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Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A, Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A. Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study). Crit Care 2024; 28:4. [PMID: 38167516 PMCID: PMC10759709 DOI: 10.1186/s13054-023-04774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Group A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients' characteristics, and determine ICU mortality associated factors. METHODS We performed a retrospective multicenter cohort study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center's microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate. RESULTS Two hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively (p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients (n = 222) had a median SOFA score of 8 (5-13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71-21.60), p = 0.005), STSS (OR = 5.75 (1.71-19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05-22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03-15.59), p = 0.044), and diabetes (OR = 3.92 (1.42-10.79), p = 0.008) were significantly associated with ICU mortality. CONCLUSION The incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.
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Affiliation(s)
- Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Margot Dumery
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | | | - Noémie Zucman
- Service de Réanimation Médico-Chirurgicale, CH Annecy Genevois, Epagny Metz-Tessy, France
| | - Florian Reizine
- Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
| | - Pierre Fillatre
- Service de Réanimation Polyvalente, CH de Saint Brieuc, Saint Brieuc, France
| | - Charles Detollenaere
- Service de Réanimation - Unité de Soins Continus, CH de Boulogne Sur Mer, Boulogne, France
| | - Cédric Darreau
- Service de Réanimation Médico-Chirurgicale, CH Le Mans, Le Mans, France
| | | | | | - Guillaume Schnell
- Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier du Havre, Le Havre, France
| | - Béatrice La Combe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Charlotte Guesdon
- Service de Réanimation Polyvalente, Centre Hospitalier de Pau, Pau, France
| | - Franklin Bruna
- Service de Réanimation, CH Alpes Leman, Contamine Sur Arve, France
| | - Antoine Guillon
- Service de Médecine Intensive Réanimation, INSERM, Centre d'Étude des Pathologies Respiratoires (CEPR), UMR 1100, CHRU de Tours, Université de Tours, Tours, France
| | - Caroline Varillon
- Service de Médecine Intensive Réanimation, CH Dunkirk, Dunkirk, France
| | - Olivier Lesieur
- Service de Réanimation Médico-Chirurgical, CH La Rochelle, La Rochelle, France
| | - Hubert Grand
- Service de Réanimation Polyvalente, Hôpital Robert Boulin, Libourne, France
| | - Benjamin Bertrand
- Service de Réanimation Polyvalente, CH Intercommunal Toulon, La Seyne sur Mer (CHITS), Toulon, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, CH Sud Essonne, Étampes, France
| | - Pierre Oudeville
- Service de Réanimation Médicale, Groupe Hospitalier Régional Mulhouse Sud Alsace (GHRMSA), Mulhouse, France
| | - Céline Besnard
- Service de Médecine Intensive Réanimation, CH Régional de Orléans, Orléans, France
| | - Romain Persichini
- Service de Réanimation Et Soins Continus, CH de Saintonge, Saintes, France
| | - Pierrick Bauduin
- Service de Médecine Intensive Réanimation, CHU de Caen, Caen, France
| | - Martial Thyrault
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord Essonne - site Longjumeau, Longjumeau, France
| | - Mathieu Evrard
- Service Réanimation Polyvalente et Surveillance Continue, CH de Lens, Lens, France
| | - David Schnell
- Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France
| | - Johann Auchabie
- Service de Réanimation Polyvalente, CH de Cholet, Cholet, France
| | - Adrien Auvet
- Service de Réanimation Polyvalente, CH de Dax, Dax, France
| | | | - Pascal Beuret
- Service de Réanimation et Soins Continus, CH de Roanne, Roanne, France
| | - Maxime Leclerc
- Service de Réanimation et Soins Intensifs Polyvalents, CH Mémorial Saint-Lô, Saint-Lô, France
| | - Asaël Berger
- Service de Réanimation, CH de Haguenau, Haguenau, France
| | - Omar Ben Hadj Salem
- Service de Réanimation Médico-Chirurgicale, CHI Meulan - les Mureaux, Meulan en Yvelines, France
| | - Julien Lorber
- Service de Médecine Intensive Réanimation, CH de Saint Nazaire, Saint Nazaire, France
| | - Annabelle Stoclin
- Département Interdisciplinaire d'Organisation des Parcours Patients (DIOPP), Service de Réanimation, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Léa Bientz
- Laboratoire de Bactériologie, CHU de Bordeaux; Microbiologie Fondamentale et Pathogénicité UMR5234, Université de Bordeaux, Bordeaux, France
| | - Pierre Khan
- Département d'Anesthésie Réanimation Sud, Centre Médico-Chirurgical Magellan, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Vivien Guillotin
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, CH Départemental de la Vendée, La Roche-sur-Yon, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
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Huang F, Ammirati E, Ponnaiah M, Montero S, Raimbault V, Abrams D, Lebreton G, Pellegrino V, Ihle J, Bottiroli M, Persichini R, Barrionuevo-Sánchez MI, Ariza-Solé A, Ng PY, Sin SWC, Ayer R, Buscher H, Belaid S, Delmas C, Ferreira R, Roncon-Albuquerque R, Lόpez-Sobrino T, Bunge JJH, Fisser C, Franchineau G, McCanny J, Ohshimo S, Sionis A, Hernández-Pérez FJ, Barge-Caballero E, Balik M, Muglia H, Park S, Donker DW, Porral B, Aïssaoui N, Mekontso Dessap A, Burgos V, Lesouhaitier M, Fried J, Jung JS, Rosillo S, Scherrer V, Nseir S, Winszewski H, Jorge-Pérez P, Kimmoun A, Diaz R, Combes A, Schmidt M. Fulminant myocarditis proven by early biopsy and outcomes. Eur Heart J 2023; 44:5110-5124. [PMID: 37941449 DOI: 10.1093/eurheartj/ehad707] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.
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Affiliation(s)
- Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Maharajah Ponnaiah
- ICAN Intelligence and Omics, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Departament de Medicina, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Victor Raimbault
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital and Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris Cedex 13, France
| | | | - Joshua Ihle
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Maurizio Bottiroli
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, France
| | - Marisa Isabel Barrionuevo-Sánchez
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pauline Yeung Ng
- Adult Intensive Care Unit, Queen Mary Hospital, Hong-Kong, China
| | - Simon Wai Ching Sin
- Department of Anaesthesiology, The University of Hong Kong, Hong-Kong, China
| | - Raj Ayer
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Hergen Buscher
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Slimane Belaid
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Rita Ferreira
- Intensive Care Unit, Saint João Hospital, Porto, Portugal
| | | | | | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christoph Fisser
- Intensive Care Unit, University Medical Centre Regensburg, Regensburg, Germany
| | - Guillaume Franchineau
- Department of Intensive Care Medicine and Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Sorbonne Université, Paris Cedex 18, France
| | - Jamie McCanny
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust Hospital, London, UK
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco José Hernández-Pérez
- Advanced Heart Failure and Transplant Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Eduardo Barge-Caballero
- Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, A Coruña, Spain
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, General University Hospital, Prague, Czech Republic
| | | | - Sunghoon Park
- Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Beatriz Porral
- Intensive Care Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Nadia Aïssaoui
- Intensive Care Unit, Cochin Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris Cedex 5, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Mondor Hospital, Créteil, France
| | - Virginia Burgos
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Mathieu Lesouhaitier
- Departement of Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, Rennes 35200, France
| | - Justin Fried
- Department of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Sandra Rosillo
- Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Vincent Scherrer
- Department of Anesthesiology and Critical Care, CHU Rouen, Rouen F-76000, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, CHU de Lille, University Lille, Lille, France
| | | | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias Nuestra Señora de Candelaria, Canary Islands, Tenerife, Spain
| | - Antoine Kimmoun
- CHRU de NANCY, Service de Médecine Intensive et Réanimation, Inserm U1116, Université de Lorraine, Nancy, France
| | - Rodrigo Diaz
- Department of Cardiology, Clínica Las Condes, Las Condes, Chile
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
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Bourcier S, Coutrot M, Ferré A, Van Grunderbeeck N, Charpentier J, Hraiech S, Azoulay E, Nseir S, Aissaoui N, Messika J, Fillatre P, Persichini R, Carreira S, Lautrette A, Delmas C, Terzi N, Mégarbane B, Lascarrou JB, Razazi K, Repessé X, Pichereau C, Contou D, Frérou A, Barbier F, Ehrmann S, de Montmollin E, Sztrymf B, Morawiec E, Bigé N, Reuter D, Schnell D, Ellrodt O, Dellamonica J, Combes A, Schmidt M. Critically ill severe hypothyroidism: a retrospective multicenter cohort study. Ann Intensive Care 2023; 13:15. [PMID: 36892784 PMCID: PMC9998819 DOI: 10.1186/s13613-023-01112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/19/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients. METHODS We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure. RESULTS Eighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75-24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47-84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27-18.6)] as being independently associated with in-ICU mortality. CONCLUSIONS SH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.
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Affiliation(s)
- Simon Bourcier
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Maxime Coutrot
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France
| | - Alexis Ferré
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | | | - Julien Charpentier
- Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, APHP, Paris, France
| | - Sami Hraiech
- Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, 59000, Lille, France.,INSERM U1285, Université de Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
| | - Nadia Aissaoui
- Department of Critical Care Unit, Hôpital Européen Georges-Pompidou (HEGP), APHP, Paris, France
| | - Jonathan Messika
- Medico-Surgical Intensive Care Unit, APHP. Nord-Université Paris Cité, Hôpital Louis Mourier, 92700, Colombes, France
| | - Pierre Fillatre
- Medical-Surgical Intensive Care Unit, CH de Saint-Brieuc, Saint-Brieuc, France
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire (CHU) de La Réunion, Felix-Guyon Hospital, Saint-Denis, La Réunion, France
| | - Serge Carreira
- Medical-Surgical Intensive Care Unit, Saint-Camille Hospital, Bry-sur-Marne, France
| | | | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse, France.,REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France
| | - Nicolas Terzi
- Department of Medical Intensive Care, CHU de Grenoble Alpes, Grenoble, France
| | - Bruno Mégarbane
- Department of Medical Intensive Care, Lariboisière Hospital, APHP, Paris, France
| | | | - Keyvan Razazi
- Service de Médecine Intensive Réanimation, AP-HP, CHU Henri Mondor, DHU A-TVB, Créteil, France
| | - Xavier Repessé
- Intensive Care Unit, University Hospital Ambroise-Paré, APHP, Boulogne-Billancourt, France
| | - Claire Pichereau
- Intensive Care Unit, Poissy Saint-Germain-en-Laye Hospital, Poissy, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Aurélien Frérou
- Medical Intensive Care Unit, Hôpital Pontchaillou, CHU de Rennes, Rennes, France
| | - François Barbier
- Medical Intensive Care Unit, CH Regional d'Orléans, Orléans, France
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CHRU Tours, CIC INSERM 1415, CRICS-TriggerSep F-CRIN Research Network, Tours, France.,INSERM, Centre d'étude Des Pathologies Respiratoires, U1100, Tours, France.,Université de Tours, Tours, France
| | | | - Benjamin Sztrymf
- Service de Réanimation Polyvalente et Surveillance Continue, AP-HP, Hôpital Antoine Béclère, 157 rue de la porte de Triveaux, 92140, Clamart, France
| | - Elise Morawiec
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Naïke Bigé
- Medical Intensive Care Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - Danielle Reuter
- Medical-Surgical Intensive Care Unit, CH Sud Francilien, Corbeil, France
| | - David Schnell
- Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France
| | - Olivier Ellrodt
- Département de Médecine Intensive, Groupe Hospitalier Sud Île-de-France, Hôpital de Melun, Melun, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, UR2CA Université Cote d'Azur, Nice, France
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France.,Medecine Intensive Reanimation, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, INSERM, UMRS_1166-ICAN, Hôpital de la Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 75651, Paris Cedex 13, France. .,Medecine Intensive Reanimation, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, INSERM, UMRS_1166-ICAN, Hôpital de la Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
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Montero S, Rivas‐Lasarte M, Huang F, Chommeloux J, Demondion P, Bréchot N, Hékimian G, Franchineau G, Persichini R, Luyt C, Garcia‐Garcia C, Bayes‐Genis A, Lebreton G, Cinca J, Leprince P, Combes A, Alvarez‐Garcia J, Schmidt M. Time course, factors related to, and prognostic impact of venoarterial extracorporeal membrane flow in cardiogenic shock. ESC Heart Fail 2022; 10:568-577. [PMID: 36369748 PMCID: PMC9871705 DOI: 10.1002/ehf2.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/06/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is currently one of the most used devices in refractory cardiogenic shock. However, there is a lack of evidence on how to set the 'optimal' flow. We aimed to describe the evolution of VA-ECMO flows in a cardiogenic shock population and determine the risk factors of 'high-ECMO flow'. METHODS AND RESULTS A 7 year database of patients supported with VA-ECMO was used. Based on the median flow during the first 48 h of the VA-ECMO run, patients were classified as 'high-flow' or 'low-flow', respectively, when median ECMO flow was ≥3.6 or <3.6 L/min. Outcomes included rates of ventilator-associated pneumonia, ECMO-related complications, days on ECMO, days on mechanical ventilation, intensive care unit and hospitalization lengths of stay, and in-hospital and 60 day mortality. Risk factors of high-ECMO flow were assessed using univariate and multivariate cox regression. The study population included 209 patients on VA-ECMO, median age was 51 (40-59) years, and 78% were males. The most frequent aetiology leading to cardiogenic shock was end-stage dilated cardiomyopathy (57%), followed by acute myocardial infarction (23%) and fulminant myocarditis (17%). Among the 209 patients, 105 (50%) were classified as 'high-flow'. This group had a higher rate of ischaemic aetiology (16% vs. 30%, P = 0.023) and was sicker at admission, in terms of worse Simplified Acute Physiology Score II score [40 (26-58) vs. 56 (42-74), P < 0.001], higher lactate [3.6 (2.2-5.8) mmol/L vs. 5.2 (3-9.7) mmol/L, P < 0.001], and higher aspartate aminotransferase [97 (41-375) U/L vs. 309 (85-939) U/L, P < 0.001], among others. The 'low-flow' group had less ventilator-associated pneumonia (40% vs. 59%, P = 0.007) and less days on mechanical ventilation [4 (1.5-7.5) vs. 6 (3-12) days, P = 0.009]. No differences were found in lengths of stay or survival according to the ECMO flow. The multivariate analysis showed that risk factors independently associated with 'high-flow' were mechanical ventilation at cannulation [odds ratio (OR) 3.9, 95% confidence interval (CI) 2.1-7.1] and pre-ECMO lactate (OR 1.1, 95% CI 1.0-1.2). CONCLUSIONS In patients with refractory cardiogenic shock supported with VA-ECMO, sicker patients had higher support since early phases, presenting thereafter higher rates of ventilator-associated pneumonia but similar survival compared with patients with lower flows.
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Affiliation(s)
- Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain,Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France
| | - Mercedes Rivas‐Lasarte
- Advanced Heart Failure and Heart Transplant Unit, Cardiology DepartmentHospital Universitario Puerta de Hierro Majadahonda, CIBERCVMadridSpain
| | - Florent Huang
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France
| | - Juliette Chommeloux
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France
| | - Pierre Demondion
- Thoracic and Cardiovascular DepartmentAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Nicolas Bréchot
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Guillaume Hékimian
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Guillaume Franchineau
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Romain Persichini
- Medical–Surgical Intensive Care UnitCHU de La Réunion, Felix‐Guyon HospitalSaint DenisLa RéunionFrance
| | - Charles‐Édouard Luyt
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Cosme Garcia‐Garcia
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Antoni Bayes‐Genis
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Guillaume Lebreton
- Thoracic and Cardiovascular DepartmentAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Juan Cinca
- Cardiology DepartmentHospital de la Santa Creu i Sant Pau, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Pascal Leprince
- Thoracic and Cardiovascular DepartmentAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Alain Combes
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
| | - Jesus Alvarez‐Garcia
- Cardiology DepartmentHospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Matthieu Schmidt
- Medical Intensive Care UnitAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière HospitalParis Cedex 13France,Institute of Cardiometabolism and NutritionSorbonne Université, INSERM UMRS_1166‐iCAN75651Paris Cedex 13France
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Decavèle M, Rivals I, Persichini R, Mayaux J, Serresse L, Morélot-Panzini C, Dres M, Demoule A, Similowski T. Prognostic Value of the Intensive Care Respiratory Distress Observation Scale on ICU Admission. Respir Care 2022; 67:823-832. [PMID: 35440498 PMCID: PMC9994097 DOI: 10.4187/respcare.09601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The association between dyspnea and mortality has not been demonstrated in the ICU setting. We tested the hypothesis that dyspnea (self-reported respiratory discomfort) or its observational correlates (5-item intensive care Respiratory Distress Observation Scale [IC-RDOS]) assessed on ICU admission would be associated with ICU mortality. METHODS Ancillary analysis of single-center data prospectively collected from 220 communicative ICU subjects allocated to a derivation cohort of 120 subjects and a separate validation cohort of 100 subjects. Dyspnea was assessed dichotomously (yes/no), with a dyspnea visual analog scale (measured in mm), and IC-RDOS was calculated. Multivariate logistic regression was used to identify factors associated with ICU and hospital mortality. RESULTS Dyspnea was reported by 69 (58%; median 45 [interquartile range [IQR] 32-60] mm) and 47 (47%; 38 [IQR 26-48] mm) subjects in the derivation and validation cohorts, respectively. IC-RDOS was 2.3 (1.2-3.1) and 2.4 (1.3-2.8), respectively. IC-RDOS values were higher in subjects with dyspnea than in subjects without dyspnea in both the derivation cohort (2.6 [2.2-4.6] vs 1.4 [0.9-2.4], P < .001) and the validation cohort (2.6 [2.3-4.4] vs 2.2 [1.0-2.8], P < .001). On multivariate analysis of the derivation cohort, admission for hemorrhagic shock (odds ratio 13.98), IC-RDOS (odds ratio 1.77), and Simplified Acute Physiology Score II (odds ratio 1.10) was associated with ICU mortality. Areas under the receiving operating characteristic curve of IC-RDOS to predict ICU mortality were 0.785 and 0.794 in the derivation and validation cohorts, respectively. CONCLUSIONS IC-RDOS, an observational correlate of dyspnea, but not dyspnea itself, was associated with higher mortality in ICU subjects.
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Affiliation(s)
- Maxens Decavèle
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France.
| | - Isabelle Rivals
- Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Romain Persichini
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France
| | - Julien Mayaux
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France
| | - Laure Serresse
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Unité Mobile d'Accompagnement et de Soins Palliatifs, Paris, France
| | - Capucine Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie (Département R3S), F-75013 Paris, France
| | - Martin Dres
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, F-75013 Paris, France
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Persichini R, Lai C, Teboul JL, Adda I, Guérin L, Monnet X. Venous return and mean systemic filling pressure: physiology and clinical applications. Crit Care 2022; 26:150. [PMID: 35610620 PMCID: PMC9128096 DOI: 10.1186/s13054-022-04024-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/17/2022] [Indexed: 01/15/2023] Open
Abstract
Venous return is the flow of blood from the systemic venous network towards the right heart. At steady state, venous return equals cardiac output, as the venous and arterial systems operate in series. However, unlike the arterial one, the venous network is a capacitive system with a high compliance. It includes a part of unstressed blood, which is a reservoir that can be recruited via sympathetic endogenous or exogenous stimulation. Guyton’s model describes the three determinants of venous return: the mean systemic filling pressure, the right atrial pressure and the resistance to venous return. Recently, new methods have been developed to explore such determinants at the bedside. In this narrative review, after a reminder about Guyton’s model and current methods used to investigate it, we emphasize how Guyton’s physiology helps understand the effects on cardiac output of common treatments used in critically ill patients.
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Affiliation(s)
- Romain Persichini
- Service de Réanimation et Soins Continus, Centre Hospitalier de Saintonge, 11 Boulevard Ambroise Paré, 17108, Saintes cedex, France.
| | - Christopher Lai
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Imane Adda
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Laurent Guérin
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Montero S, Huang F, Rivas-Lasarte M, Chommeloux J, Demondion P, Bréchot N, Hékimian G, Franchineau G, Persichini R, Luyt CÉ, Garcia-Garcia C, Bayes-Genis A, Lebreton G, Cinca J, Leprince P, Combes A, Alvarez-Garcia J, Schmidt M. Awake venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2021; 10:585-594. [PMID: 33822901 DOI: 10.1093/ehjacc/zuab018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is currently one of the first-line therapies for refractory cardiogenic shock (CS), but its applicability is undermined by the high morbidity associated with its complications, especially those related to mechanical ventilation (MV). We aimed to assess the prognostic impact of keeping patients in refractory CS awake at cannulation and during the VA-ECMO run. METHODS A 7-year database of patients given peripheral VA-ECMO support was used to conduct a propensity-score (PS)-matched analysis to balance their clinical profiles. Patients were classified as 'awake ECMO' or 'non-awake ECMO', respectively, if invasive MV was used during ≤50% or >50% of the VA-ECMO run. Primary outcomes included ventilator-associated pneumonia and ECMO-related complication rates, and secondary outcomes were 60-day and 1-year mortality. A multivariate logistic-regression analysis was used to identify whether MV at cannulation was independently associated with 60-day mortality. RESULTS Among 231 patients included, 91 (39%) were 'awake' and 140 (61%) 'non-awake'. After PS-matching adjustment, the 'awake ECMO' group had significantly lower rates of pneumonia (35% vs. 59%, P = 0.017), tracheostomy, renal replacement therapy, and less antibiotic and sedative consumption. This strategy was also associated with reduced 60-day (20% vs. 41%, P = 0.018) and 1-year mortality rates (31% vs. 54%, P = 0.021) compared to the 'non-awake' group, respectively. Lastly, MV at ECMO cannulation was independently associated with 60-day mortality. CONCLUSION An 'awake ECMO' management in VA-ECMO-supported CS patients is feasible, safe, and associated with improved short- and long-term outcomes.
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Affiliation(s)
- Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Autònoma de Barcelona, Spain.,Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France
| | - Florent Huang
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France
| | - Mercedes Rivas-Lasarte
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juliette Chommeloux
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France
| | - Pierre Demondion
- Thoracic and Cardiovascular Department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Nicolas Bréchot
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Guillaume Hékimian
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Guillaume Franchineau
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, CHU de La Réunion, Felix-Guyon Hospital, Saint Denis, La Réunion, France
| | - Charles-Édouard Luyt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Cosme Garcia-Garcia
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Antoni Bayes-Genis
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Guillaume Lebreton
- Thoracic and Cardiovascular Department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pascal Leprince
- Thoracic and Cardiovascular Department, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France
| | - Alain Combes
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France.,Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Jesus Alvarez-Garcia
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris Cedex 13 75651, France.,Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris Cedex 13 75651, France.,Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
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9
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Lecadieu A, Veyret S, Persichini R, Duarte L, Caron M, Vidal C, Bordet E, Traversier N, Allyn J, Allou N. Case Report: Refractory Acute Respiratory Distress Syndrome Supported by Extracorporeal Membrane Oxygenation due to Coinfection with Chlamydia pneumoniae and Leptospirosis in Reunion Island. Am J Trop Med Hyg 2021; 104:866-867. [PMID: 33399045 DOI: 10.4269/ajtmh.20-1186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022] Open
Abstract
Infection with Leptospira spp. is common in Réunion, a tropical island in the Indian Ocean. However, respiratory coinfections between strains of Leptospira spp. and other microorganisms are rarely described. Here, we describe the first reported case of coinfection between Leptospira spp. and Chlamydia pneumoniae, responsible for refractory acute respiratory distress syndrome requiring extracorporeal membrane oxygenation with a favorable outcome. In a case of leptospirosis with severe respiratory illness, testing for respiratory coinfection, especially with atypical pathogens, could explain the seriousness of the clinical condition and lead to specific treatment.
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Affiliation(s)
- Arnaud Lecadieu
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Simon Veyret
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Romain Persichini
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Lucie Duarte
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Margot Caron
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Charles Vidal
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Elora Bordet
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Nicolas Traversier
- Service de Microbiologie, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
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10
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Vandroux D, Allyn J, Ferdynus C, Gaüzere BA, Kerambrun H, Galas T, Allou N, Persichini R, Martinet O, Jabot J. Mortality of critically ill patients with severe influenza starting four years after the 2009 pandemic. Infect Dis (Lond) 2019; 51:831-837. [DOI: 10.1080/23744235.2019.1668957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- David Vandroux
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
- René Labusquière Centre of Tropical Medicine, University of Bordeaux, Bordeaux Cedex, France
- UMR 1094 Neuroépidémiologie Tropicale, University of Limoges, Limoges, France
| | - Jérôme Allyn
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
| | | | - Bernard-Alex Gaüzere
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
- René Labusquière Centre of Tropical Medicine, University of Bordeaux, Bordeaux Cedex, France
| | - Hugo Kerambrun
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
| | - Thomas Galas
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
| | - Nicolas Allou
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
| | - Romain Persichini
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
| | - Olivier Martinet
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
| | - Julien Jabot
- Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France
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11
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Decavèle M, Campbell ML, Persichini R, Morélot-Panzini C, Similowski T, Demoule A, Dres M. Management of Dyspnea in the Noncommunicative Patients: Consider Hetero-evaluation Scales. Chest 2019; 154:991-992. [PMID: 30290940 DOI: 10.1016/j.chest.2018.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Maxens Decavèle
- Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France; Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | | | - Romain Persichini
- Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France; Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Capucine Morélot-Panzini
- Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France; Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Thomas Similowski
- Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France; Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Alexandre Demoule
- Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France; Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Martin Dres
- Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, UMRS1158, Paris, France; Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.
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12
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Vally S, Ferdynus C, Persichini R, Bouchet B, Braunberger E, Lo Pinto H, Martinet O, Vandroux D, Aujoulat T, Allyn J, Allou N. Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit. Ann Intensive Care 2019; 9:24. [PMID: 30707314 PMCID: PMC6358626 DOI: 10.1186/s13613-019-0503-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 11/14/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU). METHODS This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated. RESULTS A total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P < 0.0001) and aortic velocity-time integral from 8.9 ± 4 cm to 12.5 ± 3.8 cm (P = 0.002) 24 h after drug infusion. After propensity score matching, levosimendan was the only factor associated with a significant reduction in VA-ECMO weaning failure rates (hazard ratio = 0.16; 95% confidence interval 0.04-0.7; P = 0.01). Kaplan-Meier survival curves showed that survival rates at 30 days were 78.4% for the levosimendan group and 49.5% for the non-levosimendan group (P = 0.02). After propensity score matching analysis, the difference in 30-day mortality between the two groups was not significant (hazard ratio = 0.55; 95% confidence interval 0.27-1.10; P = 0.09). CONCLUSIONS Our results suggest that levosimendan was associated with a beneficial effect on VA-ECMO weaning in ICU patients.
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Affiliation(s)
- Shamir Vally
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, France.,INSERM, CIC 1410, Saint-Pierre, France
| | - Romain Persichini
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Bruno Bouchet
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Eric Braunberger
- Chirurgie cardiaque, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Hugo Lo Pinto
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Olivier Martinet
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - David Vandroux
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Thomas Aujoulat
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Jérôme Allyn
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Nicolas Allou
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France. .,Réanimation polyvalente, Hôpital Félix Guyon, Bellepierre, 97405, Saint-Denis, France.
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13
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Decavèle M, Gay F, Persichini R, Mayaux J, Morélot-Panzini C, Similowski T, Demoule A. The Mechanical Ventilation-Respiratory Distress Observation Scale as a surrogate of self-reported dyspnoea in intubated patients. Eur Respir J 2018; 52:13993003.00598-2018. [PMID: 30209199 DOI: 10.1183/13993003.00598-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/31/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Maxens Decavèle
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | - Frédérick Gay
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Pôle Biologie Médicale et Pathologie, Service de Parasitologie et Mycologie, Paris, France
| | - Romain Persichini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | - Julien Mayaux
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | - Capucine Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France
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14
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Montero S, Aissaoui N, Tadié JM, Bizouarn P, Scherrer V, Persichini R, Delmas C, Rolle F, Besnier E, Le Guyader A, Combes A, Schmidt M. Fulminant giant-cell myocarditis on mechanical circulatory support: Management and outcomes of a French multicentre cohort. Int J Cardiol 2018; 253:105-112. [PMID: 29306448 DOI: 10.1016/j.ijcard.2017.10.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/04/2017] [Accepted: 10/13/2017] [Indexed: 11/17/2022]
Abstract
AIMS Giant-cell myocarditis (GCM) is a rare and often fatal form of myocarditis. Only a few reports have focused on fulminant forms. We describe the clinical characteristics, management and outcomes of GCM patients rescued by mechanical circulatory support (MCS). METHODS AND RESULTS The clinical features, diagnoses, treatments and outcomes of MCS-treated patients in refractory cardiogenic shock secondary to fulminant GCM admitted to eight French intensive care units (2002-2016) were analysed. We also conducted a systematic review of this topic. Thirteen patients (median age 44 [range 21-76]years, Simplified Acute Physiology Score II 55 [40-79]) in severe cardiogenic shock (median [range] left ventricular ejection fraction 15% [15-35%] and blood lactate 4 mmol/L) were placed on MCS 4 [0-28]days after hospital admission. Severe arrhythmic disturbances were frequent (77%), with six (46%) patients experiencing an electrical storm prior to MCS. Venoarterial extracorporeal membrane oxygenation was the first MCS option for 11 (85%) patients. GCM was diagnosed in five (38%) patients before transplant or death and treated with immunosuppressants; infections were the main complication (80%). Four patients died on MCS and no patient presented long-term survival free from heart transplant (nine patients, 69%). All transplanted patients were alive 1year later and no GCM recurrence was reported after median follow-up of 42 [12-145]months. CONCLUSION Outcomes of fulminant GCMs may differ from those of milder forms. In this context, heart transplant might likely be the only long-term survival option.
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Affiliation(s)
- Santiago Montero
- Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Nadia Aissaoui
- Intensive Care Unit, U970, European Georges-Pompidou Hospital, Paris Descartes University, Paris, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Vincent Scherrer
- Rouen University Hospital, Department of Anaesthesiology and Critical Care, Rouen, France
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, CHU de La Réunion, Felix-Guyon Hospital, Saint Denis, La Réunion, France
| | - Clément Delmas
- Medical Intensive Care Unit, Rangueil Hospital, Toulouse, France
| | - Florence Rolle
- Thoracic and Cardiac Surgery Department, CHU Limoges, Limoges, France
| | - Emmanuel Besnier
- Rouen University Hospital, Department of Anaesthesiology and Critical Care, Rouen, France
| | | | - Alain Combes
- Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
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15
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Allyn J, Ferdynus C, Lo Pinto H, Bouchet B, Persichini R, Vandroux D, Puech B, Allou N. Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification. PLoS One 2018; 13:e0203643. [PMID: 30204777 PMCID: PMC6133279 DOI: 10.1371/journal.pone.0203643] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background Treatment by venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used today, even though it is associated with high risks of complications and death. While studies have focused on the relationship between some of these complications and the risk of death, the relationship between different complications has never been specifically examined, despite the fact that the occurrence of one complication is known to favor the occurrence of others. Our objective was to describe the relationship between complications in patients undergoing VA-ECMO in intensive care unit (ICU) and to identify, if possible, patterns of patients according to complications. Methods and findings As part of a retrospective cohort study, we conducted a multiple correspondence analysis followed by a hierarchical ascendant classification in order to identify patterns of patients according to main complications (sepsis, thromboembolic event, major transfusion, major bleeding, renal replacement therapy) and in-ICU death. Our cohort of 145 patients presented an in-ICU mortality rate of 50.3%. Morbidity was high, with 36.5% of patients presenting three or more of the five complications studied. Multiple correspondence analysis revealed a cumulative inertia of 76.9% for the first three dimensions. Complications were clustered together and clustered close to death, prompting the identification of four patterns of patients according to complications, including one with no complications. Conclusions Our study, based on a large cohort of patients undergoing VA-ECMO in ICU and presenting a mortality rate comparable to that reported in the literature, identified numerous and often interrelated complications. Multiple correspondence analysis and hierarchical ascendant classification yielded clusters of patients and highlighted specific links between some of the complications studied. Further research should be conducted in this area.
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Affiliation(s)
- Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
- Departement d’Informatique Clinique, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
- * E-mail:
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, France
- INSERM, CIC 1410, Saint-Pierre, France
| | - Hugo Lo Pinto
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Bruno Bouchet
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Romain Persichini
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - David Vandroux
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Berenice Puech
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
- Departement d’Informatique Clinique, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
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16
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Allou N, Soubeyrand A, Traversier N, Persichini R, Brulliard C, Valance D, Martinet O, Picot S, Belmonte O, Allyn J. Waterborne Infections in Reunion Island, 2010-2017. Am J Trop Med Hyg 2018; 99:578-583. [PMID: 30039783 PMCID: PMC6169186 DOI: 10.4269/ajtmh.17-0981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/15/2017] [Accepted: 04/11/2018] [Indexed: 11/07/2022] Open
Abstract
Gram-negative bacilli Vibrio spp., Aeromonas spp., and Shewanella spp. are a major cause of severe waterborne infection. The aim of this study was to assess the clinical and microbiological characteristics and prognosis of patients hospitalized in Reunion Island for a waterborne infection. This retrospective study was conducted in the two university hospitals of Reunion Island between January 2010 and March 2017. Patients diagnosed with a Vibrio, Aeromonas, or Shewanella infection were evaluated. Over the study period, 112 aquatic strains were isolated at Reunion Island: Aeromonas spp. were found in 91 patients (81.3%), Shewanella spp. in 13 patients (11.6%), and Vibrio spp. in eight patients (7.2%). The in-hospital mortality rate was 11.6%. The main sites of infection were skin and soft tissue (44.6%) and the abdomen (19.6%). Infections were polymicrobial in 70 cases (62.5%). The most commonly prescribed empiric antibiotic regimen was amoxicillin-clavulanate (34.8%). Eighty-four percent of the aquatic strains were resistant to amoxicillin-clavulanate and more than > 95% were susceptible to third or fourth generation cephalosporins and fluoroquinolones. After multivariate analysis, the only independent risk factor of in-hospital mortality was the presence of sepsis (P < 0.0001). In Reunion Island, the most commonly isolated aquatic microorganisms were Aeromonas spp. Sepsis caused by aquatic microorganisms was frequent (> 50%) and associated with higher in-hospital mortality. This study suggests that empiric antibiotic regimens in patients with sepsis or septic shock caused by suspected aquatic microorganisms (tropical climate, skin lesion exposed to seawater…) should include broad-spectrum antibiotics (third or fourth generation cephalosporins).
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Affiliation(s)
- Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
| | - Aurélien Soubeyrand
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
| | - Nicolas Traversier
- Bacteriologie, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Saint Denis, France
| | - Romain Persichini
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
| | - Caroline Brulliard
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
| | - Dorothée Valance
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
| | - Olivier Martinet
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
| | - Sandrine Picot
- Bacteriologie, Centre Hospitalier Universitaire Sud Réunion, Saint Pierre, Saint Pierre, France
| | - Olivier Belmonte
- Bacteriologie, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Saint Denis, France
| | - Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, Saint Denis, France
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Lo Pinto H, Allyn J, Persichini R, Bouchet B, Brochier G, Martinet O, Brulliard C, Valance D, Delmas B, Braunberger E, Dangers L, Allou N. Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation. Int J Artif Organs 2018; 41:644-652. [PMID: 29998775 DOI: 10.1177/0391398818785132] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Few data are available on the potential benefits and risks of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation. The aim of this study was to identify the determinants and prognosis of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation, with a special focus on biological parameters during extracorporeal membrane oxygenation treatment. METHODS We conducted a single-center retrospective cohort study including all consecutive patients who underwent extracorporeal membrane oxygenation between January 2010 and December 2015. RESULTS The 201 evaluated patients received a median of 0.9 [0.5-1.7] units of red blood cell per day. Significant and clinically relevant variables that best correlated with units of red blood cell transfused per day of extracorporeal membrane oxygenation were lower median daily prothrombin time in percentage (Quick) ( t = -0.016, p < 0.0001), higher median daily free bilirubin level ( t = 0.016, p < 0.0001), and lower pH ( t = -2.434, p < 0.0001). In multivariate analysis, red blood cell transfusion was associated with a significantly higher rate of in-intensive care unit mortality (per red blood cell unit increment; adjusted odds ratio: 1.07, 95% confidence interval: 1.02-1.12, p = 0.005). It was also associated with higher rates of acute renal failure ( p = 0.025), thromboembolic complications ( p = 0.0045), and sepsis ( p = 0.015). CONCLUSION This study suggests that red blood cell transfusion may be associated with a higher mortality rate and with severe complications. However, we cannot conclude a direct causal relationship, as red blood cell transfusion may be only a marker of poor outcome. We recommend that physicians correct acidosis and hemolysis in patients undergoing extracorporeal membrane oxygenation whenever possible.
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Affiliation(s)
- Hugo Lo Pinto
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Jérôme Allyn
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Romain Persichini
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Bruno Bouchet
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Gilbert Brochier
- 2 Établissement Français du Sang, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Olivier Martinet
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Caroline Brulliard
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Dorothée Valance
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Benjamin Delmas
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Eric Braunberger
- 3 Chirurgie Cardiaque, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Laurence Dangers
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Nicolas Allou
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
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Allyn J, Brottet E, Antok E, Dangers L, Persichini R, Coolen-Allou N, Roquebert B, Allou N, Vandroux D. Case Report: Severe Imported Influenza Infections Developed during Travel in Reunion Island. Am J Trop Med Hyg 2017; 97:1943-1944. [PMID: 29016311 DOI: 10.4269/ajtmh.17-0278] [Citation(s) in RCA: 3] [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] [Indexed: 11/07/2022] Open
Abstract
We report two cases of severe influenza infection imported by tourist patients from their country of origin and developed during travel. While studies have reported cases of influenza infections acquired during travel, here we examine two cases of severe influenza infection contracted in the country of origin that led to diagnosis and therapeutic problems in the destination country. No international recommendation exists concerning influenza vaccination before travel, and few countries recommend it for all travelers. Our study suggests that travel should be canceled when infectious signs are observed before departure. Influenza is a very common infection that is often benign, but sometimes very severe. The most severe cases include shock, acute respiratory distress syndrome (ARDS), myocarditis, rhabdomyolysis, and multiple organ failure. Management can require exceptional therapies, such as extracorporeal membrane oxygenation. A number of studies have focused on influenza infection in travelers. Cases of influenza acquired during travel have been reported in this literature, but no study has examined cases of influenza imported from the country of origin and developed while abroad. The latter situation may lead to 1) diagnostic problems during the nonepidemic season or in places where diagnostic techniques are lacking and 2) therapeutic difficulties resulting from the unavailability of techniques for the management of severe influenza infection in tourist areas. Here, we report two cases of extremely severe influenza infection imported by tourists from their country of origin and developed during travel.
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Affiliation(s)
- Jérôme Allyn
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
| | - Elise Brottet
- Santé publique France, French National Public Health Agency, Regional Unit (Cire) Océan Indien, La Réunion, France
| | - Emmanuel Antok
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Site Sud, Saint-Pierre, France
| | - Laurence Dangers
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
| | - Romain Persichini
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
| | - Nathalie Coolen-Allou
- Pneumologie, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
| | - Bénédicte Roquebert
- Laboratoire de virologie, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
| | - Nicolas Allou
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
| | - David Vandroux
- Centre René Labusquière, Institute of Tropical Medicine, Université de Bordeaux, Bordeaux, France.,Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre, Saint-Denis, France
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Montero Aradas S, Aissaoui N, Persichini R, Bizouarn P, Scherrer V, Rolle F, Delmas C, Tadie J, Combes A, Schmidt M. P5144Nationwide cohort of giant-cell myocarditis fulminant forms on mechanical circulatory support. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Masmoudi H, Persichini R, Cecchini J, Delemazure J, Dres M, Mayaux J, Demoule A, Assouad J, Similowski T. Corrective effect of diaphragm pacing on the decrease in cardiac output induced by positive pressure mechanical ventilation in anesthetized sheep. Respir Physiol Neurobiol 2016; 236:23-28. [PMID: 27836647 DOI: 10.1016/j.resp.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/17/2016] [Accepted: 10/25/2016] [Indexed: 01/13/2023]
Abstract
Positive pressure ventilation (PPV) is a fundamental life support measure, but it decreases cardiac output (CO). Diaphragmatic contractions produce negative intrathoracic and positive abdominal pressures, promoting splanchnic venous return. We hypothesized that: 1) diaphragm pacing alone could produce adequate ventilation without decreasing CO; 2) diaphragm pacing on top of PPV could improve CO. Of 11 anesthetized and mechanically ventilated ewes (39.6±5.9kg), 3 were discarded from analysis because of hemodynamic instability during the experiment, and 8 retained for analysis. Phrenic stimulation electrodes were inserted in the diaphragm (implanted phrenic nerve stimulation, iPS). CO was measured by the thermodilution technique (pulmonary artery catheter). CO during end-expiratory apnea served as reference. Median CO was 9.77 [6.25-11.25] lmin-1 during end-expiratory apnea, 8.25 [5.06-9.25] lmin-1 during "PPV" (-15%) (p<0.05), 9.19 [5.60-10.19] lmin-1 during "PPV-iPS" (NS vs apnea) and 9.37 [6.12-10.48] lmin-1 during "iPS" (NS vs. apnea). iPS-driven ventilation was comparable to its PPV counterpart (median 92% [74-97], NS). Diaphragm pacing alone can produce adequate ventilation without reducing CO. Superimposed onto PPV, diaphragm pacing can reduce the PPV-induced decrease in CO.
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Affiliation(s)
- Hicham Masmoudi
- AP-HP, Groupe Hospitalier Saint-Antoine Tenon Trousseau, Service de Chirurgie Thoracique, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France
| | - Romain Persichini
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Jérôme Cecchini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Julie Delemazure
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Martin Dres
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Julien Mayaux
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Alexandre Demoule
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France
| | - Jalal Assouad
- AP-HP, Groupe Hospitalier Saint-Antoine Tenon Trousseau, Service de Chirurgie Thoracique, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013 Paris, France.
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Guérin L, Teboul JL, Persichini R, Dres M, Richard C, Monnet X. Effects of passive leg raising and volume expansion on mean systemic pressure and venous return in shock in humans. Crit Care 2015; 19:411. [PMID: 26597901 PMCID: PMC4657233 DOI: 10.1186/s13054-015-1115-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/26/2015] [Indexed: 12/03/2022]
Abstract
Introduction The aim of this study was to assess how mean systemic pressure (Psm) and resistance to venous return (Rvr) behave during passive leg raising (PLR) in cases of fluid responsiveness and fluid unresponsiveness. Method In 30 patients with an acute circulatory failure, in order to estimate the venous return curve, we constructed the regression line between pairs of cardiac index (CI) and central venous pressure (CVP). Values were measured during end-inspiratory and end-expiratory ventilatory occlusions performed at two levels of positive end-expiratory pressure. The x-axis intercept was used to estimate Psm and the inverse of the slope to quantify Rvr. These measurements were obtained at baseline, during PLR and after fluid infusion. Patients in whom fluid infusion increased CI by more than 15 % were defined as “fluid-responders”. Results In fluid-responders (n = 15), CVP and Psm significantly increased (from 7 ± 3 to 9 ± 4 mmHg and from 25 ± 13 to 31 ± 13 mmHg, respectively) during PLR. The Psm-CVP gradient significantly increased by 20 ± 30 % while Rvr did not change significantly during PLR. In fluid-nonresponders, CVP and Psm increased significantly but the Psm-CVP gradient did not change significantly during PLR. PLR did not change the intra-abdominal pressure in the whole population (14 ± 6 mmHg before vs. 13 ± 5 mmHg during PLR, p = 0.26) and in patients with intra-abdominal hypertension at baseline (17 ± 4 mmHg before vs. 16 ± 4 mmHg during PLR, p = 0.14). In the latter group, PLR increased Psm from 22 ± 11 to 27 ± 10 mmHg (p <0.01) and did not change Rvr (5.1 ± 2.6 to 5.2 ± 3 mmHg/min/m2/mL, p = 0.71). In fluid-responders, Psm, CVP and the Psm-CVP gradient significantly increased during fluid infusion while the Rvr did not change. In fluid-nonresponders, CVP and Psm increased significantly during fluid infusion while the Psm-CVP gradient and Rvr did not change. Conclusion PLR significantly increased Psm without modifying Rvr. This was also the case in patients with intra-abdominal hypertension. In case of fluid responsiveness, PLR increased venous return by increasing Psm to a larger extent than CVP. In patients with fluid unresponsiveness, PLR increased Psm but did not change the Psm–CVP gradient. Fluid infusion induced similar effects on Psm and Rvr.
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Affiliation(s)
- Laurent Guérin
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. .,Univ Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR_S 999, Le Kremlin-Bicêtre, F-94270, France.
| | - Jean-Louis Teboul
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. .,Univ Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR_S 999, Le Kremlin-Bicêtre, F-94270, France.
| | - Romain Persichini
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. .,Univ Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR_S 999, Le Kremlin-Bicêtre, F-94270, France.
| | - Martin Dres
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. .,Univ Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR_S 999, Le Kremlin-Bicêtre, F-94270, France.
| | - Christian Richard
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. .,Univ Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR_S 999, Le Kremlin-Bicêtre, F-94270, France.
| | - Xavier Monnet
- AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. .,Univ Paris-Sud, Faculté de médecine Paris-Sud, Inserm UMR_S 999, Le Kremlin-Bicêtre, F-94270, France.
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Schmidt M, Kindler F, Cecchini J, Poitou T, Morawiec E, Persichini R, Similowski T, Demoule A. Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction. Crit Care 2015; 19:56. [PMID: 25879592 PMCID: PMC4355459 DOI: 10.1186/s13054-015-0763-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/22/2015] [Indexed: 12/02/2022]
Abstract
Introduction The objective was to compare the impact of three assistance levels of different modes of mechanical ventilation; neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), and pressure support ventilation (PSV) on major features of patient-ventilator interaction. Methods PSV, NAVA, and PAV were set to obtain a tidal volume (VT) of 6 to 8 ml/kg (PSV100, NAVA100, and PAV100) in 16 intubated patients. Assistance was further decreased by 50% (PSV50, NAVA50, and PAV50) and then increased by 50% (PSV150, NAVA150, and PAV150) with all modes. The three modes were randomly applied. Airway flow and pressure, electrical activity of the diaphragm (EAdi), and blood gases were measured. VT, peak EAdi, coefficient of variation of VT and EAdi, and the prevalence of the main patient-ventilator asynchronies were calculated. Results PAV and NAVA prevented the increase of VT with high levels of assistance (median 7.4 (interquartile range (IQR) 5.7 to 10.1) ml/kg and 7.4 (IQR, 5.9 to 10.5) ml/kg with PAV150 and NAVA150 versus 10.9 (IQR, 8.9 to 12.0) ml/kg with PSV150, P <0.05). EAdi was higher with PAV than with PSV at level100 and level150. The coefficient of variation of VT was higher with NAVA and PAV (19 (IQR, 14 to 31)% and 21 (IQR 16 to 29)% with NAVA100 and PAV100 versus 13 (IQR 11 to 18)% with PSV100, P <0.05). The prevalence of ineffective triggering was lower with PAV and NAVA than with PSV (P <0.05), but the prevalence of double triggering was higher with NAVA than with PAV and PSV (P <0.05). Conclusions PAV and NAVA both prevent overdistention, improve neuromechanical coupling, restore the variability of the breathing pattern, and decrease patient-ventilator asynchrony in fairly similar ways compared with PSV. Further studies are needed to evaluate the possible clinical benefits of NAVA and PAV on clinical outcomes. Trial registration Clinicaltrials.gov NCT02056093. Registered 18 December 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0763-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthieu Schmidt
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), F-75013, Paris, France. .,Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, Cedex 13, France.
| | - Felix Kindler
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), F-75013, Paris, France.
| | - Jérôme Cecchini
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.
| | - Tymothée Poitou
- Université Pierre et Marie Curie-CNRS-INSERM, ICM, Equipe Neurologie et Thérapeutique Expérimentale, Hôpital de la Salpêtrière, Paris, France.
| | - Elise Morawiec
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), F-75013, Paris, France.
| | - Romain Persichini
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), F-75013, Paris, France.
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), F-75013, Paris, France.
| | - Alexandre Demoule
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,INSERM, UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), F-75013, Paris, France. .,U974, Institut National de la Santé et de la Recherche médicale, Paris, France.
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Guérin L, Teboul JL, Persichini R, Dres M, Richard C, Monnet X. EFFECTS OF PASSIVE LEG RAISING AND VOLUME EXPANSION ON MEAN SYSTEMIC PRESSURE AND VENOUS RETURN IN SHOCK IN HUMANS. Intensive Care Med Exp 2015. [PMCID: PMC4798224 DOI: 10.1186/2197-425x-3-s1-a16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Persichini R, Guerin L, Monnet X. Physiopathologie du retour veineux systémique au cours de l’insuffisance circulatoire aiguë. Réanimation 2014. [DOI: 10.1007/s13546-014-0869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Artaud-Macari E, Gilbert M, Persichini R, Rifai R, Gunther S, Seferian A, Montani D, Jais X, Assayag P, Humbert M, Simonneau G, Sitbon O, Savale L. Pertinence du monitorage du débit cardiaque par thermodilution transpulmonaire (PiCCO) chez les patients atteints d’hypertension pulmonaire précapillaire en décompensation cardiaque droite sévère. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.069] [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: 12/01/2022]
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Jozwiak M, Teboul JL, Anguel N, Persichini R, Silva S, Chemla D, Richard C, Monnet X. Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2013; 188:1428-33. [PMID: 24102072 DOI: 10.1164/rccm.201303-0593oc] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [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: 02/06/2023] Open
Abstract
RATIONALE The effects of prone positioning during acute respiratory distress syndrome on all the components of cardiac function have not been investigated under protective ventilation and maximal alveolar recruitment. OBJECTIVES To investigate the hemodynamic effects of prone positioning. METHODS We included 18 patients with acute respiratory distress syndrome ventilated with protective ventilation and an end-expiratory positive pressure titrated to a plateau pressure of 28-30 cm H2O. Before and within 20 minutes of starting prone positioning, hemodynamic, respiratory, intraabdominal pressure, and echocardiographic data were collected. Before prone positioning, preload reserve was assessed by a passive leg raising test. MEASUREMENTS AND MAIN RESULTS In all patients, prone positioning increased the ratio of arterial oxygen partial pressure over inspired oxygen fraction, the intraabdominal pressure, and the right and left cardiac preload. The pulmonary vascular resistance decreased along with the ratio of the right/left ventricular end-diastolic areas suggesting a decrease of the right ventricular afterload. In the nine patients with preload reserve, prone positioning significantly increased cardiac index (3.0 [2.3-3.5] to 3.6 [3.2-4.4] L/min/m(2)). In the remaining patients, cardiac index did not change despite a significant decrease in the pulmonary vascular resistance. CONCLUSIONS In patients with acute respiratory distress syndrome under protective ventilation and maximal alveolar recruitment, prone positioning increased the cardiac index only in patients with preload reserve, emphasizing the important role of preload in the hemodynamic effects of prone positioning.
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Artaud-Macari E, Montani D, Mercier O, Persichini R, Günther S, Jais X, Parent F, Simonneau G, Humbert M, Sitbon O, Savale L. Drainage péricardique des tamponnades des patients atteints d’une hypertension pulmonaire précapillaire : une étude monocentrique. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Monnet X, Persichini R, Ktari M, Jozwiak M, Richard C, Teboul JL. Precision of the transpulmonary thermodilution measurements. Crit Care 2011; 15:R204. [PMID: 21871112 PMCID: PMC3387646 DOI: 10.1186/cc10421] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/30/2011] [Accepted: 08/23/2011] [Indexed: 01/28/2023]
Abstract
Introduction We wanted to determine the number of cold bolus injections that are necessary for achieving an acceptable level of precision for measuring cardiac index (CI), indexed global end-diastolic volume (GEDVi) and indexed extravascular lung water (EVLWi) by transpulmonary thermodilution. Methods We included 91 hemodynamically stable patients (age 59 (25% to 75% interquartile range: 39 to 79) years, simplified acute physiologic score (SAPS)II 59 (53 to 65), 56% under norepinephrine) who were monitored by a PiCCO2 device. We performed five successive cold saline (15 mL, 6°C) injections and recorded the measurements of CI, GEDVi and EVLWi. Results Considering five boluses, the coefficient of variation (CV, calculated as standard deviation divided by the mean of the five measurements) was 7 (5 to 11)%, 7 (5 to 12)% and 7 (6 to 12)% for CI, GEDVi and EVLWi, respectively. If the results of two bolus injections were averaged, the precision (2 × CV/√ number of boluses) was 10 (7 to 15)%, 10 (7 to 17)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively. If the results of three bolus injections were averaged, the precision dropped below 10%, that is, the cut-off that is generally considered as acceptable (8 (6 to 12)%, 8 (6 to 14)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively). If two injections were performed, the least significant change, that is, the minimal change in value that could be trusted to be significant, was 14 (10 to 21)%, 14 (10 to 24)% and 14 (11 to 23)% for CI, GEDVi and EVLWi, respectively. If three injections were performed, the least significant change was 12 (8 to 17)%, 12 (8 to 19)% and 12 (9 to 19)% for CI, GEDVi and EVLWi, respectively, that is, below the 15% cut-off that is usually considered as clinically relevant. Conclusions These results support the injection of at least three cold boluses for obtaining an acceptable precision when transpulmonary thermodilution is used for measuring CI, GEDVi and EVLWi.
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Affiliation(s)
- Xavier Monnet
- AP-HP, Hôpitaux Universitaires Paris-Sud, Service de Réanimation Médicale, Le Kremlin-Bicêtre F-94270, France.
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Abstract
Sepsis-induced cardiac dysfunction is a frequent and severe complication of septic shock. The mechanisms responsible for its development are complex and intricate. Echocardiography is the best method to make the diagnosis of cardiac dysfunction. Biomarkers (B-type natriuretic peptides and cardiac troponins) can alert clinicians of the possibility of cardiac dysfunction. Low plasma levels can serve to rule out a severe cardiac dysfunction. By contrast, high levels should prompt the performance of an echocardiographic examination. The transpulmonary thermodilution monitor and the pulmonary artery catheter can also be used to alert clinicians or to monitor the effects of inotropic therapy. Dobutamine is the first-line therapy. Its administration remains a matter of debate and should be carefully monitored in terms of efficacy and tolerance.
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Affiliation(s)
- Mathieu Jozwiak
- Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre, France
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