1
|
Labro G, Tubach F, Belin L, Dubost JL, Osman D, Muller G, Quenot JP, Da Silva D, Zarka J, Turpin M, Mayaux J, Lamer C, Doyen D, Chevrel G, Plantefeve G, Demeret S, Piton G, Manzon C, Ochin E, Gaillard R, Dautzenberg B, Baldacini M, Lebbah S, Miyara M, Pineton de Chambrun M, Amoura Z, Combes A. Nicotine patches in patients on mechanical ventilation for severe COVID-19: a randomized, double-blind, placebo-controlled, multicentre trial. Intensive Care Med 2022; 48:876-887. [PMID: 35676335 PMCID: PMC9177407 DOI: 10.1007/s00134-022-06721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/27/2022] [Indexed: 01/08/2023]
Abstract
Purpose Epidemiologic studies have documented lower rates of active smokers compared to former or non-smokers in symptomatic patients affected by coronavirus disease 2019 (COVID-19). We assessed the efficacy and safety of nicotine administered by a transdermal patch in critically ill patients with COVID-19 pneumonia. Methods In this multicentre, double-blind, placebo-controlled trial conducted in 18 intensive care units in France, we randomly assigned adult patients (non-smokers, non-vapers or who had quit smoking/vaping for at least 12 months) with proven COVID-19 pneumonia receiving invasive mechanical ventilation for up to 72 h to receive transdermal patches containing either nicotine at a daily dose of 14 mg or placebo until 48 h following successful weaning from mechanical ventilation or for a maximum of 30 days, followed by 3-week dose tapering by 3.5 mg per week. Randomization was stratified by centre, non- or former smoker status and Sequential Organ Function Assessment score (< or ≥ 7). The primary outcome was day-28 mortality. Main prespecified secondary outcomes included 60-day mortality, time to successful extubation, days alive and free from mechanical ventilation, renal replacement therapy, vasopressor support or organ failure at day 28. Results Between November 6th 2020, and April 2nd 2021, 220 patients were randomized from 18 active recruiting centers. After excluding 2 patients who withdrew consent, 218 patients (152 [70%] men) were included in the analysis: 106 patients to the nicotine group and 112 to the placebo group. Day-28 mortality did not differ between the two groups (30 [28%] of 106 patients in the nicotine group vs 31 [28%] of 112 patients in the placebo group; odds ratio 1.03 [95% confidence interval, CI 0.57–1.87]; p = 0.46). The median number of day-28 ventilator-free days was 0 (IQR 0–14) in the nicotine group and 0 (0–13) in the placebo group (with a difference estimate between the medians of 0 [95% CI -3–7]). Adverse events likely related to nicotine were rare (3%) and similar between the two groups. Conclusion In patients having developed severe COVID-19 pneumonia requiring invasive mechanical ventilation, transdermal nicotine did not significantly reduce day-28 mortality. There is no indication to use nicotine in this situation. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06721-1.
Collapse
Affiliation(s)
- Guylaine Labro
- Service de Médecine Intensive-Réanimation Groupement Hospitalier Régional Mulhouse Et Sud Alsace, Hôpital Emile Muller, 68100, Mulhouse, France
| | - Florence Tubach
- Département de Santé Publique, Unité de Recherche Clinique PSL-CFX, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1901, 75013, Paris, France
| | - Lisa Belin
- Département de Santé Publique, Unité de Recherche Clinique PSL-CFX, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1901, 75013, Paris, France
| | - Jean-Louis Dubost
- Centre Hospitalier René Dubos, 6, avenue de l'Ile de, 95303, Cergy-Pontoise, France
| | - David Osman
- CHU Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Grégoire Muller
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Daniel Da Silva
- Service de Médecine Intensive Réanimation du Centre, Hospitalier de Saint-Denis, Saint-Denis, France
| | - Jonathan Zarka
- Service de Réanimation Polyvalente, Grand Hôpital de L'Est Francilien, site de Marne-La-Vallée, Jossigny, France
| | - Matthieu Turpin
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive RéanimationHôpital Tenon, Sorbonne Université, Paris, France
| | - Julien Mayaux
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Médecine Intensive Et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France
| | - Christian Lamer
- Service de RéanimationInstitut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Denis Doyen
- Médecine Intensive RéanimationHôpital L'Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Guillaume Chevrel
- Service de Réanimation; Centre Hospitalier Sud Francilien (CHSF), 40 Avenue Serge Dassault, Corbeil-Essonne, France
| | - Gaétan Plantefeve
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Victor Dupouy, 95107, Argenteuil, France
| | - Sophie Demeret
- Médecine Intensive Réanimation À Orientation Neurologique - Site Pitié Salpêtrière - Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Gaël Piton
- Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, Besançon, France
| | - Cyril Manzon
- Service de Réanimation, Médipole Lyon Villeurbanne. Service de Réanimation, 158 rue Léon Blum, 69100, Villeurbanne, France
| | - Evelina Ochin
- Service de Médecine Intensive-Réanimation Hôpital Simone Veil, Eaubonne, France
| | - Raphael Gaillard
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Bertrand Dautzenberg
- Sorbonne Université APHP (La Pitié-Salpêtrière), 75013, Paris, France.,Tabacologue Institut Arthur Vernes, Paris, France
| | - Mathieu Baldacini
- Service de Médecine Intensive-Réanimation Groupement Hospitalier Régional Mulhouse Et Sud Alsace, Hôpital Emile Muller, 68100, Mulhouse, France
| | - Said Lebbah
- Département de Santé Publique, Unité de Recherche Clinique PSL-CFX, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1901, 75013, Paris, France
| | - Makoto Miyara
- Service de Médecine Interne 2, Institut E3M, CRMR Lupus. SAPL Et Autres Maladies Auto-Immunes, Hôpital Pitié Salpêtrière Et Université Paris 6, Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 47, Boulevard de l'Hôpital, 75013, Paris, France
| | - Zahir Amoura
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France. .,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 47, Boulevard de l'Hôpital, 75013, Paris, France.
| | | |
Collapse
|
2
|
Faermark N, Fuks D, Nassar A, Ferraz JM, Lamer C, Lefevre M, Gayet B, Bonnet S. Quality of oncological resection criteria in minimally invasive esophagectomy. Surg Endosc 2022; 36:3940-3946. [PMID: 34494148 DOI: 10.1007/s00464-021-08713-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Even though minimally invasive esophageal surgery (MIE) is spreading, questions remain regarding its oncological outcomes. The aim of this study was to assess the quality of oncological resection criteria in MIE. METHODS All patients undergoing a two-way Ivor Lewis esophagectomy for esophageal or junctional cancer between 2010 and 2020 in a single tertiary upper gastrointestinal surgery ward were analyzed retrospectively. The following oncological criteria were analyzed: lymph node (LN) harvest and location, positive lymph node rate, margins, and R0 rates. They were compared between the MIE group (thoracoscopy + laparoscopy) and the hybrid group (H/O, thoracotomy + laparoscopy). RESULTS Among the 240 patients included, 34 (14%) had MIE and 206 a hybrid esophagectomy. Main surgical indication was lower thoracic adenocarcinoma and the rate of neoadjuvant treatments administered (chemotherapy or chemoradiotherapy) was comparable between both groups (p = 1.0). LN harvest was significantly higher in the MIE group (31 ± 9 vs. 28 ± 9, p = 0.04) as well as thoracic LN harvest (14 ± 7 vs. 11 ± 5, p = 0.002). When analyzing patients according to T stage and response to neoadjuvant treatments, patients with T1 and T2 tumors and patients with a poor pathological response (TRG3, 4, 5) had a significantly higher LN harvest when undergoing a minimally invasive approach (p = 0.021 and p = 0.01, respectively). Positive LN rates (1.26 ± 3.63 in the MIE group vs. 1.60 ± 2.84 in the H/O group, p = 0.061), R0 rates (97% vs. 98.5%, p = 0.46) as well as proximal (p = 0.083), distal (p = 0.063), and lateral (p = 0.15) margins were comparable between both approaches. CONCLUSION MIE seems oncologically safe and may even be better than the open approach in terms of LN harvest especially in patients with T1 and T2 tumors and in poor responders.
Collapse
Affiliation(s)
- Nicole Faermark
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Alexandra Nassar
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Jean-Marc Ferraz
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Christian Lamer
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marine Lefevre
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Stéphane Bonnet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France.
| |
Collapse
|
3
|
Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
4
|
Mazeraud A, Jamme M, Mancusi RL, Latroche C, Megarbane B, Siami S, Zarka J, Moneger G, Santoli F, Argaud L, Chillet P, Muller G, Bruel C, Asfar P, Beloncle F, Reignier J, Vinsonneau C, Schimpf C, Amour J, Goulenok C, Lemaitre C, Rohaut B, Mateu P, De Rudnicki S, Mourvillier B, Declercq PL, Schwebel C, Stoclin A, Garnier M, Madeux B, Gaudry S, Bailly K, Lamer C, Aegerter P, Rieu C, Sylla K, Lucas B, Sharshar T. Intravenous immunoglobulins in patients with COVID-19-associated moderate-to-severe acute respiratory distress syndrome (ICAR): multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2021; 10:158-166. [PMID: 34774185 PMCID: PMC8585489 DOI: 10.1016/s2213-2600(21)00440-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023]
Abstract
Background Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 and is associated with high mortality and morbidity. We aimed to assess whether intravenous immunoglobulins (IVIG) could improve outcomes by reducing inflammation-mediated lung injury. Methods In this multicentre, double-blind, placebo-controlled trial, done at 43 centres in France, we randomly assigned patients (1:1) receiving invasive mechanical ventilation for up to 72 h with PCR confirmed COVID-19 and associated moderate-to-severe ARDS to receive either IVIG (2 g/kg over 4 days) or placebo. Random assignment was done with a web-based system and was stratified according to the participating centre and the duration of invasive mechanical ventilation before inclusion in the trial (<12 h, 12–24 h, and >24–72 h), and treatment was administered within the first 96 h of invasive mechanical ventilation. To minimise the risk of adverse events, the IVIG administration was divided into four perfusions of 0·5 g/kg each administered over at least 8 hours. Patients in the placebo group received an equivalent volume of sodium chloride 0·9% (10 mL/kg) over the same period. The primary outcome was the number of ventilation-free days by day 28, assessed according to the intention-to-treat principle. This trial was registered on ClinicalTrials.gov, NCT04350580. Findings Between April 3, and October 20, 2020, 146 patients (43 [29%] women) were eligible for inclusion and randomly assigned: 69 (47%) patients to the IVIG group and 77 (53%) to the placebo group. The intention-to-treat analysis showed no statistical difference in the median number of ventilation-free days at day 28 between the IVIG group (0·0 [IQR 0·0–8·0]) and the placebo group (0·0 [0·0–6·0]; difference estimate 0·0 [0·0–0·0]; p=0·21). Serious adverse events were more frequent in the IVIG group (78 events in 22 [32%] patients) than in the placebo group (47 events in 15 [20%] patients; p=0·089). Interpretation In patients with COVID-19 who received invasive mechanical ventilation for moderate-to-severe ARDS, IVIG did not improve clinical outcomes at day 28 and tended to be associated with an increased frequency of serious adverse events, although not significant. The effect of IVIGs on earlier disease stages of COVID-19 should be assessed in future trials. Funding Programme Hospitalier de Recherche Clinique.
Collapse
Affiliation(s)
- Aurélien Mazeraud
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Société Française d'Anesthésie-Réanimation Research Network, France; Department of Neurosiences, Université de Paris, Paris, France.
| | - Matthieu Jamme
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France; INSERM U1018, CESP, Équipe Epidémiologie Clinique, Université Paris Saclay, Villejuif, France
| | - Rossella Letizia Mancusi
- Direction de la recherche clinique et de l'innovation, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Paris, France
| | - Claire Latroche
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Bruno Megarbane
- Department of Neurosiences, Université de Paris, Paris, France; Service de Médecine Intensive et Réanimation, Centre Hospitalo-universitaire Lariboisière Paris, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, Centre Hospitalier Sud-Essonnes, Etampes, France
| | - Jonathan Zarka
- Service de Médecine Intensive et Réanimation, Grand hôpital de l'Est francilien site Marne-la-Vallée, Marne-la-Vallée, France
| | - Guy Moneger
- Service de Réanimation polyvalente, Hôpital Nord Franche Comté, Trevenans, France
| | - Francesco Santoli
- Service de Réanimation Médicale, Centre Hospitalo-universitaire Robert Ballanger, Aulnay, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Patrick Chillet
- Service de Réanimation Polyvalente, Centre Hospitalier Chalons en Champagne, Chalons en Champagne, France
| | - Gregoire Muller
- Service de Médecine Intensive et Réanimation, Centre hospitalier, Orléans, France; Clinical Research in Intensive Care and Sepsis - TRIal Group for global Evaluation and Research in Sepsis research network, Tours, France
| | - Cedric Bruel
- Service de Réanimation Médico-chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Francois Beloncle
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Béthune, France
| | - Caroline Schimpf
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery, Ramsay Health Care, Hôpital Privé Jacques Cartier, Massy, France
| | - Cyril Goulenok
- Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Caroline Lemaitre
- Département de Gastroentérologie et Hépatologie, Hôpital Jacques Monod, Montivilliers, France; Département de Médecine Intensive et Réanimation, Hôpital Jacques Monod, Avenue Pierre Mendès France, Montivilliers, France
| | - Benjamin Rohaut
- Département de Neurologie, Neurointensive care unit, Assistance Publique -Hopitaux de Paris-Pitié Salpêtrière, Paris, France; Department of Neurology, Sorbonne Université, Paris, France; Institut du Cerveau-Paris Brain Institute-Institut du Cerveau et de la Moelle, Paris, France; Pinic Lab, INSERM, Paris, France; Centre National de la Recherche Scientifique, Paris, France
| | - Philippe Mateu
- Service de Réanimation polyvalente, Centre Hospitalier Interrégional Nord Ardennes, Charleville-Mézières, France
| | - Stephane De Rudnicki
- Service d'Anesthésie Réanimation, Hôpital d'instruction des Armées de Percy, Clamart, France
| | - Bruno Mourvillier
- Service de Médecine Intensive et Réanimation Polyvalente, Centre Hospitalo-Universitaire Robert Debré, Reims, France
| | | | - Carole Schwebel
- Service de Médecine Intensive et Réanimation, Centre Hospitalo-Universitaire de Grenoble Alpe, Grenoble, France
| | | | - Marc Garnier
- Service d'Anesthésie-Réanimation, Centre Hospitalo-Universitaire Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Benjamin Madeux
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France; Service de Médecine Intensive et Réanimation, Centre Hospitalier De Tarbes, Tarbes, France
| | - Stéphane Gaudry
- Service de Médecine Intensive et Réanimation Centre Hospitalo-Universitaire Avicenne, Bobigny, France
| | - Karine Bailly
- Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Christian Lamer
- Service de Réanimation Polyvalente, Institut mutualiste Montsouris, Paris, France
| | - Philippe Aegerter
- Groupement inter-régional de recherche clinique et d'innovation - Île de France, Cellule Méthodologie, Paris, France; Équipe d'Épidémiologie respiratoire intégrative, Centre de recherche en Epidémiologie et Santé des Populations, U1018 INSERM Université Paris Saclay - Université Versailles Saint Quentin en Yveline, Villejuif, France
| | - Christine Rieu
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France
| | - Khaoussou Sylla
- Direction de la recherche clinique et de l'innovation, Groupe Hospitalier Universitaire Paris Psychiatrie et Neurosciences, Paris, France
| | - Bruno Lucas
- Department of Neurosiences, Université de Paris, Paris, France; Institut Cochin, Centre National de la Recherche Scientifique UMR8104, INSERM U1016, Paris, France
| | - Tarek Sharshar
- Service d'Anesthésie-Réanimation, Groupe Hospitalier Université Paris Psychiatrie et Neurosciences, Pôle Neuro, Paris, France; Department of Neurosiences, Université de Paris, Paris, France; INSERM UMR S894, Sorbonne Université, Paris, France
| |
Collapse
|
5
|
Choussy O, Choussy O, Viault N, Ghanem W, Dubray Vautrin A, Lamer C. A New Device for Managing Refractory Epistaxis in ICU Patients with COVID-19. Surg Case Rep 2021. [DOI: 10.31487/j.scr.2021.09.13] [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: 11/12/2022] Open
Abstract
Epistaxis is a common and a well-known symptom. Nasal packing is an effective treatment in most cases [1]. The COVID-19 disease treatment includes conventional or high flow nasal oxygen therapy and systemic anticoagulation [2]. Patients in intensive care unit may require therapeutic anticoagulation for venous thromboembolism, hyperinflammatory status, extracorporeal membrane oxygenation (ECMO) and multiple other pathologies. The use of therapeutic anticoagulation increases risk of nose bleeding, and its management may be challenging. CAVI-T (Figures 1 & 2) is a new asymmetrical low-pressure balloon that have shown promising results to control epistaxis in emergency. We report herein the management of severe epistaxis in two COVID-19 patients admitted to ICU for severe respiratory failure.
Collapse
|
6
|
Nassar A, Hobeika C, Lamer C, Beaussier M, Sarran A, Yamazaki S, Sanou Y, Bonnet S, Gayet B, Fuks D. Relevance of blood loss as key indicator of the quality of surgical care in laparoscopic liver resection for colorectal liver metastases. Surgery 2020; 168:411-418. [PMID: 32600884 DOI: 10.1016/j.surg.2020.04.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The development of laparoscopic liver resection has led to the hypothesis that intraoperative blood loss may be a key indicator of surgical care quality. This study assessed short- and long-term results of patients according to three levels of intraoperative blood loss during laparoscopic liver resection for colorectal liver metastasis. METHODS All patients who underwent laparoscopic liver resection for colorectal liver metastasis between 2000 and 2018 were included. Difficulty of laparoscopic liver resection was defined according to the Institut Mutualiste Montsouris classification. Three levels of the extent of intraoperative blood loss were defined: massive (≥1,000 mL), substantial (≥75th percentile of intraoperative blood loss within each grade of difficulty), and normal intraoperative blood loss. RESULTS During study period, 317 patients underwent laparoscopic liver resection for colorectal liver metastasis. Among them, 213 (67.2%), 80 (25.2%), and 24 (7.6%) patients had normal, substantial, and massive intraoperative blood loss, respectively. Twenty-six patients (8.2%) required transfusion. Massive intraoperative blood loss came from a major hepatic vein in 54% of cases and were managed by laparoscopy in 83% of the cases. Laparoscopic liver resection difficulty grade (odds ratio = 3.15; P = .053) and number of colorectal liver metastasis (odds ratio = 1.24; P = .020) were independently associated with massive intraoperative blood loss. Risks factors for substantial intraoperative blood loss were bi-lobar colorectal liver metastasis (odds ratio = 3.12; P = .033) and sinusoidal obstruction syndrome (odds ratio = 3.27; P = .004). The level of intraoperative blood loss was not associated with severe complications nor overall and disease-free survival. Requirement of transfusion was associated with severe complications (odds ratio = 7.27; P = .002) and decreased 1-, 3-, and 5-year overall survival (87%, 68%, and 61% vs 95%, 88%, and 79%; P = .042). CONCLUSION The extent of intraoperative blood loss did not affect short- and long-term results of laparoscopic liver resection for colorectal liver metastasis. Massive intraoperative blood loss was often incidental and, 83% of the time, manageable by laparoscopy. Rather than intraoperative blood loss, transfusion is a better relevant indicator of laparoscopic liver resection surgical quality.
Collapse
Affiliation(s)
- Alexandra Nassar
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France.
| | - Christian Hobeika
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - Christian Lamer
- Intensive Care Unit, Institut Mutualiste Montsouris, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France
| | - Anthony Sarran
- Department of Radiology, Institut Mutualiste Montsouris, Paris, France
| | - Shintaro Yamazaki
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - Yves Sanou
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - Stephane Bonnet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| |
Collapse
|
7
|
Chopinet S, Fuks D, Rinaudo M, Massol J, Gregoire E, Lamer C, Belgaumkar A, Hardwigsen J, Le Treut YP, Gayet B. Postoperative Bleeding After Laparoscopic Pancreaticoduodenectomy: the Achilles' Heel? World J Surg 2018; 42:1138-1146. [PMID: 29018911 DOI: 10.1007/s00268-017-4269-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic pancreaticoduodenectomy (LPD) is technically demanding, and its impact on postoperative outcomes remains controversial. OBJECTIVE To compare short-term outcomes between laparoscopic versus open pancreaticoduodenectomy (OPD) in order to assess the safety of LPD. METHODS From 2002 to 2014, all consecutive patients undergoing LPD or OPD at two tertiary centers were retrospectively analyzed. Patients were matched for demographics, comorbidities, pathological diagnosis, and pancreatic texture. Results for the two groups were compared for postoperative outcomes. RESULTS Sixty-five LPD were performed and compared to 290 OPD. In the whole population, postoperative pancreatic fistula (PF) was higher in the LPD group, but the proportion of ampullary adénocarcinoma (25 vs. 10%, p = 0.004) and soft pancreatic parenchyma (52 vs. 38%, p = 0.001) were higher in the LDP group. After matching (n = 65), LPD was associated with longer operative time (429 vs. 328 min, p < 0.001) and lower blood loss (370 vs. 515 mL, p = 0.047). The PF rate and its severity were similar (33 vs. 27%, p = 0.439, p = 0.083) in the two groups. However, both complications (78 vs. 71%, p = 0.030) and major complications (40 vs. 23%, p = 0.033) were more frequent in the LPD group. LPD patients experience more postoperative bleeding (21 vs. 14%, p = 0.025) compared to their open counterparts. In multivariate analysis, perioperative transfusion (OR = 5 IC 95% (1.5-16), p = 0.008), soft pancreas (OR = 2.5 IC 95% (1.4-4.6), p = 0.001), and ampullary adenocarcinoma (OR = 2.6 IC 95% (1.2-5.6), p = 0.015) were independent risks factors of major complications. CONCLUSION Despite lower blood loss and lower intraoperative transfusion, LPD leads to higher rate of postoperative complications with postoperative bleeding in particular.
Collapse
Affiliation(s)
- Sophie Chopinet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
- Department of Digestive Surgery, Hôpital de la Conception, Marseille, France.
| | - David Fuks
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France
- Université Paris Descartes, 12 rue de l'Ecole de Médecine, Paris, France
| | - Mathieu Rinaudo
- Department of Digestive Surgery, Hôpital de la Conception, Marseille, France
| | - Julien Massol
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Emilie Gregoire
- Department of Digestive Surgery, Hôpital de la Conception, Marseille, France
| | - Christian Lamer
- Department of Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Ajay Belgaumkar
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Jean Hardwigsen
- Department of Digestive Surgery, Hôpital de la Conception, Marseille, France
| | | | - Brice Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France
- Université Paris Descartes, 12 rue de l'Ecole de Médecine, Paris, France
| |
Collapse
|
8
|
Barth C, Soares M, Toffart AC, Timsit JF, Burghi G, Irrazabal C, Pattison N, Tobar E, Almeida BF, Silva UV, Azevedo LC, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Salluh J, Azoulay E, Lemiale V. Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs). Ann Intensive Care 2018; 8:80. [PMID: 30076547 PMCID: PMC6076209 DOI: 10.1186/s13613-018-0426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. Methods A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. Results Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4–12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11–16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07–0.81]; p = 0.020). Conclusion This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors’ characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.
Collapse
Affiliation(s)
- C Barth
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A C Toffart
- Inserm, u 823, Institut A Bonniot, Grenoble, France
| | - J F Timsit
- Medical ICU, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazabal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - B F Almeida
- ICU, Hospital A. C. Camargo, São Paulo, Brazil
| | - U V Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos, Brazil
| | - L C Azevedo
- ICU, Hospital Sírio Libanês, São Paulo, Brazil
| | - A Rabbat
- Thoracic ICU, Hôpital Cochin, Paris, France
| | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris, France
| | - A Parrot
- Medical ICU, Hôpital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France
| | - F Blot
- ICU, Institut Gustave Roussy, Villejuif, France
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - J Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Lemiale
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | | |
Collapse
|
9
|
Pietrasz D, Fuks D, Subar D, Donatelli G, Ferretti C, Lamer C, Portigliotti L, Ward M, Cowan J, Nomi T, Beaussier M, Gayet B. Laparoscopic extended liver resection: are postoperative outcomes different? Surg Endosc 2018; 32:4833-4840. [PMID: 29770886 DOI: 10.1007/s00464-018-6234-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/02/2018] [Accepted: 05/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH. METHODS All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH. RESULTS Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH. CONCLUSION LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.
Collapse
Affiliation(s)
- Daniel Pietrasz
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France.
| | - David Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Daren Subar
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
- Department of General and HPB Surgery, Royal Blackburn Hospital, Haslingden Road, Lancashire, BB2 3HH, UK
| | - Gianfranco Donatelli
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Carlotta Ferretti
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Christian Lamer
- Department of Intensive Care Unit - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Luca Portigliotti
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marc Ward
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Jane Cowan
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Takeo Nomi
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology - Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, 42 Boulevard Jourdan, 75014, Paris, France
| |
Collapse
|
10
|
Gupta R, Fuks D, Bourdeaux C, Radkani P, Nomi T, Lamer C, Gayet B. Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection. Surg Endosc 2017; 31:4451-4457. [PMID: 28364154 DOI: 10.1007/s00464-017-5496-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 11/26/2016] [Accepted: 02/28/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intraoperative blood loss is one of the predictors of outcome of open hepatectomy. But the impact of blood loss in laparoscopic hepatectomy (LH) on postoperative outcomes is poorly understood. The aim of this study is to analyze the association between blood loss and postoperative outcomes after LH. METHODS A retrospective analysis of prospectively maintained database of patients undergoing LH from 1995 to 2016 was performed. The data were divided into two groups based on the extent of blood loss: Group 1 (<250 ml) and Group 2 (≥250 ml). The basic characteristics and postoperative outcomes were compared between these groups. RESULTS A total of 504 patients underwent 611 LH (Group 1: 414 and Group 2: 197). The mean age was 62.4 years. The most common indication was liver secondaries (71.7%). Major hepatectomy was performed in 37% cases. Mean operative time was 225 ± 110.5 min and estimated blood loss was 239 ± 399.4 ml (range 0-4500 ml). Group 2 had significantly higher number of patients with malignant lesions undergoing major hepatectomy, anatomical resection with higher requirement for blood transfusion, and longer hospital stay. The incidence of conversion rate, overall complications including liver failure, renal failure, and postoperative mortality, was significantly higher in Group 2. However, the bile leak rate was similar in the two groups. CONCLUSION Intraoperative blood loss is most frequent in patients undergoing major LH. Blood loss ≥250 ml during LH may adversely affect the postoperative outcomes.
Collapse
Affiliation(s)
- Rahul Gupta
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.,Department of HPB Surgery and Liver Transplantation, CARE Hospital, Hyderabad, India
| | - David Fuks
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. .,Université Paris Descartes, 15 rue de l'Ecole de Médecine, Paris, France.
| | - Christophe Bourdeaux
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Pejman Radkani
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Takeo Nomi
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Christian Lamer
- Department of Intensive Care Unit, Institut Mutualiste Montsouris, Paris, France
| | - Brice Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'Ecole de Médecine, Paris, France
| |
Collapse
|
11
|
Monge M, Boura B, Cosserat J, Lamer C, Chen L, Bennamoun M, Nochy D, Combes M. Insuffisance rénale aiguë par thrombose d’une artère rénale sur rein unique, traitement par pontage veineux iliorénal : à propos d’un cas. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Soares M, Toffart AC, Timsit JF, Burghi G, Irrazábal C, Pattison N, Tobar E, Almeida BFC, Silva UVA, Azevedo LCP, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Tejera D, Salluh JIF, Azoulay E. Intensive care in patients with lung cancer: a multinational study. Ann Oncol 2014; 25:1829-1835. [PMID: 24950981 DOI: 10.1093/annonc/mdu234] [Citation(s) in RCA: 63] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. PATIENTS AND METHODS Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
Collapse
Affiliation(s)
- M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
| | | | - J-F Timsit
- Medical Intensive Care Unit (ICU), Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazábal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London; ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | | | - U V A Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos
| | | | | | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris
| | - A Parrot
- Medical ICU, APHP-Hopital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon
| | - F Blot
- ICU, Gustave Roussy, Villejuif
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - D Tejera
- ICU, Hospital de Clínicas, Montevideo, Uruguay
| | - J I F Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France
| |
Collapse
|
13
|
Le Saché F, Dibie A, Lamer C. Cardiac tamponade after ovarian stimulation. N Engl J Med 2007; 356:425-6. [PMID: 17251546 DOI: 10.1056/nejmc062667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
14
|
Ben Mansour EH, Bachet J, Tran D, Lamer C. Ruptured mycotic aortic pseudoaneurysm with concomitant aorto-tracheal and aorto-oesophageal fistulas. Eur J Cardiothorac Surg 2005; 27:711. [PMID: 15784384 DOI: 10.1016/j.ejcts.2005.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Revised: 12/22/2004] [Accepted: 01/03/2005] [Indexed: 11/23/2022] Open
Affiliation(s)
- El Hassen Ben Mansour
- Department of Intensive Care Medicine, Institut Mutualiste Montsouris, 42 Bld Jourdan, Paris cedex 14 75674, France.
| | | | | | | |
Collapse
|
15
|
Lamer C, Harboun M, Knani L, Moreau D, Tric L, LeGuillou JL, Gasquet I, Moreau T. Quality of life after complicated elective surgery requiring intensive care. Intensive Care Med 2004; 30:1594-601. [PMID: 15085322 DOI: 10.1007/s00134-004-2260-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 02/25/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate outcomes of patients admitted to the ICU for complications after elective surgery and to assess perceived quality of life (pQOL) in survivors. DESIGN Two-year prospective case-control study. SETTING Twelve-bed ICU in a university-affiliated hospital. PATIENTS Patients admitted to the ICU for a complication following elective surgery were included. Six months after discharge, pQOL was assessed using the Nottingham Health Profile (NHP). Results were compared to those of matched controls without complications. INTERVENTIONS None. MEASUREMENTS AND RESULTS Of the 182 patients, 124 were alive after 6 months, among whom 116 had 6-month data and 104 of these had matched controls. Overall pQOL as assessed by the global NHP score was similar in both groups (median, 0.82 and 0.87 in cases and controls; P=0.24). NHP subscores showed significantly worse pain ( P=0.03) and physical impairment ( P=0.02) in the ICU patients. In the multivariate analysis, pQOL was better in patients with cancer as the reason for surgery ( P=0.05). Severity of illness at inclusion had no influence on subsequent pQOL, but cardiovascular dysfunction was associated with decreased energy ( P=0.04). CONCLUSIONS Although overall pQOL was satisfactory after 6 months, patients admitted to the ICU for postoperative complications had worse pain and physical impairment than controls. Whether these outcomes could be improved by early physiotherapy and aggressive pain management deserves investigation.
Collapse
Affiliation(s)
- Christian Lamer
- Département de Réanimation Polyvalente, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75674 Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Martinez V, Le Guillou JL, Lamer C, Le Jouan M, Tod M, Dromer F. Serum voriconazole levels following administration via percutaneous jejunostomy tube. Antimicrob Agents Chemother 2004; 47:3375. [PMID: 14506064 PMCID: PMC201143 DOI: 10.1128/aac.47.10.3375.2003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
Stern JB, Caliandro R, Lamer C, Lenoir S, Théodore C, Grunenwald D, Girard P. [Acute respiratory failure due to Gemcitabine-induced pulmonary toxicity]. Rev Mal Respir 2002; 19:253-6. [PMID: 12040327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Gemcitabine is a therapeutic agent that has been recently employed in the treatment of various cancers. Pulmonary toxicity has rarely been described. We report a case of a patient treated with Gemcitabine who developed acute respiratory symptoms related to a hypersensitivity pneumonia. Despite a severe clinical and radiological presentation, the outcome was favorable with corticosteroid treatment. In the event of respiratory symptoms in patients receiving Gemcitabine further investigations (chest X-ray, thorax CT-scan, bronchoalveolar lavage) are indicated. In view of the severity of pulmonary toxicity that can be caused by Gemcitabine, re-introduction of treatment is not recommended. We compare our case with other published cases of Gemcitabine-induced pulmonary toxicity.
Collapse
Affiliation(s)
- J B Stern
- Département Thoracique, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
18
|
Grunenwald DH, André F, Le Péchoux C, Girard P, Lamer C, Laplanche A, Tarayre M, Arriagada R, Le Chevalier T. Benefit of surgery after chemoradiotherapy in stage IIIB (T4 and/or N3) non-small cell lung cancer. J Thorac Cardiovasc Surg 2001; 122:796-802. [PMID: 11581616 DOI: 10.1067/mtc.2001.116472] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate postchemoradiotherapy surgery in stage IIIB non-small cell lung cancer. METHODS Forty patients with stage IIIB non-small cell lung cancer were included in this phase II study. A preoperative diagnosis of stage IIIB cancer was based on mediastinoscopy or a thoracotomy in all patients. Induction treatment included two cycles of cisplatin (100 mg/m(2), day 1), 5-fluorouracil (1 g/m(2), days 1-3), and vinblastine (4 mg/m(2), day 1) combined with 42 Gy of hyperfractionated radiotherapy delivering 21 Gy in two sessions. Patients with a clinical response were offered surgery. RESULTS The minimum follow-up for survivors was 48 months. Thirty patients had a T4 lesion and 18 had N3 disease. Twenty-nine patients (73%) had a clinical objective tumor response after induction treatment. These 29 patients underwent thoracotomy, and a complete resection was performed in 23 (58%). Two postoperative deaths occurred (7%). Four patients had a pathologic complete response at the time of surgery (10%). The 5-year survival is 19% for the overall population. When only patients who had persistent viable tumor cells at surgery are considered (n = 25), the 5-year survival is 28%. The 5-year survival is 42% for patients having no mediastinal lymph node involvement at the time of surgery and being treated with complete resection. CONCLUSION This study shows that surgery, when feasible, is associated with a 28% long-term survival for patients in whom chemoradiotherapy alone fails to control disease.
Collapse
Affiliation(s)
- D H Grunenwald
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Girard P, Decousus M, Laporte S, Buchmuller A, Hervé P, Lamer C, Parent F, Tardy B. Diagnosis of pulmonary embolism in patients with proximal deep vein thrombosis: specificity of symptoms and perfusion defects at baseline and during anticoagulant therapy. Am J Respir Crit Care Med 2001; 164:1033-7. [PMID: 11587992 DOI: 10.1164/ajrccm.164.6.2101045] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects in patients with deep vein thrombosis (DVT), we analyzed data on 400 patients with phlebography-proven proximal DVT included in a prospective trial. As the incidence of PE during anticoagulant therapy was the main outcome measure of the trial, all patients underwent lung scanning and/or pulmonary angiography within 48 h of inclusion, and then whenever PE was suspected. Angiography was recommended in patients with nondiagnostic lung scan. At baseline, the presence or absence of PE could be ascertained in 350 patients (87.5%), and 197 (56%) had PE. Sensitivity and specificity of symptoms for PE were 74 and 67%, respectively. Among 37 patients with symptoms and nondiagnostic lung scan, only 8 (22%) had PE at angiography. During anticoagulant therapy (3 mo), there were 29 events suspicious for PE, mostly (53%) within 2 wk of inclusion. Repeated perfusion studies with comparison to baseline tests excluded PE in 21 cases. Cumulated 3-mo risks of suspected and confirmed on-treatment PE were 6.8% (95% CI, 5.4- 8.2%) and 2.0% (95% CI, 0.6-3.4%) respectively. Even in patients with known proximal DVT, PE symptoms are unspecific and careful imaging studies are needed for diagnosis, both at baseline and during anticoagulant therapy.
Collapse
Affiliation(s)
- P Girard
- Département Thoracique and Département de Réanimation, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Lévy P, Boudet MJ, Perniceni T, Mal F, Leguillou JL, Lamer C, Zins M, Gayet B. [Spontaneous gas gangrene of the pancreas caused by Clostridium perfringens]. Gastroenterol Clin Biol 1999; 23:1248-50. [PMID: 10617836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The case of a 60-year-old patient with acute biliary pancreatitis spontaneously infected by Clostridium perfringens is reported. On CT scan, all the pancreatic bed was filled by gas. The patient survived. Four cases have previously been published. Three were fatal and 2 occurred after a pancreatic biopsy. Complete gas gangrene of the pancreas is a severity criterion and suggests an infection by Clostridium perfringens.
Collapse
Affiliation(s)
- P Lévy
- Département Médico-Chirurgical de Pathologie Digestive, Institut Mutualiste Montsouris, Paris
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Grunenwald D, Spaggiari L, Girard P, Baldeyrou P, Posea R, Lamer C, Bourel P, Le Chevalier T. Lung resection for recurrence after pneumonectomy for metastases. Bull Cancer 1997; 84:277-81. [PMID: 9207874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Resection of pulmonary recurrences after pneumonectomy for metastases is exceptional. Nevertheless in carefully selected patients surgery on the residual lung might be successfully performed. From January 1987 to February 1996, 5 patients underwent metastasectomy on single lung after pneumonectomy performed for the same metastatic disease. There were 3 male and 2 female with a mean age of 38 years at the time of surgery on single lung. All patients had a FEV1 > 40%. One patient (n degree 1) had 2 consecutive operations (wedge resections) on the right lower lobe followed 17 months later by right inferior lobectomy for metastases of soft tissue sarcoma. Three patients had only an operation on the residual lung (patient n degree 2 had 2 wedge resections for carcinoma; patient n degree 3 had 7 wedge resections for carcinoma; patient n degree 4 had 6 wedge resections for osteogenic sarcoma). The last patient (n degree 5) had 2 wedge resections on the right upper lobe and a large wedge resection on the right lower lobe for metastases of malignant corticosurrenaloma using a cardiopulmonary femoro-femoral by-pass without cardiac arrest. She postoperatively developed a right lower lobe venous infarction treated subsequently with a completion right lower lobectomy. She died in the postoperative course from cardiorespiratory insufficiency. The other patients had an uneventful postoperative course. Two patients (n degree 2 and n degree 4) died of their disease 14 and 12 months respectively after the surgery on the residual lung; by contrast 2 patients (40%) (n degree 1 and n degree 3) are still alive without recurrences 36 and 27 months after the last resection. In selected patients aggressive surgery for metastases on the residual lung can be successfully performed but the benefits in terms of long-term disease-free survival remain to be determined.
Collapse
Affiliation(s)
- D Grunenwald
- Service de chirurgie thoracique, Institut mutualiste Montsouris, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Lamer C, Letournel-Glomaud C, LeGuillou JL, Moulinié JP, Letournel E. Nosocomial meningitis caused by multiresistant enterococcus as a life-threatening complication of pelvic injury: case report. J Trauma 1995; 39:609-11. [PMID: 7473936 DOI: 10.1097/00005373-199509000-00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bacterial meningitis after pelvic trauma has never been described. We recently treated a patient who developed, during the course of his hospitalization, multiresistant enterococcal meningitis after severe pelvic injury, including a comminutive sacral fracture. Dural tear may have been the main factor leading to secondary infection of the cerebrospinal fluid. Treatment with intravenous continuous infusion of vancomycin plus rifampin, associated with closed subarachnoid drainage, resulted in a complete cure. Therapeutic cerebrospinal fluid levels of vancomycin were obtained only during the first 8 days of treatment. Use of glycopeptides in meningitis and the role of cerebrospinal fluid drainage are discussed. Physicians should be aware of the diagnosis and therapeutic features of this life-threatening complication.
Collapse
Affiliation(s)
- C Lamer
- Service de Réanimation Polyvalente, Centre Médico-Chirurgical de la Porte de Choisy, Paris, France
| | | | | | | | | |
Collapse
|
23
|
Girard P, Baldeyrou P, Le Guillou JL, Lamer C, Grunenwald D. Thrombolysis for life-threatening pulmonary embolism 2 days after lung resection. Am Rev Respir Dis 1993; 147:1595-7. [PMID: 8503574 DOI: 10.1164/ajrccm/147.6_pt_1.1595] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Early postoperative severe pulmonary embolism is usually considered an indication for surgical embolectomy because thrombolytic agents cannot be used. Severe pulmonary embolism was diagnosed 2 days after lung resection in two patients, including one with hypercapnia during spontaneous breathing, perhaps a unique feature of massive embolism on a single lung. Although emergency surgical embolectomy was available, both patients were given a bolus infusion of thrombolytic agents, with an immediate (within 1 h) clinical and hemodynamic improvement and a favorable outcome despite delayed major bleeding in one patient. The reported data and an analysis of the available literature support the view that recent surgery should be considered a relative rather than absolute contraindication to thrombolysis and that decision making in this setting should be based on a careful case-by-case evaluation of the expected benefits and risks of the various available treatments.
Collapse
Affiliation(s)
- P Girard
- Department of Thoracic Surgery, Centre Médico-Chirurgical de la Porte de Choisy, Paris, France
| | | | | | | | | |
Collapse
|
24
|
Lamer C, de Beco V, Soler P, Calvat S, Fagon JY, Dombret MC, Farinotti R, Chastre J, Gibert C. Analysis of vancomycin entry into pulmonary lining fluid by bronchoalveolar lavage in critically ill patients. Antimicrob Agents Chemother 1993; 37:281-6. [PMID: 8452359 PMCID: PMC187653 DOI: 10.1128/aac.37.2.281] [Citation(s) in RCA: 234] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Vancomycin penetration into the fluid lining the epithelial surface of the lower respiratory tract was studied by performing fiberoptic bronchoscopy with bronchoalveolar lavage on 14 critically ill, ventilated patients who had received the drug for at least 5 days. The apparent volume of epithelial lining fluid (ELF) recovered by bronchoalveolar lavage was determined by using urea as an endogenous marker. Vancomycin levels in ELF ranged from 0.4 to 8.1 micrograms/ml (mean, 4.5 micrograms/ml), while the mean simultaneous level of the drug in plasma was 24 micrograms/ml (range, 9 to 37.4 micrograms/ml). There was a significant relationship (r = 0.64, P < 0.02) between vancomycin levels in plasma and those in ELF, with a correlation whose slope (0.15) indicated that the blood-to-ELF ratio of drug penetration was 6:1. Using the albumin concentration in ELF as a marker of lung inflammation, we found that vancomycin penetration was higher in patients with ELF albumin values of > or = 3.4 mg/ml than in patients with normal values (< 3.4 mg/ml) (P < 0.02). These results suggest that the vancomycin distribution includes the ELF of the lower respiratory tract at a concentration that is dependent upon the levels in blood and the alveolar capillary membrane protein permeability. These concentrations were well above the MICs for most staphylococci and enterococci.
Collapse
Affiliation(s)
- C Lamer
- Service de Réanimation Médicale, Hôpital Bichat, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
The optimal technique for diagnosing nosocomial bacterial pneumonia in critically ill patients cared for in the intensive care unit remains unclear, especially in the subgroup of patients requiring mechanical ventilation. An important advance has been the development of the protected specimen brush technique. Secretions obtained using this technique and evaluated by quantitative cultures are useful in distinguishing patients with and without pneumonia. However, this procedure has important limitations in that results are not available immediately, and in that a few false negative of false positive results may occur. Bronchoalveolar lavage has been suggested to be of value in establishing the diagnosis of pneumonia, because the cells and liquid recovered can be examined microscopically immediately after the procedure and are also suitable for quantitative culture. Microscopic identification of bacteria within cells recovered by lavage may provide a sensitive and specific means for the early and rapid diagnosis of pneumonia in this setting. The lavage technique can also be conveniently incorporated into a protocol along with quantitative culture of samples obtained using the protected specimen brush. This combination will probably improve the overall accuracy of diagnosis while allowing the administration of prompt empiric antimicrobial therapy in most patients with pneumonia.
Collapse
Affiliation(s)
- J Chastre
- Service de Réanimation Médicale de l'Hôpital Bichat, Paris, France
| | | | | |
Collapse
|
26
|
Lamer C, Valleaux T, Plaisance P, Kucharski K, Payen D, Menasche P, Piwnica A. Continuous arteriovenous hemodialysis for acute renal failure after cardiac operations. J Thorac Cardiovasc Surg 1990; 99:175-6. [PMID: 2294356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
27
|
Lamer C, Fraisse D, Ruttiman M, Mahiou P, Richter F, Raggueneau JL, Payen D, Pasteyer J. [Feasibility of calcium inhibitors in the treatment of brain disease following cardiac arrest]. Agressologie 1989; 30:451-4. [PMID: 2817243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
One of the crucial factors affecting mortality and morbidity after circulatory arrest the ischemic neuronal damage following complete cessation of cerebral blood-flow. To date, no accepted pharmacologic neuroprotective therapy has emerged. Cerebral ischemia causes a rapid shift of Ca++ from the extracellular spaces into cells and it is assumed that this excessive entry of Ca++ is the final pathway of cell death. In addition, Ca++ is involved in the diffuse vasospasm which occurs after global cerebral ischemia. Therefore, calcium entry blockers such as dihydropyridines derivatives have sparked considerable interest especially because of their preferential cerebrovasodilating effects. In vivo studies have demonstrated protection from brain ischemia with calcium entry blockers. However no direct protective effect of these drugs has been shown on neurons. More recent results have underscored the importance of excitatory amino acid neurotransmitters and receptors (particularly N-Methyl-D-Aspartate receptors) in causing intracellular calcium overload and neuronal death after ischemia. Blockade of these receptors or their associated channels may be an interesting way to protect the brain against ischemic damage.
Collapse
|
28
|
Payen D, Lamer C, Raggueneau JL. [Calcium inhibitors: effects on cerebral blood flow and intracranial pressure]. Agressologie 1989; 30:408-10. [PMID: 2817237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Calcium entry blockers (CEB) have been a major advance in pharmacologic research in the last decade, especially in cardiovascular diseases. In neurology and intensive care, prescription of CEB seems to be more selective. CEB are potent cerebrovascular vasodilating drugs especially after KCL induced vasoconstriction. This property appears less evident when vasoconstriction is achieved by agonist substances. CEB act selectively on cerebral vessels, an effect which prevents the occurrence of systemic arterial hypotension. However they greatly modify the cerebrovascular response to arterial CO2. Concerning the cerebrovascular response to arterial CO2. Concerning their potential benefits in brain ischemia, it is now well admitted that CEB are useful in subarachnoid hemorrhage. Several controlled and uncontrolled human studies have demonstrated the CEB potency in vasospasm prevention and in cerebral ischemic consequences. Nonetheless when the vasospasm is installed, the benefit of the CEB appears less evident. In focal cerebral ischemia, data are few and unclear suggesting a cautious prescription of CEB. Finally CEB seem to increase intracranial pressure in humans, although this effect depends on the underlying neurologic pathology.
Collapse
|
29
|
Payen D, Lamer C, Raggueneau JL, Cophignon J, Houdart R. [Criteria for brain death: cessation of cerebral circulation demonstrated by Doppler ultrasonography of the carotid arteries]. Bull Acad Natl Med 1989; 173:149-55; discussion 155-6. [PMID: 2670076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
If human death is defined by brain death, its diagnosis needs medicolegal criteria based on clinical examination and EEG. However, this evaluation could be difficult because technical or physiological limitations might impair the interpretation, especially after barbiturates and/or hypothermia. Since brain death is characterized by an intracranial circulatory arrest, methods assessing this phenomenon are warranted. Among these methods, conventional or isotopic cerebral angiography appears the most promising, but it cannot be easily performed everywhere. Because superficial blood flow in arteries is now accurately measured by the pulsed Döppler technique, this prompted us to test the specificity and sensitivity of common carotid blood flow data for brain death diagnosis. Two series of age-matched patients (36 yrs in mean) were studied. Series 1 (n = 28) was used to define the discriminant parameters between 14 severe coma patients and 14 brain-dead patients diagnosed by the classical criteria. Then these parameters were prospectively tested in a blind manner on a second series of 28 patients suffering from severe coma. The parameters allowing us to classify patients as brain dead or not with a 100% specificity and sensitivity were: end diastolic blood flow (QED in ml/min), end diastolic blood flow velocity (VED), and cerebral metabolic index (CMI = QED x AV D 02). The most powerful discriminant parameter was QED, allowing a strictly non-invasive diagnosis of brain death.
Collapse
|
30
|
Payen D, Lamer C, Chiron B, Gaston A. [Hemodynamic carotid effects of the administration of nicardipine during the early phase of meningeal hemorrhage]. Agressologie 1987; 28:395-6. [PMID: 3618904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|