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Xu X, Ma H, Zhang Y, Liu W, Jung B, Li X, Shen L. Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial. BMC Anesthesiol 2024; 24:181. [PMID: 38773386 DOI: 10.1186/s12871-024-02560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression. METHODS This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute. RESULTS A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants. CONCLUSIONS The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings. TRIAL REGISTRATION Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yuelun Zhang
- Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University, Montpellier, France
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Xu Li
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
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Shahn Z, Jung B, Talmor D, Kennedy EH, Lehman LWH, Baedorf-Kassis E. The impact of aggressive and conservative propensity for initiation of neuromuscular blockade in mechanically ventilated patients with hypoxemic respiratory failure. J Crit Care 2024; 82:154803. [PMID: 38552450 DOI: 10.1016/j.jcrc.2024.154803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Neuromuscular blockade (NMB) in ventilated patients may cause benefit or harm. We applied "incremental interventions" to determine the impact of altering NMB initiation aggressiveness. METHODS Retrospective cohort study of ventilated patients with PaO2/FiO2 ratio < 150 mmHg and PEEP≥ 8cmH2O from the Medical Information Mart of Intensive Care IV database (MIMIC-IV version 1.0) estimating the effect of incremental interventions on in-hospital mortality and ventilator-free days, modifying hourly propensity for NMB initiation to be aggressive or conservative relative to usual care, adjusting for confounding with inverse probability weighting. RESULTS 5221 patients were included (13.3% initiated on NMB). Incremental interventions estimated a strong effect on NMB usage: 5-fold higher hourly odds of initiation increased usage to 36.5% (CI = [34.3%,38.7%]) and 5-fold lower odds decreased usage to 3.8% (CI = [3.3%,4.3%]). Aggressive and conservative strategies demonstrated a U-shaped mortality relationship. 5-fold higher or lower propensity increased in-hospital mortality by 2.6% (0.95 CI = [1.5%,3.7%]) or 1.3% (0.95 CI = [0.1%,2.5%]) respectively. In secondary analysis of a healthier patient cohort, results were similar, however conservative strategies also improved ventilator-free days. INTERPRETATION Aggressive or conservative initiation of NMB may worsen mortality. In healthier populations, marginally conservative NMB initiation strategies may lead to increased ventilator free days with minimal impact on mortality.
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Affiliation(s)
- Zach Shahn
- MIT-IBM Watson AI Lab, Cambridge, MA, United States of America; CUNY Graduate School of Public Health and Health Policy, New York City, NY, United States of America
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University, Montpellier, France; Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, United States of America; Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, United States of America
| | - Daniel Talmor
- Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, United States of America
| | - Edward H Kennedy
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, PA 15213, United States of America
| | - Li-Wei H Lehman
- MIT-IBM Watson AI Lab, Cambridge, MA, United States of America; Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02142, United States of America
| | - Elias Baedorf-Kassis
- Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, United States of America; Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, United States of America.
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von Wedel D, Redaelli S, Suleiman A, Wachtendorf LJ, Fosset M, Santer P, Shay D, Munoz-Acuna R, Chen G, Talmor D, Jung B, Baedorf-Kassis EN, Schaefer MS. Adjustments of Ventilator Parameters during Operating Room-to-ICU Transition and 28-Day Mortality. Am J Respir Crit Care Med 2024; 209:553-562. [PMID: 38190707 DOI: 10.1164/rccm.202307-1168oc] [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: 07/09/2023] [Accepted: 01/08/2024] [Indexed: 01/10/2024] Open
Abstract
Rationale: Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives: To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods: Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results: Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (-1.1 ml/kg predicted body weight [IQR, -2.0 to -0.2]; P < 0.001; and -4.3 cm H2O [-8.2 to -1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [-1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4-1.0, both per 1 J/min). Conclusion: During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality.
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Affiliation(s)
- Dario von Wedel
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Simone Redaelli
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Maxime Fosset
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Medical Intensive Care Unit and PhyMedExp, Institut National de la Santé et de la Recherche Médicale, Montpellier University Hospital, Montpellier, France
| | - Peter Santer
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Denys Shay
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Medical Intensive Care Unit and PhyMedExp, Institut National de la Santé et de la Recherche Médicale, Montpellier University Hospital, Montpellier, France
| | - Elias N Baedorf-Kassis
- Department of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine
- Center for Anesthesia Research Excellence, and
- Department of Anesthesiology, Düsseldorf University Hospital, Dusseldorf, Germany
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Redaelli S, von Wedel D, Fosset M, Suleiman A, Chen G, Alingrin J, Gong MN, Gajic O, Goodspeed V, Talmor D, Schaefer MS, Jung B. Inflammatory subphenotypes in patients at risk of ARDS: evidence from the LIPS-A trial. Intensive Care Med 2023; 49:1499-1507. [PMID: 37906258 DOI: 10.1007/s00134-023-07244-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/23/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Latent class analysis (LCA) has identified hyper- and non-hyper-inflammatory subphenotypes in patients with acute respiratory distress syndrome (ARDS). It is unknown how early inflammatory subphenotypes can be identified in patients at risk of ARDS. We aimed to test for inflammatory subphenotypes upon presentation to the emergency department. METHODS LIPS-A was a trial of aspirin to prevent ARDS in at-risk patients presenting to the emergency department. In this secondary analysis, we performed LCA using clinical, blood test, and biomarker variables. RESULTS Among 376 (96.4%) patients from the LIPS-A trial, two classes were identified upon presentation to the emergency department (day 0): 72 (19.1%) patients demonstrated characteristics of a hyper-inflammatory and 304 (80.9%) of a non-hyper-inflammatory subphenotype. 15.3% of patients in the hyper- and 8.2% in the non-hyper-inflammatory class developed ARDS (p = 0.07). Patients in the hyper-inflammatory class had fewer ventilator-free days (median [interquartile range, IQR] 28[23-28] versus 28[27-28]; p = 0.010), longer intensive care unit (3[2-6] versus 0[0-3] days; p < 0.001) and hospital (9[6-18] versus 5[3-9] days; p < 0.001) length of stay, and higher 1-year mortality (34.7% versus 20%; p = 0.008). Subphenotypes were identified on day 1 and 4 in a subgroup with available data (n = 244). 77.9% of patients remained in their baseline class throughout day 4. Patients with a hyper-inflammatory subphenotype throughout the study period (n = 22) were at higher risk of ARDS (36.4% versus 10.4%; p = 0.003). CONCLUSION Hyper- and non-hyper-inflammatory subphenotypes may precede ARDS development, remain identifiable over time, and can be identified upon presentation to the emergency department. A hyper-inflammatory subphenotype predicts worse outcomes.
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Affiliation(s)
- Simone Redaelli
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Dario von Wedel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maxime Fosset
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Medical Intensive Care Unit and PhyMedExp, Montpellier University Hospital, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INRIA, Montpellier, France
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julie Alingrin
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille Université, Assistance Publique Hôpitaux Universitaire de Marseille, Nord Hospital, Marseille, France
| | - Michelle N Gong
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ognjen Gajic
- Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Valerie Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
- Center for Anesthesia Research Excellence (CARE), Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Medical Intensive Care Unit and PhyMedExp, Montpellier University Hospital, Montpellier, France
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Jung B, Huguet H, Molinari N, Jaber S. Sodium bicarbonate for the treatment of severe metabolic acidosis with moderate or severe acute kidney injury in the critically ill: protocol for a randomised clinical trial (BICARICU-2). BMJ Open 2023; 13:e073487. [PMID: 37591655 PMCID: PMC10441043 DOI: 10.1136/bmjopen-2023-073487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION When both severe metabolic acidemia (pH equal or less than 7.20; PaCO2 equal or less than 45 mm Hg and bicarbonate concentration equal or less than of 20 mmol/L) and moderate-to-severe acute kidney injury are observed, day 28 mortality is approximately 55%-60%. A multiple centre randomised clinical trial (BICARICU-1) has suggested that sodium bicarbonate infusion titrated to maintain the pH equal or more than 7.30 is associated with a higher survival rate (secondary endpoint) in a prespecified stratum of patients with both severe metabolic acidemia and acute kidney injury patients. Whether sodium bicarbonate infusion may improve survival at day 90 (primary outcome) in these severe acute kidney injury patients is currently unknown. METHODS AND ANALYSIS The sodium bicarbonate for the treatment of severe metabolic acidosis with moderate or severe acute kidney injury in the critically ill: a randomised clinical trial (BICARICU-2) trial is an investigator-initiated, multiple centre, stratified, parallel-group, unblinded trial with a computer-generated allocation sequence and an electronic system-based randomisation. After randomisation, the intervention group will receive 4.2% sodium bicarbonate infusion to target a plasma pH equal or more than 7.30 while the control group will not receive sodium bicarbonate. The primary outcome is the day 90 mortality. Main secondary outcomes are organ support dependences. ETHICS AND DISSEMINATION The trial has been approved by the appropriate ethics committee (CPP Nord Ouest, Rouen, France, 25 April 2019, number: 19.03.15.72446). Informed consent is required. If sodium bicarbonate improves day 90 mortality, it will become part of the routine care. TRIAL REGISTRATION NUMBER NCT04010630.
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Affiliation(s)
- Boris Jung
- Department of Medical Intensive Care, Montpellier University Hospital, Montpellier, France
- PhyMedExp Laboratory, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Department of Statistics, Montpellier Université d'Excellence, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, Montpellier Université d'Excellence, Montpellier, France
| | - Samir Jaber
- PhyMedExp Laboratory, University of Montpellier, Montpellier, France
- Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France
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Azizi BA, Munoz-Acuna R, Suleiman A, Ahrens E, Redaelli S, Tartler TM, Chen G, Jung B, Talmor D, Baedorf-Kassis EN, Schaefer MS. Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study. J Intensive Care 2023; 11:14. [PMID: 37024938 PMCID: PMC10077655 DOI: 10.1186/s40560-023-00662-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Previous studies linked a high intensity of ventilation, measured as mechanical power, to mortality in patients suffering from "classic" ARDS. By contrast, mechanically ventilated patients with a diagnosis of COVID-19 may present with intact pulmonary mechanics while undergoing mechanical ventilation for longer periods of time. We investigated whether an association between higher mechanical power and mortality is modified by a diagnosis of COVID-19. METHODS This retrospective study included critically ill, adult patients who were mechanically ventilated for at least 24 h between March 2020 and December 2021 at a tertiary healthcare facility in Boston, Massachusetts. The primary exposure was median mechanical power during the first 24 h of mechanical ventilation, calculated using a previously validated formula. The primary outcome was 30-day mortality. As co-primary analysis, we investigated whether a diagnosis of COVID-19 modified the primary association. We further investigated the association between mechanical power and days being alive and ventilator free and effect modification of this by a diagnosis of COVID-19. Multivariable logistic regression, effect modification and negative binomial regression analyses adjusted for baseline patient characteristics, severity of disease and in-hospital factors, were applied. RESULTS 1,737 mechanically ventilated patients were included, 411 (23.7%) suffered from COVID-19. 509 (29.3%) died within 30 days. The median mechanical power during the first 24 h of ventilation was 19.3 [14.6-24.0] J/min in patients with and 13.2 [10.2-18.0] J/min in patients without COVID-19. A higher mechanical power was associated with 30-day mortality (ORadj 1.26 per 1-SD, 7.1J/min increase; 95% CI 1.09-1.46; p = 0.002). Effect modification and interaction analysis did not support that this association was modified by a diagnosis of COVID-19 (95% CI, 0.81-1.38; p-for-interaction = 0.68). A higher mechanical power was associated with a lower number of days alive and ventilator free until day 28 (IRRadj 0.83 per 7.1 J/min increase; 95% CI 0.75-0.91; p < 0.001, adjusted risk difference - 2.7 days per 7.1J/min increase; 95% CI - 4.1 to - 1.3). CONCLUSION A higher mechanical power is associated with elevated 30-day mortality. While patients with COVID-19 received mechanical ventilation with higher mechanical power, this association was independent of a concomitant diagnosis of COVID-19.
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Affiliation(s)
- Basit A Azizi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simone Redaelli
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim M Tartler
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA
| | - Elias N Baedorf-Kassis
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline Ave 330, Boston, MA, USA.
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
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Shahn Z, Choudhri A, Jung B, Talmor D, Lehman LWH, Baedorf-Kassis E. Effects of aggressive and conservative strategies for mechanical ventilation liberation. J Crit Care 2023; 76:154275. [PMID: 36796189 DOI: 10.1016/j.jcrc.2023.154275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The optimal approach for transitioning from strict lung protective ventilation to support modes of ventilation when patients determine their own respiratory rate and tidal volume remains unclear. While aggressive liberation from lung protective settings could expedite extubation and prevent harm from prolonged ventilation and sedation, conservative liberation could prevent lung injury from spontaneous breathing. RESEARCH QUESTION Should physicians take a more aggressive or conservative approach to liberation? METHODS Retrospective cohort study of mechanically ventilated patients from the Medical Information Mart for Intensive Care IV database (MIMIC-IV version 1.0) estimating effects of incremental interventions modifying the propensity for liberation to be more aggressive or conservative relative to usual care, with adjustment for confounding via inverse probability weighting. Outcomes included in-hospital mortality, ventilator free days, and ICU free days. Analysis was performed on the entire cohort as well as subgroups differentiated by PaO2/FiO2 ratio, and SOFA. RESULTS 7433 patients were included. Strategies multiplying the odds of a first liberation relative to usual care at each hour had a large impact on time to first liberation attempt (43 h under usual care, 24 h (0.95 CI = [23,25]) with an aggressive strategy doubling liberation odds, and 74 h (0.95 CI = [69,78]) under a conservative strategy halving liberation odds). In the full cohort, we estimated aggressive liberation increased ICU-free days by 0.9 days (0.95 CI = [0.8,1.0]) and ventilator free days by 0.82 days (0.95 CI = [0.67,0.97]), but had minimal effect on mortality (only a 0.3% (0.95 CI = [-0.2%,0.8%]) difference between minimum and maximum rates). With baseline SOFA≥ 12 (n = 1355), aggressive liberation moderately increased mortality (58.5% [0.95 CI = (55.7%,61.2%)]) compared with conservative liberation (55.1% [0.95 CI = (51.6%,58.6%)]). INTERPRETATION Aggressive liberation may improve ventilator free and ICU free days with little impact on mortality in patients with SOFA score < 12. Trials are needed.
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Affiliation(s)
- Zach Shahn
- IBM Research, Yorktown Heights, NY 10598, USA; MIT-IBM Watson AI Lab, Cambridge, MA, USA; CUNY School of Public Health, New York City, New York, USA.
| | - Aman Choudhri
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University, Montpellier, France; Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel Talmor
- Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Li-Wei H Lehman
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA; MIT-IBM Watson AI Lab, Cambridge, MA, USA
| | - Elias Baedorf-Kassis
- Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA; Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
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8
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De Jong A, Bignon A, Stephan F, Godet T, Constantin JM, Asehnoune K, Sylvestre A, Sautillet J, Blondonnet R, Ferrandière M, Seguin P, Lasocki S, Rollé A, Fayolle PM, Muller L, Pardo E, Terzi N, Ramin S, Jung B, Abback PS, Guerci P, Sarton B, Rozé H, Dupuis C, Cousson J, Faucher M, Lemiale V, Cholley B, Chanques G, Belafia F, Huguet H, Futier E, Azoulay E, Molinari N, Jaber S, BIGNON ANNE, STEPHAN FRANÇOIS, GODET THOMAS, CONSTANTIN JEANMICHEL, ASEHNOUNE KARIM, SYLVESTRE AUDE, SAUTILLET JULIETTE, BLONDONNET RAIKO, FERRANDIERE MARTINE, SEGUIN PHILIPPE, LASOCKI SIGISMOND, ROLLE AMELIE, FAYOLLE PIERREMARIE, MULLER LAURENT, PARDO EMMANUEL, TERZI NICOLAS, RAMIN SEVERIN, JUNG BORIS, ABBACK PAERSELIM, GUERCI PHILIPPE, SARTON BENJAMINE, ROZE HADRIEN, DUPUIS CLAIRE, COUSSON JOEL, FAUCHER MARION, LEMIALE VIRGINIE, CHOLLEY BERNARD, CHANQUES GERALD, BELAFIA FOUAD, HUGUET HELENA, FUTIER EMMANUEL, GNIADEK CLAUDINE, VONARB AURELIE, PRADES ALBERT, JAILLET CARINE, CAPDEVILA XAVIER, CHARBIT JONATHAN, GENTY THIBAUT, REZAIGUIA-DELCLAUX SAIDA, IMBERT AUDREY, PILORGE CATHERINE, CALYPSO ROMAN, BOUTEAU-DURAND ASTRID, CARLES MICHEL, MEHDAOUI HOSSEN, SOUWEINE BERTRAND, CALVET LAURE, JABAUDON MATTHIEU, RIEU BENJAMIN, CANDILLE CLARA, SIGAUD FLORIAN, RIU BEATRICE, PAPAZIAN LAURENT, VALERA SABINE, MOKART DJAMEL, CHOW CHINE LAURENT, BISBAL MAGALI, POULIQUEN CAMILLE, DE GUIBERT JEANMANUEL, TOURRET MAXIME, MALLET DAMIEN, LEONE MARC, ZIELESKIEWICZ LAURENT, COSSIC JEANNE, ASSEFI MONA, BARON ELODIE, QUEMENEUR CYRIL, MONSEL ANTOINE, BIAIS MATTHIEU, OUATTARA ALEXANDRE, BONNARDEL ELINE, MONZIOLS SIMON, MAHUL MARTIN, LEFRANT JEANYVES, ROGER CLAIRE, BARBAR SABER, LAMBIOTTE FABIEN, SAINT-LEGER PIEHR, PAUGAM CATHERINE, POTTECHER JULIEN, LUDES PIERREOLIVIER, DARRIVERE LUCIE, GARNIER MARC, KIPNIS ERIC, LEBUFFE GILLES, GAROT MATTHIAS, FALCONE JEREMY, CHOUSTERMAN BENJAMIN, COLLET MAGALI, GAYAT ETIENNE, DELLAMONICA JEAN, MFAM WILLYSERGE, OCHIN EVELINA, NEBLI MOHAMED, TILOUCHE NEJLA, MADEUX BENJAMIN, BOUGON DAVID, AARAB YASSIR, GARNIER FANNY, AZOULAY ELIE, MOLINARI NICOLAS, JABER SAMIR. Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial. Lancet Respir Med 2023:S2213-2600(22)00529-X. [PMID: 36693403 DOI: 10.1016/s2213-2600(22)00529-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Non-invasive ventilation (NIV) and oxygen therapy (high-flow nasal oxygen [HFNO] or standard oxygen) following extubation have never been compared in critically ill patients with obesity. We aimed to compare NIV (alternating with HFNO or standard oxygen) and oxygen therapy (HFNO or standard oxygen) following extubation of critically ill patients with obesity. METHODS In this multicentre, parallel group, pragmatic randomised controlled trial, conducted in 39 intensive care units in France, critically ill patients with obesity undergoing extubation were randomly assigned (1:1) to either the NIV group or the oxygen therapy group. Two randomisations were performed: first, randomisation to either NIV or oxygen therapy, and second, randomisation to either HFNO or standard oxygen (also 1:1), which was nested within the first randomisation. Blinding of the randomisation was not possible, but the statistician was masked to group assignment. The primary outcome was treatment failure within 3 days after extubation, a composite of reintubation for mechanical ventilation, switch to the other study treatment, or premature discontinuation of study treatment. The primary outcome was analysed by intention to treat. Effect of medical and surgical status was assessed. The reintubation within 3 days was analysed by intention to treat and after a post-hoc crossover analysis. This study is registered with ClinicalTrials.gov, number NCT04014920. FINDINGS From Oct 2, 2019, to July 17, 2021, of the 1650 screened patients, 981 were enrolled. Treatment failure occurred in 66 (13·5%) of 490 patients in the NIV group and in 130 (26·5%) of 491 patients in the oxygen-therapy group (relative risk 0·43; 95% CI 0·31-0·60, p<0·0001). Medical or surgical status did not modify the effect of NIV group on the treatment-failure rate. Reintubation within 3 days after extubation was similar in the non-invasive ventilation group and in the oxygen therapy group in the intention-to-treat analysis (48 (10%) of 490 patients and 59 (12%) of 491 patients, p=0·26) and lower in the NIV group than in the oxygen-therapy group in the post-hoc cross-over (51 (9%) of 560 patients and 56 (13%) of 421 patients, p=0·037) analysis. No severe adverse events were reported. INTERPRETATION Among critically ill adults with obesity undergoing extubation, the use of NIV was effective to reduce treatment-failure within 3 days. Our results are relevant to clinical practice, supporting the use of NIV after extubation of critically ill patients with obesity. However, most of the difference in the primary outcome was due to patients in the oxygen therapy group switching to NIV, and more evidence is needed to conclude that an NIV strategy leads to improved patient-centred outcomes. FUNDING French Ministry of Health.
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Affiliation(s)
- Audrey De Jong
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Anne Bignon
- CHU Lille, Réanimation Chirurgicale, F-59000, France
| | - François Stephan
- Surgical Intensive Care unit, Le Plessis Robinson Marie Lannelongue Hospital; Saclay University, school of Medicine, INSERM U999, France
| | - Thomas Godet
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Karim Asehnoune
- Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France
| | - Aude Sylvestre
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; Aix-Marseille Université, Faculté de médecine, Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005 Marseille, France
| | | | - Raiko Blondonnet
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Martine Ferrandière
- Département Anesthésie Réanimation, Université de Tours, CHU de Tours, Tours, France
| | - Philippe Seguin
- Département Anesthésie Réanimation, Université de Rennes, CHU de Rennes, Rennes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, Université d'Angers, CHU d'Angers, Angers, France
| | - Amélie Rollé
- Department of intensive care, Guadeloupe University Hospital, French Caribbean, France
| | - Pierre-Marie Fayolle
- Department of intensive care, Fort de France Hospital, Martinique, French Caribbean, France
| | - Laurent Muller
- Department of Intensive Care, Nîmes University Hospital, Nîmes, France
| | - Emmanuel Pardo
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Saint-Antoine Hospital, 75012 Paris, France
| | - Nicolas Terzi
- Department of Medical Intensive Care, CHU de Rennes, Rennes, France
| | - Séverin Ramin
- Anaesthesiology and Intensive Care, Anaesthesia and Critical Care Department A, Lapeyronie Teaching Hospital, Montpellier Cedex 5, France
| | - Boris Jung
- Département de Médecine Intensive-Réanimation, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Paer-Selim Abback
- Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Paris, France
| | - Philippe Guerci
- Département d'Anesthésie-Réanimation, Hôpital de Nancy, Nancy, France
| | - Benjamine Sarton
- Critical Care Unit. University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059, Toulouse Cedex 9, France
| | - Hadrien Rozé
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Biology of Cardiovascular Diseases, Bordeaux University, INSERM, UMR 1034, F-33600 Pessac, France
| | - Claire Dupuis
- Service de médecine intensive et réanimation, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Joel Cousson
- Pole Anesthésie Réanimation Hopital R Debré CHU de Reims, France
| | - Marion Faucher
- Département d'Anesthésie-Réanimation, Institut Paoli-Calmettes, Hôpital de Marseille, Marseille, France
| | - Virginie Lemiale
- Médecine Intensive et Réanimation, Groupe GRRROH, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Bernard Cholley
- Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Gerald Chanques
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Fouad Belafia
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Helena Huguet
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France; Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Emmanuel Futier
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe GRRROH, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France; Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France.
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Buzancais A, Brunot V, Larcher R, Tudesq JJ, Platon L, Besnard N, Amalric M, Daubin D, Corne P, Moulaire V, Jung B, Canaud B, Cristol JP, Klouche K. Sodium flux during hemodialysis and hemodiafiltration treatment of acute kidney injury: Effects of dialysate and infusate sodium concentration at 140 and 145 mmol/L. Artif Organs 2022. [PMID: 36527419 DOI: 10.1111/aor.14487] [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: 08/31/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND A higher sodium (Na) dialysate concentration is recommended during renal replacement therapy (RRT) of acute kidney injury (AKI) to improve intradialytic hemodynamic tolerance, but it may lead to Na loading to the patient. We aimed to evaluate Na flux according to Na dialysate and infusate concentrations at 140 and 145 mmol/L during hemodialysis (HD) and hemodiafiltration (HDF). METHODS Fourteen AKI patients that underwent consecutive HD or HDF sessions with Na dialysate/infusate at 140 and 145 mmol/L were included. Per-dialytic flux of Na was estimated using mean sodium logarithmic concentration including diffusive and convective influx. We compared the flux of sodium between HD140 and 145, and between HDF140 and 145. RESULTS Nine HD140, ten HDF140, nine HD145, and 11 HDF145 sessions were analyzed. A Na gradient from the dialysate/replacement fluid to the patient was observed with dialysate/infusate Na at 145 mmol/L in both HD and HDF (p = 0.01). The comparison of HD145 to HD140 showed that higher Na dialysate induced a diffusive Na gradient to the patient (163 mmol vs. -25 mmol, p = 0.004) and that of HDF145 to -140 (211 vs. 36 mmol, p = 0.03) as well. Intradialytic hemodynamic tolerance was similar across all RRT sessions. CONCLUSIONS During both HD and HDF, a substantial Na loading occurred with a Na dialysate and infusate at 145 mmol/L. This Na loading is smaller in HDF with Na dialysate and infusate concentration at 140 mmol/L and inversed with HD140. Clinical and intradialytic hemodynamic tolerance was fair regardless of Na dialysate and infusate.
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Affiliation(s)
- Aurèle Buzancais
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Vincent Brunot
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France.,PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, School of Medicine, Montpellier, France
| | - Jean-Jacques Tudesq
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Laura Platon
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Noémie Besnard
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Matthieu Amalric
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Delphine Daubin
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Philippe Corne
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Valérie Moulaire
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France.,PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, School of Medicine, Montpellier, France.,University of Montpellier, UFR of Medicine, Montpellier, France
| | - Bernard Canaud
- University of Montpellier, UFR of Medicine, Montpellier, France.,Global Medical Office, Fresenius Medical Care Deutschland, Bad Homburg, Germany
| | - Jean-Paul Cristol
- University of Montpellier, UFR of Medicine, Montpellier, France.,Biochemistry/Hormonology Department, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, Montpellier, France.,PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, School of Medicine, Montpellier, France.,University of Montpellier, UFR of Medicine, Montpellier, France
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10
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Grob L, Guensch D, Oeri S, Kuganathan S, Neuenschwander M, Utz C, Jung B, Von Tengg-Kobligk H, Fischer K. USING NOVEL CARDIOVASCULAR MAGNETIC RESONANCE 4D FLOW HEMODYNAMIC IMAGING TO INVESTIGATING VENTRICULAR AORTIC COUPLING. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.041] [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: 12/05/2022]
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11
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Fischer K, Grob L, Kuganathan S, Utz C, Becker P, Oeri S, Jung B, Gräni C, Huber A, Guensch D. FEASIBILITY OF NEW CMR POST-PROCESSING SOFTWARE PROTOTYPES IN ASSESSING THE RIGHT HEART AND TRICUSPID FUNCTION. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.017] [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: 12/05/2022]
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12
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Utz C, Fischer K, Jung B, Friess J, Terbeck S, Erdoes G, Eberle B, Huettenmoser S, Huber A, Guensch D. VALIDATING NOVEL FREE-BREATHING CARDIOVASCULAR MAGNETIC RESONANCE SEQUENCES FOR FUTURE APPLICATIONS OF PERI-OPERATIVE IMAGING OF INDUCIBLE MYOCARDIAL DEOXYGENATION. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.057] [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: 12/07/2022]
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13
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Schorlemmer J, Jung B, Zeller C. Collaboration and health promotion for the health care system – evaluation of the WOL healthcare. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.296] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Health care and social services are industries with special challenges: Constant emotional demands, the shortage of skilled workers is noticeable (in Germany) and special organizational stresses, not only since the Corona pandemic. This study evaluates the Working out Loud (WOL) program for healthcare, which aims to create a learning culture for interdisciplinary collaboration and network-oriented learning and increases growth-oriented thinking at organizational level.
Methods
The sample consists of 51 participants. From 16 persons data could be analyzed in the pre-post-design of the 10-week intervention accompanied by individual coaching. All respondents work in the health care system in Germany. Dependent variables were collected with validated scales for psychological safety, psychological flexibility, cooperative learning, emotional energy, engagement and voice behavior.
Results
Effects of moderate strength were shown for all variables: psychological safety (Mt1= 4.86, Mt2 = 5.45 t(15) =-1.86, p =.083, d = 0.46), psychological flexibility (Mt1= 3.57, Mt2 = 3.82 t(15) = -2.12, p = .051, d = 0.53), cooperative learning (Mt1= 4.63, Mt2 = 4.81 t(15) = -2.18, p =. 045, d = 0.54), emotional energy (Mt1= 2.70, Mt2 = 2.75 t(15) = -0.82, p = .423, d = 0.20), engagement (Mt1= 2.87, Mt2 = 3.05 t(15) = -1.65, p = .119, d = 0.41)and voice behavior (Mt1= 3.84, Mt2 = 4.05 t(15) = -1.64, p = .120, d = 0.41). Correlations are shown for psychological safety with emotional energy (r = .426, p = .012) and job satisfaction (r = .612, p = .000).
Conclusions
The 10-week WOL Healthcare program can strengthen employees in the important area of health promotion and care. The program serves as behavioral prevention and, by empowering individuals, brings about job crafting structural prevention in the workplace. The intervention follows a bottom-up principle, it is an approach for health promotion in the healthcare sector, that can strengthen patient's safety.
Key messages
• Evidence for the effectiveness of a health promotion intervention for health care workers.
• Organizational learning promotes workers health.
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Affiliation(s)
- J Schorlemmer
- Institute for Health, FOM Hochschule fuer Oekonomie und Management , Berlin, Germany
| | | | - C Zeller
- Zukunftsherz, Frankfurt, Germany
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14
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Péju E, Belicard F, Silva S, Hraiech S, Painvin B, Kamel T, Thille AW, Goury A, Grimaldi D, Jung B, Piagnerelli M, Winiszewski H, Jourdain M, Jozwiak M. Management and outcomes of pregnant women admitted to intensive care unit for severe pneumonia related to SARS-CoV-2 infection: the multicenter and international COVIDPREG study. Intensive Care Med 2022; 48:1185-1196. [PMID: 35978137 PMCID: PMC9383668 DOI: 10.1007/s00134-022-06833-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 04/07/2022] [Accepted: 07/16/2022] [Indexed: 01/08/2023]
Abstract
Purpose Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated. Methods A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported. Results Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks’ gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05–3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02–1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30–5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09–3.90), p = 0.03). Delivery was required during ICU stay in 70 (37%) patients, mainly due to maternal respiratory worsening, and improved the driving pressure and oxygenation. Maternal and fetal/neonatal mortality rates were 1% and 4%, respectively. The rate of maternal and/or neonatal complications increased with the invasiveness of maternal respiratory support. Conclusion In ICU, corticosteroids, tocilizumab and prone positioning were used in few pregnant women with COVID-19. Over a third of patients were intubated and delivery improved the driving pressure. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06833-8.
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Affiliation(s)
- Edwige Péju
- Service de Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR8104, 75006, Paris, France
| | - Félicie Belicard
- Service de Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint Jacques, 75014, Paris, France
| | - Stein Silva
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Purpan, 31300, Toulouse, France
| | - Sami Hraiech
- Service de Médecine Intensive et Réanimation, AP-HM, Hôpital Nord, Marseille, France.,Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Benoît Painvin
- Service de réanimation médicale, service des maladies infectieuses et réanimation médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Toufik Kamel
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Arnaud W Thille
- Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France
| | - Antoine Goury
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Reims, Reims, France
| | - David Grimaldi
- Service de soins intensifs CUB-Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Boris Jung
- Service de Médecine Intensive et Réanimation, CHU de Lapeyronie, Montpellier, France.,PhyMedExp, Université de Montpellier, Montpellier, France
| | - Michael Piagnerelli
- Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, 140, chaussée de Bruxelles, 6042, Charleroi, Belgium
| | - Hadrien Winiszewski
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Merce Jourdain
- Pôle de Médecine Intensive et Réanimation, Hôpital Roger Salengro, CHU Lille, Lille, France.,Inserm U1190, Université de Lille, 59000, Lille, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, 151 rue saint Antoine de Ginestière, 06200, Nice, France. .,Équipe 2 CARRES, UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
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15
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Mirouse A, Friol A, Moreau A, Jung B, Jullien E, Bureau C, Djibre M, De Prost N, Zafrani L, Argaud L, Reuter D, Calvet L, De Montmollin E, Benghanem S, Pichereau C, Pham T, Cacoub P, Biard L, Saadoun D. Pneumonie grave à SARS-Cov2 chez les patients vaccinés : une étude multicentrique. Rev Med Interne 2022. [PMCID: PMC9212737 DOI: 10.1016/j.revmed.2022.03.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction La vaccination contre le SARS-Cov2 réduit le risque d’infection, d’hospitalisation et de décès liés à l’infection. Cependant, certains patients peuvent développer une infection après une vaccination. L’objectif était de décrire les caractéristiques des patients vaccinés et qui développaient une infection grave à SARS-Cov2 nécessitant une admission en réanimation. Patients et méthodes Nous avons réalisé une étude de cohorte multicentrique incluant les patients vaccinés avec une infection grave à SARS-CoV2 et admis dans 15 réanimations françaises entre janvier et septembre 2021. Nous avons comparé ces patients à une cohorte publiée de patients non vaccinés avec une pneumonie grave à SARS-Cov2. Résultats Cent patients dont 68 (68 %) hommes avec un âge médian de 64 [57–71] ans ont été inclus. Une immunodépression était présente chez 3838 %) des patients. Parmi les patients ayant eu une sérologie à leur admission, 64 % avait un niveau d’anticorps anti-SARS-Cov2 efficace. À l’admission en réanimation, le score SOFA médian était de 4 [4–6,3] et le rapport PaO2/FiO2 médian de 84 [69–128]mmHg. Une oxygénothérapie humidifiée à haut débit a été initiée chez 79 (79 %) patients et une ventilation non invasive chez 18 (18 %) patients. Au cours de la prise en charge, 48 (48 %) patients ont nécessité le recours à l’intubation oro-trachéale avec une durée de ventilation de 11 [5–19] jours. Sur une durée de séjout médiane de 8 [4–20] jours, 31 patients sont décédés. L’âge (OR pour 5 années supplémentaires 1,38 [1,02–1,85], p = 0,035) et le score SOFA à l’admission (OR 1,40 [1,14–1,72] par point, p = 0,002) étaient indépendamment associés à la mortalité. En comparaison avec les patients non vaccinés, les patients vaccinés présentaient moins souvent du diabète (16 [16 %] vs. 351 [27 %], p = 0,029), étaient plus souvent immunodéprimés (38 [38 %] vs. 109 (8,3 %), p < 0,0001), insuffisants rénaux chroniques (24 [24 %] vs. 89 (6,8 %), p < 0,0001), insuffisants cardiaques chroniques (16 [16 %] vs. 58 [4,4 %], p < 0,0001), and insuffisants hépatiques chroniques chronic liver disease(3 [3 %] vs. 8 [0,6 %], p = 0,037). Malgré une gravit similaire à l’admission, les patients vaccinés nécessitaient moins souvent le recours à la ventilation invasive, que ce soit à l’admission ou au cours de la prise en charge en réanimation (23 [23 %] vs. 785 [59,7 %], p < 0,0001, et 48 [48 %] vs. 930 [70,7 %], p < 0,0001, respectivement). Il n’y avait pas de différence en terme de mortalité (31 [31 %] vs. 379 [28,8 %], p = 0,64). Conclusion Les infections sévères à SARS-Cov2 peuvent survenir chez des patients vaccinés, principalement ceux immunodéprimés ou avec des insuffisances rénale, hépatique ou cardiaque. L’âge et la gravité à l’admission sont associés à la mortalité.
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Dres M, de Abreu MG, Merdji H, Müller-Redetzky H, Dellweg D, Randerath WJ, Mortaza S, Jung B, Bruells C, Moerer O, Scharffenberg M, Jaber S, Besset S, Bitter T, Geise A, Heine A, Malfertheiner MV, Kortgen A, Benzaquen J, Nelson T, Uhrig A, Moenig O, Meziani F, Demoule A, Similowski T. Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients. Am J Respir Crit Care Med 2022; 205:1169-1178. [PMID: 35108175 PMCID: PMC9872796 DOI: 10.1164/rccm.202107-1709oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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] [Indexed: 01/27/2023] Open
Abstract
Rationale: Diaphragm dysfunction is frequently observed in critically ill patients with difficult weaning from mechanical ventilation. Objectives: To evaluate the effects of temporary transvenous diaphragm neurostimulation on weaning outcome and maximal inspiratory pressure. Methods: Multicenter, open-label, randomized, controlled study. Patients aged ⩾18 years on invasive mechanical ventilation for ⩾4 days and having failed at least two weaning attempts received temporary transvenous diaphragm neurostimulation using a multielectrode stimulating central venous catheter (bilateral phrenic stimulation) and standard of care (treatment) (n = 57) or standard of care (control) (n = 55). In seven patients, the catheter could not be inserted, and in seven others, pacing therapy could not be delivered; consequently, data were available for 43 patients. The primary outcome was the proportion of patients successfully weaned. Other endpoints were mechanical ventilation duration, 30-day survival, maximal inspiratory pressure, diaphragm-thickening fraction, adverse events, and stimulation-related pain. Measurements and Main Results: The incidences of successful weaning were 82% (treatment) and 74% (control) (absolute difference [95% confidence interval (CI)], 7% [-10 to 25]), P = 0.59. Mechanical ventilation duration (mean ± SD) was 12.7 ± 9.9 days and 14.1 ± 10.8 days, respectively, P = 0.50; maximal inspiratory pressure increased by 16.6 cm H2O and 4.8 cm H2O, respectively (difference [95% CI], 11.8 [5 to 19]), P = 0.001; and right hemidiaphragm thickening fraction during unassisted spontaneous breathing was +17% and -14%, respectively, P = 0.006, without correlation with changes in maximal inspiratory pressure. Serious adverse event frequency was similar in both groups. Median stimulation-related pain in the treatment group was 0 (no pain). Conclusions: Temporary transvenous diaphragm neurostimulation did not increase the proportion of successful weaning from mechanical ventilation. It was associated with a significant increase in maximal inspiratory pressure, suggesting reversal of the course of diaphragm dysfunction. Clinical trial registered with www.clinicaltrials.gov (NCT03096639) and the European Database on Medical Devices (CIV-17-06-020004).
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Affiliation(s)
- Martin Dres
- Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, INSERM, UMRS1158, Paris, France;,AP-HP, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, R3S Department, Sorbonne University, Paris, France
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;,Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio;,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hamid Merdji
- Université de Strasbourg, Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Holger Müller-Redetzky
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominic Dellweg
- Department of Pulmonary and Critical Care Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, Germany
| | - Winfried J. Randerath
- Institute for Pneumology at the University of Cologne Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
| | - Satar Mortaza
- Département de Médecine Intensive, Réanimation et Médecine Hyperbare, CHU d’Angers, Faculté de Santé, Université d’Angers, Angers, France
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital and PhyMedExp, University of Montpellier, Montpellier, France
| | - Christian Bruells
- Department of Anesthesiology, Aachen University Hospital of the RWTH Aachen, Aachen, Germany
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Scharffenberg
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, France
| | - Sébastien Besset
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Thomas Bitter
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Arnim Geise
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuremberg Lung Cancer Center, Paracelsus Medical University, General Hospital Nuremberg, Nuremburg, Germany
| | - Alexander Heine
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Maximilian V. Malfertheiner
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Kortgen
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Jonathan Benzaquen
- Department of Pulmonary Medicine and Oncology, Université Côte d'Azur, CHU de Nice, University Hospital Federation OncoAge, Nice, France
| | - Teresa Nelson
- Technomics Research, LLC, Minneapolis, Minnesota; and
| | - Alexander Uhrig
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Moenig
- Department of Pulmonary and Critical Care Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, Germany
| | - Ferhat Meziani
- Université de Strasbourg, Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Alexandre Demoule
- Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, INSERM, UMRS1158, Paris, France;,AP-HP, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, R3S Department, Sorbonne University, Paris, France
| | - Thomas Similowski
- Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, INSERM, UMRS1158, Paris, France;,AP-HP, Pitie-Salpêtrière Hospital, R3S Department, Sorbonne Université, Paris, France
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17
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Lecronier M, Jung B, Molinari N, Pinot J, Similowski T, Jaber S, Demoule A, Dres M. Severe but reversible impaired diaphragm function in septic mechanically ventilated patients. Ann Intensive Care 2022; 12:34. [PMID: 35403916 PMCID: PMC9001790 DOI: 10.1186/s13613-022-01005-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Whether sepsis-associated diaphragm dysfunction may improve despite the exposure of mechanical ventilation in critically ill patients is unclear. This study aims at describing the diaphragm function time course of septic and non-septic mechanically ventilated patients. Methods Secondary analysis of two prospective observational studies of mechanically ventilated patients in whom diaphragm function was assessed twice: within the 24 h after intubation and when patients were switched to pressure support mode, by measuring the endotracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Change in diaphragm function was expressed as the difference between Ptr,stim measured under pressure support mode and Ptr,stim measured within the 24 h after intubation. Sepsis was defined according to the Sepsis-3 international guidelines upon inclusion. In a sub-group of patients, the right hemidiaphragm thickness was measured by ultrasound. Results Ninety-two patients were enrolled in the study. Sepsis upon intubation was present in 51 (55%) patients. In septic patients, primary reason for ventilation was acute respiratory failure related to pneumonia (37/51; 73%). In non-septic patients, main reasons for ventilation were acute respiratory failure not related to pneumonia (16/41; 39%), coma (13/41; 32%) and cardiac arrest (6/41; 15%). Ptr,stim within 24 h after intubation was lower in septic patients as compared to non-septic patients: 6.3 (4.9–8.7) cmH2O vs. 9.8 (7.0–14.2) cmH2O (p = 0.004), respectively. The median (interquartile) duration of mechanical ventilation between first and second diaphragm evaluation was 4 (2–6) days in septic patients and 3 (2–4) days in non-septic patients (p = 0.073). Between first and second measurements, the change in Ptr,stim was + 19% (− 13–61) in septic patients and − 7% (− 40–12) in non-septic patients (p = 0.005). In the sub-group of patients with ultrasound measurements, end-expiratory diaphragm thickness decreased in both, septic and non-septic patients. The 28-day mortality was higher in patients with decrease or no change in diaphragm function. Conclusion Septic patients were associated with a more severe but reversible impaired diaphragm function as compared to non-septic patients. Increase in diaphragm function was associated with a better survival. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01005-9.
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Affiliation(s)
- Marie Lecronier
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France. .,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France.
| | - Boris Jung
- Département de Médecine Intensive - Réanimation, CHU Montpellier, Montpellier, France.,Laboratoire de Physiologie et Médecine Expérimentale du cœur et des Muscles, INSERM U1046-CNRS UMR 9214, Université de Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, Hôpital Arnaud de Villeneuve, IMAG U5149, Université de Montpellier, Montpellier, France
| | - Jérôme Pinot
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Thomas Similowski
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France
| | - Samir Jaber
- Département de Médecine Intensive - Réanimation, CHU Montpellier, Montpellier, France.,Laboratoire de Physiologie et Médecine Expérimentale du cœur et des Muscles, INSERM U1046-CNRS UMR 9214, Université de Montpellier, Montpellier, France
| | - Alexandre Demoule
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France
| | - Martin Dres
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France
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18
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Staudacher JJ, Bauer J, Atkinson SR, Thursz M, Lang S, Schnabl B, Wiley MB, Carr R, Jung B. Systemic Activin Is Elevated in Patients With Severe Alcoholic Hepatitis. Gastro Hep Adv 2022; 1:147-149. [PMID: 35602917 PMCID: PMC9119346 DOI: 10.1016/j.gastha.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J J Staudacher
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charite-University Medicine, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Bauer
- Department of Medicine, University of Washington, Seattle, Washington
| | - S R Atkinson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - M Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - S Lang
- Department of Medicine, University of California San Diego, La Jolla, California
| | - B Schnabl
- Department of Medicine, University of California San Diego, La Jolla, California
- Department of Medicine, VA San Diego Healthcare System, San Diego, California
| | - M B Wiley
- Department of Medicine, University of Washington, Seattle, Washington
| | - R Carr
- Department of Medicine, University of Washington, Seattle, Washington
| | - B Jung
- Department of Medicine, University of Washington, Seattle, Washington
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19
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Preau S, Vodovar D, Jung B, Lancel S, Zafrani L, Flatres A, Oualha M, Voiriot G, Jouan Y, Joffre J, Uhel F, De Prost N, Silva S, Azabou E, Radermacher P. Correction to: Energetic dysfunction in sepsis: a narrative review. Ann Intensive Care 2021; 11:185. [PMID: 34964067 PMCID: PMC8714609 DOI: 10.1186/s13613-021-00970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sebastien Preau
- U1167 - RID-AGE - Facteurs de Risque Et Déterminants Moléculaires Des Maladies Liées Au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France.
| | - Dominique Vodovar
- Centre AntiPoison de Paris, Hôpital Fernand Widal, APHP, 75010, Paris, France.,Faculté de Pharmacie, UMRS 1144, 75006, Paris, France.,Université de Paris, UFR de Médecine, 75010, Paris, France
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University Hospital and PhyMedExp, University of Montpellier, Montpellier, France
| | - Steve Lancel
- U1167 - RID-AGE - Facteurs de Risque Et Déterminants Moléculaires Des Maladies Liées Au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France
| | - Lara Zafrani
- Médecine Intensive Réanimation, Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France.,INSERMUMR 976,Hôpital Saint Louis, Université de Paris, Paris, France
| | | | - Mehdi Oualha
- Pediatric Intensive Care Unit, Necker Hospital, APHP, Centre - Paris University, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive Réanimation, CHRU Tours, Tours, France.,Faculté de Médecine de Tours, INSERM U1100 Centre d'Etudes Des Pathologies Respiratoires, Tours, France
| | - Jeremie Joffre
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, 94143, USA
| | - Fabrice Uhel
- Réanimation Médico-ChirurgicaleUniversité de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Nicolas De Prost
- Service de Réanimation MédicaleHôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010, Créteil, France
| | - Stein Silva
- Réanimation URM CHU Purpan, Cedex 31300, Toulouse, France.,Toulouse NeuroImaging Center INSERM1214, Cedex 31300, Toulouse, France
| | - Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, AP-HP, Inserm UMR 1173, Infection and Infammation (2I), University of Versailles (UVSQ), Paris-Saclay University, Paris, France
| | - Peter Radermacher
- Institut Für Anästhesiologische Pathophysiologie Und VerfahrensentwicklungUniversitätsklinikum, Ulm, Germany
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20
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De la SRLF CRT, Merz T, Sarton B, Jouan Y, Bagate F, Bendib Le Lan I, Brassart B, Denoix N, Elabbadi A, Ferré F, Loiselle M, Masson G, Millot G, Salvador E, Trautwein B, Uhel F, Radermacher P, Voiriot G, Oualha M, Azabou E, Jung B, Silva S, Préau S, De Prost N, Zafrani L, Vodovar D. Reports from the 1st Young Investigator’s Day of the French Intensive Care Society. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00055] [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: 01/13/2023]
Abstract
The Translational Research Committee of the French Intensive Care Society organized the first Young Investigator’s Day on October 18th 2019.
This seminar gave young Intensive Care students the opportunity to present their Master’s or PhD research work to a college of expert researchers.
For this first event, Professors Jean-Marc Cavaillon (Paris), Laurent Papazian (Marseille), Peter Radermacher (Ulm) et Hafid Ait-Oufella (Paris) kindly accepted to give young candidates their critical support.
The subjects of presentations, covering the fields of neuroscience, immunology, hemodynamics and pharmacology illustrated the richness and diversity of translational research in Intensive Care Medicine.
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21
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Jung B, Le Bihan C, Portales P, Bourgeois N, Vincent T, Lachaud L, Chanques G, Conseil M, Corne P, Massanet P, Timsit JF, Jaber S. Monocyte human leukocyte antigen-DR but not β-D-glucan may help early diagnosing invasive Candida infection in critically ill patients. Ann Intensive Care 2021; 11:129. [PMID: 34417900 PMCID: PMC8380211 DOI: 10.1186/s13613-021-00918-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022] Open
Abstract
Background Precision medicine risk stratification is desperately needed to both avoid systemic antifungals treatment delay and over prescription in the critically ill with risk factors. The aim of the present study was to explore the combination of host immunoparalysis biomarker (monocyte human leukocyte antigen-DR expression (mHLA-DR)) and Candida sp wall biomarker β-d-glucan in risk stratifying patients for secondary invasive Candida infection (IC). Methods Prospective observational study. Two intensive care units (ICU). All consecutive non-immunocompromised septic shock patients. Serial blood samples (n = 286) were collected at day 0, 2 and 7 and mHLA-DR and β-d-glucan were then retrospectively assayed after discharge. Secondary invasive Candida sp infection occurrence was then followed at clinicians’ discretion. Results Fifty patients were included, 42 (84%) had a Candida score equal or greater than 3 and 10 patients developed a secondary invasive Candida sp infection. ICU admission mHLA-DR expression and β-d-glucan (BDG) failed to predict secondary invasive Candida sp infection. Time-dependent cause-specific hazard ratio of IC was 6.56 [1.24–34.61] for mHLA-DR < 5000 Ab/c and 5.25 [0.47–58.9] for BDG > 350 pg/mL. Predictive negative value of mHLA-DR > 5000 Ab/c and BDG > 350 pg/mL combination at day 7 was 81% [95% CI 70–92]. Conclusions This study suggests that mHLA-DR may help predicting IC in high-risk patients with septic shock. The added value of BDG and other fungal tests should be regarded according to the host immune function markers.
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Affiliation(s)
- Boris Jung
- Medical Intensive Care Unit, Montpellier University and Montpellier University Health Care Center, 34290, Montpellier, France.,PhyMedExp Laboratory, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France
| | - Clément Le Bihan
- Département des Maladies Infectieuses et Tropicales, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France.,Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Pierre Portales
- Immunology Department, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Nathalie Bourgeois
- Département de Parasitologie-Mycologie, Montpellier University and Montpellier University Health Care Center, UMR Mivegec, 34295, Montpellier, France
| | - Thierry Vincent
- Immunology Department, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Laurence Lachaud
- Département de Parasitologie-Mycologie, Montpellier University and Montpellier University Health Care Center, UMR Mivegec, 34295, Montpellier, France
| | - Gerald Chanques
- PhyMedExp Laboratory, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France.,Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Matthieu Conseil
- Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Philippe Corne
- Medical Intensive Care Unit, Montpellier University and Montpellier University Health Care Center, 34290, Montpellier, France
| | - Pablo Massanet
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Nîmes, 30000, Nîmes, France
| | - Jean François Timsit
- APHP Hôpital Bichat-Claude Bernard, Paris-Diderot University, 75000, Paris, France
| | - Samir Jaber
- PhyMedExp Laboratory, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France. .,Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France.
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22
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Aarab Y, Flatres A, Garnier F, Capdevila M, Raynaud F, Lacampagne A, Chapeau D, Klouche K, Etienne P, Jaber S, Molinari N, Gamon L, Matecki S, Jung B. Shear Wave Elastography, A New Tool for Diaphragmatic Qualitative Assessment. A Translational Study. Am J Respir Crit Care Med 2021; 204:797-806. [PMID: 34255974 DOI: 10.1164/rccm.202011-4086oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Prolonged mechanical ventilation (MV) is often associated either with a decrease (known atrophy) or an increase (supposed injury) in diaphragmatic thickness. Shear wave elastography is a non-invasive technique that measures shear modulus, a surrogate of tissue stiffness and mechanical properties. OBJECTIVES To describe changes in shear modulus (SM) during the ICU stay and the relationship with alterations in muscle thickness. To perform a comprehensive ultrasound-based characterization of histological and force production changes occurring in the diaphragm. METHODS Translational study using critically ill patients and mechanically ventilated piglets. Serial ultrasound examination of the diaphragm collecting thickness and SM was performed in both patients and piglets. Transdiaphragmatic pressure and diaphragmatic biopsies were collected in piglets. MEASUREMENTS AND MAIN RESULTS We enrolled 102 patients, 88 of whom were invasively mechanically ventilated. At baseline, SM was 14.3+/-4.3 kPa and diaphragm end-expiratory thickness was 2.0+/-0.5 mm. Decrease or increase by more than 10% from baseline was reported in 86% of the patients for thickness and in 92% of the patients for shear modulus. An increase in diaphragmatic thickness during the stay was associated with a decrease in SM (β=-9.34±4.41; p=0.03) after multivariable analysis. In the piglet sample, a decrease in SM over 3 days of MV was associated with loss of force production, slow and fast fiber atrophy and increased lipid droplets accumulation. CONCLUSIONS Increases in diaphragm thickness during critical illness is associated with decreased tissue stiffness as demonstrated by shear wave ultrasound elastography, consistent with the development of muscle injury and weakness.
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Affiliation(s)
| | | | - Fanny Garnier
- Centre Hospitalier Regional Universitaire de Montpellier, 26905, Montpellier, France
| | - Mathieu Capdevila
- Montpellier University and Montpellier Teaching Hospital,, Saint Eloi Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier Teaching Hospital, Montpellier, France , Montpellier, France.,Montpellier Universite d'Excellence, 539031, PhyMedExp, Montpellier, France
| | | | - Alain Lacampagne
- PhyMedExp, Montpellier University, INSERM, CNRS, Montpellier, France
| | - David Chapeau
- Lapeyronie University Hospital, Intensive Care Unit, Montpellier, France
| | - Kada Klouche
- Lapeyronie University Hospital, Intensive Care Unit, Montpellier, France
| | - Pascal Etienne
- Laboratoire Charles Coulomb, 131799, Montpellier, France
| | - Samir Jaber
- University hospital. CHU de MONTPELLIER HOPITAL SAINT ELOI, Intensive Care Unit and transplantation-Departement of Anesthesiology DAR B, Montpellier Cedex 5, France
| | - Nicolas Molinari
- CHU Montpellier - Hôpital la Colombière, DIM, Montpellier, France
| | - Lucie Gamon
- Montpellier University and Montpellier Teaching Hospital,, Saint Eloi Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier Teaching Hospital, Montpellier, France
| | - Stefan Matecki
- Universite de Montpellier, 27037, 4. Pediatric Functional Exploration Unit, University Hospital of Montpellier, Montpellier, France
| | - Boris Jung
- Centre Hospitalier Regional Universitaire de Montpellier, 26905, medical ICU, Montpellier, France;
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23
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Preau S, Vodovar D, Jung B, Lancel S, Zafrani L, Flatres A, Oualha M, Voiriot G, Jouan Y, Joffre J, Huel F, De Prost N, Silva S, Azabou E, Radermacher P. Energetic dysfunction in sepsis: a narrative review. Ann Intensive Care 2021; 11:104. [PMID: 34216304 PMCID: PMC8254847 DOI: 10.1186/s13613-021-00893-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Growing evidence associates organ dysfunction(s) with impaired metabolism in sepsis. Recent research has increased our understanding of the role of substrate utilization and mitochondrial dysfunction in the pathophysiology of sepsis-related organ dysfunction. The purpose of this review is to present this evidence as a coherent whole and to highlight future research directions. Main text Sepsis is characterized by systemic and organ-specific changes in metabolism. Alterations of oxygen consumption, increased levels of circulating substrates, impaired glucose and lipid oxidation, and mitochondrial dysfunction are all associated with organ dysfunction and poor outcomes in both animal models and patients. The pathophysiological relevance of bioenergetics and metabolism in the specific examples of sepsis-related immunodeficiency, cerebral dysfunction, cardiomyopathy, acute kidney injury and diaphragmatic failure is also described. Conclusions Recent understandings in substrate utilization and mitochondrial dysfunction may pave the way for new diagnostic and therapeutic approaches. These findings could help physicians to identify distinct subgroups of sepsis and to develop personalized treatment strategies. Implications for their use as bioenergetic targets to identify metabolism- and mitochondria-targeted treatments need to be evaluated in future studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00893-7.
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Affiliation(s)
- Sebastien Preau
- U1167 - RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000, Lille, France.
| | - Dominique Vodovar
- Centre AntiPoison de Paris, Hôpital Fernand Widal, APHP, 75010, Paris, France.,Faculté de pharmacie, UMRS 1144, 75006, Paris, France.,Université de Paris, UFR de Médecine, 75010, Paris, France
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University Hospital and PhyMedExp, University of Montpellier, Montpellier, France
| | - Steve Lancel
- U1167 - RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000, Lille, France
| | - Lara Zafrani
- Médecine Intensive Réanimation, Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France.,INSERM UMR 976, Hôpital Saint Louis, Université de Paris, Paris, France
| | | | - Mehdi Oualha
- Pediatric Intensive Care Unit, Necker Hospital, APHP, Centre - Paris University, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive Réanimation, CHRU Tours, Tours, France.,Faculté de Médecine de Tours, INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Tours, France
| | - Jeremie Joffre
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, 94143, USA
| | - Fabrice Huel
- Réanimation médico-chirurgicale, Université de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Cedex 94010, Créteil, France
| | - Stein Silva
- Réanimation URM CHU Purpan, Cedex 31300, Toulouse, France.,Toulouse NeuroImaging Center INSERM1214, Cedex 31300, Toulouse, France
| | - Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, AP-HP, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles (UVSQ), Paris-Saclay University, Paris, France
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany
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24
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De la SRLF CRT, Silva S, Azabou E, Vodovar D, Voiriot G, Ouahla M, Uhel F, Zafrani L, Jung B, Radermacher P, De Prost N, Préau S. Le cerveau : une nouvelle frontière pour la réanimation. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00053] [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: 01/13/2023]
Abstract
Le séminaire annuel de la Commission de Recherche Translationnelle de la SRLF a eu lieu à Paris le 3 décembre 2019. Ce séminaire est un moment privilégié d’échange entre cliniciens et scientifiques autour des axes de recherche propres à la réanimation. La sixième édition a portée sur les défis et les promesses inhérents à la recherche translationnelle autour des agressions cérébrales aiguës. Illustrant les dernières avancées dans ce domaine, les chercheurs ont présenté et discuté leurs travaux basés sur des approches complémentaires, allant de l’étude des cellules nerveuses isolées à celui des réseaux cérébraux complexes, situés au carrefour des nombreuses modulations systémiques. Une part importante des présentations a été dédiée aux nouveautés dans le domaine de l’étude du coma et des troubles acquis de la conscience. Des pistes de recherche prometteuses concernant les pathologies neurologiques prises en charge en réanimation, comme le delirium, le traumatisme crânien, les encéphalopathies métaboliques ou auto-immunes ont été aussi discutées. Enfin, nombre d’orateurs ont pu souligner les promesses et les faiblesses des nouvelles technologies actuellement disponibles pour l’étude in vivo de du cerveau humain en état critique.
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25
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Papazian L, Jaber S, Hraiech S, Baumstarck K, Cayot-Constantin S, Aissaoui N, Jung B, Leone M, Souweine B, Schwebel C, Bourenne J, Allardet-Servent J, Kamel T, Lu Q, Zandotti C, Loundou A, Penot-Ragon C, Chastre J, Forel JM, Luyt CE. Preemptive ganciclovir for mechanically ventilated patients with cytomegalovirus reactivation. Ann Intensive Care 2021; 11:33. [PMID: 33570708 PMCID: PMC7876264 DOI: 10.1186/s13613-020-00793-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background The effect of cytomegalovirus (CMV) reactivation on the length of mechanical ventilation and mortality in immunocompetent ICU patients requiring invasive mechanical ventilation remains controversial. The main objective of this study was to determine whether preemptive intravenous ganciclovir increases the number of ventilator-free days in patients with CMV blood reactivation. Methods This double-blind, placebo-controlled, randomized clinical trial involved 19 ICUs in France. Seventy-six adults ≥ 18 years old who had been mechanically ventilated for at least 96 h, expected to remain on mechanical ventilation for ≥ 48 h, and exhibited reactivation of CMV in blood were enrolled between February 5th, 2014, and January 23rd, 2019. Participants were randomized to receive ganciclovir 5 mg/kg bid for 14 days (n = 39) or a matching placebo (n = 37). Results The primary endpoint was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included day 60 mortality. The trial was stopped for futility based on the results of an interim analysis by the DSMB. The subdistribution hazard ratio for being alive and weaned from mechanical ventilation at day 60 for patients receiving ganciclovir (N = 39) compared with control patients (N = 37) was 1.14 (95% CI from 0.63 to 2.06; P = 0.66). The median [IQR] numbers of ventilator-free days for ganciclovir-treated patients and controls were 10 [0–51] and 0 [0–43] days, respectively (P = 0.46). Mortality at day 60 was 41% in patients in the ganciclovir group and 43% in the placebo group (P = .845). Creatinine levels and blood cells counts did not differ significantly between the two groups. Conclusions In patients mechanically ventilated for ≥ 96 h with CMV reactivation in blood, preemptive ganciclovir did not improve the outcome.
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Affiliation(s)
- Laurent Papazian
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
| | - Samir Jaber
- Réanimation Chirurgicale, Centre Hospitalier Universitaire de Montpellier, Hôpital St-Eloi, Montpellier, France
| | - Sami Hraiech
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Karine Baumstarck
- Laboratoire de Santé Publique, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | - Nadia Aissaoui
- Médecine Intensive Réanimation, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Boris Jung
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Montpellier, Hôpital Lapeyronie, Montpellier, France
| | - Marc Leone
- Service d'Anesthésie-Réanimation, Aix-Marseille Université, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Bertrand Souweine
- Réanimation Médicale, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Carole Schwebel
- Médecine Intensive Réanimation, CHU Grenoble Alpes, La Tronche, France
| | - Jérémy Bourenne
- Réanimation des Urgences et Médicale, Aix-Marseille Université, Hôpital Timone, APHM, Marseille, France
| | | | - Toufik Kamel
- Médecine Intensive Réanimation, Centre Hospitalier Régional, Orléans, France
| | - Qin Lu
- Réanimation Chirurgicale Polyvalente, Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France
| | - Christine Zandotti
- Laboratoire de Virologie, IHU Méditerranée Infection, CHU Timone UMR190-Emergence des Pathologies Virales, Marseille, France
| | - Anderson Loundou
- Laboratoire de Santé Publique, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | - Jean Chastre
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Marie Forel
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Charles-Edouard Luyt
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
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26
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Fischer K, Riecker C, Overney S, Stucki M, Tanner H, Jung B, Von Tengg-Kobligk H, Eberle B, Guensch DP. Visualizing myocardial injury from elective cardioversion with CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.310] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Association of Cardiothoracic Anaesthesiologists Research Grant
Background
Despite everyday use of electrical interventions in cardiovascular care, the extent and type of concomitant myocardial injury is not fully understood. Current literature disagrees about the question whether and how cardioversion or defibrillation damage the myocardium, especially when serologic markers are used. Such markers are not always cardiac-specific, nor diagnostic for type and region of myocardial injury. These limitations may be overcome by parametric T1 and T2 mapping. We aimed to investigate whether the acute and long-term impact of electrical cardioversion on myocardial structure and function is detectable using CMR imaging.
Methods
Patients scheduled for elective cardioversion were enrolled to undergo three CMR exams (3 Tesla): on the morning prior to cardioversion to assess pre-existing injury; two to five hours after cardioversion to assess the acute response; and six to ten weeks later to investigate chronic injury. The CMR exam studied left ventricular (LV) function, T2 mapping to measure edema, and extracellular volume (ECV) from T1 maps to measure diffuse fibrosis. Both the degree of injury and proportion (%) of myocardial area affected were analysed.
Results
Eight patients completed the study, requiring 1-2 shocks (totalling 120-300 J biphasic energy) to achieve sinus rhythm. LV ejection fraction increased after cardioversion from 47 ± 13% to 55 ± 15% (p = 0.020), and was 52 ± 16% at the third exam (p = 0.199). Even prior to intervention, some patients showed edema (baseline T2 > 40ms) afflicting 49 ± 23% of their LV myocardium. Area affected by edema expanded to 72 ± 18% after cardioversion (p = 0.002) and returned to 54 ± 24% by the third exam. T2 rose from baseline (40.4 ± 1.8ms) after cardioversion acutely to 44.1 ± 5.2ms (p = 0.028) and normalized until the late exam (40.8 ± 3.1ms). Myocardial area affected by diffuse fibrosis (ECV > 30%) was 28.3 ± 9.4% at baseline and 38.8 ± 18.9% late after cardioversion (p = 0.018). Pathologic T2 increases (indicative of edema) were not observed in all patients, but individuals with higher baseline ECV also experienced greater T2 increase after cardioversion (r = 0.840, p = 0.036).
Conclusion
Elective cardioversion improves LV systolic function, but also aggravates myocardial edema and possibly adds to diffuse fibrosis during several weeks thereafter. Such sequelae of cardioversion were observed mainly in patients with a greater burden of pre-existing myocardial injury. More data is needed to corroborate these preliminary findings and to study whether this type of myocardial injury predicts worse outcome. Moreover, changes in CMR markers caused by electrical interventions including defibrillation, may have the potential to confound diagnostic assessments of the underlying cardiac injury.
Abstract Figure
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Affiliation(s)
- K Fischer
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - C Riecker
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - S Overney
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - M Stucki
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - B Jung
- Bern University Hospital, Inselspital, Department of Diagnostic, Interventional and Paediatric Radiology, Bern, Switzerland
| | - H Von Tengg-Kobligk
- Bern University Hospital, Inselspital, Department of Diagnostic, Interventional and Paediatric Radiology, Bern, Switzerland
| | - B Eberle
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - DP Guensch
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
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Sutter CD, Fischer K, Yamaji K, Ueki Y, Jung B, Raeber L, Von Tengg-Kobligk H, Eberle B, Guensch DP. Changes in right ventricular deformation during hyperoxia versus normoxaemia in patients with stable coronary artery disease and healthy controls. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.276] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Local research funds of the Department of Anaesthesiology and Pain medicine, Bern University Hospital, Inselspital
Background
During anaesthesia, emergency and critical care treatment, patients with coronary artery disease (CAD) are often exposed to supraphysiologic arterial oxygen tensions. The balance between benefits and risks of hyperoxia (HO) in patients with stable CAD is controversial, with reports about reduced left ventricular contractility or increased morbidity and mortality. Effects of HO on right ventricular (RV) function in CAD are less well described. Advanced cardiovascular magnetic resonance (CMR) feature tracking software allows assessment of myocardial deformation, which may serve as early marker of ventricular dysfunction. In a CMR study we quantified the effect of HO on RV function and deformation in awake healthy participants and CAD patients.
Methods
Ten healthy participants and 26 patients with stable one- or two-vessel obstructive CAD were included. In a CMR study, a short-axis function stack of both ventricles was obtained first at room air (RA), then during HO induced by breathing oxygen at 10L/min for 5 minutes via a non-rebreathing facemask. RV strain was analysed by a blinded reader who manually traced epicardial and endocardial contours of the RV for determining peak global circumferential strain (RVGCS), time to peak strain, systolic and diastolic strain rate parameters.
Results
RV ejection fraction did not change with O2 breathing in the healthy control group (RA, 56 ± 12% vs. HO, 55 ± 10%, p = 0.999) nor in the CAD group (RA, 60 ± 8% vs. HO, 60 ± 9%, p = 0.609). RV cardiac index decreased significantly in CAD patients from RA (2.62 ± 0.88 L/min/m2) to HO (2.42 ± 0.77L/min/m2, p = 0.002). The decrease in the control group was not significant (RVCI: RA 3.28 ± 1.29 vs HO 3.04 ± 1.27L/min/m2 p = 0.068).
In the healthy control group, RVGCS, time to peak strain, and systolic strain rate did not change significantly with HO (RVGCS: RA, -14.6 ± 3.9% vs. HO, -13.1 ± 4.5%, p = 0.353; time to peak strain: 282 ± 45ms vs. 286 ± 29ms, p = 0.540; and systolic strain rate: -0.85 ± 0.27/s vs. -0.67 ± 0.28, p = 0.055).
In CAD patients RVGCS worsened from -14.8 ± 3.3% on RA to -13.9 ± 3.6% at HO (p = 0.040). Time to peak strain became significantly prolonged from 319 ± 40ms on RA to 329 ± 49ms at HO (p = 0.046). This was accompanied by a reduction of systolic strain rate from -0.79 ± 0.27/s to -0.75 ± 0.22/s (p = 0.037). Diastolic strain parameters did not differ significantly between RA and HO in either group.
Conclusion
In our cohort of CAD patients HO significantly reduced RV cardiac index and impaired systolic deformation as determined by CMR feature tracking. Studies are required in a larger patient cohort with regional analysis and assessment of longitudinal and radial deformation to assess the role of hyperoxia in CAD.
Abstract Figure. Change in RV Peak Circumferential Strain
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Affiliation(s)
- CD Sutter
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - K Fischer
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - K Yamaji
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - Y Ueki
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - B Jung
- Bern University Hospital, Inselspital, Department of Diagnostic, Interventional and Paediatric Radiology, Bern, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - H Von Tengg-Kobligk
- Bern University Hospital, Inselspital, Department of Diagnostic, Interventional and Paediatric Radiology, Bern, Switzerland
| | - B Eberle
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
| | - DP Guensch
- Bern University Hospital, Inselspital, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
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Jung B, Klouche K, Jaber S, Bigé N. Alcalinisation des acidoses métaboliques. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00041] [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
L’acidose métabolique lorsqu’elle est sévère et accompagnée à une diminution du pH plasmatique est associée à un pronostic sombre. Les indications du traitement symptomatique de l’acidémie dépend de la cause responsable de l’acidose et de la sévérité de l’atteinte. La balance bénéfice risque d’une administration de bicarbonate de sodium doit être pesée et est probablement en faveur du bénéfice chez le patient de réanimation présentant une acidémie profonde (pH inférieur ou égal à 7.20) et associée à une insuffisance rénale aigue modérée à sévère. Nous discutons dans cette mise au point les indications potentielles d’alcalinisation systémique chez le patient critique.
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Jaber S, Rolle A, Jung B, Chanques G, Bertet H, Galeazzi D, Chauveton C, Molinari N, De Jong A. Effect of endotracheal tube plus stylet versus endotracheal tube alone on successful first-attempt tracheal intubation among critically ill patients: the multicentre randomised STYLETO study protocol. BMJ Open 2020; 10:e036718. [PMID: 33033014 PMCID: PMC7542923 DOI: 10.1136/bmjopen-2019-036718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Tracheal intubation is one of the most daily practiced procedures performed in intensive care unit (ICU). It is associated with severe life-threatening complications, which can lead to intubation-related cardiac arrest. Using a preshaped endotracheal tube plus stylet may have potential advantages over endotracheal tube without stylet. The stylet is a rigid but malleable introducer which fits inside the endotracheal tube and allows for manipulation of the tube shape; to facilitate passage of the tube through the laryngeal inlet. However, some complications from stylets have been reported including mucosal bleeding, perforation of the trachea or oesophagus and sore throat. The use of a stylet for first-attempt intubation has never been assessed in ICU and benefit remains to be established. METHODS AND ANALYSIS The endotracheal tube plus stylet to increase first-attempt success during orotracheal intubation compared with endotracheal tube alone in ICU patients (STYLETO) trial is an investigator-initiated, multicentre, stratified, parallel-group unblinded trial with an electronic system-based randomisation. Patients will be randomly assigned to undergo the initial intubation attempt with endotracheal tube alone (ie,without stylet, control group) or endotracheal tube + stylet (experimental group). The primary outcome is the proportion of patients with successful first-attempt orotracheal intubation. The single, prespecified, secondary outcome is the incidence of complications related to intubation, in the hour following intubation. Other outcomes analysed will include safety, exploratory procedural and clinical outcomes. ETHICS AND DISSEMINATION The study project has been approved by the appropriate ethics committee 'Comité-de-Protection-des-Personnes Nord-Ouest3-19.04.26.65808 Cat2 RECHMPL19_0216/STYLETO2019-A01180-57'". Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If combined use of endotracheal tube plus stylet facilitates tracheal intubation of ICU patients compared with endotracheal tube alone, its use will become standard practice, thereby decreasing first-attempt intubation failure rates and, potentially, the frequency of intubation-related complications. TRIAL REGISTRATION DETAILS ClinicalTrials.gov Identifier: NCT04079387; Pre-results.
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Affiliation(s)
- Samir Jaber
- Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
| | - Amélie Rolle
- Intensive Care & Anesthesiology Department, University of Pointe à Pitre Hospital. Guadeloupe, France, Université des Antilles Bibliothèque Hospitalo-universitaire de Guadeloupe, Pointe-a-Pitre, Guadeloupe
| | - Boris Jung
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
- Departement of Medical Intensive Care, Lapeyronie Teaching Hospital, Montpellier University, 191, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, Université de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Gerald Chanques
- Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
| | - Helena Bertet
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - David Galeazzi
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Claire Chauveton
- Clinical research department of Montpellier university hospital, Montpellier, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Audrey De Jong
- Department of Anaesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier, France, Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
- PhyMed Exp, Université de Montpellier, INSERM U1046 Montpellier, France, Inserm U1046, Montpellier, Languedoc-Roussillon, France
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Fischer K, Riecker C, Overney S, Stucki M, Tanner H, Jung B, von Tengg-Kobligk H, Eberle B, Guensch D. VIsualizing myocardial injury from elective cardioversion. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.026] [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: 11/11/2022]
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Huelsenitz S, Fischer K, Yamaji K, Stucki M, Ueki Y, Jung B, Räber L, von Tengg-Kobligk H, Eberle B, Guensch D. Effects of normoxic versus hyperoxic hyperventilation followed by apnea on right ventricular strain in patients with multi-vessel coronary artery disease. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.016] [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: 11/11/2022]
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Neuenschwander M, Fischer K, Jung C, Hurni S, Winkler B, Jung B, Vogt A, Eberle B, Guensch D. Ventricular strain is compromised outside of the coronary autoregulatory range – assessment by cardiovascular magnetic resonance. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.004] [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: 11/11/2022]
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Jung B, Chanques G, Jaber S, Klouche K. Mise en place et organisation d’une équipe médicale mobile de réponse précoce aux urgences intra-hospitalières (Rapid Response Team). Méd Intensive Réa 2020. [DOI: 10.37051/mir-00018] [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 mise en place d’une Rapid Response Team a pour objectif la mise en place d’une structure de réponse hospitalièrepour la prise en charge des urgences vitales et surtout une réponse précoce à la dégradation clinique des patientshospitalisés avant que l’urgence vitale ne survienne. Nous discutons dans ce manuscrit le rationnel et le niveau depreuve motivant la mise en place d’une Rapid Response Team ainsi que les freins qui doivent être surmontés pour lesuccès de cette mise en place.
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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Prise en charge de l’exacerbation sévère d’asthme. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00011] [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
Contexte : La Société Française de Médecine d’Urgence, la Société de Réanimation de Langue Française et le GroupeFrancophone de Réanimation et d’Urgences Pédiatriques ont émis des recommandations sur la prise en charge del’exacerbation sévère d’asthme (ESA) chez l’enfant et l’adulte.Résultats : Les recommandations ont concerné 5 champs : diagnostic, traitement pharmacologique, modalités d’oxygénothérapie et de ventilation, orientation du patient, spécifi cités de la femme enceinte. L’analyse de la littérature et laformulation des recommandations ont été conduites selon la méthode GRADE (Grade of Recommendation Assessment,Development and Evaluation). Une recherche bibliographique portant sur les publications indexées dans les bases dedonnées PubMed™ et Cochrane™ a été réalisée.Sur les 21 recommandations formalisées obtenues, 4 avaient un niveau de preuve élevé (GRADE 1+/-) et 7 un niveaude preuve faible (GRADE 2 +/-). Pour 10 recommandations, la méthode GRADE n’a pas pu être appliquée, résultanten un avis d’experts. Un accord fort a été obtenu pour toutes les recommandations.Conclusion : Le travail conjoint de 36 experts issus de 3 sociétés savantes a permis d’obtenir 21 recommandations formalisées pour aider à la prise en charge aux urgences et en soins intensifs des patients adultes et pédiatriques avec une ESA.
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Villard O, Morquin D, Molinari N, Raingeard I, Nagot N, Cristol JP, Jung B, Roubille C, Foulongne V, Fesler P, Lamure S, Taourel P, Konate A, Maria ATJ, Makinson A, Bertchansky I, Larcher R, Klouche K, Le Moing V, Renard E, Guilpain P. The Plasmatic Aldosterone and C-Reactive Protein Levels, and the Severity of Covid-19: The Dyhor-19 Study. J Clin Med 2020; 9:jcm9072315. [PMID: 32708205 PMCID: PMC7408691 DOI: 10.3390/jcm9072315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background. The new coronavirus SARS-CoV-2, responsible for the Covid-19 pandemic, uses the angiotensin converting enzyme type 2 (ACE2), a physiological inhibitor of the renin angiotensin aldosterone system (RAAS), as a cellular receptor to infect cells. Since the RAAS can induce and modulate pro-inflammatory responses, it could play a key role in the pathophysiology of Covid-19. Thus, we aimed to determine the levels of plasma renin and aldosterone as indicators of RAAS activation in a series of consecutively admitted patients for Covid-19 in our clinic. Methods. Plasma renin and aldosterone levels were measured, among the miscellaneous investigations needed for Covid-19 management, early after admission in our clinic. Disease severity was assessed using a seven-category ordinal scale. Primary outcome of interest was the severity of patients’ clinical courses. Results. Forty-four patients were included. At inclusion, 12 patients had mild clinical status, 25 moderate clinical status and 7 severe clinical status. In univariate analyses, aldosterone and C-reactive protein (CRP) levels at inclusion were significantly higher in patients with severe clinical course as compared to those with mild or moderate course (p < 0.01 and p = 0.03, respectively). In multivariate analyses, only aldosterone and CRP levels remained positively associated with severity. We also observed a positive significant correlation between aldosterone and CRP levels among patients with an aldosterone level greater than 102.5 pmol/L. Conclusions. Both plasmatic aldosterone and CRP levels at inclusion are associated with the clinical course of Covid-19. Our findings may open new perspectives in the understanding of the possible role of RAAS for Covid-19 outcome.
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Affiliation(s)
- Orianne Villard
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34000 Montpellier, France
| | - David Morquin
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Nicolas Molinari
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34000 Montpellier, France
| | - Isabelle Raingeard
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
| | - Nicolas Nagot
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34000 Montpellier, France
| | - Jean-Paul Cristol
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Laboratory of Biochemistry, Montpellier University Hospital, 34000 Montpellier, France
| | - Boris Jung
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Camille Roubille
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Vincent Foulongne
- Laboratory of Virology, Montpellier University Hospital, 34000 Montpellier, France;
| | - Pierre Fesler
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Sylvain Lamure
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Patrice Taourel
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Radiology, Montpellier University Hospital, 34000 Montpellier, France
| | - Amadou Konate
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- Department of Internal Medicine—‘DIAGORA Unit’, Montpellier University Hospital, 34000 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- IRMB, INSERM U1183, Montpellier University Hospital, 34000 Montpellier, France
| | - Alain Makinson
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Ivan Bertchansky
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- Department of Internal Medicine—‘DIAGORA Unit’, Montpellier University Hospital, 34000 Montpellier, France
| | - Romaric Larcher
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Kada Klouche
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Vincent Le Moing
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Eric Renard
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34000 Montpellier, France
| | - Philippe Guilpain
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- IRMB, INSERM U1183, Montpellier University Hospital, 34000 Montpellier, France
- Correspondence: ; Tel.: +33-4-67-33-73-32; Fax: +33-4-67-33-72-91
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Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Maria ATJ, Jung B, Larcher R, Klouche K, Le Moing V. Response to: 'Severe COVID-19 associated pneumonia in 3 patients with systemic sclerosis treated with rituximab' by Avouac et al. Ann Rheum Dis 2020; 80:e38. [PMID: 32503848 DOI: 10.1136/annrheumdis-2020-217955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Universite Montpellier, Medical School, Montpellier Cedex 5, France.,IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Clément Le Bihan
- Tropical and Infectious Diseases, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier Cedex 5, Hérault, France
| | - Vincent Foulongne
- Pathogenesis and Control of Chronic Infections, Inserm, Universite Montpellier 1 Faculte de Medecine Montpellier-Nimes, Montpellier, Languedoc-Roussillon, France
| | - Patrice Taourel
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nathalie Pansu
- Tropical and Infectious Diseases, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier Cedex 5, Hérault, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Universite Montpellier, Medical School, Montpellier Cedex 5, France .,IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Lapeyronie University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Vincent Le Moing
- Tropical and Infectious Diseases, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier Cedex 5, Hérault, France
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Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Maria ATJ, Jung B, Larcher R, Klouche K, Le Moing V. Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia. Ann Rheum Dis 2020; 80:e10. [PMID: 32312768 DOI: 10.1136/annrheumdis-2020-217549] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France .,Univ Montpellier, IRMB, Univ Montpellier, INSERM, Montpellier, France
| | - Clément Le Bihan
- Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
| | - Vincent Foulongne
- Pathogenesis and Control of Chronic Infections, Inserm, Universite Montpellier 1 Faculte de Medecine Montpellier-Nimes, Montpellier, Languedoc-Roussillon, France
| | - Patrice Taourel
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nathalie Pansu
- Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
| | - Alexandre Thibault Jacques Maria
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France .,Univ Montpellier, IRMB, Univ Montpellier, INSERM, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France.,Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France.,Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France.,Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
| | - Vincent Le Moing
- Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
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Chittka D, Lennartz L, Jung B, Banas B, Bergler T. [Successful rituximab treatment of recurrent glomerulonephritis associated with antibodies against the glomerular basement membrane]. Internist (Berl) 2020; 61:416-423. [PMID: 32179970 DOI: 10.1007/s00108-020-00773-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article presents a case of recurrent anti-GBM disease (with antibodies against the glomerular basement membrane [GBM]) in a 17-year-old patient successfully treated with rituximab. Kidney biopsy with detection of linear deposition of immunoglobulin G (IgG) along the basement membrane is the diagnostic gold standard, which should be accompanied by serological testing. However, standard assays for the detection of anti-GBM antibodies have a high rate of false-negative results. In this particular case, an increase in proteinuria despite standard therapy (plasmapheresis, steroids, cyclophosphamide) was the clinical correlate of relapsing disease. The use of rituximab completely resolved the recurrent anti-GBM disease.
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Affiliation(s)
- D Chittka
- Abteilung Nephrologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - L Lennartz
- Abteilung Nephrologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Jung
- Abteilung Nephrologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Banas
- Abteilung Nephrologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - T Bergler
- Abteilung Nephrologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Boontiam W, Hyun YK, Jung B, Kim YY. Effects of lysophospholipid supplementation to reduced energy, crude protein, and amino acid diets on growth performance, nutrient digestibility, and blood profiles in broiler chickens. Poult Sci 2020; 98:6693-6701. [PMID: 31801309 PMCID: PMC6869753 DOI: 10.3382/ps/pex005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/04/2017] [Indexed: 01/13/2023] Open
Abstract
Two experiments investigated the effects of lysophospholipid (LPL) supplementation on low-energy and low-nitrogenous diets for broilers. A total of 300 one-day-old male chicks (Ross 308) was allotted to 5 treatments in a completely randomized design. Each group consisted of 6 replicates with 10 birds each. Experimental diet I included positive control (PC) having 3,025 (starter), 3,150 (grower), and 3,200 kcal/kg (finisher) of ME; negative control (NC) was 150 kcal/kg of ME lower than PC, and LPL-05, LPL-10, and LPL-15 treatments were NC + 0.05%, 0.10%, and 0.15% of LPL supplementation, respectively. Experimental diet II included positive control (PC) having a formulated amount of crude protein including Lys and Met + Cys that met the Ross 308 standards; negative control (NC) was 4% lower CP and AA than PC; other treatments were supplemented with LPL at 0.05% (LPL-05), 0.10% (LPL-10), and 0.15% (LPL-15) into the NC, respectively. Experiment I showed that growth performance linearly increased as the LPL inclusion increased (P < 0.001). Broilers fed LPL-10 and LPL-15 increased digestibility of DM (P < 0.05), crude protein (P < 0.01), and total amino acids (P < 0.01) compared to NC. Serum glucose (P < 0.01) and high-density lipoprotein (P < 0.05) concentrations were greater in groups fed LPL-10 than those fed PC. Furthermore, leg muscle increased in birds fed LPL-10 compared with NC (P < 0.05). Experiment II observed a linear response to LPL supplementation in the whole period, in terms of body weight gain (P = 0.015) and feed conversion ratio (P = 0.027). Feeding of 0.15% LPL had promising effects on digestibility of crude protein and ether extract compared with NC (P < 0.01 and P < 0.05, respectively). Overall, LPL could be considered as a feed additive to reduced energy (−150 kcal/kg) or nitrogenous diets (−5%) in order to improve growth performance and nutrient digestibility without adverse effects on lymphoid organs and hepatic enzyme of broilers.
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Affiliation(s)
- W Boontiam
- School of Agricultural Biotechnology, and Research Institute of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-921, South Korea.,Faculty of Agriculture, Department of Animal Science, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Y K Hyun
- School of Agricultural Biotechnology, and Research Institute of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-921, South Korea.,Easy Bio Inc., 310 Gangnam-daero, Gangnam-gu, Seoul 135-754, South Korea
| | - B Jung
- Easy Bio Inc., 310 Gangnam-daero, Gangnam-gu, Seoul 135-754, South Korea
| | - Y Y Kim
- School of Agricultural Biotechnology, and Research Institute of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-921, South Korea
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Larcher R, Pineton de Chambrun M, Garnier F, Rubenstein E, Carr J, Charbit J, Chalard K, Mourad M, Amalric M, Platon L, Brunot V, Amoura Z, Jaber S, Jung B, Luyt CE, Klouche K. One-Year Outcome of Critically Ill Patients With Systemic Rheumatic Disease: A Multicenter Cohort Study. Chest 2020; 158:1017-1026. [PMID: 32289313 DOI: 10.1016/j.chest.2020.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/15/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Critically ill patients with systemic rheumatic disease (SRD) have benefited from better provision of rheumatic and critical care in recent years. Recent comprehensive data regarding in-hospital mortality rates and, most importantly, long-term outcomes are scarce. RESEARCH QUESTION The aim of this study was to assess short and long-term outcome of patients with SRD who were admitted to the ICU. STUDY DESIGN AND METHODS All records of patients with SRD who were admitted to ICU between 2006 and 2016 were reviewed. In-hospital and one-year mortality rates were assessed, and predictive factors of death were identified. RESULTS A total of 525 patients with SRD were included. Causes of admission were most frequently shock (40.8%) and acute respiratory failure (31.8%). Main diagnoses were infection (39%) and SRD flare-up (35%). In-hospital and one-year mortality rates were 30.5% and 37.7%, respectively. Predictive factors that were associated with in-hospital and one-year mortalities were, respectively, age, prior corticosteroid therapy, simplified acute physiology score II ≥50, need for invasive mechanical ventilation, or need for renal replacement therapy. Knaus scale C or D and prior conventional disease modifying antirheumatic drug therapy was associated independently with death one-year after ICU admission. INTERPRETATION Critically ill patients with SRD had a fair outcome after an ICU stay. Increased age, prior corticosteroid therapy, and severity of critical illness were associated significantly with short- and long-term mortality rates. The one-year mortality rate was also associated with prior health status and conventional disease modifying antirheumatic drug therapy.
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Affiliation(s)
- Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France; PhyMedExp, INSERM, CNRS, Montpellier, France.
| | - Marc Pineton de Chambrun
- Department of Internal Medicine 2, E3M Institute, Paris, France; Medical Intensive Care Unit, Institute of Cardiology, La Pitie-Salpetriere Hospital, University of Paris 6, Paris, France
| | - Fanny Garnier
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France; UPRES EA2415, Laboratory of biostatistics, Epidemiology, Clinical Research and Health Economics, University of Montpellier, Montpellier, France
| | - Emma Rubenstein
- Internal Medicine Department, Saint Louis Hospital, University of Paris 7, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Julie Carr
- Anesthesiology and Intensive Care Departments, Saint Eloi Hospital, Montpellier, France
| | | | | | - Marc Mourad
- Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Matthieu Amalric
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France
| | - Laura Platon
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France
| | - Vincent Brunot
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France
| | - Zahir Amoura
- Department of Internal Medicine 2, E3M Institute, Paris, France
| | - Samir Jaber
- Anesthesiology and Intensive Care Departments, Saint Eloi Hospital, Montpellier, France; PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Boris Jung
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France; PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Charles-Edouard Luyt
- Medical Intensive Care Unit, Institute of Cardiology, La Pitie-Salpetriere Hospital, University of Paris 6, Paris, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier, France; PhyMedExp, INSERM, CNRS, Montpellier, France
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Garnier F, Daubin D, Larcher R, Bargnoux AS, Platon L, Brunot V, Aarab Y, Besnard N, Dupuy AM, Jung B, Cristol JP, Klouche K. Reversibility of Acute Kidney Injury in Medical ICU Patients: Predictability Performance of Urinary Tissue Inhibitor of Metalloproteinase-2 x Insulin-Like Growth Factor-Binding Protein 7 and Renal Resistive Index. Crit Care Med 2020; 48:e277-e284. [PMID: 32205617 DOI: 10.1097/ccm.0000000000004218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Urinary biomarkers and renal Doppler sonography remain considered as promising tools to distinguish transient from persistent acute kidney injury. The performance of the urinary biomarker, tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and of renal resistive index to predict persistent acute kidney injury showed contradictory results. Our aim was to evaluate the performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and renal resistive index in predicting reversibility of acute kidney injury in critically ill patients. DESIGN Prospective observational study. SETTING Twenty-bed medical ICU in an university hospital. PATIENTS Consecutive patients with acute kidney injury. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Renal resistive index was measured within 12 hours after admission, and urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 was measured at H0, H6, H12, and H24. Renal dysfunction reversibility was evaluated at day 3. Receiver operating characteristic curves were plotted to evaluate diagnostic performance of renal resistive index and tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 to predict a persistent acute kidney injury. Overall, 100 patients were included in whom 50 with persistent acute kidney injury. Renal resistive index was higher in persistent acute kidney injury group. Urinary tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was not significantly different at each time between both groups. The performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was poor with respectively an area under the receiver operating characteristic curves of 0.57 (95% CI, 0.45-0.68), 0.58 (95% CI, 0.47-0.69), 0.61 (95% CI, 0.50-0.72), and 0.57 (95% CI, 0.46-0.68) at H0, H6, H12, and H24. The area under the receiver operating characteristic curve for renal resistive index was 0.93 (95% CI, 0.89-0.98). A renal resistive index greater than or equal to 0.685 predicting persistent acute kidney injury with 78% (95% CI, 64-88%) sensitivity and 90% (95% CI, 78-97%) specificity. CONCLUSIONS Renal resistive index had a good performance for predicting the reversibility of acute kidney injury in critically ill patients. Urinary tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was unable to differentiate transient from persistent acute kidney injury.
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Affiliation(s)
- Fanny Garnier
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Delphine Daubin
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Romaric Larcher
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS 9214) - Institut National de la Santé et de la Recherche Médicale (INSERM-U1046), Montpellier University, Montpellier, France
| | - Anne-Sophie Bargnoux
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS 9214) - Institut National de la Santé et de la Recherche Médicale (INSERM-U1046), Montpellier University, Montpellier, France
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Laura Platon
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Vincent Brunot
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Yassir Aarab
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Noémie Besnard
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Boris Jung
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS 9214) - Institut National de la Santé et de la Recherche Médicale (INSERM-U1046), Montpellier University, Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS 9214) - Institut National de la Santé et de la Recherche Médicale (INSERM-U1046), Montpellier University, Montpellier, France
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, Centre National de la Recherche Scientifique (CNRS 9214) - Institut National de la Santé et de la Recherche Médicale (INSERM-U1046), Montpellier University, Montpellier, France
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Cinotti R, Besnard N, Desmedt L, Floch RL, Perrot P, Bekara F, Klouche K, Larcher R, Mahé PJ, Frasca D, Asehnoune K, Jung B, Roquilly A. Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study. Burns 2020; 46:1310-1317. [PMID: 32156477 DOI: 10.1016/j.burns.2020.02.009] [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: 11/21/2019] [Revised: 01/28/2020] [Accepted: 02/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. METHODS We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. RESULTS Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%-38%] and median ABSI was 7 [5-9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2-24] vs. 6 days [2-17] (P=0.3) and 17 days [4-32] vs. 8 days [3-23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2-24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6). CONCLUSION Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.
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Affiliation(s)
- Raphaël Cinotti
- Department of Anesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Boulevard Jacques Monod, Saint-Herblain 44800, France.
| | - Noémie Besnard
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Luc Desmedt
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Ronan Le Floch
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Pierre Perrot
- Department of Plastic and Burn Surgery, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Farid Bekara
- Department of Plastic and Burn Surgery, Montpellier University and Montpellier Teaching Hospital, Hôpital Lapeyronie 191, Avenue du Doyen Gaston Giraud, Montpellier Cedex 5, Montpellier 34295, France
| | - Kada Klouche
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France; INSERM U1046, CNRS UMR9214, Hôpital Lapeyronie 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Université deMontpellier, Montpellier 34295, France
| | - Romaric Larcher
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Pierre-Joachim Mahé
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France
| | - Denis Frasca
- Department of Anesthesia and Critical Care, Centre Hospitalo-Universitaire, University Hospital of Poitiers, 2 rue de la Milétrie Poitiers 86021, France; INSERM SPHERE U1246 «MethodS for Patients-centered outcomes and HEalth REsearch», UFR des sciences pharmaceutiques, University of Nantes, University of Tours, 22 boulevard Benoni-Goullin, Nantes 44200, France
| | - Karim Asehnoune
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections». University hospital of Nantes, 22 boulevard Benoni-Goullin, Nantes 44200, France
| | - Boris Jung
- Medical Intensive Care Unit, Hôpital Lapeyronie, Montpellier University and MontpellierTeaching Hospital, 191, Avenue du Doyen Gaston Giraud, MontpellierCedex 5, Montpellier, 34295, France
| | - Antoine Roquilly
- Anesthesia and Critical Care, University Hospital of Nantes, Hôtel Dieu, 1 place Alexis Ricordeau, Nantes 44093, France; Laboratoire UPRES EA 3826 «Thérapeutiques cliniques et expérimentales des infections». University hospital of Nantes, 22 boulevard Benoni-Goullin, Nantes 44200, France
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Flatres A, Aarab Y, Nougaret S, Garnier F, Larcher R, Amalric M, Klouche K, Etienne P, Subra G, Jaber S, Molinari N, Matecki S, Jung B. Correction to: Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients. Crit Care 2020; 24:79. [PMID: 32138763 PMCID: PMC7059701 DOI: 10.1186/s13054-020-2802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Aurelien Flatres
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Yassir Aarab
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Stephanie Nougaret
- IRCM, INSERM U1194, and Department of Radiology, Montpellier Cancer Research Institute, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Fanny Garnier
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Romaric Larcher
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Mathieu Amalric
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Kada Klouche
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Pascal Etienne
- Laboratoire Charles Coulomb (L2C), University of Montpellier, CNRS, Montpellier, France
| | - Gilles Subra
- Institut des Biomolécules Max Mousseron (IBMM), UMR5247 CNRS, ENSCM, Université de Montpellier, 34000, Montpellier, France
| | - Samir Jaber
- INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France.,Saint Eloi Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier Teaching Hospital, Montpellier, France
| | - Nicolas Molinari
- Biostatistics Department, Montpellier University and Montpellier Teaching Hospital, Montpellier, France
| | - Stefan Matecki
- INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Boris Jung
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France. .,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France.
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Flatres A, Aarab Y, Nougaret S, Garnier F, Larcher R, Amalric M, Klouche K, Etienne P, Subra G, Jaber S, Molinari N, Matecki S, Jung B. Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients. Crit Care 2020; 24:34. [PMID: 32014005 PMCID: PMC6998330 DOI: 10.1186/s13054-020-2745-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Muscle weakness following critical illness is the consequence of loss of muscle mass and alteration of muscle quality. It is associated with long-term disability. Ultrasonography is a reliable tool to quantify muscle mass, but studies that evaluate muscle quality at the critically ill bedside are lacking. Shear wave ultrasound elastography (SWE) provides spatial representation of soft tissue stiffness and measures of muscle quality. The reliability and reproducibility of SWE in critically ill patients has never been evaluated. METHODS Two operators tested in healthy controls and in critically ill patients the intra- and inter-operator reliability of the SWE using transversal and longitudinal views of the diaphragm and limb muscles. Reliability was calculated using the intra-class correlation coefficient and a bootstrap sampling method assessed their consistency. RESULTS We collected 560 images. Longitudinal views of the diaphragm (ICC 0.83 [0.50-0.94]), the biceps brachii (ICC 0.88 [0.67-0.96]) and the rectus femoris (ICC 0.76 [0.34-0.91]) were the most reliable views in a training set of healthy controls. Intra-class correlation coefficient for inter-operator reproducibility and intra-operator reliability was above 0.9 for all muscles in a validation set of healthy controls. In critically ill patients, inter-operator reproducibility and intra-operator 1 and 2 reliability ICCs were respectively 0.92 [0.71-0.98], 0.93 [0.82-0.98] and 0.92 [0.81-0.98] for the diaphragm; 0.96 [0.86-0.99], 0.98 [0.94-0.99] and 0.99 [0.96-1] for the biceps brachii and 0.91 [0.51-0.98], 0.97 [0.93-0.99] and 0.99 [0.97-1] for the rectus femoris. The probability to reach intra-class correlation coefficient greater than 0.8 in a 10,000 bootstrap sampling for inter-operator reproducibility was respectively 81%, 84% and 78% for the diaphragm, the biceps brachii and the rectus femoris respectively. CONCLUSIONS SWE is a reliable technique to evaluate limb muscles and the diaphragm in both healthy controls and in critically ill patients. TRIAL REGISTRATION The study was registered (ClinicalTrial NCT03550222).
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Affiliation(s)
- Aurelien Flatres
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Yassir Aarab
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Stephanie Nougaret
- IRCM, INSERM U1194, and Department of Radiology, Montpellier Cancer Research Institute, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Fanny Garnier
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Romaric Larcher
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Mathieu Amalric
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Kada Klouche
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Pascal Etienne
- Laboratoire Charles Coulomb (L2C), University of Montpellier, CNRS, Montpellier, France
| | - Gilles Subra
- Institut des Biomolécules Max Mousseron (IBMM), UMR5247 CNRS, ENSCM, Université de Montpellier, 34000, Montpellier, France
| | - Samir Jaber
- INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France.,Saint Eloi Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier Teaching Hospital, Montpellier, France
| | - Nicolas Molinari
- Biostatistics Department, Montpellier University and Montpellier Teaching Hospital, Montpellier, France
| | - Stefan Matecki
- INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
| | - Boris Jung
- Medical Intensive Care Unit, Montpellier University and Montpellier Lapeyronie Teaching Hospital, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France. .,INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France.
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Dridi H, Yehya M, Barsotti R, Reiken S, Angebault C, Jung B, Jaber S, Marks AR, Lacampagne A, Matecki S. Mitochondrial oxidative stress induces leaky ryanodine receptor during mechanical ventilation. Free Radic Biol Med 2020; 146:383-391. [PMID: 31756525 DOI: 10.1016/j.freeradbiomed.2019.11.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 07/09/2019] [Revised: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 12/28/2022]
Abstract
RATIONALE Ventilator-induced diaphragm dysfunction (VIDD) increases morbidity and mortality in critical care patients. Although VIDD has been associated with mitochondrial oxidative stress and calcium homeostasis impairment, the underling mechanisms are still unknown. We hypothesized that diaphragmatic mitochondrial oxidative stress causes remodeling of the ryanodine receptor (RyR1)/calcium release channel, contributing to sarcoplasmic reticulum (SR) Ca2+ leak, proteolysis and VIDD. METHOD In mice diaphragms mechanically ventilated for short (6 h) and long (12 h) period, we assessed mitochondrial ROS production, mitochondrial aconitase activity as a marker of mitochondrial oxidative stress, RyR1 remodeling and function, Ca2+ dependent proteolysis, TGFβ1 and STAT3 pathway, muscle fibers cross-sectional area, and diaphragm specific force production, with or without the mitochondrial targeted anti-oxidant peptide d-Arg-2', 6'-dimethyltyrosine-Lys-Phe-NH2 (SS31). MEASUREMENTS AND MAIN RESULTS 6 h of mechanical ventilation (MV) resulted in increased mitochondrial ROS production, reduction of mitochondrial aconitase activity, increased oxidation, S-nitrosylation, S-glutathionylation and Ser-2844 phosphorylation of RyR1, depletion of stabilizing subunit calstabin1 from RyR1, increased SR Ca2+ leak. Preventing mROS production by SS31 treatment does not affect the TGFβ1 and STAT3 activation, which suggests that mitochondrial oxidative stress is a downstream pathway to TGFβ1 and STAT3, early involved in VIDD. This is further supported by the fact that SS-31 rescue all the other described cellular events and diaphragm contractile dysfunction induced by MV, while SS20, an analog of SS31 lacking antioxidant properties, failed to prevent these cellular events and the contractile dysfunction. Similar results were found in ventilated for 12 h. Moreover, SS31 treatment prevented calpain1 activity and diaphragm atrophy observed after 12 h of MV. This study emphasizes that mitochondrial oxidative stress during 6 h-MV contributes to SR Ca2+ leak via RyR1 remodeling, and diaphragm weakness, while longer periods of MV (12 h) were also associated with increased Ca2+-dependent proteolysis and diaphragm atrophy.
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Affiliation(s)
- Haikel Dridi
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology Columbia University College of Physicians and Surgeons, New York, USA
| | - Mohamad Yehya
- PhyMedExp, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France
| | - Robert Barsotti
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Steven Reiken
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology Columbia University College of Physicians and Surgeons, New York, USA
| | - Claire Angebault
- PhyMedExp, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France
| | - Boris Jung
- PhyMedExp, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France; Medical Intensive Care Unit, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Samir Jaber
- PhyMedExp, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France; St Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France
| | - Andrew R Marks
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology Columbia University College of Physicians and Surgeons, New York, USA
| | - Alain Lacampagne
- PhyMedExp, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France.
| | - Stephan Matecki
- PhyMedExp, Montpellier University, INSERM, CNRS, CHRU Montpellier, 34295, Montpellier, France; Arnaud de Villeneuve Physiological Department, Montpellier University and Montpellier University Health Care Center, 34295, Montpellier, France.
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Ait-Belkacem R, Hochart G, Marini J, Tomezyk A, Mantefeul P, Jung B, Bonnel D, Kenzie DM, Stauber J. Abstract A114: Quantitative mass spectrometry imaging: A game changer in the pharmaceutical industry. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-a114] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Developing a drug requires to demonstrate its efficacy in preclinical and clinical studies but also to characterize its pharmacokinetics properties. If Quantitative Whole-Body Autoradiography (QWBA) is still a gold standard to support the design of radiolabelled clinical studies, its lack of molecular specificity limits the understanding of the distribution of the drug and its metabolites, with no establishing of separate quantitative results for each target tissue of interest. On the contrary, the use of high resolution mass spectrometers such as FT-ICR MS allows a quantitative characterization of the metabolic profile of the drug at the tissue level in order to further understand its behaviour in the organism. A comparative analysis between QWBA and QMSI was applied as a complementary approach to follow chloroquine and one of its metabolites (desethyl-chloroquine) at different time-points after a single administration of a radiolabeled dose to Long-Evans male rats (30 mg/kg). 1H-Chloroquine and 1H-desethyl chloroquine were well detected by MALDI-FTICR in the eye including; the uveal tract, the vitreous humor, the lens and the Harderian gland. In the mid whole-body region, both compounds were also detected in various organs from the unique prepared T4h sections. Interestingly the two compounds were co-localized into the tissue sections and their distributions matched the zones obtained by QWBA. In QWBA additional regions containing the radiolabeled moiety could be clearly identified because of the high sensitivity of the technique. The advantage brought by MALDI QMSI was the ability to discriminate between parent drug 1H-choloroquine and its metabolite 1H-desethyl chloroquine so that each compound had its own distribution image and thus its own quantification data directly in one tissue section. The used labeled forms of both compounds during the matrix deposit allowed normalizing the data for each position targeted with the MALDI onto the section of interest and the calibration range of both 1H-choloroquine and 1H-desethyl chloroquine and quantifying each compound into the organs of interest with the ILC approach. Finally the QMSI was able to demonstrate the disappearance of the drug and its metabolite with time to better understand differential pharmacokinetics analysis demonstrating the additional input of the technology compared to QWBA.
Citation Format: Rima Ait-Belkacem, Guillaume Hochart, Joseph Marini, Aurore Tomezyk, p Mantefeul, B. Jung, David Bonnel, Don Mc Kenzie, Jonathan Stauber. Quantitative mass spectrometry imaging: A game changer in the pharmaceutical industry [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A114. doi:10.1158/1535-7163.TARG-19-A114
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Affiliation(s)
| | | | | | | | | | - B. Jung
- 3Covance Laboratories, Wiscousin, WI
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Chen C, Jung B, Kim WK. Effects of lysophospholipid on growth performance, carcass yield, intestinal development, and bone quality in broilers. Poult Sci 2019; 98:3902-3913. [PMID: 31329958 DOI: 10.3382/ps/pez111] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/21/2022] Open
Abstract
A study was conducted to evaluate the effects of supplementing different levels of lysophospholipid (LPL) to normal or reduced energy diets on growth performance, carcass yield, intestinal morphology, and skeletal development in broilers. A total of 960 one-day-old Cobb 500 male birds were allocated using a 2 × 4 factorial arrangement with 2 energy levels (NE: normal and RE: 100 kcal/kg metabolizable energy reduction) and 4 LPL supplement levels (0, 0.025, 0.050, and 0.075%). Three diet phases were fed throughout the trial: starter (days 0 to 7), grower (days 8 to 21), and finisher (days 22 to 42) phases. Body weight (BW), feed intake (FI), and feed conversion ratio were calculated at the end of each phase. At day 7 and 21, duodenum and jejunum samples were collected for intestinal morphology and claudin-3 expression analyses, and tibia were sampled for bone quality analyses. At day 42, 4 birds per replicate were selected to measure carcass yield. The results showed low metabolizable energy diets impaired bird's growth performance, intestine development, and bone quality. The 0.075% LPL supplement in NE improved BW, BW gain, and FI in the finisher and overall period compared with no LPL supplement in NE (P < 0.05). In RE, the 0.025% LPL supplement significantly improved growth performance compared to the other treatments in RE (P < 0.05). The interactions on processing parameters were detected with LPL supplement in NE diets; 0.025, 0.05, and 0.075% LPL supplements significantly increased pectoral major percentages compared to the one without LPL supplement in NE (P < 0.05). The 0.075% LPL supplement increased dressing percentage (cold carcass weight/live BW) compared with the others (P < 0.05). The intestine morphology results showed LPL had positive effects on intestine development mainly during the early age (day 7) and claudin-3 expression at both day 7 and 21. Furthermore, LPL supplement significantly increased the total Ca and P deposition and positively affected the bone structure development. In summary, dietary LPL supplementation promoted growth performance, carcass yield, intestinal development, intestinal health, and bone quality.
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Affiliation(s)
- C Chen
- Department of Poultry Science, University of Georgia, Athens, GA 30602
| | - B Jung
- Easy Bio Inc., 310 Gangnam-daero, Gangnam-gu, Seoul 135-754, South Korea
| | - W K Kim
- Department of Poultry Science, University of Georgia, Athens, GA 30602
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Dres M, Jung B, Molinari N, Manna F, Dubé BP, Chanques G, Similowski T, Jaber S, Demoule A. Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts. Crit Care 2019; 23:370. [PMID: 31752937 PMCID: PMC6873450 DOI: 10.1186/s13054-019-2650-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/16/2019] [Indexed: 01/16/2023]
Abstract
Background Intensive care unit (ICU)-acquired weakness (ICU-AW) and ICU-acquired diaphragm dysfunction (ICU-DD) occur frequently in mechanically ventilated (MV) patients. It is unknown whether they have different risk factors and different impacts on outcome. This study was designed to (1) describe the respective risk factors associated with ICU-AW and severe ICU-DD and (2) evaluate the respective impact of ICU-AW and severe ICU-DD on outcome. Methods Post hoc analysis of two prospective cohort studies conducted in two ICUs. In patients mechanically ventilated for at least 24 h undergoing a first spontaneous breathing trial, severe ICU-DD was defined as diaphragm twitch pressure < 7 cmH2O and ICU-AW was defined as Medical Research Council Score < 48. Results One hundred sixteen patients were assessed. Factors independently associated with severe ICU-DD were age, longer duration of MV, and exposure to sufentanil, and those factors associated with ICU-AW were longer duration of MV and exposure to norepinephrine. Severe ICU-DD (OR 3.56, p = 0.008), but not ICU-AW, was independently associated with weaning failure (59%). ICU-AW (OR 4.30, p = 0.033), but not severe ICU-DD, was associated with ICU mortality. Weaning failure and mortality rate were higher in patients with both severe ICU-DD and ICU-AW (86% and 39%, respectively) than in patients with either severe ICU-DD (64% and 0%) or ICU-AW (63% and 13%). Conclusion Severe ICU-DD and ICU-AW have different risk factors and different impacts on weaning failure and mortality. The impact of the combination of ICU-DD and ICU-AW is more pronounced than their individual impact.
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Affiliation(s)
- Martin Dres
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Boris Jung
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Medical Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, CHU Montpellier, IMAG, CNRS, Univ Montpellier, Montpellier, France
| | - Federico Manna
- Department of Statistics, CHU Montpellier, IMAG, CNRS, Univ Montpellier, Montpellier, France
| | - Bruno-Pierre Dubé
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Gerald Chanques
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Thomas Similowski
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Samir Jaber
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Alexandre Demoule
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France. .,Service de Pneumologie, Médecine Intensive et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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Dres M, Jung B, Molinari N, Manna F, Dubé BP, Chanques G, Similowski T, Jaber S, Demoule A. Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts. Crit Care 2019. [PMID: 31752937 DOI: 10.1186/s13054-019-2650-z].] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness (ICU-AW) and ICU-acquired diaphragm dysfunction (ICU-DD) occur frequently in mechanically ventilated (MV) patients. It is unknown whether they have different risk factors and different impacts on outcome. This study was designed to (1) describe the respective risk factors associated with ICU-AW and severe ICU-DD and (2) evaluate the respective impact of ICU-AW and severe ICU-DD on outcome. METHODS Post hoc analysis of two prospective cohort studies conducted in two ICUs. In patients mechanically ventilated for at least 24 h undergoing a first spontaneous breathing trial, severe ICU-DD was defined as diaphragm twitch pressure < 7 cmH2O and ICU-AW was defined as Medical Research Council Score < 48. RESULTS One hundred sixteen patients were assessed. Factors independently associated with severe ICU-DD were age, longer duration of MV, and exposure to sufentanil, and those factors associated with ICU-AW were longer duration of MV and exposure to norepinephrine. Severe ICU-DD (OR 3.56, p = 0.008), but not ICU-AW, was independently associated with weaning failure (59%). ICU-AW (OR 4.30, p = 0.033), but not severe ICU-DD, was associated with ICU mortality. Weaning failure and mortality rate were higher in patients with both severe ICU-DD and ICU-AW (86% and 39%, respectively) than in patients with either severe ICU-DD (64% and 0%) or ICU-AW (63% and 13%). CONCLUSION Severe ICU-DD and ICU-AW have different risk factors and different impacts on weaning failure and mortality. The impact of the combination of ICU-DD and ICU-AW is more pronounced than their individual impact.
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Affiliation(s)
- Martin Dres
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Boris Jung
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Medical Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, CHU Montpellier, IMAG, CNRS, Univ Montpellier, Montpellier, France
| | - Federico Manna
- Department of Statistics, CHU Montpellier, IMAG, CNRS, Univ Montpellier, Montpellier, France
| | - Bruno-Pierre Dubé
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Gerald Chanques
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Thomas Similowski
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Samir Jaber
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Alexandre Demoule
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France. .,Service de Pneumologie, Médecine Intensive et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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Dres M, Jung B, Molinari N, Manna F, Dubé BP, Chanques G, Similowski T, Jaber S, Demoule A. Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts. Crit Care 2019. [PMID: 31752937 DOI: 10.1186/s13054-019-2650-z]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness (ICU-AW) and ICU-acquired diaphragm dysfunction (ICU-DD) occur frequently in mechanically ventilated (MV) patients. It is unknown whether they have different risk factors and different impacts on outcome. This study was designed to (1) describe the respective risk factors associated with ICU-AW and severe ICU-DD and (2) evaluate the respective impact of ICU-AW and severe ICU-DD on outcome. METHODS Post hoc analysis of two prospective cohort studies conducted in two ICUs. In patients mechanically ventilated for at least 24 h undergoing a first spontaneous breathing trial, severe ICU-DD was defined as diaphragm twitch pressure < 7 cmH2O and ICU-AW was defined as Medical Research Council Score < 48. RESULTS One hundred sixteen patients were assessed. Factors independently associated with severe ICU-DD were age, longer duration of MV, and exposure to sufentanil, and those factors associated with ICU-AW were longer duration of MV and exposure to norepinephrine. Severe ICU-DD (OR 3.56, p = 0.008), but not ICU-AW, was independently associated with weaning failure (59%). ICU-AW (OR 4.30, p = 0.033), but not severe ICU-DD, was associated with ICU mortality. Weaning failure and mortality rate were higher in patients with both severe ICU-DD and ICU-AW (86% and 39%, respectively) than in patients with either severe ICU-DD (64% and 0%) or ICU-AW (63% and 13%). CONCLUSION Severe ICU-DD and ICU-AW have different risk factors and different impacts on weaning failure and mortality. The impact of the combination of ICU-DD and ICU-AW is more pronounced than their individual impact.
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Affiliation(s)
- Martin Dres
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Boris Jung
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Medical Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, CHU Montpellier, IMAG, CNRS, Univ Montpellier, Montpellier, France
| | - Federico Manna
- Department of Statistics, CHU Montpellier, IMAG, CNRS, Univ Montpellier, Montpellier, France
| | - Bruno-Pierre Dubé
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Gerald Chanques
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Thomas Similowski
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France
| | - Samir Jaber
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France
| | - Alexandre Demoule
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), F-75013, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Intensive Care Unit and Respiratory Division (Département "R3S"), F-75013, Paris, France. .,Service de Pneumologie, Médecine Intensive et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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