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Reizine F, Michelet P, Delbove A, Rieul G, Bodenes L, Bouju P, Fillâtre P, Frérou A, Lesieur O, Markarian T, Gacouin A. Development and validation of a clinico-biological score to predict outcomes in patients with drowning-associated cardiac arrest. Am J Emerg Med 2024; 81:69-74. [PMID: 38670053 DOI: 10.1016/j.ajem.2024.04.032] [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: 10/09/2023] [Revised: 03/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND While several scoring systems have been developed to predict short-term outcome in out-of-hospital cardiac arrest patients, there is currently no dedicated prognostic tool for drowning-associated cardiac arrest (DACA) patients. METHODS Patients experiencing DACA from two retrospective multicenter cohorts of drowning patients were included in the present study. Among the patients from the development cohort, risk-factors for day-28 mortality were assessed by logistic regression. A prediction score was conceived and assessed in patients from the validation cohort. RESULTS Among the 103 included patients from the development cohort, the day-28 mortality rate reached 51% (53/103). Identified independent early risk-factors for day-28 mortality included cardiopulmonary resuscitation duration longer than 20 min (OR 6.40 [95% CI 1.88-23.32]; p = 0.003), temperature at Intensive Care Unit admission <34 °C (OR 8.84 [95% CI 2.66-32.92]; p < 0.001), need for invasive mechanical ventilation (OR 6.83 [95% CI 1.47-40.87]; p = 0.02) and lactate concentration > 7 mmol/L (OR 3.56 [95% CI 1.01-13.07]; p = 0.04). The Area Under the ROC Curve (AUC) of the developed score based on those variables reached 0.91 (95% CI, 0.86-0.97). The optimal cut-off for predicting poor outcomes was 4 points with a sensitivity of 92% (95% CI, 82-98%), a specificity of 82% (95% CI, 67-91%), a positive predictive value (PPV) of 84% (95% CI, 72-95%) and a negative predictive value (NPV) of 91% (95% CI, 79-96%). The assessment of this score on the validation cohort of 81 patients exhibited an AUC of 0.82. Using the same 4 points threshold, sensitivity, specificity, PPV and NPV values of the validation cohort were: 81%, 67%, 72% and 77%, respectively. CONCLUSION In patients suffering from drowning induced initial cardiac arrest admitted to ICU with a DACA score ≥ 4, the likelihood of survival at day-28 is significantly lower. Prospective validation of the DACA score and assessment of its usefulness are warranted in the future.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F 35033 Rennes, France; CH Vannes, Service de Réanimation Polyvalente, 56000, Vannes, France.
| | - Pierre Michelet
- Hôpital de la Conception, Service d'Anesthésie Réanimation, UMR 1263 C2VN, 13005, Marseille, France
| | - Agathe Delbove
- CH Vannes, Service de Réanimation Polyvalente, 56000, Vannes, France
| | - Guillaume Rieul
- CH Vannes, Service de Réanimation Polyvalente, 56000, Vannes, France
| | | | - Pierre Bouju
- CH Lorient, Service de Réanimation Polyvalente, 56100, Lorient, France
| | - Pierre Fillâtre
- CH Saint Brieuc, Service de Réanimation Polyvalente, 22000, Saint Brieuc, France
| | - Aurélien Frérou
- CH Saint Malo, Service de Réanimation Polyvalente, 35400, Saint Malo, France
| | - Olivier Lesieur
- CH La Rochelle, Service de Réanimation Polyvalente, 17000, La Rochelle, France
| | - Thibaut Markarian
- Aix-Marseille University, UMR 1263 C2VN, Department of Emergency Medicine, APHM, Timone University Hospital, 13005 Marseille, France
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, F 35033 Rennes, France
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L'Hermitte N, Markarian T, Grau-Mercier L, Coisy F, Muller L, Saadi L, Claret PG, Krebs H, Bobbia X. Diagnostic performance of a clinical ultrasound-based algorithm for acute heart failure in patients presenting to the emergency department with dyspnea. Emergencias 2024; 36:109-115. [PMID: 38607306 DOI: 10.55633/s3me/011.2024] [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] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To study the diagnostic performance of an ultrasound-based algorithm that includes the deceleration time (DT) of early mitral filling to establish a diagnosis of acute heart failure (AHF) in patients who come to an emergency department because of dyspnea. MATERIAL AND METHODS Prospective analysis in a convenience sample of patients who came to a hospital emergency department with acute dyspnea. The algorithm included ultrasound findings and 4 echocardiographic findings as follows: mitral annular plane systolic excursion, Doppler mitral flow velocity, tissue Doppler imaging measure of the lateral annulus, and the DT of early mitral filling. The definitive diagnosis was made by 2 physicians blinded to each other's diagnosis and the ultrasound findings. RESULTS A total of 166 adult patients with a mean (SD) age of 76 (13) years were included; 79 (48%) were women. AHF was the definitive diagnosis in 62 patients (37%). Diagnostic agreement was good between the 2 physicians (κ = 0.71). The algorithm classified all the patients, and there were no undetermined diagnoses. Diagnostic performance indicators for the ultrasound-based algorithm integrating early DT findings were as follows: area under the receiver operating characteristic curve, 0.91 (95% CI, 0.86-0.96); sensitivity, 87% (95% CI, 76%-94%); specificity, 95% (95% CI, 89%-98%); positive likelihood ratio, 18.1 (95% CI, 7.7-42.8); and negative likelihood ratio, 0.14 (95% CI, 0.07-0.26). CONCLUSION The ultrasound-based algorithm integrating the DT of early mitral filling performs well for diagnosing AHF in emergency patients with dyspnea. The inclusion of early DT allows all patients to be diagnosed.
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Affiliation(s)
- Nicolas L'Hermitte
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
| | - Laura Grau-Mercier
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Fabien Coisy
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Laurent Muller
- Montpellier University, EA2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Laysa Saadi
- Montpellier University, EA2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Pierre-Géraud Claret
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Hugo Krebs
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Xavier Bobbia
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Montpellier University Hospital, Montpellier, Francia
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Sanchez T, Coisy F, Grau-Mercier L, Occelli C, Ajavon F, Claret PG, Markarian T, Bobbia X. Is the shock index correlated with blood loss? An experimental study on a controlled hemorrhagic shock model in piglets. Am J Emerg Med 2024; 75:59-64. [PMID: 37922831 DOI: 10.1016/j.ajem.2023.10.026] [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: 06/13/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION The quantification of blood loss in a severe trauma patient allows prognostic quantification and the engagement of adapted therapeutic means. The Advanced Trauma Life Support classification of hemorrhagic shock, based in part on hemodynamic parameters, could be improved. The search for reproducible and non-invasive parameters closely correlated with blood depletion is a necessity. An experimental model of controlled hemorrhagic shock allowed us to obtain hemodynamic and echocardiographic measurements during controlled blood spoliation. The primary aim was to demonstrate the correlation between the Shock Index (SI) and blood depletion volume (BDV) during the hemorrhagic phase of an experimental model of controlled hemorrhagic shock in piglets. The secondary aim was to study the correlations between blood pressure (BP) values and BDV, SI and cardiac output (CO), and pulse pressure (PP) and stroke volume during the same phase. METHODS We analyzed data from 66 anesthetized and ventilated piglets that underwent blood spoliation at 2 mL.kg-1.min-1 until a mean arterial pressure (MAP) of 40 mmHg was achieved. During this bleeding phase, hemodynamic and echocardiographic measurements were performed regularly. RESULTS The correlation coefficient between the SI and BDV was 0.70 (CI 95%, [0.64; 0.75]; p < 0.01), whereas between MAP and BDV, the correlation coefficient was -0.47 (CI 95%, [-0.55; -0.38]; p < 0.01). Correlation coefficient between SI and CO and between PP and stroke volume were - 0.45 (CI 95%, [-0.53; -0.37], p < 0.01) and 0.62 (CI 95%, [0.56; 0.67]; p < 0.01), respectively. CONCLUSIONS In a controlled hemorrhagic shock model in piglets, the correlation between SI and BDV seemed strong.
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Affiliation(s)
- Thomas Sanchez
- University of Montpellier, Research Unit IMAGINE, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France.
| | - Fabien Coisy
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Laura Grau-Mercier
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Céline Occelli
- University of Côte d'Azur, Faculty of Medecine, Transporter in Imaging and Radiotherapy in Oncology Laboratory, Basic Research Direction - Department of Emergency Medicine, Nice University Hospital, Nice, France
| | - Florian Ajavon
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- University of Montpellier, Research Unit IMAGINE, Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- University of Aix-Marseille, UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE - Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Xavier Bobbia
- University of Montpellier, Research Unit IMAGINE, Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Martin J, Depietro R, Bartoli A, Markarian T, De Maria L, Di Bisceglie M, Persico N, Michelet P, Mege D. Acute mesenteric ischemia: which predictive factors of delayed diagnosis at emergency unit? Eur J Trauma Emerg Surg 2023; 49:1999-2008. [PMID: 36129476 DOI: 10.1007/s00068-022-02112-9] [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: 06/27/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Acute mesenteric ischemia (AMI) is frequently diagnosed late, leading to a poor prognosis. Our aims were to identify predictive factors of delayed diagnosis and to analyze the outcomes of patients with AMI admitted in emergency units. METHODS All the patients with AMI (2015-2020), in two Emergency units, were retrospectively included. Two groups were defined according to the time of diagnosis between the arrival at emergency unit and the CT scan: ≤ 6 h (early), > 6 h (delayed). RESULTS 119 patients (mean age = 71 ± 7 years) were included. The patients with a delayed diagnosis (n = 33, 28%) were significantly associated with atypical presentation, including lower rates of abdominal pain (73 vs 89%, p = 0.003), abdominal tenderness (33 vs 43%, p = 0.03), and plasma lactate (4 ± 2 vs 6 ± 7 mmol/l, p = 0.03) when compared with early diagnosis. After multivariate analysis, the absence of abdominal pain was the only independent predictive factor of delayed diagnosis (Odd Ratio = 0.17; 95% CI = 0.03-0.88, p = 0.03). Patients with delayed diagnosis tended to be associated to lower rates of revascularization (9 vs 17%, p = 0.4), higher rates of major surgical morbidity (90 vs 57%, p = 0.1), longer length of stay (16 ± 23 vs 13 ± 15 days, p = 0.4) and, at the end of follow-up, higher rate of short small bowel syndrome (18 vs 7%, p = 0.095). CONCLUSION AMI is a challenge for emergency physicians. History of patient, physical exam, biological data are not sufficient to diagnose AMI. New biomarkers, and awareness of emergency physicians should improve and accelerate the diagnosis of AMI.
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Affiliation(s)
- Julie Martin
- Department of Emergency, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Rémi Depietro
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Axel Bartoli
- Department of Radiology, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Thibaut Markarian
- Department of Emergency, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Lucille De Maria
- Department of Biochemistry, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Mathieu Di Bisceglie
- Department of Medical Imaging, North Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Nicolas Persico
- Department of Emergency, North Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Pierre Michelet
- Department of Emergency, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Diane Mege
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France.
- Department of Digestive and Oncology Surgery, Timone University Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France.
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Markarian T, Grau-Mercier L, Occelli C, Ajavon F, Claret PG, Coisy F, Bobbia X. Evaluation of a New Echocardiographic Tool for Cardiac Output Monitoring: An Experimental Study on A Controlled Hemorrhagic Shock Model in Anesthetized Piglets. J Clin Med 2022; 11:jcm11185420. [PMID: 36143066 PMCID: PMC9503332 DOI: 10.3390/jcm11185420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/18/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiac output (CO) monitoring is recommended in patients with shock. The search for a reliable, rapid, and noninvasive tool is necessary for clinical practice. A new echocardiographic CO flow index (COF) is the automatic calculation of the sub-aortic VTI multiplied by the automatic calculation of the heart rate (HR). The primary objective of this study was to show the correlation between COF and CO measured by thermodilution (COth) in a controlled hemorrhagic shock model in anesthetized piglets. Secondary objectives were to show the correlation between COth and CO calculated from left outflow tract (LVOT) measurement and manual VTI (COman), and CO measured by LVOT measurement and VTIauto (COauto). Methods: Prospective interventional experimental study. In seventeen ventilated and anesthetized piglets, a state of hemorrhagic shock was induced, maintained, then resuscitated and stabilized. The gold standard for CO and stroke volume measurement was thermodilution (COth). Results: 191 measurements were performed. The correlation coefficients (r) between COth and COF, COman, and COauto were 0.73 [0.62; 0.81], 0.66 [0.56; 0.74], and 0.73 [0.63; 0.81], respectively. Conclusions: In this study, the COF appears to have a strong correlation to the COth. This automatic index, which takes into account the HR and does not require the measurement of LVOT, could be a rapidly obtained index in clinical practice.
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Affiliation(s)
- Thibaut Markarian
- Emergency Department, Timone University Hospital, Aix-Marseille University, 13005 Marseille, France
- Correspondence:
| | - Laura Grau-Mercier
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Céline Occelli
- Emergency Department, Pasteur 2 University Hospital, Nice Côte-d’Azur University, 06000 Nice, France
| | - Florian Ajavon
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Pierre-Géraud Claret
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Fabien Coisy
- Emergency Department, Nîmes University Hospital, Montpellier University, UR UM 103 IMAGINE, 30029 Nîmes, France
| | - Xavier Bobbia
- Emergency Department, Montpellier University Hospital, Montpellier University, UR UM 103 IMAGINE, 34295 Montpellier, France
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Markarian T. Authors reply. Emergencias 2022; 34:328. [PMID: 35833780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
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Grau-Mercier L, Coisy F, Markarian T, Muller L, Roger C, Lefrant JY, Claret PG, Bobbia X. Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets. J Trauma Acute Care Surg 2022; 92:924-930. [PMID: 34991127 DOI: 10.1097/ta.0000000000003518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Assessment of the volemic loss is a major challenge during the management of hemorrhagic shock. Echocardiography is an increasingly used noninvasive tool for hemodynamic assessment. In mechanically ventilated patients, some studies suggest that respiratory variations of mean subaortic time-velocity integral (∆VTI) would be predictive of fluid filling response. An experimental model of controlled hemorrhagic shock provides a precise approach to study correlation between blood volume and cardiac ultrasonographic parameters. OBJECTIVES The main objective was to analyze the ∆VTI changes during hemorrhage in an anesthetized-piglet model of controlled hemorrhagic shock. The secondary objective was to evaluate ∆VTI during the resuscitation process after hemorrhage and other echocardiographic parameters changes during the whole protocol. METHODS Twenty-four anesthetized and ventilated piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to two resuscitation groups: fluid filling group resuscitated with saline solution and noradrenaline group resuscitated with saline solution and noradrenaline. Echocardiography and hemodynamic measures, including pulsed pressure variations (PPV), were performed at different stages of the protocol. RESULTS The correlation coefficient between ΔVTI and PPV with the volume of bleeding during the hemorrhagic phase were respectively 0.24 (95% confidence interval, 0.08-0.39; p < 0.01) and 0.57 (95% CI, 0.44-0.67; p < 0.01). Two parameters had a moderate correlation coefficient with hemorrhage volume (over 0.5): mean subaortic time-velocity index (VTI) and mitral annulus diastolic tissular velocity (E'). CONCLUSION In this hemorrhagic shock model, ΔVTI had a low correlation with the volume of bleeding, but VTI and E' had a correlation with blood volume comparable to that of PPV.
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Affiliation(s)
- Laura Grau-Mercier
- From the Division of Anesthesiology, Critical Care, Pain and Emergency Medicine (L.G.-M., F.C., L.M., C.R., J.-Y.L., P.-G.C.), Nîmes University Hospital, Prévention et prise en charge de la défaillance circulatoire des patients en état de choc (IMAGINE), University of Montpellier, Nîmes; Department of Emergency Medicine (T.M.), Timone University Hospital, Marseille; and Department of Emergency Medicine (X.B.), Montpellier University Hospital Université de Montpellier, Prévention et prise en charge de la défaillance circulatoire des patients en état de choc (IMAGINE), University of Montpellier, Montpellier, France
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Markarian T. Nouvelles approches diagnostiques de l’insuffisance rénale aiguë. Ann Fr Med Urgence 2022. [DOI: 10.3166/afmu-2022-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
L’insuffisance rénale, véritable problème de santé publique, concernerait plus de 82 000 personnes en France. On estime que 5 à 10 % de la population française souffriraient d’une maladie rénale pouvant conduire à une insuffisance rénale avec un taux de mortalité de plus de 10 % par an. À l’inverse de la maladie rénale chronique irréversible, l’insuffisance rénale aiguë est considérée comme un dysfonctionnement transitoire et réversible. Au-delà de l’intérêt de la prévention, le diagnostic précoce de l’insuffisance rénale aiguë permettrait de mettre en place des thérapeutiques adaptées et ciblées afin d’éviter l’évolution vers des lésions rénales irréversibles. Cependant, il demeure un véritable challenge pour le praticien puisque l’on présume que près de 10 % de la population française présenteraient des lésions rénales asymptomatiques. Bien que la définition de l’insuffisance rénale aiguë ait été simplifiée durant ces dernières années, il existe de nombreuses limites. En parallèle, des progrès majeurs ont été réalisés notamment en termes de diagnostic. L’objectif de cette mise au point est de faire un rappel sur l’évolution de l’insuffisance rénale aiguë, les définitions actuelles et de présenter les nouvelles approches diagnostiques en cours de développement.
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Vauthier C, Chabannon M, Markarian T, Taillandy Y, Guillemet K, Krebs H, Bazalgette F, Muller L, Claret PG, Bobbia X. Point-of-care chest ultrasound to diagnose acute heart failure in emergency department patients with acute dyspnea: diagnostic performance of an ultrasound-based algorithm. Emergencias 2021; 33:441-446. [PMID: 34813191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Cardiopulmonary ultrasound imaging can be useful for diagnosing acute heart failure (AHF). We aimed to evaluate the diagnostic performance of an algorithm based on point-of-care ultrasound (POCUS) in patients coming to the emergency department with acute dyspnea. MATERIAL AND METHODS Prospective analysis of a convenience sample of patients with acute dyspnea in 2 hospital emergency departments. The POCUS algorithm included lung ultrasound findings and 3 echocardiographic measurements taken from an apical view of 4 chambers: mitral annular plane systolic excursion, Doppler mitral flow velocity, and tissue Doppler imaging of the lateral mitral annulus. The definitive diagnosis was made by 2 physicians blinded to the POCUS findings. RESULTS A total of 103 adult patients with a mean (SD) age of 73 (12) years were included; about half (51 patients) were women. Forty-two patients (41%) were finally diagnosed with AHF. Interindividual agreement on the physicians' diagnoses was good (k = 0.82). The POCUS algorithm assigned an AHF diagnosis to 76 patients (74%); 56 of them (85%) were in sinus rhythm. The diagnostic performance indicators for the algorithm were as follows: area under the receiver operating characteristic curve, 0.94 (95% CI, 0.88-1.00); sensitivity 96% (95% CI, 78%-100%); specificity, 93% (95% CI, 8%-98%); positive predictive value, 85% (95% CI, 67%-100%); negative predictive value, 98% (95% CI, 88%-100%). CONCLUSION The POCUS-based algorithm for diagnosing AHF performed well in patients coming to the emergency department with acute dyspnea.
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Affiliation(s)
- Candice Vauthier
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Margaux Chabannon
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Thibaut Markarian
- Emergency Department, Hôpital de la Timone, UMR MD2 P2COE, Aix-Marseille Université, Marsella, Francia
| | - Yann Taillandy
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Kevin Guillemet
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Hugo Krebs
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Florian Bazalgette
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Laurent Muller
- Montpellier university, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Pierre-Géraud Claret
- Montpellier university, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Xavier Bobbia
- Montpellier university, EA 2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
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Markarian T, Persico N, Roch A, Ahriz D, Taguet C, Birman G, Mahboubi A, Ducassou J, Bourenne J, Zieleskiewicz L, Bobbia X, Michelet P. Early assessment of patients with COVID-19 and dyspnea using lung ultrasound scoring. Emergencias 2021; 33:354-360. [PMID: 34581528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The main objective was to evaluate the precision of the Modified Lung Ultrasound (MLUS score) for predicting the need for respiratory support in the first 48 hours in patients with dyspnea due to the coronavirus disease 2019 (COVID-19). The secondary objectives were 1) to compare the MLUS and National Early Warning Score 2 (NEWS2), as well as the combination of both scores, as predictors of severity according to the World Health Organization (WHO) Ordinal Scale for Clinical Improvement; and 2) to compare severity assessed by ultrasound scoring to severity assessed by lung computed tomography (CT). MATERIAL AND METHODS Multicenter prospective observational cohort study conducted from March 30 to April 30, 2020, in 2 university hospitals. Adult patients with dyspnea due to COVID-19 were included. An initial lung ultrasound was performed, and the results of MLUS, NEW2, and lung CT evaluations were recorded. Patients were classified by risk according to the WHO scale at 48 hours, as follows: low risk (score less than 5) or high risk (score of 5 or more). RESULTS A total of 100 patients were included: 35 (35%) were classified as low risk and 65 (65%) as high risk. The correlation between the MLUS and WHO assessments was positive and very high (Spearman rank correlation = 0.832; P .001). The area under the receiver operating characteristic curves of the MLUS, NEW2 and combined ultrasound scores, in relation to prediction of risk classification were, respectively, 0.96 (0.93-0.99), 0.89 (0.82-0.95) and 0.98 (0.96-1.0). The MLUS and lung CT assessments were correlated. CONCLUSION An early lung ultrasound score can predict clinical severity in patients with dyspnea due to COVID-19.
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Affiliation(s)
- Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
| | - Nicolas Persico
- Department of Emergency Medicine, North University Hospital, Marsella, Francia. Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia
| | - Antoine Roch
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. Department of Emergency Medicine, North University Hospital, Marsella, Francia. Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia
| | - Dalia Ahriz
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Chloe Taguet
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Guillaume Birman
- Department of Emergency Medicine, North University Hospital, Marsella, Francia
| | - Adela Mahboubi
- Department of Emergency Medicine, North University Hospital, Marsella, Francia
| | - Justine Ducassou
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia
| | - Jeremy Bourenne
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279, CEReSS - Health Services Research and Quality of Life Center, Marsella, Francia. Medecine Intensive Réanimation, Réanimation des Urgences, Timone University Hospital, Marsella, Francia
| | - Laurent Zieleskiewicz
- UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia. Department of Anesthesiology and Intensive Care Medicine, North University Hospital, Marsella, Francia
| | - Xavier Bobbia
- Medecine Intensive Réanimation, Réanimation des Urgences, Timone University Hospital, Marsella, Francia
| | - Pierre Michelet
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. Department of Emergency Medicine, North University Hospital, Marsella, Francia
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Ait Belkacem I, Mossadegh‐keller N, Bourgoin P, Arnoux I, Loosveld M, Morange P, Markarian T, Michelet P, Busnel JM, Roulland S, Galland F, Malergue F. Cell Analysis from Dried Blood Spots: New Opportunities in Immunology, Hematology, and Infectious Diseases. Adv Sci (Weinh) 2021; 8:e2100323. [PMID: 34278739 PMCID: PMC8456206 DOI: 10.1002/advs.202100323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/03/2021] [Indexed: 05/04/2023]
Abstract
Blood cell analysis is a major pillar of biomedical research and healthcare. These analyses are performed in central laboratories. Rapid shipment from collection site to the central laboratories is currently needed because cells and biomarkers degrade rapidly. The dried blood spot from a fingerstick allows the preservation of cellular molecules for months but entire cells are never recovered. Here leucocyte elution is optimized from dried blood spots. Flow cytometry and mRNA expression profiling are used to analyze the recovered cells. 50-70% of the leucocytes that are dried on a polyester solid support via elution after shaking the support with buffer are recovered. While red blood cells lyse upon drying, it is found that the majority of leucocytes are preserved. Leucocytes have an altered structure that is improved by adding fixative in the elution buffer. Leucocytes are permeabilized, allowing an easy staining of all cellular compartments. Common immunophenotyping and mRNAs are preserved. The ability of a new biomarker (CD169) to discriminate between patients with and without Severe Acute Respiratory Syndrome induced by Coronavirus 2 (SARS-CoV-2) infections is also preserved. Leucocytes from blood can be dried, shipped, and/or stored for at least 1 month, then recovered for a wide variety of analyses, potentially facilitating biomedical applications worldwide.
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Affiliation(s)
- Ines Ait Belkacem
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
- Aix Marseille UniversitéCNRSINSERMCIMLCentre d'Immunologie de Marseille‐LuminyMarseille13009France
| | | | - Penelope Bourgoin
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
| | - Isabelle Arnoux
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
| | - Marie Loosveld
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
| | - Pierre‐emmanuel Morange
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
- Aix Marseille UniversitéINSERMINRAEC2VN, 27 Boulevard Jean MoulinMarseille13385France
| | - Thibaut Markarian
- Department of Hematology LaboratoryTimone University HospitalAPHM264 Rue Saint‐PierreMarseille13005France
- Aix Marseille UniversitéINSERMINRAEC2VN, 27 Boulevard Jean MoulinMarseille13385France
| | - Pierre Michelet
- Aix Marseille UniversitéINSERMINRAEC2VN, 27 Boulevard Jean MoulinMarseille13385France
- Department of Emergency Medicine and Intensive CareTimone University HospitalAPHM264 Rue Saint PierreMarseille13005France
| | - Jean Marc Busnel
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
| | - Sandrine Roulland
- Aix Marseille UniversitéCNRSINSERMCIMLCentre d'Immunologie de Marseille‐LuminyMarseille13009France
| | - Franck Galland
- Aix Marseille UniversitéCNRSINSERMCIMLCentre d'Immunologie de Marseille‐LuminyMarseille13009France
| | - Fabrice Malergue
- Department of Research and DevelopmentBeckman Coulter Life Sciences‐Immunotech130 Avenue de Lattre de TassignyMarseille13009France
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Bourgoin P, Soliveres T, Barbaresi A, Loundou A, Belkacem IA, Arnoux I, Bernot D, Loosveld M, Morange PE, Michelet P, Malergue F, Markarian T. CD169 and CD64 could help differentiate bacterial from CoVID-19 or other viral infections in the Emergency Department. Cytometry A 2021; 99:435-445. [PMID: 33491921 PMCID: PMC8014466 DOI: 10.1002/cyto.a.24314] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023]
Abstract
The identification of a bacterial, viral, or even noninfectious cause is essential in the management of febrile syndrome in the emergency department (ED), especially in epidemic contexts such as flu or CoVID-19. The aim was to assess discriminative performances of two biomarkers, CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), using a new flow cytometry procedure, in patients presenting with fever to the ED during epidemics. Eighty five adult patients presenting with potential infection were included during the 2019 flu season in the ED of La Timone Hospital. They were divided into four diagnostic outcomes according to their clinical records: no-infection, bacterial infection, viral infection and co-infection. Seventy six patients with confirmed SARS-CoV-2 infection were also compared to 48 healthy volunteers. For the first cohort, 38 (45%) patients were diagnosed with bacterial infections, 11 (13%) with viral infections and 29 (34%) with co-infections. mCD169 was elevated in patients with viral infections, with a majority of Flu A virus or Respiratory Syncytial Virus, while nCD64 was elevated in subjects with bacterial infections, with a majority of Streptococcus pneumoniae and Escherichia coli. nCD64 and mCD169 showed 90% and 80% sensitivity, and 78% and 91% specificity, respectively, for identifying patients with bacterial or viral infections. When studied in a second cohort, mCD169 was elevated in 95% of patients with SARS-CoV-2 infections and remained at normal level in 100% of healthy volunteers. nCD64 and mCD169 have potential for accurately distinguishing bacterial and acute viral infections. Combined in an easy and rapid flow cytometry procedure, they constitute a potential improvement for infection management in the ED, and could even help for triage of patients during emerging epidemics.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France.,Aix Marseille University, INSERM, INRAE, Marseille, France
| | - Thomas Soliveres
- Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
| | - Alexandra Barbaresi
- Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
| | - Anderson Loundou
- Department of Public Health, EA3279 Self-Perceived Health Assessment Research Unit, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Inès Ait Belkacem
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France.,UMR 7280, Marseille-Luminy Immunology Center (CIML), Marseille, France
| | - Isabelle Arnoux
- Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Denis Bernot
- Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Marie Loosveld
- Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Pierre-Emmanuel Morange
- Aix Marseille University, INSERM, INRAE, Marseille, France.,Department of Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Pierre Michelet
- Aix Marseille University, INSERM, INRAE, Marseille, France.,Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
| | - Fabrice Malergue
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Thibaut Markarian
- Aix Marseille University, INSERM, INRAE, Marseille, France.,Department of Emergency Medicine and Intensive Care, Timone University Hospital, APHM, Marseille, France
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Bobbia X, Markarian T. Intérêt de l'échographie dans la prise en charge des dyspnées en urgence. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
La dyspnée est un motif de prise en charge fréquent en médecine d’urgence. Il y a une relation entre la mise en place du bon traitement étiologique et la morbi-mortalité. Le diagnostic étiologique est souvent cliniquement complexe, en particulier chez les patients âgés. L’échographie pulmonaire permet une excellente analyse lésionnelle pulmonaire. L’échocardiographie transthoracique permet souvent d’en comprendre le mécanisme. L’échographie de compression veineuse des membres inférieurs a un rôle dans la recherche d’embolie pulmonaire. L’articulation de ces outils avec l’examen clinique permet d’améliorer la pertinence clinique du médecin confronté à une situation de dyspnée aigue. L’échographie peut également avoir un rôle d’aide au triage des patients dyspnéiques. Une bonne connaissance des différents syndromes échographiques et de leur intégration dans le raisonnement diagnostique par tous les praticiens est nécessaire à l’amélioration de la prise en charge de ces patients.
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Zieleskiewicz L, Markarian T, Lopez A, Taguet C, Mohammedi N, Boucekine M, Baumstarck K, Besch G, Mathon G, Duclos G, Bouvet L, Michelet P, Allaouchiche B, Chaumoître K, Di Bisceglie M, Leone M. Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Med 2020; 46:1707-1713. [PMID: 32728966 PMCID: PMC7388119 DOI: 10.1007/s00134-020-06186-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022]
Abstract
Purpose The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio. Methods A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. Results One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68–0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357. Conclusion In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity. Electronic supplementary material The online version of this article (10.1007/s00134-020-06186-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France. .,Center for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, 13005, Marseille, France.
| | - Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Alexandre Lopez
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
| | - Chloé Taguet
- Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Neyla Mohammedi
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
| | - Mohamed Boucekine
- Centre D'Etudes Et de Recherches Sur Les Services de Santé Et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Karine Baumstarck
- Centre D'Etudes Et de Recherches Sur Les Services de Santé Et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Guillaume Besch
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital of Besancon,, University of Franche-Comte, 2. EA3920, Besancon, France
| | - Gautier Mathon
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Service de Réanimation, 69310, Pierre-Bénite, France
| | - Gary Duclos
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
| | - Lionel Bouvet
- Service Anesthésie Réanimation, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.,Lyon1, Université Claude Bernard, Villeurbanne, France.,VetAgro Sup, Pulmonary and Cardiovascular Aggresion in Sepsis, UPSP 2016.A101, Université de Lyon, Campus Vétérinaire de Lyon, 69280, Marcy l'Étoile, France
| | - Pierre Michelet
- Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Bernard Allaouchiche
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Service de Réanimation, 69310, Pierre-Bénite, France.,Lyon1, Université Claude Bernard, Villeurbanne, France.,VetAgro Sup, Pulmonary and Cardiovascular Aggresion in Sepsis, UPSP 2016.A101, Université de Lyon, Campus Vétérinaire de Lyon, 69280, Marcy l'Étoile, France
| | - Kathia Chaumoître
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Aix Marseille University, Service d'Imagerie Médicale, 13015, Marseille, France
| | - Mathieu Di Bisceglie
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Aix Marseille University, Service d'Imagerie Médicale, 13015, Marseille, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
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Chaptal M, Tendron L, Claret PG, Muller L, Markarian T, Mattatia L, Roger C, de la Coussaye JE, Pelaccia T, Bobbia X. Focused Cardiac Ultrasound: A Prospective Randomized Study of Simulator-Based Training. J Am Soc Echocardiogr 2020; 33:404-406. [DOI: 10.1016/j.echo.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022]
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Bourgoin P, Lediagon G, Arnoux I, Bernot D, Morange PE, Michelet P, Malergue F, Markarian T. Flow cytometry evaluation of infection-related biomarkers in febrile subjects in the emergency department. Future Microbiol 2020; 15:189-201. [PMID: 32065550 DOI: 10.2217/fmb-2019-0256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: In an Emergency Department (ED), the etiological identification of infected subjects is essential. 13 infection-related biomarkers were assessed using a new flow cytometry procedure. Materials & methods: If subjects presented with febrile symptoms at the ED, 13 biomarkers' levels, including CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), were tested and compared with clinical records. Results: Among 50 subjects, 78% had bacterial infections and 8% had viral infections. nCD64 showed 82% sensitivity and 91% specificity for identifying subjects with bacterial infections. mCD169, HLA-ABC ratio and HLA-DR on monocytes had high values in subjects with viral infections. Conclusion: Biomarkers showed promising performances to improve the ED's infectious stratification.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France.,C2VN INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - Guillaume Lediagon
- Adult Emergency Unit, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Isabelle Arnoux
- Hematology Laboratory, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Denis Bernot
- Hematology Laboratory, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Pierre-Emmanuel Morange
- C2VN INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France.,Hematology Laboratory, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Pierre Michelet
- Adult Emergency Unit, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Fabrice Malergue
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France
| | - Thibaut Markarian
- Adult Emergency Unit, La Timone Hospital, APHM, 264 Rue Saint Pierre, 13385 Marseille, France
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Markarian T, Loundou A, Heyer V, Marimoutou C, Borghese L, Coulange M, Michelet P. Drowning Classification: A Reappraisal of Clinical Presentation and Prognosis for Severe Cases. Chest 2020; 158:596-602. [PMID: 32067943 DOI: 10.1016/j.chest.2020.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles. METHODS This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in ICUs located in France, French Polynesia, and the French Antilles. Patients were classified according to the drowning classification system proposed by Szpilman. RESULTS During the study period, 312 drowning patients were admitted with severe clinical presentation (grades 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (emergency medical services), starting from the prehospital period. Although the global hospital mortality was similar to that previously reported (18.5%), great differences existed among the severity grades. Respective grade mortalities were low for grades 2 through 5 (grade 2, 0%; grade 3, 3%; grade 4, 0%; grade 5, 2%), and the mortality for grade 6 remained similar to that previously reported (54%). These results confirmed that the occurrence of cardiac arrest after drowning is still bad prognosis. Conversely, for other grades, this study strengthens the importance of specialized intervention to interrupt the drowning process. CONCLUSIONS On the basis of these results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, the prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.
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Affiliation(s)
- Thibaut Markarian
- Emergency Department, Timone University Hospital, Aix-Marseille University, Marseille, France.
| | - Anderson Loundou
- Emergency Department, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Vera Heyer
- Emergency Department, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Cyril Marimoutou
- Intensive Care Unit, Pointe-à-Pitre University Hospital, Guadeloupe, France
| | - Laurie Borghese
- Emergency Department, Taone Hospital, Papeete, French Polynesia
| | - Mathieu Coulange
- Hyperbaric Medicine Unit, Sainte Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Pierre Michelet
- Emergency Department, Timone University Hospital, Aix-Marseille University, Marseille, France
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Bourgoin P, Soliveres T, Ahriz D, Arnoux I, Meisel C, Unterwalder N, Morange PE, Michelet P, Malergue F, Markarian T. Clinical research assessment by flow cytometry of biomarkers for infectious stratification in an Emergency Department. Biomark Med 2019; 13:1373-1386. [PMID: 31617736 DOI: 10.2217/bmm-2019-0214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: Management of patients with infections within the Emergency Department (ED) is challenging for practitioners, as the identification of infectious causes remains difficult with current techniques. A new combination of two biomarkers was tested with a new rapid flow cytometry technique. Materials & methods: Subjects from the ED were tested for their CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169) levels and results were compared to their clinical records. Results: Among 139 patients, 29% had confirmed bacterial infections and 5% viral infections. nCD64 and mCD169 respectively showed 88 and 86% sensitivity and 90 and 100% specificity for identifying subjects in bacterial or viral conditions. Conclusion: This point-of-care technique could allow better management of patients in the ED.
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Affiliation(s)
- Pénélope Bourgoin
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France.,C2VN Department, INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - Thomas Soliveres
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Dalia Ahriz
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Isabelle Arnoux
- Hematology Laboratory Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Christian Meisel
- Department of Medical Immunology, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Sylter Strasse 2, 13353 Berlin, Germany
| | - Nadine Unterwalder
- Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Sylter Strasse 2, 13353 Berlin, Germany
| | - Pierre-Emmanuel Morange
- C2VN Department, INSERM-INRA, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille, France.,Hematology Laboratory Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Pierre Michelet
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - Fabrice Malergue
- Department of Research & Development, Beckman Coulter Life Sciences-Immunotech, 130 Avenue de Lattre de Tassigny, 13009 Marseille, France
| | - Thibaut Markarian
- Adult Emergency Department, La Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
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Genre Grandpierre R, Bobbia X, Muller L, Markarian T, Occéan BV, Pommet S, Roger C, Lefrant JY, de la Coussaye JE, Claret PG. Ultrasound guidance in difficult radial artery puncture for blood gas analysis: A prospective, randomized controlled trial. PLoS One 2019; 14:e0213683. [PMID: 30893349 PMCID: PMC6426205 DOI: 10.1371/journal.pone.0213683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/22/2018] [Accepted: 02/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Ultrasound (US) guidance has yet to prove its applicability in radial arterial blood gas analysis (ABGA) punctures. The main objective of our study was to compare the number of first-attempt successes (NFAS) for radial arterial puncture in difficult patients with or without US guidance. The Secondary aims were to compare the number of punctures (NOP), puncture time, and patient pain. Methods In this single-center, randomized controlled trial, patients who required a radial ABGA and in whom the arterial puncture was assessed as difficult (because of non-palpable radial arteries or two previous puncture failures by a nurse) were assigned to the US group or no-US (NUS) group (procedure performed by a trained physician). Results Thirty-six patients were included in the US group and 37 in the NUS groups. The NFAS was 7 (19%) in the NUS group and 19 (53%) in the US group. The relative risk of success in the US group was 2.79 (95% CI,1.34 to 5.82), p = 0.01. In the NUS and US groups, respectively, the median NOP was 3 [2; 6] vs. 1 [1; 2], estimated difference −2.0 (95%CI, −3.4 to −0.6), p < 0.01; the respective puncture time was 3.1 [1.6; 5.4] vs. 1.4 [0.6; 3.1] min, estimated difference −1.45 (95%CI, −2.57 to −0.39), p = 0.01; the respective median patient pain was 6 [4; 8] vs. 2 [1; 4], estimated difference −4.0 (95%CI, −5.8 to −2.3); p < 0.01. Conclusion US guidance by a trained physician significantly improves the rate of success in difficult radial ABGA patients.
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Affiliation(s)
- Romain Genre Grandpierre
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
- * E-mail:
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Bob-Valéry Occéan
- Department of Biostatistics, Nîmes University Hospital, Nîmes, France
| | - Stéphane Pommet
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de la Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
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Stowell A, Bobbia X, Cheret J, Genre Grandpierre R, Moreau A, Pommet S, Lefrant JY, de La Coussaye JE, Markarian T, Claret PG. Out-of-hospital Times Using Helicopters Versus Ground Services for Emergency Patients. Air Med J 2019; 38:100-105. [PMID: 30898280 DOI: 10.1016/j.amj.2018.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/25/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Minimizing out-of-hospital time reduces morbidity and mortality in patients with severe trauma, acute coronary syndrome, or acute stroke. Our objective was to compare out-of-hospital times by helicopter versus ground services when the estimated time of arrival on the scene was over 20 minutes. METHODS We proposed a retrospective observational monocentric study following 2 cohorts. The helicopter group and the ground group included patients with severe trauma, acute coronary syndrome, or acute stroke transported by helicopter or ground services. RESULTS Two hundred thirty-nine patients were included; 118 were in the ground group, and 121 were in the helicopter group. Distances for the helicopter group were higher (62.1 ± 22.5 km vs. 27.6 ± 10.4 km, P < .001). When distances were over 35 km, the helicopter group was faster. We identified distance, need for surgery, and intensive care hospitalization as 3 predicting factors for choosing helicopters over ground modes of transport. CONCLUSION In cases of severe trauma, acute coronary syndrome, or acute stroke, emergency medical helicopter transport can be chosen over ground transport when patients are in a severe state and when the distance is further than 35 km from the hospital.
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Affiliation(s)
- Andrew Stowell
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France; Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
| | - Julien Cheret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Romain Genre Grandpierre
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Alexandre Moreau
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Stéphane Pommet
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean-Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
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Cassignol A, Markarian T, Cotte J, Marmin J, Nguyen C, Cardinale M, Pauly V, Kerbaul F, Meaudre E, Bobbia X. Evaluation and Comparison of Different Prehospital Triage Scores of Trauma Patients on In-Hospital Mortality. PREHOSP EMERG CARE 2019; 23:543-550. [DOI: 10.1080/10903127.2018.1549627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chetioui A, Masia T, Claret PG, Markarian T, Muller L, Lefrant JY, de La Coussaye JE, Roger C, Bobbia X. Pocket-sized ultrasound device for internal jugular puncture: A randomized study of performance on a simulation model. J Vasc Access 2018; 20:404-408. [DOI: 10.1177/1129729818812733] [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] [Indexed: 01/05/2023] Open
Affiliation(s)
- Adrien Chetioui
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaud Masia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
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Seguin C, Blaquière G, Loundou A, Michelet P, Markarian T. Unmanned aerial vehicles (drones) to prevent drowning. Resuscitation 2018; 127:63-67. [PMID: 29653153 DOI: 10.1016/j.resuscitation.2018.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/19/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Drowning literature have highlighted the submersion time as the most powerful predictor in assessing the prognosis. Reducing the time taken to provide a flotation device and prevent submersion appears of paramount importance. Unmanned aerial vehicles (UAVs) can provide the location of the swimmer and a flotation device. OBJECTIVE The objective of this simulation study was to evaluate the efficiency of a UAV in providing a flotation device in different sea conditions, and to compare the times taken by rescue operations with and without a UAV (standard vs UAV intervention). Several comparisons were made using professional lifeguards acting as simulated victims. A specifically-shaped UAV was used to allow us to drop an inflatable life buoy into the water. RESULTS During the summer of 2017, 28 tests were performed. UAV use was associated with a reduction of time it took to provide a flotation device to the simulated victim compared with standard rescue operations (p < 0.001 for all measurements) and the time was reduced even further in moderate (81 ± 39 vs 179 ± 78 s; p < 0.001) and rough sea conditions (99 ± 34 vs 198 ± 130 s; p < 0.001). The times taken for UAV to locate the simulated victim, identify them and drop the life buoy were not altered by the weather conditions. CONCLUSION UAV can deliver a flotation device to a swimmer safely and quickly. The addition of a UAV in rescue operations could improve the quality and speed of first aid while keeping lifeguards away from dangerous sea conditions.
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Affiliation(s)
- Celia Seguin
- Emergency Medical Service - SAMU 40, Centre Hospitalier Layné, Mont de Marsan, France
| | - Gilles Blaquière
- Emergency Medical Service - SAMU 40, Centre Hospitalier Layné, Mont de Marsan, France
| | - Anderson Loundou
- Health Assessment Research Unit, EA 3279, Department of Public Health, Aix-Marseille Université, Marseille, France
| | - Pierre Michelet
- Emergency Department, Hôpital de la Timone, UMR MD2 P2COE, Aix-Marseille Université, Marseille, France
| | - Thibaut Markarian
- Emergency Department, Hôpital de la Timone, UMR MD2 P2COE, Aix-Marseille Université, Marseille, France.
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Pujol S, Laurent J, Markarian T, Claret PG, Lefrant JY, Roger C, Muller L, de La Coussaye JE, Perez-Martin A, Bobbia X. Compression with a pocket-sized ultrasound device to diagnose proximal deep vein thrombosis. Am J Emerg Med 2018; 36:1262-1264. [PMID: 29653786 DOI: 10.1016/j.ajem.2018.03.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Compression ultrasonography (CUS) is a validated technique for the diagnosis of deep venous thrombosis (DVT), but has never been studied with pocket-sized ultrasound device (PUD). The main objective of this study was to assess the diagnostic performance of CUS made by emergency physicians (EPs) using a PUD. MATERIALS This was a prospective, diagnostic test assessment, single-center study. Patients underwent VCU performed by a trained EP with PUD (CUS-PUD) for searching proximal DVT (PDVT) and were then seen by an expert vascular physician who blindly performed a duplex venous ultrasound, which was the criterion standard. CUS-PUD's diagnostic performance was evaluated by sensitivity (Se), specificity (Sp), and positive and negative predictive values (PPV and NPV). RESULTS The sample included 57 patients of whom 56 were analyzed. Eleven (20%) PDVT were diagnosed with CUS-PUD: 7 (64%) femoral and 4 (36%) popliteal. The CUS-PUD's Se was 100% [72%; 100%], Sp 100% [92%; 100%]. The PPV was 100% [74%; 100%], and the NPV was 100% [90%; 100%]. CONCLUSION CUS-PUD performed with a pocket-sized ultrasound appears to be feasible in emergency practice for the diagnosis of proximal DVT. A study with a larger sample size will have to describe the accuracy.
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Affiliation(s)
- Sarah Pujol
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jeremy Laurent
- Department of Vascular Medicine and Laboratory, CHU de Nîmes, hôpital Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Antonia Perez-Martin
- Department of Vascular Medicine and Laboratory, CHU de Nîmes, hôpital Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France; Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
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Pontis E, Claret PG, Markarian T, Javaudin F, Flacher A, Roger C, Muller L, de La Coussaye JE, Bobbia X. Integration of lung ultrasound in the diagnostic reasoning in acute dyspneic patients: A prospective randomized study. Am J Emerg Med 2018; 36:1597-1602. [PMID: 29366658 DOI: 10.1016/j.ajem.2018.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Misdiagnosis in acute dyspneic patients (ADP) has consequences on their outcome. Lung ultrasound (LUS) is an accurate tool to improve diagnostic performance. The main goal of this study was to assess the determinants of increased diagnostic accuracy using LUS. MATERIALS Multicentre, prospective, randomized study including emergency physicians and critical care physicians treating ADP on a daily basis. Each participant received three difficult clinical cases of ADP: one with only clinical data (OCD), one with only LUS data (OLD), and one with both. Ultrasound video loops of A, B and C profiles were associated with the cases. Which physician received what data for which clinical case was randomized. Physicians assessed the diagnostic probability from 0 to 10 for each possible diagnosis. The number of uncertain diagnoses (NUD) was the number of diagnoses with a diagnostic probability between 3 and 7, inclusive. RESULTS Seventy-six physicians responded to the study cases (228 clinical cases resolved). Among the respondents, 28 (37%) were female, 64 (84%) were EPs, and the mean age was 37±8 years. The mean NUDs, respectively, when physicians had OCD, OLD, and both were 2.9±1.8, 2.2±1.7, 2.2±1.8 (p = 0.02). Ultrasound data and ultrasound frequency of use were the only variables related to the NUD. Higher frequency of ultrasound use by physicians decreased the number of uncertain diagnoses in difficult clinical cases with ultrasound data (OLD or associated with clinical data). CONCLUSION LUS decreases the NUD in ADP. The ultrasound frequency of use decreased the NUD in ADP clinical cases with LUS data.
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Affiliation(s)
- Emmanuel Pontis
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
| | - Francois Javaudin
- Emergency Department, Nantes University Hospital, 44093 Nantes, France.
| | | | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France.
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré, 30029 Nîmes, France; Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
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