaud JP, Perez P, Clere-Jehl R, Merdji H, Devilliers H, Binquet C, Meziani F, Fournel I. Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study. Ann Intensive Care 2020; 10:20. [PMID: 32048075 PMCID: PMC7013026 DOI: 10.1186/s13613-020-0637-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background The influence of socioeconomic status on patient outcomes is unclear. We assessed the impact of socioeconomic deprivation on severity of illness at intensive care unit (ICU) admission, and on the risk of death at 3 months after ICU admission. Methods The IVOIRE study was a prospective, observational, multicentre cohort study in the ICU of 8 participating hospitals in France, including patients aged ≥ 18 years admitted to the ICU and receiving at least one life support therapy for organ failure. The primary outcomes were severity at admission (assessed by SAPSII score), and mortality at 3 months. Socioeconomic data were obtained from interviews with patients or family. Deprivation was assessed using the EPICES score. Results Among 1294 patents included between 2013 and 2016, 629 (48.6%) were classed as deprived and differed significantly from non-deprived subjects in terms of sociodemographic characteristics and pre-existing conditions. The mean SAPS II score at admission was 50.1 ± 19.4 in deprived patients and 52.3 ± 17.3 in non-deprived patients, with no significant difference by multivariable analysis (β = − 1.85 [95% CI − 3.86; + 0.16, p = 0.072]). The proportion of death was 31.1% at 3 months, without significant differences between deprived and non-deprived patients, even after adjustment for confounders. Conclusions Deprivation is frequent in patients admitted to the ICU and is not associated with disease severity at admission, or with mortality at 3 months between deprived and non-deprived patients. Trial registration The IVOIRE cohort is registered with ClinicalTrials.gov under the identifier NCT01907581, registration date 17/7/2013
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Affiliation(s)
- Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France. .,INSERM, U1231, Equipe Lipness, Dijon, France. .,LipSTIC LabEx, Fondation de coopération scientifique Bourgogne-Franche-Comté, Dijon, France. .,INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.
| | - Julie Helms
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France
| | - Guylaine Labro
- Service de Réanimation Médicale, CHU de Besançon, Besançon, France
| | - Auguste Dargent
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France.,INSERM, U1231, Equipe Lipness, Dijon, France.,LipSTIC LabEx, Fondation de coopération scientifique Bourgogne-Franche-Comté, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.,DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Elea Ksiazek
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.,DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | | | | | - Audrey Large
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France
| | - Pascal Andreu
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France
| | - Christophe Bein
- Service de Réanimation Polyvalente, CH de la Haute-Saône, Vesoul, France
| | | | - Pierre Perez
- Service de Réanimation Médicale, CHRU Brabois, Nancy, France
| | - Raphaël Clere-Jehl
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France
| | - Hamid Merdji
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France
| | - Hervé Devilliers
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.,Service de Médecine Interne et Maladies Systémiques, CHU Dijon Bourgogne, Dijon, France
| | | | - Ferhat Meziani
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
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8
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Volkov L, Grard G, Bollaert PE, Durand GA, Cravoisy A, Conrad M, Nace L, Courte G, Marnai R, Leparc-Goffart I, Gibot S. Viscerotropic disease and acute uveitis following yellow fever vaccination: a case report. BMC Infect Dis 2020; 20:116. [PMID: 32041533 PMCID: PMC7011288 DOI: 10.1186/s12879-020-4838-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/28/2019] [Accepted: 01/30/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Yellow fever vaccine exists for over 80 years and is considered to be relatively safe. However, in rare cases it can produce serious neurotropic and viscerotropic complications. We report a case of a patient who presented both viscerotropic and neurological manifestations after yellow fever vaccination. CASE PRESENTATION We describe the case of a 37 years old man who developed after the yellow fever vaccination a yellow fever vaccine-associated viscerotropic disease followed by acute uveitis. Prolonged detection of yellow fever RNA in blood and urine was consistent with yellow fever vaccine-associated adverse event. The final outcome was good, although with persistent fatigue over a few months. CONCLUSIONS Even if the yellow fever vaccine is relatively safe, physicians should be aware of its possible serious adverse effects.
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Affiliation(s)
- Lev Volkov
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France.
| | - Gilda Grard
- Institut de Recherche Biomédicale des Armées, National Reference Laboratory for arboviruses, Marseille, France.,Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Pierre-Edouard Bollaert
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Guillaume A Durand
- Institut de Recherche Biomédicale des Armées, National Reference Laboratory for arboviruses, Marseille, France.,Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Aurélie Cravoisy
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Marie Conrad
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Lionel Nace
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Guilhem Courte
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Rémy Marnai
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Isabelle Leparc-Goffart
- Institut de Recherche Biomédicale des Armées, National Reference Laboratory for arboviruses, Marseille, France.,Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Sébastien Gibot
- CHRU de Nancy, Intensive Care Unit, Réanimation Médicale Hôpital Central-CHU de Nancy, 29 avenue du maréchal de Lattre de Tassigny, 54035, Nancy, France
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9
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Labroca P, Chiesa G, Laroyenne I, Borrini L, Klotz R, Phan Sy Q, Cristina MC, Martinez AB, Bollaert PE, Paysant J, Lemarié J. Quality of life assessment following amputation for septic shock: a long-term descriptive survey after symmetric peripheral gangrene. J Crit Care 2019; 53:231-235. [PMID: 31277050 DOI: 10.1016/j.jcrc.2019.06.027] [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: 02/19/2019] [Revised: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess health-related quality of life (HRQOL) following rehabilitation of amputees suffering symmetric peripheral gangrene (SPG) after septic shock. MATERIAL AND METHODS A retrospective cohort study was conducted in nine French specialized rehabilitation centers. Thirty-two ICU adult patients hospitalized between 2005 and 2015 for septic shock who additionally presented with SPG resulting in at least two major amputations were enrolled. HRQOL was assessed by EQ-5D-3 L questionnaire. RESULTS All patients (mean ICU length of stay 39 ± 22d, SAPS II 58 ± 18) had both lower limbs amputated and 84% were quadruple amputees. HRQOL, assessed 4.8 ± 2.8 years after amputation, was inferior to the French reference. However, patients' self-rated health status was similar to the reference at the time of HRQOL assessment. The main factor of impaired HRQOL was intense phantom pain, not the mobility or self-care dimensions of EQ-5D. All patients except one preferred to be treated again for SPG despite disability. CONCLUSION ICU survivors referred to rehabilitation centers after SPG-related amputations had impaired HRQOL. At the time of HRQOL assessment, they considered themselves in good health and preferred to be treated again despite disability. Appraisal of long-term functional outcome should not be used to guide end-of-life decision-making in this situation.
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Affiliation(s)
- Pierre Labroca
- Réanimation médicale, hôpital central, C.H.R.U. de Nancy, Nancy, France
| | - Gérard Chiesa
- Service de rééducation et d'appareillage, Institut Robert Merle d'Aubigné, Valenton, France
| | - Isabelle Laroyenne
- Service de médecine physique et de réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues, Lyon, France
| | - Léo Borrini
- Service de médecine physique et de réadaptation, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Rémi Klotz
- Service de médecine physique et de réadaptation, centre de médecine physique et de réadaptation de la tour de Gassies, Bruges, France
| | - Quoc Phan Sy
- Service de médecine physique et de réadaptation, Hôpital la renaissance sanitaire, Villiers-Saint-Denis, France
| | | | - Anne Brunon Martinez
- Service de rééducation réadaptation, Hôpital Universitaire du Grau du Roi, Le Grau du Roi, France
| | | | - Jean Paysant
- Centre Louis Pierquin, Institut Régional de Médecine Physique et de Réadaptation, Nancy, France
| | - Jérémie Lemarié
- Réanimation médicale, hôpital central, C.H.R.U. de Nancy, Nancy, France.
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10
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Agrinier N, Monnier A, Argaud L, Bemer M, Virion JM, Alleyrat C, Charpentier C, Ziegler L, Louis G, Bruel C, Jamme M, Quenot JP, Badie J, Schneider F, Bollaert PE. Effect of fluid balance control in critically ill patients: Design of the stepped wedge trial POINCARE-2. Contemp Clin Trials 2019; 83:109-116. [PMID: 31260794 DOI: 10.1016/j.cct.2019.06.020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 01/28/2023]
Abstract
A high number of recent studies have shown that a positive fluid balance is independently associated with impaired prognosis in specific populations of patients hospitalized in intensive care unit (ICU): acute kidney injury, acute respiratory distress syndrome (ARDS), sepsis, high risk surgery. However, to date, there is no evidence that control of fluid overload reduces mortality in critically ill patients. The main objective is to assess the efficacy of a strategy limiting fluid overload on mortality in unselected critically ill patients hospitalized in ICU. We hypothesized that a strategy based on a weight-driven recommendation of restricted fluid intake, diuretics, and ultrafiltration initiated from 48 h up to 14 days after admission in critically ill patients would reduce all-cause mortality as compared to usual care. We use a stepped wedge cluster randomized controlled trial combined with a quasi-experimental (before-and-after) study. Patients under mechanical ventilation, admitted since >48 h and < 72 h in ICU, and with no discharge planned for the next 24 h are eligible. A total of 1440 patients are expected to be enrolled in 12 ICUs. Sociodemographic and clinical data are collected at inclusion, and outcomes are collected during the follow-up. Primary outcome is all-cause mortality at 60 days after admission. Secondary outcomes are patients weight differences between admission and day7 (or day 14), 28-day, in-hospital, and 1-year mortality, end-organ damages, and unintended harmful events. Analyses will be held in intention-to-treat. If POINCARE-2 strategy proves effective, then guidelines on fluid balance control might be extended to all critically ill patients. Trial registration: ClinicalTrials.govNCT02765009.
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Affiliation(s)
- Nelly Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
| | - Alexandra Monnier
- CHRU Strasbourg, Nouvel Hôpital Civil, Service de Réanimation médicale, F-67000 Strasbourg, France
| | - Laurent Argaud
- Hospices civils de Lyon, Hôpital Edouard Herriot, Service de réanimation médicale, F-69000 Lyon, France
| | - Michel Bemer
- CHR Metz-Thionville, Service de Réanimation polyvalente, F-57000 Thionville, France
| | - Jean-Marc Virion
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000 Nancy, France
| | - Camille Alleyrat
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000 Nancy, France
| | - Claire Charpentier
- CHRU-Nancy, Université de Lorraine, Service d'Anesthésie Réanimation chirurgicale, F-54000 Nancy, France
| | - Laurent Ziegler
- CH Verdun, Service d'anesthésie réanimation, F-55000 Verdun, France
| | - Guillaume Louis
- CHR Metz-Thionville, Service de Réanimation polyvalente, F-57000 Metz, France
| | - Cédric Bruel
- Groupe hospitalier Paris Saint-Joseph, Service de réanimation polyvalente, F-75000 Paris, France
| | - Matthieu Jamme
- CHI Poissy Saint-Germain, Service de Réanimation, F-78303 Poissy, France
| | - Jean-Pierre Quenot
- CHU Dijon-Bourgogne, Service de Médecine Intensive-Réanimation, F-21000 Dijon, France
| | - Julio Badie
- Hôpital Nord Franche-Comté, Service de Réanimation médicale, F-90015 Belfort, France
| | - Francis Schneider
- CHU Strasbourg, Hôpital de Hautepierre, Service de Médecine Intensive Réanimation, INSERM U 1121, F-67000 Strasbourg, France
| | - Pierre-Edouard Bollaert
- Université de Lorraine, CHRU-Nancy, Service de Médecine Intensive Réanimation, F-54000 Nancy, France
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11
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Thiriet C, Mahjoub K, Courte G, Labroca P, Cravoisy A, Lemarie J, Conrad M, Nace L, Bollaert PE, Gibot S. Automated measurement of neutrophil CD64 expression for diagnosing sepsis in critically ill patients. Minerva Anestesiol 2019; 85:943-950. [PMID: 30871305 DOI: 10.23736/s0375-9393.19.13420-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although early identification of sepsis improves outcome, prompt and correct diagnostic remains often challenging. The expression of the high affinity immunoglobulin-Fc fragment receptor I CD64 on neutrophils is upregulated during acute inflammation. We here aimed at determining the usefulness of its rapid measurement in diagnosing sepsis. METHODS Seventy-two consecutive patients were enrolled upon admission to Intensive Care Unit within a two-month period. Sequential determination of serum C-reactive protein (CRP) and procalcitonin (PCT) concentrations was obtained. The neutrophil CD64 index was measured using Accellix-CD64® device, an in vitro diagnosis system allowing for an automatic and standardized measure. RESULTS Serum concentrations of CRP and PCT as well as the neutrophil CD64 index were higher in septic patients compared to all others (P<0.05 for the three markers). Only CD64 index was an independent predictor of sepsis, though with modest sensitivity and specificity (78% and 70%, respectively). Repeat determination of CD64 index at day 2 correctly classified 85% of patients. CONCLUSIONS This prospective study demonstrates the moderate performance of the neutrophil CD64 index, assessed through the Accellix-CD64® device, in diagnosing sepsis in the critically ill patient. However, repeat measurements improve its accuracy and may help to predict ICU-acquired infections.
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Affiliation(s)
- Claire Thiriet
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Khaoula Mahjoub
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Guilhem Courte
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Pierre Labroca
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Aurélie Cravoisy
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jérémie Lemarie
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Marie Conrad
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Lionel Nace
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Pierre-Edouard Bollaert
- Service of Reanimation, Central Hospital, Nancy, France.,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Sébastien Gibot
- Service of Reanimation, Central Hospital, Nancy, France - .,Inserm U1116, Faculty of Medicine, University of Lorraine, Nancy, France
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Corriger J, Beaudouin E, Rothmann R, Penven E, Haumonte Q, Thomas H, Picaud J, Nguyen-Grosjean VM, Corriger-Ippolito J, Braun F, De Talancé M, Auburtin B, Atain-Kouadio P, Borsa-Dorion A, Baugnon D, De Carvalho M, Jaussaud R, Nguyen-Thi PL, Bollaert PE, Demoly P, Tanno LK. Epidemiological Data on Anaphylaxis in French Emergency Departments. J Investig Allergol Clin Immunol 2018; 29:357-364. [PMID: 30411700 DOI: 10.18176/jiaci.0348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxisrelated codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions.
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Affiliation(s)
- J Corriger
- Allergy Department, Hospital Emile Durkheim, Epinal, France.,Internal Medicine and Clinical Immunology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - E Beaudouin
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - R Rothmann
- Emergency Department, Hospital Mercy-Metz, Ars-Laquenexy, France
| | - E Penven
- Occupational Diseases Department, University Hospital, Vandoeuvre-lès-Nancy, France.,Division of Allergy, Dermatology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - Q Haumonte
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - H Thomas
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | - J Picaud
- Allergy Department, Hospital Emile Durkheim, Epinal, France
| | | | - J Corriger-Ippolito
- Division of Allergy, Dermatology Department, University Hospital, Vandoeuvre-lès-Nancy, France.,Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - F Braun
- Emergency Department, Hospital Mercy-Metz, Ars-Laquenexy, France
| | - M De Talancé
- Emergency Department, Hospital Emile Durkheim, Epinal, France
| | - B Auburtin
- Pediatric Emergency Department, Hospital Emile Durkheim, Epinal, France
| | - P Atain-Kouadio
- Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - A Borsa-Dorion
- Pediatric Emergency Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - D Baugnon
- Emergency Department, Hospital of Verdun-Saint-Mihiel, Verdun, France
| | - M De Carvalho
- Biology and Immunology Laboratory, University Hospital, Vandoeuvre-lès-Nancy, France
| | - R Jaussaud
- Internal Medicine and Clinical Immunology Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - P L Nguyen-Thi
- Clinical Research Platform, ESPRI-BioBase Unit, University Hospital, Vandoeuvre-lès-Nancy, France
| | - P E Bollaert
- Medical Intensive Care Unit, University Hospital, Nancy, France
| | - P Demoly
- Division of Allergy, Department of Pulmonology, University of Montpellier, France and Sorbonne University, INSERM, IPLESP, EPAR team, Paris, France
| | - L K Tanno
- Division of Allergy, Department of Pulmonology, University of Montpellier, France and Sorbonne University, INSERM, IPLESP, EPAR team, Paris, France
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Barraud D, Toussaint-Hacquard M, Bollaert PE, Lecompte T, Perrin J. Rapid onset heparin-induced thrombocytopenia (HIT) without history of heparin exposure: A new case of so-called ‘spontaneous’ HIT. Thromb Haemost 2017; 107:795-7. [DOI: 10.1160/th11-12-0825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/27/2011] [Indexed: 11/05/2022]
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14
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Labroca P, Lemarié J, Chiesa G, Laroyenne I, Borrini L, Klotz R, Sy QP, Cristina MC, Bollaert PE, Paysant J. Epidemiology and long-term outcome after severe symmetric peripheral gangrene. Ann Phys Rehabil Med 2017. [DOI: 10.1016/j.rehab.2017.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Demiselle J, Auchabie J, Beloncle F, Gatault P, Grangé S, Du Cheyron D, Dellamonica J, Boyer S, Beauport DT, Piquilloud L, Letheulle J, Guitton C, Chudeau N, Geri G, Fourrier F, Robert R, Guérot E, Boisramé-Helms J, Galichon P, Dequin PF, Lautrette A, Bollaert PE, Meziani F, Guillevin L, Lerolle N, Augusto JF. Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study. Ann Intensive Care 2017; 7:39. [PMID: 28382598 PMCID: PMC5382116 DOI: 10.1186/s13613-017-0262-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/23/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce. METHODS We included 97 consecutive patients with acute AAV manifestations (new onset or relapsing disease), admitted to 18 intensive care units (ICUs) over a 10-year period (2002-2012). A group of 95 consecutive AAV patients with new onset or relapsing disease, admitted to two nephrology departments with acute vasculitis manifestations, constituted the control group. RESULTS In the ICU group, patients predominantly showed granulomatosis with polyangiitis and proteinase-3 ANCAs. Compared with the non-ICU group, the ICU group showed comparable Birmingham vasculitis activity score and a higher frequency of heart, central nervous system and lungs involvements. Respiratory assistance, renal replacement therapy and vasopressors were required in 68.0, 56.7 and 26.8% of ICU patients, respectively. All but one patient (99%) received glucocorticoids, 85.6% received cyclophosphamide, and 49.5% had plasma exchanges as remission induction regimens. Fifteen (15.5%) patients died during the ICU stay. The following were significantly associated with ICU mortality in the univariate analysis: the need for respiratory assistance, the use of vasopressors, the occurrence of at least one infection event in ICU, cyclophosphamide treatment, sequential organ failure assessment at admission and simplified acute physiology score II. After adjustment on sequential organ failure assessment or infection, cyclophosphamide was no longer a risk factor for mortality. Despite a higher initial mortality rate of ICU patients within the first hospital stay (p < 0.0001), the long-term mortality of hospital survivors did not differ between ICU and non-ICU groups (18.6 and 20.4%, respectively, p = 0.36). Moreover, we observed no renal survival difference between groups after a 1-year follow-up (82.1 and 80.5%, p = 0.94). CONCLUSION This study supports the idea that experiencing an ICU challenge does not impact the long-term prognosis of AAV patients.
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Affiliation(s)
- Julien Demiselle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.,Néphrologie-Dialyse-Transplantation, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Johann Auchabie
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - François Beloncle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Philippe Gatault
- Service de Néphrologie et Immunologie Clinique, CHRU Tours, Tours, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Damien Du Cheyron
- Service de Réanimation Médicale, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, 14033, Caen Cedex 9, France
| | - Jean Dellamonica
- Medical Intensive Care Unit, Archet 1 University Hospital, Route de St Antoine, CS 23079, 06202, Nice, France
| | - Sonia Boyer
- Medical Intensive Care Unit, Archet 1 University Hospital, Route de St Antoine, CS 23079, 06202, Nice, France
| | - Dimitri Titeca Beauport
- Medical Intensive Care Unit, Amiens University Medical Center, 80054, Amiens, Cedex 1, France
| | - Lise Piquilloud
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.,Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Julien Letheulle
- Service de Réanimation Médicale, Hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Christophe Guitton
- Medical Intensive Care Unit, Hôtel-Dieu, University Hospital of Nantes, 30 bd Jean Monnet, 44093, Nantes, France.,UMR 1064, Inserm, 30 bd Jean Monnet, 44093, Nantes, France
| | - Nicolas Chudeau
- Service de Reanimation Medico-Chirurgicale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans, France
| | - Guillaume Geri
- Service de Réanimation Médicale, Hôpital Cochin, Paris, France
| | - François Fourrier
- Réanimation, Centre de Réanimation Polyvalente, Hôpital Roger Salengro, CHRU de Lille, Lille, France
| | - René Robert
- Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - Emmanuel Guérot
- Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Paris, France
| | - Julie Boisramé-Helms
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Pierre Galichon
- APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | | | - Alexandre Lautrette
- Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, CHU de Nancy Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035, Nancy Cedex, France
| | - Ferhat Meziani
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Loïc Guillevin
- Département de Médecine Interne, Assistance Public des Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Jean-François Augusto
- Néphrologie-Dialyse-Transplantation, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
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Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer D, Jost D, Lamhaut L, Beganton F, Cariou A, Meyer G, Jouven X, Bureau C, Charpentier J, Salem OBH, Guillemet L, Arnaout M, Ferre A, Geri G, Mongardon N, Pène F, Chiche JD, Mira JP, Labro G, Belon F, Luu VP, Chenet J, Besch G, Puyraveau M, Piton G, Capellier G, Martin M, Lascarrou JB, Le Thuaut A, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Henry-Laguarrigue M, Colin G, Reignier J, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Robert-Edan V, Lakhal K, Quartin A, Hobbs B, Cely C, Bell C, Pham T, Schein R, Geng Y, Ng C, Ehrmann S, Gandonnière CS, Boisramé-Helms J, Le Tilly O, De Bretagne IB, Mercier E, Mankikian J, Bretagnol A, Meziani F, Halimi JM, Le Guellec CB, Gaudry S, Hajage D, Tubach F, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Mayaux J, Nseir S, Ricard JD, Dreyfuss D, Robert R, Garzotto F, Kipnis E, Tetta C, Ronco C, Schnell D, Aurelie B, Reynaud M, Clec’h C, Benyamina M, Vincent F, Mariat C, Bornstain C, Gloulou O, Boussarsar M, Zelmat SA, Batouche DD, Chaffi B, Mazour F, Benatta N, Fathallah I, Aloui R, Zoubli A, Rouleau S, Kouraichi N, Fathallah I, Kouraichi N, Salem S, Vicaut E, Megarbane B, Ambroise D, Loriot AM, Bourgogne E, Megarbane B, Leroy C, Ghadhoune H, Jihene G, Trabelsi I, Allouche H, Brahmi H, Samet M, Ghord HE, Lebeau R, Laplanche JL, Benturquia N, Cohen Y, Megarbane B, Blel Y, M’rad A, Essafi F, Benabderrahim A, Jouffroy R, Resiere D, Sanchez B, Inamo J, Megarbane B, Morel J, Batouche DD, Zerhouni A, Tabeliouna K, Negadi A, Mentouri Z, Le Gall F, Hanouz JL, Normand H, Khoury A, Sall FS, Legrand M, De Luca A, Pugin A, Pazart L, Vidal C, Leroux F, Khoury A, L’Her E, Marjanovic N, Khoury A, Desmettre T, Terreaux J, Lambert C, Ragey SP, Baboi L, Bazin JE, Koffel C, Dhonneur G, Bouzit Z, Bradai L, Ayed IB, Aissa F, Darmon M, Haouache H, Marechal Y, Biston P, Piagnerelli M, Bortolotti P, Colling D, Colas V, Voisin B, Dewavrin F, Onimus T, Cantier M, Girardie P, Saulnier F, Urbina T, Nguyen Y, Druoton AL, Soudant M, Barraud D, Conrad M, Cravoisy-Popovic A, Nace L, Morisot A, Bollaert PE, Martin R, Bitker L, Richard JC, Brossier D, Goyer I, Marquis C, Lampin M, Duhamel A, Béhal H, Guérot E, Dhaoui T, Godeffroy V, Devouge E, Evrard D, Delepoulle F, Racoussot S, Grandbastien B, Lampin M, Heilbronner C, Roy E, Canet E, Masson A, Hadchouel-Duvergé A, Rigourd V, Delacroix E, Wroblewski I, Pin I, Ego A, Payen V, Debillon T, Millet A, De Montmollin E, Denot J, Berthelot V, Thueux E, Reymond M, De Larrard A, Amblard A, Leger PL, Aoul NT, Lemiale V, Oziel J, Voiriot G, Brule N, Moreau AS, Marhbène T, Sellami S, Jamoussi A, Ayed S, Mhiri E, Slim L, Khelil JB, Besbes M, Neuville M, Chawki S, Hamdi A, Ciroldi M, Cottereau A, Obadia E, Zerbib Y, Andrejak C, Ricome S, Dupont H, Baudin F, Timsit JF, Dureau P, Tanguy A, Arbelot C, Ben HK, Charfeddine A, Granger B, Laporte L, Hermetet C, Regaieg K, Khemakhem R, Sonneville R, Chelly H, Cheikh CM, Mountij H, Rghioui K, Haddad W, Cherkab R, Barrou H, Naima A, bennani OM, Regaieg K, Fayssoil A, Douib A, Samet A, Cungi PJ, Nguyen C, Cotte J, D’aranda E, Meaudre E, Avaro JP, Slaoui MT, Mokline A, Stojkovic T, Rahmani I, Laajili A, Amri H, Gharsallah L, Gasri B, Tlaili S, Hammouda R, Messadi AA, Behin A, Ogna A, Lofaso F, Laforet P, Wahbi K, Prigent H, Duboc D, Orlikowski D, Eymard B, Annane D, Le Guennec L, Cholet C, Bréchot N, Hekimian G, Besset S, Lebreton G, Nieszkowska A, Trouillet JL, Leprince P, Combes A, Luyt CE, Griton M, Sesay M, De Panthou NS, Bienvenu T, Biais M, Nouette-Gaulain K, Fossat G, Baudin F, Coulanges C, Bobet S, Dupont A, Courtes L, Benzekri D, Kamel T, Muller G, Bercault N, Barbier F, Runge I, Skarzynski M, Mathonnet A, Boulain T, Jouan Y, Teixera N, Hassen-Khodja C, Guillon A, Gaborit C, Grammatico-Guillon L, Rebière C, Azoulay E, Misset B, Ruckly S, Garrouste-Orgeas M, Kentish-Barnes N, Duranteau J, Thuong M, Joseph L, Renault A, Lesieur O, Larbi AGS, Viquesnel G, Zuber B, Marque S, Kandelman S, Pichon N, Floccard B, Galon M, Chevret S, Kentish-Barnes N, Seegers V, Legriel S, Jaber S, Lefrant JY, Reuter D, Guisset O, Cracco C, Seguin A, Durand-Gasselin J, Thirion M, Cohen-Solal Z, Foulgoc H, Rogier J, Delobbe E, Schortgen F, Asfar P, Julie BH, Grimaldi D, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Radermacher P, Kentish-Barnes N, Makunza JN, Nathalie MK, Pierre A, Adolphe KM, Mahieu R, Reydel T, Jamet A, Chudeau N, Huntzinger J, Grange S, Courte A, Lemarie J, Gibot S, Champey J, Dellamonica J, Du Cheyron D, Contou D, Tadié JM, Cour M, Beduneau G, Marchalot A, Guérin L, Jochmans S, Terzi N, Preau S, Brun-Buisson C, Dessap AM, Vedrenne-Cloquet M, Breinig S, Jung C, Brussieux M, Marcoux MO, Durrmeyer X, Blondé R, Angoulvant F, Grasset J, Naudin J, Dauger S, Remy S, Kolev-Descamp K, Demaret J, Monneret G, Javouhey E, Chomton M, Sauthier M, Vallieres E, Jouvet P, Geslain G, Guellec I, Rambaud J, Schmidt M, Schellongowski P, Dorget A, Patroniti N, Taccone FS, Miranda DR, Reuter J, Prodanovic H, Pierrot M, Balik M, Park S, Guérin C, Papazian L, Jean R, Ayzac L, Loundou A, Forel JM, Mezidi M, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Yonis H, Coudroy R, Frat JP, Boissier F, Thille AW, Richard F, Le Gullou-Guillemette H, Fahri J, Kouatchet A, Bodet-Contentin L, Garot D, Le Pennec D, Vecellio L, Tavernier E, Dequin PF, Messika J, Martin Y, Maquigneau N, Puechberty C, Stoclin A, Villard S, Dechanet A, De Jong A, Monnin M, Girard M, Chanques G, Molinari N, Decavèle M, Campion S, Ainsouya R, Niérat MC, Raux M, Similowski T, Demoule A, Razazi K, Tchir M, May F, Carteaux G, Pauline RB, Marc A, Bedos JP, Mehrsa K, Mauger-Briche C, Mijon F, Trouiller P, Sztrymf B, Cretallaz P, Mermillod-Blondin R, Savary D, Sedghiani I, Doghri H, Jendoubi A, Hamdi D, Cherif MA, Hechmi YZE, Zouheir J, Persico N, Maltese F, Ferrigno C, Bablon A, Marmillot C, Roch A, Sedghiani I, Papin G, Gainnier M, Argaud L, Christophe A, Souweine B, Goldgran-Toledano D, Marcotte G, Dumenil AS, Carole S, Cecchini J, Tuffet S, Fartoukh M, Roux D, Thyrault M, Armand MD, Chauveau S, Wesner N, Monnier-Cholley L, Bigé N, Ait-Oufella H, Guidet B, Dubée V, Labroca P, Lemarié J, Chiesa G, Laroyenne I, Borrini L, Klotz R, Sy QP, Cristina MC, Paysant J, Fillâtre P, Gacouin A, Revest M, Tattevin P, Flecher E, Le Tulzo Y, Jamme M, Daviaud F, Marin N, Thy M, Duceau B, Ardisson F, Sandrine V, Venot M, Schlemmer B, Zafrani L, Pons S, Styfalova L, Bouadma L, Radjou A, Lebut J, Mourvillier B, Dorent R, Dilly MP, Nataf P, Wolff M, Le Gall A, Bourcier S, Tandjaoui-Lambiotte Y, Das V, Alves M, Bigé N, Kamilia C, Rania A, Baccouch N, Turki O, Ben HC, Bahloul M, Bouaziz M, Dupuis C, Perozziello A, Letheulle J, Valette M, Herrmann-Storck C, Crosby L, Elkoun K, Madeux B, Martino F, Migueres H, Piednoir P, Posch M, Thiery G, Huynh-Ky MT, Bouchard PA, Sarrazin JF, Lellouche F, Nay MA, Lortat-Jacob B, Rozec B, Colnot M, Belin N, Barrot L, Navellou JC, Patry C, Chaignat C, Claveau M, Claude F, Aubron C, Mcquilten Z, Bailey M, Board J, Buhr H, Cartwright B, Dennis M, Forrest P, Hodgson C, Mcilroy D, Murphy D, Murray L, Pellegrino V, Pilcher D, Sheldrake J, Tran H, Vallance S, Cooper J, Bombled C, Vidal C, Margetis D, Amour J, Coart D, Dubois J, Van Herpe T, Mesotten D, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Tudesq JJ, Valade S, Galicier L, De Bazelaire C, Munoz-Bongrand N, Mignard X, Biard L, Mokart D, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Mariotte E, Ehooman F, Hamidfar-Roy R, Hourmant Y, Mailloux A, Beurton A, Teboul JL, Girroto V, Laura G, Richard C, Monnet X, Dubée V, Merdji H, Dang J, Preda G, Baudel JL, Desnos C, Zeitouni M, Belaroussi I, Parrot A, Blayau C, Fulgencio JP, Quesnel C, Labbe V, De Chambrun MP, Beloncle F, Merceron S, Fedun Y, Lecomte B, Devaquet J, Puidupin M, Verdière B, Amoura Z, Vuillard C, Xavier J, Bourlier D, David A, Caroline S, David M, Gerald S, Olivier S, Humbert M, Laurent S, Dujardin O, Bouglé A, Ait HN, Salem JE, El-Helali N, Coppere Z, Gibelin A, Taconet C, Djibre M, Maamar A, Colobert E, Fillatre P, Uhel F, Camus C, Moraly J, Dahoumane R, Maury E, Tan BK, Emmanuel V, Pauline M, Laurence P, Philippe P, Zahar JR, Catherine H, Christian P, Karim AB, Mounia H, Laura T, Rasoldier VH, Mager G, Eraldi JP, Gelinotte S, Bougerol F, Dehay J, Rigaud JP, Declercq PL, Michel J, Aissa N, Henard S, Guerci P, Latar I, Levy B, Girerd N, Kimmoun A, Abdallah SB, Nakaa S, Hraiech K, Braiek DB, Adhieb A, M’ghirbi A, Ousji A, Hammouda Z, Abroug F, Sellami W, Hajjej Z, Samoud W, Labbene I, Ferjani M, Medhioub FK, Allela R, Algia NB, Cherif S, Attia D, Herinjatovo A, Francois XL, Bouhouri MA, Slaoui MT, Soufi A, Khaleq K, Hamoudi D, Nsiri A, Harrar R, Maury E, Goursaud S, Gauberti M, Labeyrie PE, Gaberel T, Agin V, Maubert E, Vivien D, Gakuba C, Armel A, Abdou R, Kalouch S, Yaqini K, Chlilek A, Sellami W, Yedder SB, Tonnelier A, Hervé F, Halley G, Frances JL, Moriconi M, Saoli M, Garnero A, Demory D, Arnal JM, Canoville B, Daubin C, Brunet J, Ghezala HB, Snouda S, Ben CI, Kaddour M, Ouanes I, Marzouk M, Haniez F, Jaillet H, Maas H, Andrivet P, Darné C, Viau F, Ghezala HB, Ouanes I, Dangers L, Montlahuc C, Perbet S, Ouanes I, Hamouda Z, Nakee S, Ouanes-Besbes L, Meddeb K, Khedher A, Sma N, Ayachi J, Khelfa M, Fraj N, Lakhal HB, Hammed H, Boukadida R, Hafsa H, Chouchene I, Boussarsar M, Ben BD, Ouanes-Besbes L, Benatti K, Dafir A, Aissaoui W, Elallame W, Haddad W, Cherkab R, Elkettani C, Barrou L, Hamou ZA, Repessé X, Charron C, Aubry A, Paternot A, Maizel J, Slama M, Vieillard-Baron A, Trifi A, Abdellatif S, Fatnassi M, Daly F, Nasri R, Ismail KB, Lakhal SB, Bazalgette F, Daurat A, Roger C, Muller L, Doyen D, Plattier R, Robert A, Hyvernat H, Bernardin G, Jozwiak M, Gimenez J, Mercado P, Depret F, Tilouch N, Mater H, Habiba BSA, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Pasquier P, Vuillemin Q, Schaal JV, Martinez T, Duron S, Trousselard M, Schwartzbrod PE, Baugnon T, Dupic L, Gout CD, De Saint Blanquat L, Séguret S, Le Ficher G, Orliaguet G, Hubert P, Bigé N, Leblanc G, Briand R, Brousse L, Brunet V, Chatelain L, Prat D, Jacobs F, Demars N, Hamzaoui O, Moneger G, Sztrymf B, Duburcq-Gury E, Satre-Buisson L, Duburcq T, Poissy J, Robriquet L, Jourdain M, Sécheresse T, Miquet M, Simond A, Usseglio P, Hamdaoui Y, Boussarsar M, Desailly V, Brun P, Iglesias P, Huet J, Masseran C, Claudon A, Ebeyer C, Truong T, Tesnière A, Mignon A, Gaudry S, Resiere D, Valentino R, Fabre J, Roze B, Ferge JL, Charbatier C, Marie S, Scholsser M, Aitsatou S, Raad M, Cabie A, Mehdaoui H, Cousin C, Rousseau C, Llitjos JF, Alby-Laurent F, Toubiana J, Belaidouni N, Cherruault M, Tamburini J, Bouscary D, Fert S, Delile E, Besnier E, Coquerel D, Nevière R, Richard V, Tamion F, Wei C, Louis H, Margaux S, Eliane A, Sophie O, Kimmoun A, Riad Z, Coroir M, Rémy B, Camille B, Joffre J, Aegerter P, Ilic D, Ginet M, Pignard C, Nguyen P, Mourey G, Samain E, Pili-Floury S, Jouffroy R, Nicolas C, Alvarez JC, Tomasso M, Philippe P, Raphalen JH, Frédéric JB, Vivien B, Pierre C, Baud F, Fredj H, Blel Y, Brahmi N, Ghezala HB, Hanak AS, Malissin I, Poupon J, Risede P, Chevillard L, Megarbane B, Barghouth M, M’rad A, Hmida MB, Thabet H, Liang H, Callebert J, Lagard C, Megarbane B, Habacha S, Chatbri B, Camillerapp C, Labat L, Soichot M, Garçon P, Goury A, Kerdjana L, Voicu S, Deye N, Megarbane B, Armel A, Anas B, Othman M, Moumine S, Kalouch S, Yakini KK, Chlilek A, Hajji A, Louati A, Khaldi A, Borgi A, Ghali N, Bouziri A, Menif K, Ben JN, Armel A, Brochon J, Dumitrescu M, Thévenot S, Saulnier JP, Husseini K, Laland C, Cremniter J, Bousseau A, Castel O, Brémaud-Csizmadia C, Diss M, Portefaix A, Berthiller J, Gillet Y, Aoul NT, Douah A, Addou Z, Youbi H, Moussati M, Belhabiche K, Mir S, Abada S, Amel Z, Aouffen N, Bouzit Z, Grati AH, Dhonneur GF, Boussarsar M, Lau N, Mezhari I, Roucaud N, Le Meur M, Paulet R, Coudray JM, Ghomari WI, Boumlik R, Peigne V, Daban JL, Boutonnet M, Lenoir B, Yassine H, Mohamed CC, Khalid A, Ihssan M, Said E, Said S, Jazia AB, Fatima J, Wafa S, Maha B, Khaoula BA, Sami T, Abdallah Taeib B, Medhioub FK, Rollet-Cohen V, Sachs P, Merchaoui Z, Renolleau S, Oualha M, Eloi M, Jean S, Demoulin M, Valentin C, Guilbert J, Walti H, Carbajal R, Leger PL, Karaca-Altintas Y, Botte A, Labreuche J, Drumez E, Devos P, Bour F, Leclerc F, Ahmed A, khaled M, Louati A, Aida B, Ammar K, Narjess G, Ahmed H, Asma B, Jaballah NB, Leger PL, Pansiot J, Besson V, Palmier B, Baud O, Cauli B, Charriaut-Marlangue C, Mansuy A, Michel F, Le Bel S, Boubnova J, Ughetto F, Ovaert C, Fouilloux V, Paut O, Jacquet-Lagrèze M, Tiebergien N, Hanna N, Evain JN, Baudin F, Courtil-Teyssedre S, Bompard D, Lilot M, Chardonal L, Fellahi JL, Claverie C, Pouessel G, Dorkenoo A, Renaudin JM, Eb M, Deschildre A, Leteurtre S, Yassine H, Kamal B, Adil O, Ouafa A, Mouhamed M, Rachid C, Lahoucine B, Dachraoui F, Nakkaa S, Zaineb H, Mlika D. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225387 DOI: 10.1186/s13613-016-0223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, Rodriguez J, Taddei M, Di Bari M, Hickmann C, Castanares-Zapatero D, Sayed FE, Deldicque L, Van Den Bergh P, Caty G, Roeseler J, Francaux M, Laterre PF, Dupuis B, Machayeckhi S, Sarfati C, Moore A, Dinh A, Mendialdua P, Rodet E, Pilorge C, Stephan F, Rezaiguia-Delclaux S, Dugernier J, Hesse M, Jumetz T, Bialais E, Depoortere V, Charron C, Michotte JB, Wittebole X, Jamar F, Geri G, Vieillard-Baron A, Repessé X, Kallel H, Mayence C, Houcke S, Guegueniat P, Hommel D, Dhifaoui K, Hajjej Z, Fatnassi A, Sellami W, Labbene I, Ferjani M, Dachraoui F, Nakkaa S, M’ghirbi A, Adhieb A, Braiek DB, Hraiech K, Ousji A, Ouanes I, Zaineb H, Abdallah SB, Ouanes-Besbes L, Abroug F, Klein S, Miquet M, Thouret JM, Peigne V, Daban JL, Boutonnet M, Lenoir B, Merhbene T, Derreumaux C, Seguin T, Conil JM, Kelway C, Blasco V, Nafati C, Harti K, Reydellet L, Albanese J, Aicha NB, Meddeb K, Khedher A, Ayachi J, Fraj N, Sma N, Chouchene I, Boussarsar M, Yedder SB, Samoud W, Radhouene B, Mariem B, Ammar A, Cheikh AB, Lakhal HB, Khelfa M, Hamdaoui Y, Bouafia N, Trampont T, Daix T, Legarçon V, Karam HH, Pichon N, Essafi F, Foudhaili N, Thabet H, Blel Y, Brahmi N, Ezzouine H, Kerrous M, Haoui SE, Ahdil S, Benslama A, Abidi K, Dendane T, Oussama S, Belayachi J, Madani N, Abouqal R, Zeggwagh AA, Ghadhoune H, Chaari A, Jihene G, Allouche H, Trabelsi I, Brahmi H, Samet M, Ghord HE, Habiba BSA, Hajer N, Tilouch N, Yaakoubi S, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Arcizet J, Leroy B, Abdulmalack C, Renzullo C, Hamet M, Doise JM, Coutet J, Cheikh CM, Quechar Z, Joris M, Beauport DT, Kontar L, Lebon D, Gruson B, Slama M, Marolleau JP, Maizel J, Gorham J, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP, Guillot M, Ledoux MP, Braun T, Maestraggi Q, Michard B, Castelain V, Herbrecht R, Schneider F, Couffin S, Lobo D, Mongardon N, Dhonneur G, Mounier R, Le Borgne P, Couraud S, Herbrecht JE, Boivin A, Lefebvre F, Bilbault P, Zelmat SA, Batouche DD, Mazour F, Chaffi B, Benatta N, Sik AH, Talik I, Perrier M, Gouteix E, Koubi C, Escavy A, Guilbaut V, Fosse JP, Jazia RB, Abdelghani A, Cungi PJ, Bordes J, Nguyen C, Pierrou C, Cruc M, Benois A, Duprez F, Bonus T, Cuvelier G, Ollieuz S, Machayekhi S, Paciorkowski F, Reychler G, Coudroy R, Thille AW, Drouot X, Diaz V, Meurice JC, Robert R, Turki O, Ben HC, Assefi M, Deransy R, Brisson H, Monsel A, Conti F, Scatton O, Langeron O, Ghezala HB, Snouda S, Ben CI, Kaddour M, Armel A, Youness L, Abdelhak B, Youssef M, Najib AH, Mustapha A, Noufel M, Mohamed Z, Salma EK, Ghizlane M, Mohamed B, Benyounes R, Montini F, Moschietto S, Gregoire E, Claisse G, Guiot J, Morimont P, Krzesinski JM, Mariat C, Lambermont B, Cavalier E, Delanaye P, Benbernou S, Ilies S, Azza A, Bouyacoub K, Louail M, Mokhtari-Djebli H, Arrestier R, Daviaud F, Francois XL, Brocas E, Choukroun G, Peñuelas O, Lorente JA, Cardinal-Fernandez P, Rodriguez JM, Aramburu JA, Esteban A, Frutos-Vivar F, Bitker L, Costes N, Le Bars D, Lavenne F, Devouassoux M, Richard JC, Mechati M, Gainnier M, Papazian L, Guervilly C, Garnero A, Arnal JM, Roze H, Richard JC, Repusseau B, Dewitte A, Joannes-Boyau O, Ouattara A, Harbouze N, Amine AM, Olandzobo AG, Herbland A, Richard M, Girard N, Lambron L, Lesieur O, Wainschtein S, Hubert S, Hugues A, Tran M, Bouillard P, Loteanu V, Leloup M, Laurent A, Lheureux F, Prestifilippo A, Cruz MDM, Romain R, Antonelli M, Blanch TL, Bonnetain F, Grazzia-Bocci M, Mancebo J, Samain E, Paul H, Capellier G, Zavgorodniaia T, Soichot M, Malissin I, Voicu S, Garçon P, Goury A, Kerdjana L, Deye N, Bourgogne E, Megarbane B, Mejri O, Hmida MB, Tannous S, Chevillard L, Labat L, Risede P, Fredj H, Léger M, Brunet M, Le Roux G, Boels D, Lerolle N, Farah S, Amiel-Niemann H, Kubis N, Declèves X, Peyraux N, Baud F, Serafini M, Alvarez JC, Heinzelman A, Jozwiak M, Millasseau S, Teboul JL, Alphonsine JE, Depret F, Richard N, Attal P, Richard C, Monnet X, Chemla D, Jerbi S, Khedhiri W, Necib H, Scarfo P, Chevalier C, Piagnerelli M, Lafont A, Galy A, Mancia C, Zerhouni A, Tabeliouna K, Gaja A, Hamrouni B, Malouch A, Fourati S, Messaoud R, Zarrouki Y, Ziadi A, Rhezali M, Zouizra Z, Boumzebra D, Samkaoui MA, Brunet J, Canoville B, Verrier P, Ivascau C, Seguin A, Valette X, Du Cheyron D, Daubin C, Bougouin W, Aissaoui N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Dumas F, Marijon E, Jouven X, Cariou A, Poirson F, Chaput U, Beeken T, Maxime L, Haikel O, Vodovar D, Chelly J, Marteau P, Chocron R, Juvin P, Loeb T, Adnet F, Lecarpentier E, Riviere A, De Cagny B, Soupison T, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Leteurtre S, Fresco M, Bubenheim M, Beduneau G, Carpentier D, Grange S, Artaud-Macari E, Misset B, Tamion F, Girault C, Dumas G, Chevret S, Lemiale V, Mokart D, Mayaux J, Pène F, Nyunga M, Perez P, Moreau AS, Bruneel F, Vincent F, Klouche K, Reignier J, Rabbat A, Azoulay E, Frat JP, Ragot S, Constantin JM, Prat G, Mercat A, Boulain T, Demoule A, Devaquet J, Nseir S, Charpentier J, Argaud L, Beuret P, Ricard JD, Teiten C, Marjanovic N, Palamin N, L’Her E, Bailly A, Boisramé-Helms J, Champigneulle B, Kamel T, Mercier E, Le Thuaut A, Lascarrou JB, Rolle A, De Jong A, Chanques G, Jaber S, Hariri G, Baudel JL, Dubée V, Preda G, Bourcier S, Joffre J, Bigé N, Ait-Oufella H, Maury E, Mater H, Merdji H, Grimaldi D, Rousseau C, Mira JP, Chiche JD, Sedghiani I, Benabderrahim A, Hamdi D, Jendoubi A, Cherif MA, Hechmi YZE, Zouheir J, Bagate F, Bousselmi R, Schortgen F, Asfar P, Guérot E, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Dreyfuss D, Radermacher P, Frère A, Martin-Lefèvre L, Colin G, Fiancette M, Henry-Laguarrigue M, Lacherade JC, Lebert C, Vinatier I, Yehia A, Joret A, Menunier-Beillard N, Benzekri-Lefevre D, Desachy A, Bellec F, Plantefève G, Quenot JP, Meziani F, Tavernier E, Ehrmann S, Chudeau N, Raveau T, Moal V, Houillier P, Rouve E, Lakhal K, Gandonnière CS, Jouan Y, Bodet-Contentin L, Balmier A, Messika J, De Montmollin E, Pouyet V, Sztrymf B, Thiagarajah A, Roux D, De Chambrun MP, Luyt CE, Beloncle F, Zapella N, Ledochowsky S, Terzi N, Mazou JM, Sonneville R, Paulus S, Fedun Y, Landais M, Raphalen JH, Combes A, Amoura Z, Jacquemin A, Guerrero F, Marcheix B, Hernandez N, Fourcade O, Georges B, Delmas C, Makoudi S, Genton A, Bernard R, Lebreton G, Amour J, Mazet C, Bounes F, Murat G, Cronier L, Robin G, Biendel C, Silva S, Boubeche S, Abriou C, Wurtz V, Scherrer V, Rey N, Gastaldi G, Veber B, Doguet F, Gay A, Dureuil B, Besnier E, Rouget A, Gantois G, Magalhaes E, Wanono R, Smonig R, Lermuzeaux M, Lebut J, Olivier A, Dupuis C, Radjou A, Mourvillier B, Neuville M, D’ortho MP, Bouadma L, Rouvel-Tallec A, Rudler M, Weiss N, Perlbarg V, Galanaud D, Thabut D, Rachdi E, Mhamdi G, Trifi A, Abdelmalek R, Abdellatif S, Daly F, Nasri R, Tiouiri H, Lakhal SB, Rousseau G, Asmolov R, Grammatico-Guillon L, Auvet A, Laribi S, Garot D, Dequin PF, Guillon A, Fergé JL, Abgrall G, Hinault R, Vally S, Roze B, Chaplain A, Chabartier C, Savidan AC, Marie S, Cabie A, Resiere D, Valentino R, Mehdaoui H, Benarous L, Soda-Diop M, Bouzana F, Perrin G, Bourenne J, Eon B, Lambert D, Trebuchon A, Poncelet G, Le Bourgeois F, Michael L, Camille G, Naudin J, Deho A, Dauger S, Sauthier M, Bergeron-Gallant K, Emeriaud G, Jouvet P, Tiebergien N, Jacquet-Lagrèze M, Fellahi JL, Baudin F, Essouri S, Javouhey E, Guérin C, Lampin M, Mamouri O, Devos P, Karaca-Altintas Y, Vinchon M, Brossier D, Eltaani R, Teyssedre S, Sabine M, Bouchut JC, Peguet O, Petitdemange L, Guilbert AS, Aoul NT, Addou Z, Aouffen N, Anas B, Kalouch S, Yaqini K, Chlilek A, Abdou R, Gravellier P, Chantreuil J, Travers N, Listrat A, Le Reun C, Favrais G, Coppere Z, Blanot S, Montmayeur J, Bronchard R, Rolando S, Orliaguet G, Leger PL, Rambaud J, Thueux E, De Larrard A, Berthelot V, Denot J, Reymond M, Amblard A, Morin-Zorman S, Lengliné E, Pichereau C, Mariotte E, Emmanuel C, Poujade J, Trumpff G, Janssen-Langenstein R, Harlay ML, Zaid N, Ait-Ammar N, Bonnal C, Merle JC, Botterel F, Levesque E, Riad Z, Mezidi M, Yonis H, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Louis B, Forel JM, Bisbal M, Lehingue S, Rambaud R, Adda M, Hraiech S, Marchi E, Roch A, Guerin V, Rozencwajg S, Schmidt M, Hekimian G, Bréchot N, Trouillet JL, Besset S, Franchineau G, Nieszkowska A, Pascal L, Loiselle M, Sarah C, Laurence D, Guillemette T, Jacquens A, Kerever S, Guidet B, Aegerter P, Das V, Fartoukh M, Hayon J, Desmard M, Fulgencio JP, Zuber B, Soufi A, Khaleq K, Hamoudi D, Garret C, Peron M, Coron E, Bretonnière C, Audureau E, Audrey W, Christophe D, Christian J, Daniel A, Cyrille F, Aissaoui W, Rghioui K, Haddad W, Barrou H, Carteaux-Taeib A, Lupinacci R, Manceau G, Jeune F, Tresallet C, Habacha S, Fathallah I, Zoubli A, Aloui R, Kouraichi N, Jouet E, Badin J, Fermier B, Feller M, Serie M, Pillot J, Marie W, Gisbert-Mora C, Vinclair C, Lesbordes P, Mathieu P, De Brabant F, Muller E, Robaux MA, Giabicani M, Marchalot A, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Meunier-Beillard N, Devilliers H, Rigaud JP, Verrière C, Ardisson F, Kentish-Barnes N, Jacq G, Chermak A, Lautrette A, Legrand M, Soummer A, Thiery G, Cottereau A, Canet E, Caujolle M, Allyn J, Valance D, Brulliard C, Martinet O, Jabot J, Gallas T, Vandroux D, Allou N, Durand A, Nevière R, Delguste F, Boulanger E, Preau S, Martin R, Cochet H, Ponthus JP, Amilien V, Tchir M, Barsam E, Ayoub M, Georger JF, Guillame I, Assaraf J, Tripon S, Mallet M, Barbara G, Louis G, Gaudry S, Barbarot N, Jamet A, Outin H, Gibot S, Bollaert PE, Holleville M, Legriel S, Chateauneuf AL, Cavelot S, Moyer JD, Bedos JP, Merle P, Laine A, Natalie DS, Cornuault M, Libot J, Asehnoune K, Rozec B, Dantal J, Videcoq M, Degroote T, Jaillette E, Zerimech F, Malika B, Llitjos JF, Amara M, Lacave G, Pangon B, Mavinga J, Makunza JN, Mafuta ME, Yanga Y, Eric A, Ilunga J, Kilembe M, Alby-Laurent F, Toubiana J, Mokline A, Laajili A, Amri H, Rahmani I, Mensi N, Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lai A, Outin HD, Jabot J, Mégarbane B, Gaudry S, Coudroy R, Louis G, Schneider F, Barbarot N, Roch A, Lerolle N, Luis D, Fourrier F, Renault A, Argaud L, Sharshar T, Gibot S, Bollaert PE. Functional outcome of prolonged refractory status epilepticus. Crit Care 2015; 19:199. [PMID: 25925042 PMCID: PMC4426536 DOI: 10.1186/s13054-015-0914-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 01/17/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction To characterize etiology, clinical course and outcomes of patients in prolonged refractory status epilepticus (PRSE) and looking for prognostic factors. Methods Retrospective study conducted in patients hospitalized from January 1, 2001 to December 31, 2011 in 19 polyvalent intensive care units in French university and general hospitals. Patients were adults with a generalized convulsive refractory status epilepticus that lasted more than seven days, despite treatment including an anesthetic drug and mechanical ventilation. Patients with anoxic encephalopathy were excluded. Follow-up phone call was used to determine functional outcome using modified Rankin Scale (mRS) with mRS 0–3 defining good and mRS 4–6 poor outcome. Results 78 patients (35 female) were included. Median age was 57 years. Causes of status epilepticus were various, mainly including prior epilepsy (14.1%), CNS infection (12.8%), and stroke (12.8%). No etiology was found in 27 (34.6%) patients. PRSE was considered controlled in only 53 (67.9%) patients after a median duration of 17 (IQR 12–26) days. The median length of ICU stay was 28 (19–48) days. Forty-one (52.5%) patients died in the ICU, 26 from multiple organ failure, 8 from care withdrawal, 2 from sudden cardiac arrest, 1 from brain death and 4 from unknown causes. PRSE was previously resolved in 20 patients who died in the ICU. At one-year follow-up, there were 12 patients with good outcome and 58 with poor outcome and 8 lost of follow-up. On multivariate analysis, only vasopressor use was a predictor of poor outcome (OR 6.54; 95%CI 1.09-39.29; p = 0.04). Conclusion Poor outcome was observed in about 80% of this population of PRSE. Most patients died from systemic complications linked to their ICU stay. Some patients can recover satisfactorily over time though we did not identify any robust factor of good outcome.
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Affiliation(s)
- Alexandre Lai
- Service de Réanimation médicale, Hôpital Central, CHU de Nancy, Nancy, France.
| | - Hervé D Outin
- Service de Réanimation médico-chirurgicale, CHI de Poissy-Saint Germain en Laye, Poissy, France.
| | - Julien Jabot
- Service de Réanimation Polyvalente, CHU Réunion, Saint Denis de la Réunion, France.
| | - Bruno Mégarbane
- Service de Réanimation et de Toxicologie, CHU Lariboisière, Université Paris VI, Paris, France.
| | - Stéphane Gaudry
- Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Univ Paris Diderot, UMRS 1123, Paris, France.
| | - Rémi Coudroy
- Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France.
| | - Guillaume Louis
- Service de Réanimation Polyvalente, CHR de Metz-Thionville, Metz, France.
| | - Francis Schneider
- Service de Réanimation Médicale, Hôpital de Strasbourg-Hautepierre, Université Louis Pasteur, Strasbourg, France.
| | - Nicolas Barbarot
- Service de Réanimation Polyvalente, CH de St Brieuc, St Brieuc, France.
| | - Antoine Roch
- Service de Réanimation, Hôpital Nord, CHU de Marseille, Marseille, France.
| | - Nicolas Lerolle
- Service de Réanimation Médicale et de Médecine Hyperbare, CHU et Université d'Angers, Angers, France.
| | - David Luis
- Service de Réanimation Médico-chirurgicale, Garches, France.
| | - François Fourrier
- Service de Réanimation Polyvalente, Hôpital Roger Salengro, CHU de Lille, Lille, France.
| | - Anne Renault
- Service de Réanimation Médicale, CHU de Brest, Brest, France.
| | - Laurent Argaud
- Service de Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Tarek Sharshar
- Service de Réanimation Médico-chirurgicale, Hôpital Raymond Poincaré, Garches and Université de Versailles St Quentin en Yvelines, Garches, France.
| | - Sébastien Gibot
- Service de Réanimation médicale, Hôpital Central, CHU de Nancy, Nancy, France.
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Kentish-Barnes N, Chaize M, Seegers V, Legriel S, Cariou A, Jaber S, Lefrant JY, Floccard B, Renault A, Vinatier I, Mathonnet A, Reuter D, Guisset O, Cohen-Solal Z, Cracco C, Seguin A, Durand-Gasselin J, Éon B, Thirion M, Rigaud JP, Philippon-Jouve B, Argaud L, Chouquer R, Adda M, Dedrie C, Georges H, Lebas E, Rolin N, Bollaert PE, Lecuyer L, Viquesnel G, Léone M, Chalumeau-Lemoine L, Garrouste M, Schlemmer B, Chevret S, Falissard B, Azoulay É. Complicated grief after death of a relative in the intensive care unit. Eur Respir J 2015; 45:1341-52. [PMID: 25614168 DOI: 10.1183/09031936.00160014] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/16/2014] [Indexed: 11/05/2022]
Abstract
An increased proportion of deaths occur in the intensive care unit (ICU). We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.
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Affiliation(s)
| | - Marine Chaize
- For a list of the authors' affiliations see the Acknowledgements section
| | - Valérie Seegers
- For a list of the authors' affiliations see the Acknowledgements section
| | - Stéphane Legriel
- For a list of the authors' affiliations see the Acknowledgements section
| | - Alain Cariou
- For a list of the authors' affiliations see the Acknowledgements section
| | - Samir Jaber
- For a list of the authors' affiliations see the Acknowledgements section
| | - Jean-Yves Lefrant
- For a list of the authors' affiliations see the Acknowledgements section
| | - Bernard Floccard
- For a list of the authors' affiliations see the Acknowledgements section
| | - Anne Renault
- For a list of the authors' affiliations see the Acknowledgements section
| | - Isabelle Vinatier
- For a list of the authors' affiliations see the Acknowledgements section
| | - Armelle Mathonnet
- For a list of the authors' affiliations see the Acknowledgements section
| | - Danielle Reuter
- For a list of the authors' affiliations see the Acknowledgements section
| | - Olivier Guisset
- For a list of the authors' affiliations see the Acknowledgements section
| | - Zoé Cohen-Solal
- For a list of the authors' affiliations see the Acknowledgements section
| | - Christophe Cracco
- For a list of the authors' affiliations see the Acknowledgements section
| | - Amélie Seguin
- For a list of the authors' affiliations see the Acknowledgements section
| | | | - Béatrice Éon
- For a list of the authors' affiliations see the Acknowledgements section
| | - Marina Thirion
- For a list of the authors' affiliations see the Acknowledgements section
| | | | | | - Laurent Argaud
- For a list of the authors' affiliations see the Acknowledgements section
| | - Renaud Chouquer
- For a list of the authors' affiliations see the Acknowledgements section
| | - Mélanie Adda
- For a list of the authors' affiliations see the Acknowledgements section
| | - Céline Dedrie
- For a list of the authors' affiliations see the Acknowledgements section
| | - Hugues Georges
- For a list of the authors' affiliations see the Acknowledgements section
| | - Eddy Lebas
- For a list of the authors' affiliations see the Acknowledgements section
| | - Nathalie Rolin
- For a list of the authors' affiliations see the Acknowledgements section
| | | | - Lucien Lecuyer
- For a list of the authors' affiliations see the Acknowledgements section
| | - Gérard Viquesnel
- For a list of the authors' affiliations see the Acknowledgements section
| | - Marc Léone
- For a list of the authors' affiliations see the Acknowledgements section
| | | | - Maïté Garrouste
- For a list of the authors' affiliations see the Acknowledgements section
| | - Benoit Schlemmer
- For a list of the authors' affiliations see the Acknowledgements section
| | - Sylvie Chevret
- For a list of the authors' affiliations see the Acknowledgements section
| | - Bruno Falissard
- For a list of the authors' affiliations see the Acknowledgements section
| | - Élie Azoulay
- For a list of the authors' affiliations see the Acknowledgements section
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Meyfroidt G, Bollaert PE, Marik PE. Acute ischemic stroke in the ICU: to admit or not to admit? Intensive Care Med 2014; 40:749-51. [PMID: 24711090 DOI: 10.1007/s00134-014-3289-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Geert Meyfroidt
- Intensive Care Medicine, KU Leuven, Line 1: UZ Leuven, 3000, Louvain, Belgium,
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21
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Mourvillier B, Tubach F, van de Beek D, Garot D, Pichon N, Georges H, Lefevre LM, Bollaert PE, Boulain T, Luis D, Cariou A, Girardie P, Chelha R, Megarbane B, Delahaye A, Chalumeau-Lemoine L, Legriel S, Beuret P, Brivet F, Bruel C, Camou F, Chatellier D, Chillet P, Clair B, Constantin JM, Duguet A, Galliot R, Bayle F, Hyvernat H, Ouchenir K, Plantefeve G, Quenot JP, Richecoeur J, Schwebel C, Sirodot M, Esposito-Farèse M, Le Tulzo Y, Wolff M. Induced hypothermia in severe bacterial meningitis: a randomized clinical trial. JAMA 2013; 310:2174-83. [PMID: 24105303 DOI: 10.1001/jama.2013.280506] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite advances in care, mortality and morbidity remain high in adults with acute bacterial meningitis, particularly when due to Streptococcus pneumoniae. Induced hypothermia is beneficial in other conditions with global cerebral hypoxia. OBJECTIVE To test the hypothesis that induced hypothermia improves outcome in patients with severe bacterial meningitis. DESIGN, SETTING, AND PATIENTS An open-label, multicenter, randomized clinical trial in 49 intensive care units in France, February 2009-November 2011. In total, 130 patients were assessed for eligibility and 98 comatose adults (Glasgow Coma Scale [GCS] score of ≤8 for <12 hours) with community-acquired bacterial meningitis were randomized. INTERVENTIONS Hypothermia group received a loading dose of 4°C cold saline and were cooled to 32°C to 34°C for 48 hours. The rewarming phase was passive. Controls received standard care. MAIN OUTCOMES AND MEASURES Primary outcome measure was the Glasgow Outcome Scale score at 3 months (a score of 5 [favorable outcome] vs a score of 1-4 [unfavorable outcome]). All patients received appropriate antimicrobial therapy and vital support. Analyses were performed on an intention-to-treat basis. The data and safety monitoring board (DSMB) reviewed severe adverse events and mortality rate every 50 enrolled patients. RESULTS After inclusion of 98 comatose patients, the trial was stopped early at the request of the DSMB because of concerns over excess mortality in the hypothermia group (25 of 49 patients [51%]) vs the control group (15 of 49 patients [31%]; relative risk [RR], 1.99; 95% CI, 1.05-3.77; P = .04). Pneumococcal meningitis was diagnosed in 77% of patients. Mean (SD) temperatures achieved 24 hours after randomization were 33.3°C (0.9°C) and 37.0°C (0.9°C) in the hypothermia and control group, respectively. At 3 months, 86% in the hypothermia group compared with 74% of controls had an unfavorable outcome (RR, 2.17; 95% CI, 0.78-6.01; P = .13). After adjustment for age, score on GCS at inclusion, and the presence of septic shock at inclusion, mortality remained higher, although not significantly, in the hypothermia group (hazard ratio, 1.76; 95% CI, 0.89-3.45; P = .10). Subgroup analysis on patients with pneumococcal meningitis showed similar results. Post hoc analysis showed a low probability to reach statistically significant difference in favor of hypothermia at the end of the 3 planned sequential analyses (probability to conclude in favor of futility, 0.977). CONCLUSIONS AND RELEVANCE Moderate hypothermia did not improve outcome in patients with severe bacterial meningitis and may even be harmful. Careful evaluation of safety issues in future trials on hypothermia are needed and may have important implications in patients presenting with septic shock or stroke. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00774631.
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Affiliation(s)
- Bruno Mourvillier
- Réanimation Médicale et Infectieuse, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Bichat-Claude Bernard, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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22
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Mirabel M, Sonneville R, Hajage D, Novy E, Tubach F, Vignon P, Perez P, Lavoué S, Kouatchet A, Pajot O, Mekontso-Dessap A, Tonnelier JM, Bollaert PE, Frat JP, Navellou JC, Hyvernat H, Hssain AA, Timsit JF, Megarbane B, Wolff M, Trouillet JL. Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J 2013; 35:1195-204. [PMID: 23964033 DOI: 10.1093/eurheartj/eht303] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess long-term outcomes and the management of critical left-sided infective endocarditis (IE) and evaluate the impact of surgery. METHODS AND RESULTS Among the 198 patients included prospectively for IE across 33 adult intensive care units (ICU) in France from 1 April 2007 to 1 October 2008, 137 (69%) were dead at a median follow-up time of 59.5 months. Characteristics significantly associated with mortality were: Sepsis-related Organ-Failure Assessment (SOFA) score at ICU admission [Hazard ratio (HR), 95% Confidence Interval (CI) of 1.43 (0.79-2.59) for SOFA 5-9; 2.01 (1.05-3.85) for SOFA 10-14; 3.53 (1.75-7.11) for SOFA 15-20; reference category SOFA 0-4; P = 0.003]; prosthetic mechanical valve IE [HR 2.01; 95% CI 1.09-3.69, P = 0.025]; vegetation size ≥15 mm [HR 1.64; 95% CI 1.03-2.63, P = 0.038]; and cardiac surgery [HR (95%CI), 0.33 (0.16-0.67) for surgery ≤1 day after IE diagnosis; 0.61 (0.29-1.26) for surgery 2-7 days after IE diagnosis; 0.42 (0.21-0.83) for surgery >7 days after IE diagnosis; reference category no surgery; P = 0.005]. One hundred and three (52%) patients underwent cardiac surgery after a median time of 6 (16) days. Independent predictors of surgical intervention on multivariate analysis were: age ≤60 years [Odds ratio (OR) 5.30; 95% CI (2.46-11.41), P < 0.01], heart failure [OR 3.27; 95% CI (1.03-10.35), P = 0.04], cardiogenic shock [OR 3.31; 95% CI (1.47-7.46), P = 0.004], septic shock [OR 0.25; 95% CI (0.11-0.59), P = 0.002], immunosuppression [OR 0.15; 95% CI (0.04-0.55), P = 0.004], and diagnosis before or within 24 h of ICU admission [OR 2.81; 95% CI (1.14-6.95), P = 0.025]. SOFA score calculated the day of surgery was the only independently associated factor with long-term mortality [HR (95% CI) 1.59 (0.77-3.28) for SOFA 5-9; 3.56 (1.71-7.38) for SOFA 10-14; 11.58 (4.02-33.35) for SOFA 15-20; reference category SOFA 0-4; P < 0.0001]. Surgical timing was not associated with post-operative outcomes. Of the 158 patients with a theoretical indication for surgery, the 58 deemed not fit had a 95% mortality rate. CONCLUSION Mortality in patients with critical IE remains unacceptably high. Factors associated with long-term outcomes are the severity of multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and surgical treatment. Up to one-third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. The strongest independent predictor of post-operative mortality is the pre-operative multiorgan failure score while surgical timing does not seem to impact on outcomes.
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Affiliation(s)
- Mariana Mirabel
- Service de Réanimation Médicale, Institut de Cardiologie, Université Paris VI-Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Gonzalez L, Cravoisy A, Barraud D, Conrad M, Nace L, Lemarié J, Bollaert PE, Gibot S. Factors influencing the implementation of antibiotic de-escalation and impact of this strategy in critically ill patients. Crit Care 2013; 17:R140. [PMID: 23849321 PMCID: PMC4055984 DOI: 10.1186/cc12819] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/12/2013] [Indexed: 12/29/2022]
Abstract
Introduction A rational use of antibiotics is of paramount importance in order to prevent the emergence of multidrug resistant bacteria that can lead to therapeutic impasse, especially in intensive care units (ICUs). A de-escalation strategy is therefore naturally advocated as part of better antibiotics usage. However, the clinical impact of such a strategy has not been widely studied. We aimed to assess the feasibility and the clinical impact of a de-escalation strategy in a medical ICU and to identify factors associated when de-escalation was possible. Methods We performed a retrospective study of patients hospitalized in a medical ICU over a period of six months. Independent factors associated with de-escalation and its clinical impact were assessed. Results Two hundred and twenty-nine patients were included in the study. Antibiotics were de-escalated in 117 patients (51%). The appropriateness of initial antibiotic therapy was the only independent factor associated with the performance of de-escalation (OR = 2.9, 95% CI, 1.5-5.7; P = 0.002). By contrast, inadequacy of initial antibiotic therapy (OR = 0.1, 0.0 to 0.1, P <0.001) and the presence of multidrug resistant bacteria (OR = 0.2, 0.1 to 0.7, P = 0.006) prevented from de-escalation. There were no differences in terms of short (ICU) or long-term (at 1 year) mortality rates or any secondary criteria such as ICU length of stay, duration of antibiotic therapy, mechanical ventilation, incidence of ICU-acquired infection, or multi-drug resistant bacteria emergence. Conclusions De-escalation appears feasible in most cases without any obvious negative clinical impact in a medical ICU.
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Barraud D, Bollaert PE, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest 2013; 143:646-655. [PMID: 23460153 DOI: 10.1378/chest.12-1745] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs) that have compared important outcomes in critically ill patients who received an administration of probiotics. METHODS A systematic literature search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials was conducted using specific search terms. Eligible studies were RCTs that compared the effect of prebiotics, probiotics, or synbiotics administration with control on ICU and hospital mortality rates in critically ill adult patients. Weighted mean differences (WMDs), pooled ORs, and 95% CIs were calculated using the Mantel-Haenszel fixed- and random-effects models. RESULTS Thirteen trials with 1,439 patients were analyzed. Probiotics did not significantly reduce ICU (OR, 0.85; 95% CI, 0.63-1.15) or hospital (OR, 0.90; 95% CI, 0.65-1.23) mortality. By contrast, probiotics administration reduced the incidence of ICU-acquired pneumonia (OR, 0.58; 95% CI, 0.42-0.79) and was associated with a shorter stay in the ICU (WMD, -1.49 days; 95% CI, -2.12 to -0.87 days). Finally, probiotics use was not associated with a shorter duration of mechanical ventilation (WMD, -0.18 days; 95% CI, -1.72-1.36 days) or a shorter hospital length of stay (WMD, -0.45 days; 95% CI, -1.41-0.52 days). CONCLUSIONS The present meta-analysis suggests that the administration of probiotics did not significantly reduce ICU or hospital mortality rates but did reduce the incidence of ICU-acquired pneumonia and ICU length of stay.
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Affiliation(s)
- Damien Barraud
- Service de Réanimation Médicale, Hôpital Central, CHU de Nancy, and Université de Lorraine, Nancy, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, Hôpital Central, CHU de Nancy, and Université de Lorraine, Nancy, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, CHU de Nancy, and Université de Lorraine, Nancy, France.
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Conrad M, Haroche J, Charlotte F, Hervier B, Amoura Z, Bollaert PE, Gibot S. A 75-Year-Old Woman Admitted to the ICU With Respiratory Failure. Chest 2012; 142:1063-1067. [DOI: 10.1378/chest.11-2700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Graftieaux JP, Bollaert PE, Haddad L, Kentish-Barnes N, Nitenberg G, Robert R, Villers D, Dreyfuss D. Contribution of the ethics committee of the French Intensive Care Society to describing a scenario for implementing organ donation after Maastricht type III cardiocirculatory death in France. Ann Intensive Care 2012; 2:23. [PMID: 22747673 PMCID: PMC3475084 DOI: 10.1186/2110-5820-2-23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022] Open
Abstract
French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors. We describe a scenario for Maastricht type III organ donation that fully complies with the ethical norms governing care to dying patients. That organ donation may occur after death should have no impact on the care given to the patient and family. The dead-donor rule must be followed scrupulously: the organ retrieval procedure must neither cause nor hasten death. The decision to withdraw life-sustaining treatments, withdrawal modalities, and care provided to the patient and family must adhere strictly to the requirements set forth in patient-rights legislation (the 2005 Léonetti law in France) and should not be influenced in any way by the possibility of organ donation. A major ethical issue regarding the family is how best to transition from discussing treatment-withdrawal decisions to discussing possible organ retrieval for donation should the patient die rapidly after treatment withdrawal. Close cooperation between the healthcare team and the organ retrieval team is crucial to minimize the distress of family members during this transition. Modalities for implementing Maastricht type III organ donation are discussed here, including the best location for withdrawing life-sustaining treatments (operating room or intensive care unit).
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Schneider F, Bach C, Chung H, Crippa L, Lavaux T, Bollaert PE, Wolff M, Corti A, Launoy A, Delabranche X, Lavigne T, Meyer N, Garnero P, Metz-Boutigue MH. Vasostatin-I, a chromogranin A-derived peptide, in non-selected critically ill patients: distribution, kinetics, and prognostic significance. Intensive Care Med 2012; 38:1514-22. [PMID: 22706917 DOI: 10.1007/s00134-012-2611-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 05/16/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE Chromogranin A (CGA) is released in the plasma during life-threatening illnesses. Its N-terminal 1-76 peptide, vasostatin-I (VS-I), has never been assessed in critically ill patients. Our aim was to examine whether the admission VS-I concentration has prognostic significance without having to specify a primary diagnosis. METHODS VS-I concentrations were assessed with a new ELISA in 481 consecutive patients and 13 healthy controls. CGA and standard biological tests (including lactate) were performed; the simplified acute physiological score II (SAPS II) was calculated. Mortality was assessed at day 28. In a subgroup of 13 patients with shock, serial VS-I doses were given over 60 h. RESULTS Critically ill patients had higher admission VS-I concentrations than controls [4.06 (2.78; 7.61) vs. 2.85 (2.47; 3.22) ng/ml, p < 0.001]. The plasma VS-I concentration was significantly lower in survivors than in non-survivors [3.70 (2.67; 6.12) vs. 5.75 (3.65; 11.20) ng/ml] and in the absence of shock [3.58 (2.59; 5.05) vs. 5.93 (3.30; 11.06) ng/ml, p < 0.001]. The survival rate was better in patients with VS-I concentrations under the median value of 3.97 ng/ml (p < 0.001). Admission VS-I and lactate values were independent predictors of mortality (p < 0.01). Moreover, taking them together, combined with age, provided a better indication for predicting mortality than taking each alone (p < 0.01). CONCLUSIONS Significant amounts of VS-I are detected on admission in critically ill patients. A plasma VS-I concentration above 3.97 ng/ml is associated with poor outcome, and in routine practice simultaneous measurements of the three independent factors VS-I, lactate and age can affect the assessment of severity.
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Affiliation(s)
- Francis Schneider
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg and INSERM U977, Université de Strasbourg, Strasbourg, France
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Boufenzer A, Sennoun N, Bouazza Y, Derive M, Bollaert PE, Gibot S. Role of TREM-1 in endothelial dysfunction during experimental sepsis. Crit Care 2012. [PMCID: PMC3504850 DOI: 10.1186/cc11736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gibot S, Boufenzer A, Bouazza Y, Groubatch F, Alauzet C, Barraud D, Bollaert PE, Leroy P, Tran N, Derive M. Effects of a TREM-like transcript-1 derived peptide during septic shock in pigs. Crit Care 2012. [PMCID: PMC3504849 DOI: 10.1186/cc11735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gibot S, Béné MC, Noel R, Massin F, Guy J, Cravoisy A, Barraud D, De Carvalho Bittencourt M, Quenot JP, Bollaert PE, Faure G, Charles PE. Combination biomarkers to diagnose sepsis in the critically ill patient. Am J Respir Crit Care Med 2012; 186:65-71. [PMID: 22538802 DOI: 10.1164/rccm.201201-0037oc] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
RATIONALE Although the outcome of sepsis benefits from the prompt administration of appropriate antibiotics on correct diagnosis, the assessment of infection in critically ill patients is often a challenge for clinicians. In this setting, simple biomarkers, especially when used in combination, could prove useful. OBJECTIVES To determine the usefulness of combination biomarkers to diagnose sepsis. METHODS Three hundred consecutive patients were enrolled to construct a biologic score that was next validated in an independent prospective cohort of 79 critically ill patients from another center. MEASUREMENT AND MAIN RESULTS Plasma concentrations of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) were assayed, and the expression of the high-affinity immunoglobulin-Fc fragment receptor I (FcγRI) CD64 on neutrophils (polymorphonuclear [PMN] CD64 index) in flow cytometry was measured. A "bioscore" combining these biomarkers was constructed. Serum concentrations of PCT and sTREM-1 and the PMN CD64 index were higher in patients with sepsis compared with all others (P < 0.001 for the three markers). These biomarkers were all independent predictors of infection, the best receiver-operating characteristic curve being obtained for the PMN CD64 index. The performance of the bioscore, better than that of each individual biomarker, was externally confirmed in the validation cohort. CONCLUSIONS This prospective study, including inceptive and validation cohorts of unselected intensive care unit patients, demonstrates the high performance of a bioscore combining the PMN CD64 index together with PCT and sTREM-1 serum levels in diagnosing sepsis in the critically ill patient.
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Affiliation(s)
- Sébastien Gibot
- Hôpital Central, Service de Réanimation Médicale, 29 avenue du Maréchal de Lattre de Tassigny, Nancy Cedex, France.
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Barraud D, Blard C, Hein F, Marçon O, Cravoisy A, Nace L, Alla F, Bollaert PE, Gibot S. Probiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial. Intensive Care Med 2010; 36:1540-7. [PMID: 20502866 DOI: 10.1007/s00134-010-1927-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 04/10/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days. METHODS This study was performed as a double-blind, concealed randomized, placebo-controlled trial in a French medical intensive care unit (ICU). Adult patients mechanically ventilated for a period of more than 48 h received enterally administered probiotics (Ergyphilus, 2 x 10(10) lactic acid bacteria, mostly Lactobacillus rhamnosus GG, once a day) or placebo until successful weaning. RESULTS A total of 167 patients were included. The two groups were comparable at baseline. The 28-day mortality rates were not different in the probiotic (25.3%) and placebo groups (23.7%). Mortality rates in ICU and at 90 days were also unaffected by the treatment. The incidence of ICU-acquired infections did not differ significantly except for that of catheter-related bloodstream infections that was lowered by probiotics. On a prespecified subgroup analysis, we found a reduction of the 28-day mortality among severe sepsis patients (total n = 101) treated with probiotics (n = 52) with an odds ratio (OR) for death at 0.38 (95% CI 0.16-0.93, p = 0.035). By contrast, probiotics were associated with a higher mortality rate in non-severe sepsis patients (OR 3.09, 95% CI 0.87-11.01, p = 0.08). CONCLUSIONS Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.
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Affiliation(s)
- Damien Barraud
- Service de Réanimation Médicale, Hôpital Central, CHU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France
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Tatopoulos A, Herbain D, Kazmierczak C, Bollaert PE, Gibot S. Parenteral use of recombinant activated factor VII during diffuse alveolar hemorrhage secondary to leptospirosis. Intensive Care Med 2010; 36:555-6. [PMID: 19924396 DOI: 10.1007/s00134-009-1718-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2009] [Indexed: 12/21/2022]
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Hein F, Massin F, Cravoisy-Popovic A, Barraud D, Levy B, Bollaert PE, Gibot S. The relationship between CD4+CD25+CD127- regulatory T cells and inflammatory response and outcome during shock states. Crit Care 2010; 14:R19. [PMID: 20156359 PMCID: PMC2875534 DOI: 10.1186/cc8876] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/07/2009] [Accepted: 02/15/2010] [Indexed: 01/31/2023]
Abstract
Introduction Although regulatory T lymphocytes (Tregs) have a pivotal role in preventing autoimmune diseases and limiting chronic inflammatory conditions, they may also block beneficial immune responses by preventing sterilizing immunity to certain pathogens. Methods To determine whether naturally occurring Treg cells have a role in inflammatory response and outcome during shock state we conducted an observational study in two adult ICUs from a university hospital. Within 12 hours of admission, peripheral whole blood was collected for the measurement of cytokines and determination of lymphocyte count. Sampling was repeated at day three, five and seven. Furthermore, an experimental septic shock was induced in adult Balb/c mice through caecal ligation and puncture. Results Forty-three patients suffering from shock (26 septic, 17 non septic), and 7 healthy volunteers were included. The percentage of Tregs increased as early as 3 days after the onset of shock, while their absolute number remained lower than in healthy volunteers. A similar pattern of Tregs kinetics was found in infected and non infected patients. Though there was an inverse correlation between severity scores and Tregs percentage, the time course of Tregs was similar between survivors and non survivors. No relation between Tregs and cytokine concentration was found. In septic mice, although there was a rapid increase in Treg cells subset among splenocytes, antibody-induced depletion of Tregs before the onset of sepsis did not alter survival. Conclusions These data argue against a determinant role of Tregs in inflammatory response and outcome during shock states.
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Affiliation(s)
- François Hein
- Service de réanimation médicale, Hôpital Central, CHU de Nancy, 29 Bld du Mal de Lattre de Tassigny, Nancy, 54000, France.
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Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, Bertrand L, Beltramini A, Gamand P, Albizzati S, Perdrizet D, Lebail G, Chollet-Xemard C, Maxime V, Brun-Buisson C, Lefrant JY, Bollaert PE, Megarbane B, Ricard JD, Anguel N, Vicaut E, Adnet F. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 2009; 374:293-300. [PMID: 19573904 DOI: 10.1016/s0140-6736(09)60949-1] [Citation(s) in RCA: 321] [Impact Index Per Article: 21.4] [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: 12/22/2022]
Abstract
BACKGROUND Critically ill patients often require emergency intubation. The use of etomidate as the sedative agent in this context has been challenged because it might cause a reversible adrenal insufficiency, potentially associated with increased in-hospital morbidity. We compared early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients. METHODS In this randomised, controlled, single-blind trial, 655 patients who needed sedation for emergency intubation were prospectively enrolled from 12 emergency medical services or emergency departments and 65 intensive care units in France. Patients were randomly assigned by a computerised random-number generator list to receive 0.3 mg/kg of etomidate (n=328) or 2 mg/kg of ketamine (n=327) for intubation. Only the emergency physician enrolling patients was aware of group assignment. The primary endpoint was the maximum score of the sequential organ failure assessment during the first 3 days in the intensive care unit. We excluded from the analysis patients who died before reaching the hospital or those discharged from the intensive care unit before 3 days (modified intention to treat). This trial is registered with ClinicalTrials.gov, number NCT00440102. FINDINGS 234 patients were analysed in the etomidate group and 235 in the ketamine group. The mean maximum SOFA score between the two groups did not differ significantly (10.3 [SD 3.7] for etomidate vs 9.6 [3.9] for ketamine; mean difference 0.7 [95% CI 0.0-1.4], p=0.056). Intubation conditions did not differ significantly between the two groups (median intubation difficulty score 1 [IQR 0-3] in both groups; p=0.70). The percentage of patients with adrenal insufficiency was significantly higher in the etomidate group than in the ketamine group (OR 6.7, 3.5-12.7). We recorded no serious adverse events with either study drug. INTERPRETATION Our results show that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis. FUNDING French Ministry of Health.
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Affiliation(s)
- Patricia Jabre
- Samu 93-Equipe d'accueil (EA) 3409, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
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Annane D, Bellissant E, Bollaert PE, Briegel J, Confalonieri M, De Gaudio R, Keh D, Kupfer Y, Oppert M, Meduri GU. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA 2009; 301:2362-75. [PMID: 19509383 DOI: 10.1001/jama.2009.815] [Citation(s) in RCA: 420] [Impact Index Per Article: 28.0] [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: 01/17/2023]
Abstract
CONTEXT The benefit of corticosteroids in severe sepsis and septic shock remains controversial. OBJECTIVE We examined the benefits and risks of corticosteroid treatment in severe sepsis and septic shock and the influence of dose and duration. DATA SOURCES We searched the CENTRAL, MEDLINE, EMBASE, and LILACS (through March 2009) databases as well as reference lists of articles and proceedings of major meetings, and we contacted trial authors. STUDY SELECTION Randomized and quasi-randomized trials of corticosteroids vs placebo or supportive treatment in adult patients with severe sepsis/septic shock per the American College of Chest Physicians/Society of Critical Care Medicine consensus definition were included. DATA EXTRACTION All reviewers agreed on trial eligibility. One reviewer extracted data, which were checked by the other reviewers and by the trials' authors whenever possible. Some unpublished data were obtained from the trials' authors. The primary outcome for this review was 28-day mortality. RESULTS We identified 17 randomized trials (n = 2138) and 3 quasi-randomized trials (n = 246) that had acceptable methodological quality to pool in a meta-analysis. Twenty-eight-day mortality for treated vs control patients was 388/1099 (35.3%) vs 400/1039 (38.5%) in randomized trials (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.71-1.00; P = .05; I(2) = 53% by random-effects model) and 28/121 (23.1%) vs 24/125 (19.2%) in quasi-randomized trials (RR, 1.05, 95% CI, 0.69-1.58; P = .83). In 12 trials investigating prolonged low-dose corticosteroid treatment, 28-day mortality for treated vs control patients was 236/629 (37.5%) vs 264/599 (44%) (RR, 0.84; 95% CI, 0.72-0.97; P = .02). This treatment increased 28-day shock reversal (6 trials; 322/481 [66.9%] vs 276/471 [58.6%]; RR, 1.12; 95% CI, 1.02-1.23; P = .02; I(2) = 4%) and reduced intensive care unit length of stay by 4.49 days (8 trials; 95% CI, -7.04 to -1.94; P < .001; I(2) = 0%) without increasing the risk of gastroduodenal bleeding (13 trials; 65/800 [8.1%] vs 56/764 [7.3%]; P = .50; I(2) = 0%), superinfection (14 trials; 184/998 [18.4%] vs 170/950 [17.9%]; P = .92; I(2) = 8%), or neuromuscular weakness (3 trials; 4/407 [1%] vs 7/404 [1.7%]; P = .58; I(2) = 30%). Corticosteroids increased the risk of hyperglycemia (9 trials; 363/703 [51.6%] vs 308/670 [46%]; P < .001; I(2) = 0%) and hypernatremia (3 trials; 127/404 [31.4%] vs 77/401 [19.2%]; P < .001; I(2) = 0%). CONCLUSIONS Corticosteroid therapy has been used in varied doses for sepsis and related syndromes for more than 50 years, with no clear benefit on mortality. Since 1998, studies have consistently used prolonged low-dose corticosteroid therapy, and analysis of this subgroup suggests a beneficial drug effect on short-term mortality.
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Affiliation(s)
- Djillali Annane
- Critical Care Department, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
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Peters N, Jay N, Barraud D, Cravoisy A, Nace L, Bollaert PE, Gibot S. Metformin-associated lactic acidosis in an intensive care unit. Crit Care 2008; 12:R149. [PMID: 19036140 PMCID: PMC2646313 DOI: 10.1186/cc7137] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 11/12/2008] [Accepted: 11/26/2008] [Indexed: 12/27/2022]
Abstract
Introduction Metformin-associated lactic acidosis (MALA) is a classic side effect of metformin and is known to be a severe disease with a high mortality rate. The treatment of MALA with dialysis is controversial and is the subject of many case reports in the literature. We aimed to assess the prevalence of MALA in a 16-bed, university-affiliated, intensive care unit (ICU), and the effect of dialysis on patient outcome. Methods Over a five-year period, we retrospectively identified all patients who were either admitted to the ICU with metformin as a usual medication, or who attempted suicide by metformin ingestion. Within this population, we selected patients presenting with lactic acidosis, thus defining MALA, and described their clinical and biological features. Results MALA accounted for 0.84% of all admissions during the study period (30 MALA admissions over five years) and was associated with a 30% mortality rate. The only factors associated with a fatal outcome were the reason for admission in the ICU and the initial prothrombin time. Although patients who went on to haemodialysis had higher illness severity scores, as compared with those who were not dialysed, the mortality rates were similar between the two groups (31.3% versus 28.6%). Conclusions MALA can be encountered in the ICU several times a year and still remains a life-threatening condition. Treatment is restricted mostly to supportive measures, although haemodialysis may possess a protective effect.
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Affiliation(s)
- Nicolas Peters
- Service de Néphrologie, CHU Brabois; Vandoeuvre les Nancy, 54500, France.
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Larue A, Loos-Ayav C, Jay N, Commun N, Rabaud C, Bollaert PE. [Impact on morbidity and costs of methicillin-resistant Staphylococcus aureus nosocomial pneumonia in intensive care patients]. Presse Med 2008; 38:25-33. [PMID: 18771897 DOI: 10.1016/j.lpm.2008.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 05/24/2008] [Accepted: 06/04/2008] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Prevention of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections in the intensive care units (ICU) has been recommended for several years. However, the workload and the costs of these programs are to be weighed against the benefit obtained in terms of reduction of morbidity and costs induced by the infection. The purpose of this study was to evaluate the cost and the current morbidity of the infection with MRSA in the ICU. METHODS In a retrospective case-control study carried out in 2004, all patients of the 6 intensive care units of a teaching hospital having developed a MRSA nosocomial infection were included. They were paired with controls on the following criteria: department, Simplified Acute Physiology Score II (SAPSII), age (+/- 5 years), type of surgery (for the surgical intensive care units). The duration of hospitalization of the paired control had to be at least equal to the time from admission to infection of the infected patient. The costs were evaluated using the following parameters: scores omega 1, 2 and 3, duration of artificial ventilation, hemodialysis, length of ICU stay, radiological procedures, surgical procedures, total antibiotic cost and other expensive drugs. RESULTS Twenty-one patients with MRSA infection were included. All had nosocomial pneumonia. The 21 paired patients were similar with regard to both initial criteria and sex. Hospital mortality was not different between the 2 groups (cases=8; controls=6; p=0.41), as well as median duration of hospital stay (cases=41 days; controls=43 days; p=0.9). The duration of mechanical ventilation, number of hemodialysis or hemofiltration sessions, number of radiological procedures were similar in both groups. The total omega score was not significantly different between cases (median 435; IQR: 218-579) and controls (median 281, IQR: 231-419; p=0.55). The median duration of isolation was 12 days for cases and 0 day for controls (p=0.0007). The pharmaceutical expenditure was significantly higher in cases (median: 1414euro; IQR: 795-4349), by comparison with the controls (median: 877euro, IQR: 687-2496) (p=0.049). CONCLUSION In the ICU having set up a policy intended to reduce the risk of MRSA nosocomial infections, MRSA pneumonia does not seem to involve major additional morbidity, as compared to a control population matched for similar severity of illness. It increases modestly the use of the medical resources.
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Affiliation(s)
- Alexandrine Larue
- Service de médecine interne, Centre hospitalier Jean Monnet, F-88000 Epinal, France
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Dhainaut JF, Payet S, Vallet B, França LR, Annane D, Bollaert PE, Tulzo YL, Runge I, Malledant Y, Guidet B, Le Lay K, Launois R. Cost-effectiveness of activated protein C in real-life clinical practice. Crit Care 2008; 11:R99. [PMID: 17822547 PMCID: PMC2556742 DOI: 10.1186/cc6116] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 06/27/2007] [Accepted: 09/06/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recombinant human activated protein C (rhAPC) has been reported to be cost-effective in severely ill septic patients in studies using data from a pivotal randomized trial. We evaluated the cost-effectiveness of rhAPC in patients with severe sepsis and multiple organ failure in real-life intensive care practice. METHODS We conducted a prospective observational study involving adult patients recruited before and after licensure of rhAPC in France. Inclusion criteria were applied according to the label approved in Europe. The expected recruitment bias was controlled by building a sample of patients matched for propensity score. Complete hospitalization costs were quantified using a regression equation involving intensive care units variables. rhAPC acquisition costs were added, assuming that all costs associated with rhAPC were already included in the equation. Cost comparisons were conducted using the nonparametric bootstrap method. Cost-effectiveness quadrants and acceptability curves were used to assess uncertainty of the cost-effectiveness ratio. RESULTS In the initial cohort (n = 1096), post-license patients were younger, had less co-morbid conditions and had failure of more organs than did pre-license patients (for all: P < 0.0001). In the matched sample (n = 840) the mean age was 62.4 +/- 14.9 years, Simplified Acute Physiology Score II was 56.7 +/- 18.5, and the number of organ failures was 3.20 +/- 0.83. When rhAPC was used, 28-day mortality tended to be reduced (34.1% post-license versus 37.4% pre-license, P = 0.34), bleeding events were more frequent (21.7% versus 13.6%, P = 0.002) and hospital costs were higher (47,870 euros versus 36,717 euros, P < 0.05). The incremental cost-effectiveness ratios gained were as follows: 20,278 euros per life-year gained and 33,797 euros per quality-adjusted life-year gained. There was a 74.5% probability that rhAPC would be cost-effective if there were willingness to pay 50,000 euros per life-year gained. The probability was 64.3% if there were willingness to pay 50,000 euros per quality-adjusted life-year gained. CONCLUSION This study, conducted in matched patient populations, demonstrated that in real-life clinical practice the probability that rhAPC will be cost-effective if one is willing to pay 50,000 euros per life-year gained is 74.5%.
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Affiliation(s)
- Jean-François Dhainaut
- Department of Intensive Care, Cochin Port-Royal University Hospital, AP-HP, René Descartes University, Paris 5, Paris, France
| | - Stéphanie Payet
- REES France, Réseau d'Evaluation en Economie de la Santé, Paris, France
| | - Benoit Vallet
- Department of Anesthesiology and Intensive Care, University Hospital of Lille, University of Lille 2, Lille, France
| | | | - Djillali Annane
- Department of Intensive Care, Raymond Poincaré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Garches, France
| | | | - Yves Le Tulzo
- Department of Infectious Diseases and Medical Intensive Care, University Hospital of Rennes, Rennes, France
| | - Isabelle Runge
- Department of Intensive Care, La Source Hospital, Orléans, France
| | - Yannick Malledant
- Department of Anesthesiology and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Bertrand Guidet
- Department of Intensive Care, Saint Antoine Hospital, AP-HP, Pierre et Marie Curie University, Paris 6, Paris, France
| | - Katell Le Lay
- REES France, Réseau d'Evaluation en Economie de la Santé, Paris, France
| | - Robert Launois
- REES France, Réseau d'Evaluation en Economie de la Santé, Paris, France
| | - the PREMISS Study Group
- Members of the Protocole en Réanimation d'Evaluation Médico-économique d'une Innovation dans le Sepsis Sévère (PREMISS) study are listed in Appendix 1
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Bollaert PE. Corticosteroids for septic shock. N Engl J Med 2008; 358:2069; author reply 2070-1. [PMID: 18467977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Bollaert PE. Normal adrenocortical function on initial testing in the intensive care unit: not a long-term warranty. Crit Care 2008; 12:163. [PMID: 18620550 PMCID: PMC2575550 DOI: 10.1186/cc6926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There has been a lot of debate about the concept of relative adrenocortical insufficiency (often defined as a reduced response to corticotropin) as a pathophysiological explanation of steroid effects in septic shock. Less is known about the prevalence of absolute adrenocortical insufficiency based on more usual definitions (low baseline and corticotropin stimulated cortisol). A study by Wu and colleagues provides convincing evidence that critically ill patients could evolve from a normal adrenal status towards very low cortisol levels within a few days. Although the exact consequences of these findings deserve more investigation, adrenal testing should not be omitted in patients not improving their hemodynamic status.
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Gibot S, Cravoisy A, Dupays R, Barraud D, Nace L, Levy B, Bollaert PE. Combined measurement of procalcitonin and soluble TREM-1 in the diagnosis of nosocomial sepsis. ACTA ACUST UNITED AC 2007; 39:604-8. [PMID: 17577825 DOI: 10.1080/00365540701199832] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This prospective, non-interventional study was conducted in a medical adult intensive care unit to determine the usefulness of procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determinations in the diagnosis of nosocomial sepsis. Serum PCT and bronchoalveolar lavage fluid sTREM-1 concentrations were measured in 50 critically ill patients suffering from nosocomial sepsis. Ventilator-associated pneumonia (VAP) was diagnosed in 31 patients and extrapulmonary sepsis in 19. Increase serum PCT concentration (>0.15 ng/ml) was found in 44 (88%) patients and was higher in those suffering from a non-pulmonary sepsis. The concomitant BAL sTREM-1 determination correctly classified pulmonary (VAP) versus non-pulmonary origin in 41 out of 44 cases (93%). Even when PCT concentration remained low, sTREM-1 assessment allowed for the detection of the sepsis (VAP) in 50% of cases. Both PCT and sTREM-1 concentrations were low in only 3 patients (6%) in whom sepsis could have been missed if only diagnosed by the measurement of these 2 biomarkers. We therefore concluded that the combined measurement of serum PCT and BAL sTREM-1 concentrations could be of interest in detecting the presence of a nosocomial sepsis and in discriminating VAP versus extrapulmonary infection.
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Affiliation(s)
- Sebastien Gibot
- Service de Réanimation Médicale, Hôpital Central, Nancy, France.
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Annane D, Vignon P, Renault A, Bollaert PE, Charpentier C, Martin C, Troché G, Ricard JD, Nitenberg G, Papazian L, Azoulay E, Bellissant E. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet 2007; 370:676-84. [PMID: 17720019 DOI: 10.1016/s0140-6736(07)61344-0] [Citation(s) in RCA: 322] [Impact Index Per Article: 18.9] [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: 12/31/2022]
Abstract
BACKGROUND International guidelines for management of septic shock recommend that dopamine or norepinephrine are preferable to epinephrine. However, no large comparative trial has yet been done. We aimed to compare the efficacy and safety of norepinephrine plus dobutamine (whenever needed) with those of epinephrine alone in septic shock. METHODS This prospective, multicentre, randomised, double-blind study was done in 330 patients with septic shock admitted to one of 19 participating intensive care units in France. Participants were assigned to receive epinephrine (n=161) or norepinephrine plus dobutamine (n=169), which were titrated to maintain mean blood pressure at 70 mm Hg or more. The primary outcome was 28-day all-cause mortality. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00148278. FINDINGS There were no patients lost to follow-up; one patient withdrew consent after 3 days. At day 28, there were 64 (40%) deaths in the epinephrine group and 58 (34%) deaths in the norepinephrine plus dobutamine group (p=0.31; relative risk 0.86, 95% CI 0.65-1.14). There was no significant difference between the two groups in mortality rates at discharge from intensive care (75 [47%] deaths vs 75 [44%] deaths, p=0.69), at hospital discharge (84 [52%] vs 82 [49%], p=0.51), and by day 90 (84 [52%] vs 85 [50%], p=0.73), time to haemodynamic success (log-rank p=0.67), time to vasopressor withdrawal (log-rank p=0.09), and time course of SOFA score. Rates of serious adverse events were also similar. INTERPRETATION There is no evidence for a difference in efficacy and safety between epinephrine alone and norepinephrine plus dobutamine for the management of septic shock.
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Affiliation(s)
- Djillali Annane
- Raymond Poincaré Hospital (AP-HP), University of Versailles Saint Quentin, PRES UniverSud, Paris, France.
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Gibot S, Massin F, Cravoisy A, Barraud D, Nace L, Levy B, Bollaert PE. High-mobility group box 1 protein plasma concentrations during septic shock. Intensive Care Med 2007; 33:1347-53. [PMID: 17525840 DOI: 10.1007/s00134-007-0691-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 04/26/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate plasma high-mobility group box 1 protein (HMGB1) concentration and its relationship with organ dysfunction and outcome in septic shock patients. DESIGN AND SETTING Prospective, noninterventional study. Medical adult intensive care unit at a university hospital in France. PATIENTS 42 critically ill patients with septic shock. METHODS Arterial blood was drawn within 12 h of admission for the measurement of plasma HMGB1 concentration by ELISA. Repeated sampling was performed on days 3, 7, and 14. RESULTS Median HMGB1 concentration was 4.4 ng/ml (IQR 1.2-12.5) at admission, with no difference between survivors and nonsurvivors. A positive correlation was observed between HMGB1 and SOFA score and lactate, and procalcitonin concentrations. There was a progressive but statistically nonsignificant decline in HMGB1 concentration among the survivors, while nonsurvivors showed an increase in HMGB1 level between days 1 and 3. SOFA score and lactate and procalcitonin concentrations did not vary significantly between days 1 and 3. When measured on day 3, HMGB1 discriminated survivors from nonsurvivors with 66% sensitivity and 67% specificity, and concentration greater than 4 ng/ml was associated with an odds ratio of death of 5.5 (95% CI 1.3-23.6).
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Affiliation(s)
- Sébastien Gibot
- Hôpital Central, Service de Réanimation Médicale, 29 avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France.
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Gibot S, Massin F, Cravoisy A, Dupays R, Barraud D, Nace L, Bollaert PE. Growth arrest-specific protein 6 plasma concentrations during septic shock. Crit Care 2007; 11:R8. [PMID: 17241453 PMCID: PMC2151874 DOI: 10.1186/cc5158] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 01/01/2007] [Accepted: 01/22/2007] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The product of growth arrest-specific gene 6 (Gas6) is a vitamin K dependent protein that is secreted by leucocytes and endothelial cells in response to injury and participates in cell survival, proliferation, migration and adhesion. Our purpose was to investigate plasma Gas6 concentration and its relation to organ dysfunction in patients with septic shock. METHODS Forty-five patients with septic shock admitted to a medical adult intensive care unit were enrolled. Plasma Gas6 concentration was determined using enzyme-linked immunosorbent assay at days 1, 3, 7 and 14. RESULTS The median (interquartile range) Gas6 concentration was 51 (5 to 95) pg/ml at admission. A positive correlation (Spearman rank-order coefficient [rs] = 0.37, P = 0.01) was found between Gas6 level and Sepsis-related Organ Failure Assessment score. Patients requiring renal support had higher Gas6 concentration that those without need for haemofiltration (76.5 [52 to 164] pg/ml versus 10.5 [1.5 to 80.5] pg/ml; P = 0.04). Moreover, there was a positive correlation between Gas6 and aspartate transaminase (rs = 0.42, P = 0.006) and between Gas6 and prothrombin time (rs = 0.45, P = 0.02). Although there was a progressive decline in Gas6 concentration in survivors (analysis of variance, P = 0.01), nonsurvivors exhibited persistently elevated Gas6. However, the two populations diverged only after day 7 (P = 0.04). CONCLUSION Plasma concentrations of Gas6 correlate with disease severity, especially with renal and hepatic dysfunction, in septic shock.
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Affiliation(s)
- Sébastien Gibot
- Service de Réanimation Médicale, Avenue du Maréchal de Lattre de Tassigny, Hôpital Central, Nancy, 54000, France
- Projet Avenir INSERM, Coordination Circulation
| | - Frédéric Massin
- Laboratoire d'Immunologie, Avenue de la Foret de Haye, Faculté de Médecine, Nancy, 54000, France
| | - Aurélie Cravoisy
- Service de Réanimation Médicale, Avenue du Maréchal de Lattre de Tassigny, Hôpital Central, Nancy, 54000, France
| | - Rachel Dupays
- Service de Réanimation Médicale, Avenue du Maréchal de Lattre de Tassigny, Hôpital Central, Nancy, 54000, France
| | - Damien Barraud
- Service de Réanimation Médicale, Avenue du Maréchal de Lattre de Tassigny, Hôpital Central, Nancy, 54000, France
| | - Lionel Nace
- Service de Réanimation Médicale, Avenue du Maréchal de Lattre de Tassigny, Hôpital Central, Nancy, 54000, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, Avenue du Maréchal de Lattre de Tassigny, Hôpital Central, Nancy, 54000, France
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Cazorla C, Cravoisy A, Gibot S, Nace L, Levy B, Bollaert PE. [Patients' perception of their experience in the intensive care unit]. Presse Med 2006; 36:211-6. [PMID: 17259029 DOI: 10.1016/j.lpm.2006.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 07/06/2006] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To analyze patients' assessment of quality of care in our intensive care unit. METHOD We sent questionnaires to the homes of all patients admitted to intensive care from November 2002 through August 2003 who received mechanical ventilation for more than 24 hours. RESULTS In all, we received 70 analyzable questionnaires. Patients' average age was 56.3 years and the mean duration of stay 13.6 days. Pain was mentioned by 47% of patients and was associated, in decreasing order of frequency, with endotracheal suctioning, placement of a urinary catheter, venipuncture, movement into a different position by staff and arterial punctures. Pain intensity evaluated by an analogic visual scale classified these procedures in the following order: endotracheal suctioning, urinary catheterization, position changing by staff, arterial punctures, venipunctures. 54% of the patients remembered mechanical ventilation. Overall, 17% reported feeling fear often or continuously. Aspects of the ICU environment that bothered them were, in order of decreasing frequency, communication difficulties, thirst, lack of sleep, staff discussions at the patient's bedside, noise and light. Finally, 34% no longer remembered the reason for their stay in the ICU and 19% reported they would have liked to be allowed more frequent visits from their relatives. CONCLUSION Nearly half of the respondents underwent painful procedures, primarily endotracheal suctioning. One third did not know why they had been in the ICU. To improve the quality of intensive care, it is essential to make the nursing and medical teams aware of these findings.
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Affiliation(s)
- Cécile Cazorla
- Service de réanimation médicale, Hôpital central, CHU, Nancy (54).
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Gibot S, Alauzet C, Massin F, Sennoune N, Faure GC, Béné MC, Lozniewski A, Bollaert PE, Lévy B. Modulation of the Triggering Receptor Expressed on Myeloid Cells–1 Pathway during Pneumonia in Rats. J Infect Dis 2006; 194:975-83. [PMID: 16960786 DOI: 10.1086/506950] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 05/09/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Triggering receptor expressed on myeloid cells-1 (TREM-1) is a cell-surface molecule that has been identified on both human and murine polymorphonuclear neutrophils and mature monocytes. The activation of TREM-1 in the presence of microbial components amplifies the inflammatory response and may be responsible for the hyperresponsiveness observed during the initial stage of sepsis. The aim of the present study was to investigate the effect of the modulation of the TREM-1 pathway during experimental pneumonia in rats. METHODS Adult male Wistar rats were intratracheally inoculated with Pseudomonas aeruginosa (PAO1 strain) and randomly treated or not treated with an analogue synthetic peptide derived from the extracellular moiety of TREM-1 (LP17). RESULTS P. aeruginosa induced a severe pneumonia associated with signs of severe sepsis within the first 24 h. In septic rats, LP17 improved hemodynamic status, attenuated the development of lactic acidosis and hypoxemia, modulated lung and systemic inflammatory responses and coagulation activation, reduced lung histological damage, and improved survival. CONCLUSIONS The modulation of the TREM-1 pathway by the use of such synthetic peptides as LP17 appears beneficial during P. aeruginosa pneumonia in rats in attenuating lung and systemic inflammatory responses.
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Affiliation(s)
- Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, 54035 Nancy, France.
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Mansart A, Bollaert PE, Giummelly P, Capdeville-Atkinson C, Atkinson J. Effects of dexamethasone andl-canavanine on the intracellular calcium-contraction relation of the rat tail artery during septic shock. Am J Physiol Heart Circ Physiol 2006; 291:H1177-82. [PMID: 16603690 DOI: 10.1152/ajpheart.00997.2005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The intracellular mechanism by which sepsis lowers vascular reactivity and the subsequent reversal by dexamethasone or nitric oxide synthase (NOS) inhibitors remain unclear. We measured the sensitivity of contraction of the rat tail artery to intracellular Ca2+in a model of polymicrobial septic shock. At 22 h after cecal ligation and puncture (CLP), rats were treated with an anti-inflammatory glucocorticoid (dexamethasone, 1 mg/kg ip), an inducible NOS inhibitor (l-canavanine, 100 mg/kg ip), or saline. At 24 h after CLP, endothelium-denuded, perfused segments of tail artery were loaded with the intracellular Ca2+-sensitive dye fura 2 in vitro. Intracellular Ca2+concentration and perfusion pressure were measured simultaneously. The rightward shift of the perfusion pressure-intracellular Ca2+mobilization curve after norepinephrine stimulation subsequent to CLP indicates decreased intracellular Ca2+sensitivity of contraction. The relation was restored by dexamethasone (which also restored in vivo blood pressure and flow), but not by l-canavanine (which restored perfusion pressure by further mobilization of intracellular Ca2+). We conclude that CLP lowers vasomotion by lowering intracellular Ca2+sensitivity, which can be restored with glucocorticoid treatment. The involvement of inducible NOS does not solely account for the sepsis-induced reduction in Ca2+sensitivity of contraction.
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Affiliation(s)
- Arnaud Mansart
- Pharmacology Laboratory, Pharmacology Faculty, Nancy University, and Intensive Care Unit, University Central Hospital, France
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Rothmann C, Ruschel N, Streiff R, Pitti R, Bollaert PE. Embolie graisseuse pulmonaire après liposuccion. ACTA ACUST UNITED AC 2006; 25:189-92. [PMID: 16269230 DOI: 10.1016/j.annfar.2005.07.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 07/26/2005] [Indexed: 11/25/2022]
Abstract
A 24-year-old woman undergoes buttock's liposuction as an outpatient procedure. As she went back home, progressive dyspnea, respiratory distress and collapse developed. At hospital admission, she was dyspneic with thoracic oppression, tachycardia and anguish. Chest X-ray and thoracic CT scan suggested a pulmonary localisation of fat emboli. Symptomatic treatment allowed complete recovery. This report discusses diagnosis of fat emboli after liposuction as well as epidemiology and physiopathology.
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Affiliation(s)
- C Rothmann
- Service d'Accueil des Urgences, CHR de Metz-Thionville, Hôpital Bon-Secours, 1, place P.-de-Vigneulles, 57038 Metz cedex, France.
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Levy B, Dusang B, Annane D, Gibot S, Bollaert PE. Cardiovascular response to dopamine and early prediction of outcome in septic shock: a prospective multiple-center study. Crit Care Med 2005; 33:2172-7. [PMID: 16215366 DOI: 10.1097/01.ccm.0000181297.14319.3c] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To compare mortality rates between dopamine-sensitive (Dopa-S) and dopamine-resistant (Dopa-R) septic shock patients, the latter group defined by a mean arterial pressure <70 mm Hg despite the use of 20 mug/kg/min dopamine. DESIGN A human, prospective observational, multiple-center, clinical trial. SETTING Ten intensive care units from ten hospitals. PATIENTS 110 patients with septic shocks. INTERVENTIONS Following volume resuscitation, patients were treated by a rapid increase in dopamine infusion from 10 to 20 mug/kg/min. If mean arterial pressure remained <70 mm Hg, dopamine treatment was promptly switched to norepinephrine or epinephrine. MEASUREMENTS AND MAIN RESULTS Dopamine sensitivity, arterial gas, lactate, and organ system failure scores were measured at admission and after 6, 12, 24, 48, 72, 96, and 120 hrs. The overall 28-day mortality rate was 54% for the entire population under study. In multivariate analysis, independent predictors of death were dopamine resistance (odds ratio, 9.5; 95% confidence interval, 3-25), arterial lactate >3.5 mmol/L (odds ratio, 1.75; 95% confidence interval, 1.06-2.55), and Sepsis-related Organ Failure Assessment score >10 (odds ratio, 1.40; 95% confidence interval, 1.07-2.12). Of the 110 patients studied, 66 were observed to be resistant to dopamine (60%). In the Dopa-S group, the 28-day mortality rate was 16% (seven of 44 patients) compared with 78% (52 of 66 patients) in the Dopa-R group (p = .0006). The capacity of dopamine resistance to predict death was associated with a sensitivity of 84% and a specificity of 74%. At 24 hrs, the association of dopamine resistance to a lactate level >3.5 mmol/L improved the prognostic value (sensitivity, 90%, specificity, 92%). CONCLUSIONS Dopamine sensitivity is associated with decreased mortality rate. Early recognition of dopamine resistant septic shock could allow for better screening of patients with an ominous prognosis.
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Affiliation(s)
- Bruno Levy
- Réanimation Médicale, Hôpital Central, Nancy Cedex, France
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