1
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Chauvin C, Levillayer L, Roumier M, Nielly H, Roth C, Karnam A, Bonam SR, Bourgarit A, Dubost C, Bousquet A, Le Burel S, Mestiri R, Sene D, Galland J, Vasse M, Groh M, Le Marchand M, Vassord-Dang C, Gautier JF, Pham-Thi N, Verny C, Pitard B, Planchais C, Mouquet H, Paul R, Simon-Loriere E, Bayry J, Gilardin L, Sakuntabhai A. Tocilizumab-treated convalescent COVID-19 patients retain the cross-neutralization potential against SARS-CoV-2 variants. iScience 2023; 26:106124. [PMID: 36776936 PMCID: PMC9894676 DOI: 10.1016/j.isci.2023.106124] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/10/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Although tocilizumab treatment in severe and critical coronavirus disease 2019 (COVID-19) patients has proven its efficacy at the clinical level, there is little evidence supporting the effect of short-term use of interleukin-6 receptor blocking therapy on the B cell sub-populations and the cross-neutralization of SARS-CoV-2 variants in convalescent COVID-19 patients. We performed immunological profiling of 69 tocilizumab-treated and non-treated convalescent COVID-19 patients in total. We observed that SARS-CoV-2-specific IgG1 titers depended on disease severity but not on tocilizumab treatment. The plasma of both treated and non-treated patients infected with the ancestral variant exhibit strong neutralizing activity against the ancestral virus and the Alpha, Beta, and Delta variants of SARS-CoV-2, whereas the Gamma and Omicron viruses were less sensitive to seroneutralization. Overall, we observed that, despite the clinical benefits of short-term tocilizumab therapy in modifying the cytokine storm associated with COVID-19 infections, there were no modifications in the robustness of B cell and IgG responses to Spike antigens.
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Affiliation(s)
- Camille Chauvin
- Institut Pasteur, Université de Paris, Functional Genetics of Infectious Diseases Unit, Department of Global Health, 75015 Paris, France.,Centre National de la Recherche Scientifique (CNRS), UMR2000, Paris Cedex 15, France
| | - Laurine Levillayer
- Institut Pasteur, Université de Paris, Functional Genetics of Infectious Diseases Unit, Department of Global Health, 75015 Paris, France.,Centre National de la Recherche Scientifique (CNRS), UMR2000, Paris Cedex 15, France
| | - Mathilde Roumier
- Service de Médecine Interne, Hôpital Foch, 92151 Suresnes, France
| | - Hubert Nielly
- Service de Médecine Interne, Hôpital d'Instruction des Armées Bégin, 94160 Saint Mandé, France
| | - Claude Roth
- Institut Pasteur, Université de Paris, Functional Genetics of Infectious Diseases Unit, Department of Global Health, 75015 Paris, France.,Centre National de la Recherche Scientifique (CNRS), UMR2000, Paris Cedex 15, France
| | - Anupama Karnam
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, 75006, France
| | - Srinivasa Reddy Bonam
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, 75006, France
| | - Anne Bourgarit
- Hôpital Jean Verdier, HUPSSD, AP-HP, 93140 Bondy, France.,Sorbonne Paris-Nord University (Paris 13), 93000 Bobigny, France.,Inserm, UMR 1135 CIMI, 75013 Paris, France
| | - Clément Dubost
- Service de réanimation, Hôpital militaire Bégin, 94120 Saint Mandé, France.,Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Aurore Bousquet
- Département des laboratoires, Hôpital militaire Bégin, 94120 Saint Mandé, France
| | - Sébastien Le Burel
- Service de Médecine Interne, Hôpital d'Instruction des Armées Bégin, 94160 Saint Mandé, France
| | - Raphaële Mestiri
- Service de Médecine Interne, Hôpital d'Instruction des Armées Bégin, 94160 Saint Mandé, France
| | - Damien Sene
- Département de médecine interne, Hôpital Lariboisière, Université de Paris (Diderot), AP-HP, 75010 Paris, France
| | - Joris Galland
- Département de médecine interne, Hôpital Lariboisière, Université de Paris (Diderot), AP-HP, 75010 Paris, France
| | - Marc Vasse
- Laboratoire de Biologie Médicale, Hôpital Foch, 92151 Suresnes, France.,UMRS-1176, Le Kremlin Bicêtre, France
| | - Matthieu Groh
- Service de Médecine Interne, Hôpital Foch, 92151 Suresnes, France
| | - Mathilde Le Marchand
- Department of Clinical Research and Innovation, Foch Hospital, 40 rue Worth, 92150 Suresnes, France
| | - Camille Vassord-Dang
- Department of Clinical Research and Innovation, Foch Hospital, 40 rue Worth, 92150 Suresnes, France
| | - Jean-François Gautier
- Departement of Diabetes and Endocrinology, Hôpital Lariboisière, APHP, and INSERM U1138 Paris, France.,Université de Paris, 75006 Paris, France
| | - Nhan Pham-Thi
- Unité de Neurophysiologie du Stress, Département des Neurosciences, Institut de Recherche Biomédicale des Armées (IRBA), BP 73 91223 Brétigny sur Orge Cedex, France
| | - Christiane Verny
- Unité de Neurophysiologie du Stress, Département des Neurosciences, Institut de Recherche Biomédicale des Armées (IRBA), BP 73 91223 Brétigny sur Orge Cedex, France
| | - Bruno Pitard
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT,UMR 1302, F-44000 Nantes, France
| | - Cyril Planchais
- Institut Pasteur, Université de Paris, Humoral Immunology Unit, Department of Immunology, 75015 Paris, France
| | - Hugo Mouquet
- Institut Pasteur, Université de Paris, Humoral Immunology Unit, Department of Immunology, 75015 Paris, France
| | - Richard Paul
- Institut Pasteur, Université de Paris, Functional Genetics of Infectious Diseases Unit, Department of Global Health, 75015 Paris, France.,Centre National de la Recherche Scientifique (CNRS), UMR2000, Paris Cedex 15, France
| | - Etienne Simon-Loriere
- Institut Pasteur, Université de Paris, G5 Evolutionary Genomics of RNA viruses, 75015 Paris, France
| | - Jagadeesh Bayry
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, 75006, France.,Department of Biological Sciences & Engineering, Indian Institute of Technology Palakkad, Palakkad 678623, India
| | - Laurent Gilardin
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, 75006, France.,Sorbonne Paris-Nord University (Paris 13), 93000 Bobigny, France.,Service de médecine interne, Hôpital Jean Verdier, HUPSSD, AP-HP, 93140 Bondy, France
| | - Anavaj Sakuntabhai
- Institut Pasteur, Université de Paris, Functional Genetics of Infectious Diseases Unit, Department of Global Health, 75015 Paris, France.,Centre National de la Recherche Scientifique (CNRS), UMR2000, Paris Cedex 15, France.,International Vaccine Design Center (vDesC), The Institute of Medical Science, The University of Tokyo (IMSUT), Tokyo, Japan
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de Rocquigny G, Dubost C, Jarrassier A, Beaucreux C, Tourtier JP. Réponse du service de réanimation d’un Hôpital d’Instruction des Armées à la première vague de COVID-19. Bulletin de l'Académie Nationale de Médecine 2022; 206:991-996. [PMID: 36035244 PMCID: PMC9396290 DOI: 10.1016/j.banm.2022.04.027] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 11/27/2022]
Abstract
En mars 2020, pour répondre à la première vague de l’épidémie de COVID-19 en Ile-de-France, la réanimation de l’Hôpital d’instruction des Armées (HIA) Bégin, situé à Saint-Mandé, opère une importante transformation. Les 4 lits d’unité de surveillance continue (USC) sont d’abord ajoutés aux 8 lits déjà dédiés à la réanimation. Puis, sur le modèle des structures médico-chirurgicales déployées en opération extérieure, un nouveau service de réanimation dit « éphémère » est pleinement déployé en 4 jours. Cette stratégie d’augmentation du capacitaire fait face à un enjeu crucial : garantir des soins sûrs et de qualité avec des ressources limitées. À partir d’un cahier des charges précis et bénéficiant d’un indispensable renfort en personnels et en matériels, 20 chambres de réanimation supplémentaires sont équipées dans le service de cardiologie de l’hôpital. Ainsi, un total de 32 lits (augmentation de 300 %) est disponible à partir du 20 mars. Au total, 113 patients seront pris en charge entre le 12 mars et le 18 mai. La saturation a en partie été évitée par l’évacuation de 16 patients stables en TGV médicalisés vers les régions moins impactées (opération CHARDON). Le service s’implique également dans différentes activités de recherche, dont l’essai académique européen Discovery évaluant l’efficacité de plusieurs antiviraux. Laisser le bloc opératoire et la salle de surveillance post-interventionnelle en partie fonctionnels a permis de rapidement reprendre l’activité chirurgicale programmée en sortie de crise, tout en conservant la réanimation éphémère disponible en cas de rebond épidémique, comme à l’automne 2020, puis au printemps 2021.
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3
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Dubost C, Tomasi J, Ducroix A, Pluchon K, Escrig P, Fouquet O, Aupart A, Mirza A, Fellah I, Bezon E, Baufreton C, El Arid JM, Roussel JC, Verhoye JP, Senage T. AORTLANTIC: French registry of aortic valve-sparing root replacement, preliminary multicenter results from Western France. Interact Cardiovasc Thorac Surg 2022; 35:6730752. [PMID: 36173328 PMCID: PMC9550271 DOI: 10.1093/icvts/ivac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Clément Dubost
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
| | - Jacques Tomasi
- University Hospital Centre Department of Thoracic and Cardiovascular Surgery, , Rennes, France—INSERM LTSI 1099
| | - Antoine Ducroix
- University Hospital Department of Thoracic and Cardiovascular Surgery, , Angers, France
| | - Kevin Pluchon
- Brest University Hospital Department of Cardiovascular and Thoracic Surgery, , Brest, France
| | - Pierre Escrig
- University Hospital Centre Department of Thoracic and Cardiovascular Surgery, , Rennes, France—INSERM LTSI 1099
| | - Olivier Fouquet
- University Hospital Department of Thoracic and Cardiovascular Surgery, , Angers, France
| | - Arthur Aupart
- Trousseau University Hospital Department of Cardiothoracic Surgery, , Tours, France
| | - Alain Mirza
- New Clinic St Gatien Department of Cardiac Surgery, , Tours, France
| | - Imen Fellah
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
| | - Eric Bezon
- Brest University Hospital Department of Cardiovascular and Thoracic Surgery, , Brest, France
| | - Christophe Baufreton
- University Hospital Department of Thoracic and Cardiovascular Surgery, , Angers, France
| | - Jean Marc El Arid
- Trousseau University Hospital Department of Cardiothoracic Surgery, , Tours, France
| | - Jean-Christian Roussel
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
| | - Jean-Philippe Verhoye
- University Hospital Centre Department of Thoracic and Cardiovascular Surgery, , Rennes, France—INSERM LTSI 1099
| | - Thomas Senage
- Thorax Institute, Nantes Hospital University Department of Thoracic and Cardiovascular Surgery, , Nantes, France
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4
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Mercier O, Dubost C, Delaporte A, Genty T, Fabre D, Mitilian D, Girault A, Issard J, Astaneh A, Menager JB, Dauriat G, Mussot S, Jevnikar M, Jais X, Humbert M, Simonneau G, Dartevelle P, Ion I, Stephan F, Brenot P, Fadel E. Pulmonary thromboendarterectomy: The Marie Lannelongue Hospital experience. Ann Cardiothorac Surg 2022; 11:143-150. [PMID: 35433355 PMCID: PMC9012189 DOI: 10.21037/acs-2021-pte-20] [Citation(s) in RCA: 6] [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: 11/02/2021] [Accepted: 03/18/2022] [Indexed: 12/01/2023]
Abstract
BACKGROUND Targeted medical therapy and balloon pulmonary angioplasty (BPA) entered the field of chronic thromboembolic pulmonary hypertension (CTEPH) treatment in the early 2010's. Multimodal therapy is emerging as the new gold standard for CTEPH management. Whether this change of paradigm impacted early outcomes of pulmonary endarterectomy (PEA) remains unknown. Our aim is to report our surgical experience in the era of CTEPH multimodal management. METHODS Patients who underwent PEA between 2016 and 2020 were included in the study. Early outcomes were described and compared between three groups of patients: PEA alone, PEA after targeted medical therapy induction and PEA after BPA. RESULTS A total of 418 patients, 225 males and 193 females, with a mean age of 59±14 years were included in the study. 336 patients underwent PEA alone, 69 after medical targeted therapy induction and 13 after unilateral BPA. Baseline preoperative pulmonary vascular resistance [4.99 (IQR, 1.71-8.48), 6.21 (IQR, 4.37-8.1), 5.03 (IQR, 4.44-7.19) wood units (WU), P=0.230, respectively] and PEA effectiveness [% decrease mean pulmonary artery pressure (mPAP), 24 (IQR, 7-42), 25 (IQR, 7-35), 23 (IQR, 3-29), P=0.580] did not differ between groups. Compared to PEA alone and PEA+BPA, the medical therapy induction group represented the most challenging group with higher baseline mPAP (45±10 vs. 42±11 and 43±11 mmHg, P=0.047), longer circulatory arrest time (30.1±15 vs. 26.6±10 and 19.6±6 min, P=0.005), higher post-PEA extracorporeal membrane oxygenation use (20.6% vs. 8.7 and 9.1%, P=0.004), higher duration on mechanical ventilation [4 (IQR, 1-12) vs. 1 (IQR, 0.5-5) and 2 (IQR, 1-3) days, P=0.005], higher complication rate (85.5% vs. 74.6% and 76.9%, P=0.052) and higher 90-day mortality (13% vs. 3.9% and 0%, P=0.002). Compared to PEA and PEA+ medical therapy induction groups, patients in the BPA induction group were older [72 (IQR, 62-76) vs. 60 (IQR, 48-69) and 62 (IQR, 52-72) years, P=0.005], and underwent shorter cardiopulmonary bypass (191.9±47.9 vs. 222±107.2 and 236.8±46.4 min, P<0.001), aortic cross clamping (54.8±21 vs. 82.7±31.4 and 80.1±32.9 min, P=0.002) and circulatory arrest time (19.6±6.2 vs. 26.6±10.8 and 30.1±15.1 min, P=0.008). CONCLUSIONS Multimodal therapy approach to CTEPH patients did not affect effectiveness of PEA. Medical therapy and BPA could act in synergy with surgery to treat more challenging patients.
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Affiliation(s)
- Olaf Mercier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Clément Dubost
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Amélie Delaporte
- Intensive care unit, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Thibault Genty
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Anesthesiology, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Dominique Fabre
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Delphine Mitilian
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Antoine Girault
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Justin Issard
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Arash Astaneh
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Jean-Baptiste Menager
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Gaelle Dauriat
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Sacha Mussot
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Mitja Jevnikar
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- AP-HP, Service de Pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, France
| | - Xavier Jais
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- AP-HP, Service de Pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- AP-HP, Service de Pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, France
| | - Gérald Simonneau
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Philippe Dartevelle
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Iolando Ion
- Intensive care unit, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - François Stephan
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Anesthesiology, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Philippe Brenot
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
| | - Elie Fadel
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, GHPSJ, Le Plessis Robinson, France
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Birnbaum R, Bitton R, Pirracchio R, Féral-Pierssens AL, Constant AL, Dubost C, Chousterman B, Lescot T, Lortat-Jacob B, Harrois A, Abback PS, Belbachir A, Basto E, Castier Y, Laitselart P, Carli P, Lapostolle F, Tourtier JP, Langlois M, Raux M, Mounier R. Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries. Anaesth Crit Care Pain Med 2021; 40:100908. [PMID: 34174462 DOI: 10.1016/j.accpm.2021.100908] [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: 01/24/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to assess the incidence and the risk factors for secondary wound infections associated to high-energy ammunition injuries (HEAI) in the cohort of civilian casualties from the 2015 terrorist attacks in Paris. METHODS This retrospective multi-centric study included casualties presenting at least one HEAI who underwent surgery during the first 48 h following hospital admission. HEAI-associated infection was defined as a wound infection occurring within the initial 30 days following trauma. Risk factors were assessed using univariate and multivariate analysis. RESULTS Among the 200 included victims, the rate of infected wounds was 11.5%. The median time between admission and the surgical revision for secondary wound infection was 11 days [IQR 9-20]. No patient died from an infectious cause. Infections were polymicrobial in 44% of the cases. The major risk factors for secondary wound infection were ISS (p < 0.001), SAPS II (p < 0.001), MGAP (p < 0.001), haemorrhagic shock (p = 0.003), use of vasopressors (p < 0.001), blood transfusion (p < 0.001), abdominal penetrating trauma (p = 0.003), open fracture (p = 0.01), vascular injury (p = 0.001), duration of surgery (p = 0.009), presence of surgical material (p = 0.01). In the multivariate analysis, the SAPS II score (OR 1.07 [1.014-1.182], p = 0.019) and the duration of surgery (OR 1.005 [1.000-1.012], p = 0.041) were the only risk factors identified. CONCLUSION We report an 11.5% rate of secondary wound infection following high-energy ammunition injuries. Risk factors were an immediately severe condition and a prolonged surgery.
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Affiliation(s)
- Ron Birnbaum
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Rudy Bitton
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Anne-Laure Féral-Pierssens
- Emergency Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Laure Constant
- Anaesthesia and Intensive Care Department, University Paris Descartes, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clément Dubost
- Intensive Care Unit, Begin Military Teaching Hospital, Saint-Mandé, France
| | - Benjamin Chousterman
- Anaesthesia and Intensive Care Department, Paris-Nord University, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Lescot
- Anaesthesia and Intensive Care Department, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brice Lortat-Jacob
- Anaesthesia and Intensive Care Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anatole Harrois
- Anaesthesia and Intensive Care Department, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Paer-Selim Abback
- Anaesthesia and Intensive Care Department, Paris-Nord University, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Anissa Belbachir
- Anaesthesia and Intensive Care Department, Paris-Centre University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Basto
- Anaesthesia and Intensive Care Department, Paris-Nord University, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Thoracic and Vascular Surgery Department, Paris-Nord University, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Laitselart
- Anaesthesia and Intensive Care Department, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Carli
- SAMU de Paris, Anaesthesia and Intensive Care Unit Department, Paris-Centre University, Necker Hospital, Paris, France
| | - Frédéric Lapostolle
- SAMU 93, UF Research-Teaching-Quality, Paris-Nord University, Avicenne Hospital, Bobigny, France, INSERM U942, Sorbonne University, Paris, France
| | | | | | - Mathieu Raux
- Anaesthesia and Intensive Care Department, Paris-Sorbonne University, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne University, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Roman Mounier
- Anaesthesia and Intensive Care Department, Paris-Est Créteil University, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; Paris-Est Créteil University, INSERM U955, Team 15, Créteil, France
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6
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Gilardin L, Nielly H, Roumier M, Chauvin C, Bastard P, Bousquet A, Vasse M, Roth C, Sakuntabhai A, Bayry J, Bourgarit A, Dubost C, Tandjaoui-Lambiotte Y. COVID-19 critique et anticorps anti-Interféron : série de 11 cas. Rev Med Interne 2021. [PMCID: PMC8192021 DOI: 10.1016/j.revmed.2021.03.232] [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: 11/16/2022]
Abstract
Introduction La survenue de formes sévères ou critiques de COVID-19, avec nécessité d’une hospitalisation en réanimation, est associée à la présence d’anticorps anti-Interféron de classe I dans environ 10 % des cas [1]. Ces anticorps identifiés dans le contexte de la COVID-19 bloquent les molécules d’interféron (IFN) et expliqueraient chez ces patients, la survenue d’une atteinte grave de COVID-19, avec une absence d’élimination précoce du virus SARS-CoV-2. Ainsi, il s’agirait d’une forme de déficit immunitaire, acquis, dirigé contre le virus SARS-CoV-2 mais aussi potentiellement contre d’autres virus. Les caractéristiques cliniques, biologiques et morphologiques des patients présentant ces anticorps n’ont pas été décrites précisément, l’évolution des patients n’est pas connue. Patients et méthodes Une recherche d’anticorps anti-Interféron a été réalisée chez des patients ayant été pris en charge en réanimation à l’hôpital Bégin, à l’hôpital Avicenne et à l’hôpital Foch pour une COVID-19. La présence d’anticorps anti-IFNalpha2 et anti-IFNomega étaient recherchée par test ELISA puis confirmée par un test fonctionnel d’inhibition de la phosphorylation de STAT1. Les caractéristiques cliniques des patients ont été relevées à partir des dossiers médicaux. Un suivi médical a été organisé afin de suivre leur évolution sur le plan clinique, biologique et morphologique. Résultats Onze patients ont été identifiés. Il s’agissait de 11 hommes. L’âge médian au diagnostic était de 60 ans (min 36 - max 80). Parmi les autres facteurs de risques de COVID-19 grave classiquement identifiés, on retrouvait chez eux, du diabète pour 1 patient, de l’hypertension artérielle pour 6 patients et de l’obésité (IMC > 30 kg/m2) pour 5 patients. L’IMC médian était de 29,8 kg/m2 (min 24 - max 32,8). Il n’était pas noté d’antécédent remarquable, notamment pas d’argument pour un déficit immunitaire, pas d’endocrinopathie auto-immune. On retrouvait 1 BPCO, 2 asthmes, 1 coronaropathie et 1 valve aortique mécanique. Au diagnostic de COVID-19, les signes cliniques initiaux habituels de l’infection étaient retrouvés : asthénie (n = 11), fièvre (n= 10), toux (n = 5). Deux patients présentaient des diarrhées et 2 de l’insuffisance rénale aiguë, modérée. Chez 2 patients, on notait une embolie pulmonaire sur le scanner initial. L’évolution était marquée par une aggravation justifiant une admission en réanimation après une médiane de 7 jours (min 3 - max 12), pour une forme sévère chez 2 patients avec au maximum une oxygénothérapie au masque à haute concentration jusqu’à 15L/min pour 1 patient et 4L/min pour 1 autre. Une forme critique survenait chez 9 patients, avec recours à une intubation oro-trachéale pour ventilation mécanique pour 7 cas, une oxygénothérapie nasale à haut débit (OPTIFLOW) était suffisante dans 2 cas. Des pneumopathies bactériennes documentées nécessitaient une antibiothérapie spécifique dans 6 cas. Dans 10 cas, des traitements à visée spécifique du COVID-19 étaient entrepris : corticothérapie (n = 4), hydroxychloroquine (n = 4), lopinavir/ritonavir (n = 3) et tocilizumab (n = 2). En raison du développement d’un SDRA sévère, des séances d’optimisation de l’oxygénothérapie par décubitus ventral étaient entreprises chez 5 patients, avec nécessité d’un recours à une ECMO véno-veineuse pour le jeune patient de 36 ans. Afin d’éliminer les Ac antiIFN, ce dernier a également bénéficié avec succès de 3 séances d’échanges plasmatiques. Au total, 9 patients ont survécu, la durée médiane d’hospitalisaiton en réanimation était de 16 jours (min 2 - max 31). Les 2 décès sont intervenus après limitation thérapeutique pour SDRA réfractaire. Avec un suivi médian de 4,2 mois (min 1 - max 11,2), on note une bonne évolution chez l’ensemble des patients survivants, aucune réinfection n’a été observée et une régression quasi complète des lésions pulmonaires scanographiques (n = 4/5) était retrouvée à 3 mois. Lors du dernier bilan réalisé, il n’était pas constaté d’anomalie de la NFS (n = 7/8), ni syndrome inflammatoire (n = 6/7) et le taux d’immunoglobulines était normal (4/4). Conclusion Cette série de cas donne une première description des patients ayant présenté une forme critique de COVID-19 avec Ac anti-IFN de classe I. En dehors de la faible prévalence de comorbidités, il ne semble pas y avoir de phénotype clinique particulier chez cette population en dehors de la prédominance masculine.
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Ader F, Peiffer-Smadja N, Poissy J, Bouscambert-Duchamp M, Belhadi D, Diallo A, Delmas C, Saillard J, Dechanet A, Mercier N, Dupont A, Alfaiate T, Lescure FX, Raffi F, Goehringer F, Kimmoun A, Jaureguiberry S, Reignier J, Nseir S, Danion F, Clere-Jehl R, Bouiller K, Navellou JC, Tolsma V, Cabié A, Dubost C, Courjon J, Leroy S, Mootien J, Gaci R, Mourvillier B, Faure E, Pourcher V, Gallien S, Launay O, Lacombe K, Lanoix JP, Makinson A, Martin-Blondel G, Bouadma L, Botelho-Nevers E, Gagneux-Brunon A, Epaulard O, Piroth L, Wallet F, Richard JC, Reuter J, Staub T, Lina B, Noret M, Andrejak C, Lê MP, Peytavin G, Hites M, Costagliola D, Yazdanpanah Y, Burdet C, Mentré F. An open-label randomized controlled trial of the effect of lopinavir/ritonavir, lopinavir/ritonavir plus IFN-β-1a and hydroxychloroquine in hospitalized patients with COVID-19. Clin Microbiol Infect 2021; 27:1826-1837. [PMID: 34048876 PMCID: PMC8149166 DOI: 10.1016/j.cmi.2021.05.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/18/2022]
Abstract
Objectives We evaluated the clinical, virological and safety outcomes of lopinavir/ritonavir, lopinavir/ritonavir–interferon (IFN)-β-1a, hydroxychloroquine or remdesivir in comparison to standard of care (control) in coronavirus 2019 disease (COVID-19) inpatients requiring oxygen and/or ventilatory support. Methods We conducted a phase III multicentre, open-label, randomized 1:1:1:1:1, adaptive, controlled trial (DisCoVeRy), an add-on to the Solidarity trial (NCT04315948, EudraCT2020-000936-23). The primary outcome was the clinical status at day 15, measured by the WHO seven-point ordinal scale. Secondary outcomes included quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in respiratory specimens and pharmacokinetic and safety analyses. We report the results for the lopinavir/ritonavir-containing arms and for the hydroxychloroquine arm, trials of which were stopped prematurely. Results The intention-to-treat population included 583 participants—lopinavir/ritonavir (n = 145), lopinavir/ritonavir–IFN–β-1a (n = 145), hydroxychloroquine (n = 145), control (n = 148)—among whom 418 (71.7%) were male, the median age was 63 years (IQR 54–71), and 211 (36.2%) had a severe disease. The day-15 clinical status was not improved with the investigational treatments: lopinavir/ritonavir versus control, adjusted odds ratio (aOR) 0.83, (95% confidence interval (CI) 0.55–1.26, p 0.39), lopinavir/ritonavir–IFN–β-1a versus control, aOR 0.69 (95%CI 0.45–1.04, p 0.08), and hydroxychloroquine versus control, aOR 0.93 (95%CI 0.62–1.41, p 0.75). No significant effect of investigational treatment was observed on SARS-CoV-2 clearance. Trough plasma concentrations of lopinavir and ritonavir were higher than those expected, while those of hydroxychloroquine were those expected with the dosing regimen. The occurrence of serious adverse events was significantly higher in participants allocated to the lopinavir/ritonavir-containing arms. Conclusion In adults hospitalized for COVID-19, lopinavir/ritonavir, lopinavir/ritonavir–IFN–β-1a and hydroxychloroquine improved neither the clinical status at day 15 nor SARS-CoV-2 clearance in respiratory tract specimens.
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Affiliation(s)
- Florence Ader
- Hospices Civils de Lyon, Département des maladies infectieuses et tropicales, F-69004, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.
| | - Nathan Peiffer-Smadja
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, F-75018 Paris, France; National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Julien Poissy
- Université de Lille, Inserm U1285, CHU Lille, Pôle de réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France
| | - Maude Bouscambert-Duchamp
- Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des Virus Respiratoires France Sud, Hospices Civils de Lyon, F-69317, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372, Lyon, France
| | - Drifa Belhadi
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - Alpha Diallo
- ANRS, France Recherche Nord & Sud Sida-hiv Hépatites, Agence autonome de l'INSERM, F-75013 Paris, France
| | - Christelle Delmas
- Institut de Santé Publique, Pôle Recherche Clinique, INSERM, F-75013 Paris, France
| | - Juliette Saillard
- Institut de Santé Publique, Pôle Recherche Clinique, INSERM, F-75013 Paris, France
| | - Aline Dechanet
- AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - Noémie Mercier
- ANRS, France Recherche Nord & Sud Sida-hiv Hépatites, Agence autonome de l'INSERM, F-75013 Paris, France
| | - Axelle Dupont
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - Toni Alfaiate
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - François-Xavier Lescure
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, F-75018 Paris, France
| | - François Raffi
- CHU de Nantes, Hôpital Hôtel-Dieu, Département des Maladies Infectieuses, Nantes, France; CIC-EC 1413, INSERM, Nantes, France
| | - François Goehringer
- Université de Lorraine, CHRU-Nancy, Service de Maladies Infectieuses et Tropicales, F-54000 Nancy, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Service de Médecine Intensive et Réanimation Brabois, Inserm U1116, F-CRIN INI CRCT, 54000 Nancy, France
| | - Stéphane Jaureguiberry
- AP-HP, Service des Maladies Infectieuses, Hôpital Bicêtre, F- 94270 Le Kremlin Bicêtre, France; AP-HP, Centre National de Référence du Paludisme, Paris, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, Université de Nantes, Nantes, France
| | - Saad Nseir
- Université de Lille, Inserm U1285, CHU Lille, Pôle de réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France
| | - François Danion
- Hôpitaux Universitaires de Strasbourg, Service des Maladies Infectieuses et Tropicales, F-67091 Strasbourg, France
| | - Raphael Clere-Jehl
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, F-67091 Strasbourg, Cedex, France; Université de Strasbourg, ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg, F-67091 Strasbourg, France
| | - Kévin Bouiller
- Centre Hospitalier Universitaire Besançon, Service des Maladies Infectieuses et Tropicales, F-25030 Besançon, France; UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Jean-Christophe Navellou
- Centre Hospitalier Universitaire Besançon, Service de Réanimation Médicale, F-25030 Besançon, France
| | - Violaine Tolsma
- Centre Hospitalier Annecy Genevois, Service des Maladies Infectieuses et Tropicales, F-74374 Annecy, France
| | - André Cabié
- PCCEI, Univ Montpellier, Univ Antilles, Inserm, EFS, Montpellier, France; CHU de Martinique, Service des Maladies Infectieuses et Tropicales, Inserm CIC1424, Martinique, France
| | - Clément Dubost
- Hôpital Militaire Bégin, Service de réanimation polyvalente, F-94160 Saint-Mandé, France; Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, F-91190 Gif-sur-Yvette, France
| | - Johan Courjon
- CHU de Nice, Service des Maladies Infectieuses et Tropicales, Nice, France; Université Côte d'Azur, U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Virulence Microbienne et Signalisation Inflammatoire, INSERM, Nice, France
| | - Sylvie Leroy
- Fédération Hospitalo-Universitaire OncoAge, Nice, France; CHU de Nice, Département de Pneumologie et d'Oncologie, F-06000 Nice, France; Université Côte d'Azur, CNRS UMR 7275, IPMC, Sophia Antipolis, France
| | - Joy Mootien
- Groupe Hospitalier de la région Mulhouse Sud-Alsace, Service de réanimation médicale, Mulhouse, France
| | - Rostane Gaci
- CHR Metz-Thionville, Service de Réanimation Polyvalente, Ars-Laquenexy, France
| | - Bruno Mourvillier
- CHU de Reims, Service de Réanimation Médicale, Reims, France; Université de Reims Champagne-Ardenne, France
| | - Emmanuel Faure
- Université de Lille Nord de France, Faculté de Médecine de Lille, Lille, France; CHRU Lille, Service des Maladies Infectieuses et Tropicales, F-59000, Lille, France
| | - Valérie Pourcher
- Sorbonne Université, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, INSERM, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Département des Maladies Infectieuses et Tropicales, F-75013 Paris, France
| | - Sébastien Gallien
- AP-HP, Hôpital Henri Mondor, Service d'Immunologie et Maladies Infectieuses, F-94000 Créteil, France; Université Paris-Est Créteil, INSERM U955, F-94000 Créteil, France
| | | | - Karine Lacombe
- Sorbonne Université, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, INSERM, F-75013, Paris, France; APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, F-75012 Paris, France
| | - Jean-Philippe Lanoix
- CHU Amiens-Picardie, Service de Maladies Infectieuses et Tropicales, F-80000 Amiens, France; Université Picardie Jules Verne, AGIR UR UPJV 4294, CURS, F-80000 Amiens, France
| | - Alain Makinson
- CHU de Montpellier, Département des Maladies Infectieuses, UMI 233 Inserm U1175, F-34000 Montpellier, France; Inserm Clinical Investigation Centre 1411, Montpellier, France
| | - Guillaume Martin-Blondel
- Centre Hospitalier Universitaire de Toulouse, Service des Maladies Infectieuses et Tropicales, F-31320 Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291, CNRS UMR5051, Université Toulouse III, F-31320 Toulouse, France
| | - Lila Bouadma
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Réanimation Médicale et Infectieuse, F-75018 Paris, France
| | - Elisabeth Botelho-Nevers
- CHU de Saint-Etienne, Service d'Infectiologie, F- 42055 Saint-Etienne, France; CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F-42023 Saint-Etienne, France; CIC 1408, INSERM, F- 42055 Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne, Service d'Infectiologie, F- 42055 Saint-Etienne, France; CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F-42023 Saint-Etienne, France; CIC 1408, INSERM, F- 42055 Saint-Etienne, France
| | - Olivier Epaulard
- CHU Grenoble Alpes, Service des Maladies Infectieuses, F-38000 Grenoble, France; Université Grenoble Alpes, Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin, F-38000 Grenoble, France; Institut de Biologie Structurale, 'Virus Humains Persistants' Team, UMR 5075 CEA-CNRS-UGA, F-38000 Grenoble, France
| | - Lionel Piroth
- CHU de Dijon, Département de maladies infectieuses, F-21000, Dijon, France; Université Bourgogne Franche-Comté, CIC 1432, INSERM, F-21000, Dijon, France
| | - Florent Wallet
- Hospices Civils de Lyon, Hôpital Lyon-Sud Pierre-Bénite, Département de Soins Intensifs, F-69000, Lyon, France
| | - Jean-Christophe Richard
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Réanimation Médicale, F-69000, Lyon, France; Université Lyon I, CREATIS, CNRS UMR5220, INSERM U1044, INSA, F-69000, Lyon, France
| | - Jean Reuter
- Centre Hospitalier de Luxembourg, Service de Réanimation-Soins Intensifs, L-1210 Luxembourg, Luxembourg
| | - Thérèse Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, L-1210 Luxembourg, Luxembourg
| | - Bruno Lina
- Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des Virus Respiratoires France Sud, Hospices Civils de Lyon, F-69317, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372, Lyon, France
| | - Marion Noret
- RENARCI, Réseau national de recherche clinique en infectiologie, France
| | - Claire Andrejak
- CHU d'Amiens, Département de Pneumologie, F-80000 Amiens, France
| | - Minh Patrick Lê
- AP-HP, Hôpital Bichat Claude Bernard, Laboratoire de Pharmacologie-toxicologie, F-75018 Paris, France; Université de Paris, INSERM, UMRS 1144, F-75006, Paris, France
| | - Gilles Peytavin
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Laboratoire de Pharmacologie-toxicologie, F-75018 Paris, France
| | - Maya Hites
- Cliniques Universitaires de Bruxelles-Hôpital Érasme, Université Libre de Bruxelles, Clinique des Maladies Infectieuses, Brussels, Belgium
| | - Dominique Costagliola
- Sorbonne Université, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, INSERM, F-75013, Paris, France
| | - Yazdan Yazdanpanah
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, F-75018 Paris, France
| | - Charles Burdet
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - France Mentré
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
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Gaille M, Araneda M, Dubost C, Guillermain C, Kaakai S, Ricadat É, Todd N, Rera M. [Ethical and social consequences of biomarkers that predict impending death in humans]. Med Sci (Paris) 2020; 36:1199-1206. [PMID: 33296638 DOI: 10.1051/medsci/2020228] [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: 11/14/2022] Open
Abstract
Fundamental research on ageing has taken an interesting turn in recent years with the rapid development of biomarkers predicting mortality in model organisms, particularly Drosophila, as well as in humans through improvements in approaches to the identification of circulating molecules in mass. These developments lead to a shift in our ability to predict the occurrence of death from the historically population level to the individual level. We question here the ethical, medical and social implications of this change of scale.
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Affiliation(s)
- Marie Gaille
- Université de Paris, SPHERE, UMR 7219, CNRS-Université Paris Diderot, bâtiment Condorcet, case 7093, 5 rue Thomas Mann, 75205 Paris, France
| | - Marco Araneda
- Université de Paris, Centre de recherche psychanalyse médecine et société (CRPMS) - EA 3522, IUH - EA 3518, bâtiment Olympe de Gouges, 8 rue Albert-Einstein, 75013 Paris, France
| | - Clément Dubost
- Chef de service de réanimation polyvalente, hôpital d'instruction des armées (HIA) Bégin et Groupe de recherche COGNAC-G (Cognition and action group), UMR CNRS-Paris Descartes-SSA, Paris, France
| | - Clémence Guillermain
- Université de Paris, SPHERE, UMR 7219, CNRS-Université Paris Diderot, bâtiment Condorcet, case 7093, 5 rue Thomas Mann, 75205 Paris, France
| | - Sarah Kaakai
- Laboratoire Manceau de mathématiques, Institut du risque et de l'assurance, Le Mans Université, 72000 Le Mans, France
| | - Élise Ricadat
- Université de Paris, Centre de recherche psychanalyse médecine et société (CRPMS) - EA 3522, IUH - EA 3518, bâtiment Olympe de Gouges, 8 rue Albert-Einstein, 75013 Paris, France
| | - Nicolas Todd
- Max Planck Institute for Demographic Research, Rostock, Allemagne
| | - Michael Rera
- Université de Paris, Inserm U1284, Center for Research and Interdisciplinarity (CRI), F-75006 Paris, France
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Gaille M, Araneda M, Dubost C, Guillermain C, Kaakai S, Ricadat E, Todd N, Rera M. Ethical and social implications of approaching death prediction in humans - when the biology of ageing meets existential issues. BMC Med Ethics 2020; 21:64. [PMID: 32718352 PMCID: PMC7385957 DOI: 10.1186/s12910-020-00502-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/09/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The discovery of biomarkers of ageing has led to the development of predictors of impending natural death and has paved the way for personalised estimation of the risk of death in the general population. This study intends to identify the ethical resources available to approach the idea of a long-lasting dying process and consider the perspective of death prediction. The reflection on human mortality is necessary but not sufficient to face this issue. Knowledge about death anticipation in clinical contexts allows for a better understanding of it. Still, the very notion of prediction and its implications must be clarified. This study outlines in a prospective way issues that call for further investigation in the various fields concerned: ethical, psychological, medical and social. METHODS The study is based on an interdisciplinary approach, a combination of philosophy, clinical psychology, medicine, demography, biology and actuarial science. RESULTS The present study proposes an understanding of death prediction based on its distinction with the relationship to human mortality and death anticipation, and on the analogy with the implications of genetic testing performed in pre-symptomatic stages of a disease. It leads to the identification of a multi-layered issue, including the individual and personal relationship to death prediction, the potential medical uses of biomarkers of ageing, the social and economic implications of the latter, especially in regard to the way longevity risk is perceived. CONCLUSIONS The present study work strives to propose a first sketch of what the implications of death prediction as such could be - from an individual, medical and social point of view. Both with anti-ageing medicine and the transhumanist quest for immortality, research on biomarkers of ageing brings back to the forefront crucial ethical matters: should we, as human beings, keep ignoring certain things, primarily the moment of our death, be it an estimation of it? If such knowledge was available, who should be informed about it and how such information should be given? Is it a knowledge that could be socially shared?
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Affiliation(s)
- Marie Gaille
- Université de Paris, SPHERE, UMR 7219, CNRS-Université Paris Diderot, bâtiment Condorcet, case 7093, 5 rue Thomas Mann, 75205, Paris, France.
| | - Marco Araneda
- Université de Paris, CRPMS - EA 3522, IUH - EA 3518, bâtiment Olympe de Gouges, 8 rue Albert Einstein, 75013, Paris, France
| | - Clément Dubost
- Head of intensive care unit, Begin military hospital & CognacG research unit, UMR CNRS-Paris Descartes-SSA, Paris, France
| | - Clémence Guillermain
- Université de Paris, SPHERE, UMR 7219, CNRS-Université Paris Diderot, bâtiment Condorcet, case 7093, 5 rue Thomas Mann, 75205, Paris, France
| | - Sarah Kaakai
- Laboratoire Manceau de Mathématiques, Institut du Risque et de l'Assurance, Le Mans Université, 72000, Le Mans, France
| | - Elise Ricadat
- Université de Paris, CRPMS - EA 3522, IUH - EA 3518, bâtiment Olympe de Gouges, 8 rue Albert Einstein, 75013, Paris, France
| | - Nicolas Todd
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Michael Rera
- Center for Research and Interdisciplinarity (CRI), Université de Paris, INSERM U1284. Sorbonne Université, IBPS, B2A, CNRS, Institut de Biologie Paris - Seine, 75005, Paris, France
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10
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Dubost C, Humbert P, Oudre L, Labourdette C, Vayatis N, Vidal PP. Quantitative assessment of consciousness during anesthesia without EEG data. J Clin Monit Comput 2020; 35:993-1005. [PMID: 32661827 DOI: 10.1007/s10877-020-00553-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
Assessing the depth of anesthesia (DoA) is a daily challenge for anesthesiologists. The best assessment of the depth of anesthesia is commonly thought to be the one made by the doctor in charge of the patient. This evaluation is based on the integration of several parameters including epidemiological, pharmacological and physiological data. By developing a protocol to record synchronously all these parameters we aim at having this evaluation made by an algorithm. Our hypothesis was that the standard parameters recorded during anesthesia (without EEG) could provide a good insight into the consciousness level of the patient. We developed a complete solution for high-resolution longitudinal follow-up of patients during anesthesia. A Hidden Markov Model (HMM) was trained on the database in order to predict and assess states based on four physiological variables that were adjusted to the consciousness level: Heart Rate (HR), Mean Blood Pressure (MeanBP) Respiratory Rate (RR), and AA Inspiratory Concentration (AAFi) all without using EEG recordings. Patients undergoing general anesthesia for hernial inguinal repair were included after informed consent. The algorithm was tested on 30 patients. The percentage of error to identify the actual state among Awake, LOC, Anesthesia, ROC and Emergence was 18%. This protocol constitutes the very first step on the way towards a multimodal approach of anesthesia. The fact that our first classifier already demonstrated a good predictability is very encouraging for the future. Indeed, this first model was merely a proof of concept to encourage research ways in the field of machine learning and anesthesia.
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Affiliation(s)
- Clément Dubost
- Begin Military Hospital, Saint-Mandé, France. .,Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France.
| | - Pierre Humbert
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Laurent Oudre
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France.,L2TI, Université Paris 13, Villetaneuse, France
| | - Christophe Labourdette
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Nicolas Vayatis
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France
| | - Pierre-Paul Vidal
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, 91190, Gif-sur-Yvette, France.,Institute of Information and Control, Hangzhou Dianzi University, Zhejiang, China
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11
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Vidal PP, Vienne-Jumeau A, Moreau A, Vidal C, Wang D, Audiffren J, Bargiotas I, Barrois R, Buffat S, Dubost C, Ghidaglia JM, Labourdette C, Mantilla J, Oudre L, Quijoux F, Robert M, Yelnik AP, Ricard D, Vayatis N. An opinion paper on the maintenance of robustness: Towards a multimodal and intergenerational approach using digital twins. Aging Med (Milton) 2020; 3:188-194. [PMID: 33103039 PMCID: PMC7574634 DOI: 10.1002/agm2.12115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022] Open
Abstract
The increasing number of frail elderly people in our aging society is becoming problematic: about 11% of community‐dwelling older persons are frail and another 42% are pre‐frail. Consequently, a major challenge in the coming years will be to test people over the age of 60 years to detect pre‐frailty at the earliest stage and to return them to robustness using the targeted interventions that are becoming increasingly available. This challenge requires individual longitudinal monitoring (ILM) or follow‐up of community‐dwelling older persons using quantitative approaches. This paper briefly describes an effort to tackle this challenge. Extending the detection of the pre‐frail stages to other population groups is also suggested. Appropriate algorithms have been used to begin the tracing of faint physiological signals in order to detect transitions from robustness to pre‐frailty states and from pre‐frailty to frailty states. It is hoped that these studies will allow older adults to receive preventive treatment at the correct institutions and by the appropriate professionals as early as possible, which will prevent loss of autonomy. Altogether, ILM is conceived as an emerging property of databases (“digital twins”) and not the reverse. Furthermore, ILM should facilitate a coordinated set of actions by the caregivers, which is a complex challenge in itself. This approach should be gradually extended to all ages, because frailty has no age, as is testified by overwork, burnout, and post‐traumatic syndrome.
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Affiliation(s)
- Pierre-Paul Vidal
- Institute of Information and Control Hangzhou Dianzi University Zhejiang China.,Centre Borelli CNRS Paris University Paris France
| | | | - Albane Moreau
- Centre Borelli CNRS Paris University Paris France.,Service de Neurologie Hôpital d'Instruction des Armées de Percy Service de Santé des Armées Clamart France
| | - Catherine Vidal
- Centre Borelli CNRS Paris University Paris France.,ENT Department Salpetriere Hospital Paris France
| | - Danping Wang
- Institute of Information and Control Hangzhou Dianzi University Zhejiang China.,Plateforme Sensorimotricité Paris University - CNRS - INSERM Paris France
| | | | | | - Remi Barrois
- Centre Borelli CNRS Paris University Paris France
| | | | - Clément Dubost
- Centre Borelli CNRS Paris University Paris France.,Hôpital d'instruction des armées Bégin Saint-Mandé France
| | | | | | | | - Laurent Oudre
- L2TI Sorbonne Paris Nord University Villetaneuse France
| | | | - Matthieu Robert
- Centre Borelli CNRS Paris University Paris France.,Service d'ophtalmologie AP-HP Hôpital Universitaire Necker-Enfants Malades Paris France
| | - Alain P Yelnik
- Centre Borelli CNRS Paris University Paris France.,PRM Department GH St Louis Lariboisière F. Widal Paris University Paris France
| | - Damien Ricard
- Centre Borelli CNRS Paris University Paris France.,Service de Neurologie Hôpital d'Instruction des Armées de Percy Service de Santé des Armées Clamart France.,École d'application du Val-de-Grâce Service de Santé des Armée Paris France
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Guerci P, Bellut H, Mokhtari M, Gaudefroy J, Mongardon N, Charpentier C, Louis G, Tashk P, Dubost C, Ledochowski S, Kimmoun A, Godet T, Pottecher J, Lalot JM, Novy E, Hajage D, Bouglé A. Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study. Crit Care 2019; 23:371. [PMID: 31752976 PMCID: PMC6873544 DOI: 10.1186/s13054-019-2649-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 06/04/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
Background There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy. Methods This nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy. Results Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively). Conclusions S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival. Trial registration clinicaltrials.gov, NCT03506191
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Affiliation(s)
- Philippe Guerci
- Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France.,INSERM U1116, Groupe Choc, University of Lorraine, Nancy, France
| | - Hugo Bellut
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Mokhtar Mokhtari
- Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France
| | - Julie Gaudefroy
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation, Hôpital Henri Mondor, DMU CARE, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Université Paris-Est Créteil, Créteil, France
| | - Claire Charpentier
- Réanimation Chirurgicale Polyvalente, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Guillaume Louis
- Réanimation polyvalente, Hôpital de Mercy, CHR Metz-Thionville, Metz, France
| | - Parvine Tashk
- Service d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Clément Dubost
- Réanimation polyvalente, Hôpital d'Instruction des Armées (HIA) Bégin, Saint-Mandé, France
| | - Stanislas Ledochowski
- Service de Réanimation Polyvalente, Groupement Hospitalier Nord Dauphiné- Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Antoine Kimmoun
- Réanimation Médicale, Institut Lorrain du Cœur et des Vaisseaux, CHU Nancy-Brabois, Vandoeuvre-Lès-Nancy, France
| | - Thomas Godet
- Réanimation Adultes et Soins Continus, Pôle de Médecine Péri-opératoire, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Julien Pottecher
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Faculté de Médecine, Institut de Physiologie, EA3072, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Jean-Marc Lalot
- Service d'Anesthésie-Réanimation, Réanimation polyvalente, Centre Hospitalier Emile Durkheim, Epinal, France
| | - Emmanuel Novy
- Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France
| | - David Hajage
- Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis de Santé Publique, Equipe Pharmacoépidémiologie et évaluation des soins, AP-HP, Hôpital Pitié-Salpêtrière, CIC-1421, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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13
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Hélias M, Planchon J, Bousquet A, Dubost C. Salmonella enterica serovar enteritidis peritonitis with spontaneous intestinal perforation in an immunocompetent patient. BMJ Case Rep 2019; 12:12/3/e228027. [PMID: 30898965 DOI: 10.1136/bcr-2018-228027] [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] [Indexed: 11/04/2022] Open
Abstract
Few data reported non-typhoidal Salmonella peritonitis in immunocompromised patients. We reported the case of a man without immunosuppression or predisposing factor, who developed Salmonella enterica serovar Enteritidis peritonitis with spontaneous intestinal perforation. After emergent surgery, the patient was transferred to intensive care unit (ICU) because of respiratory, renal and haemodynamic failures. When S. enterica serovar Enteritidis was identified, antibiotics were de-escalated for ceftriaxone and metronidazole for 5 days. No immunosuppression was found. Evolution was favourable, and the patient has been discharged from the ICU on day 8. The originality of this case arises from a perforation peritonitis secondary to S. enterica without any immunosuppression. In absence of non-Typhi Salmonella data, we treated this patient as a typhoid perforation: surgical treatment, antibiotic association and supportive care.
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Affiliation(s)
- Marion Hélias
- Hopital d'Instruction des Armees Begin, Saint Mande, France
| | | | | | - Clément Dubost
- Hopital d'Instruction des Armees Begin, Saint Mande, France
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14
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Maillot J, Poyat C, Salvadori A, Planchon J, Bordier L, Tourtier JP, Dubost C. Long acting insulin glargine overdose, a surprising long lifetime. Toxicology Communications 2019. [DOI: 10.1080/24734306.2019.1583307] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Jean Maillot
- Department of Internal Medicine, Begin Military Hospital, Saint-Mandé, France
| | - Chrystelle Poyat
- Department of Anesthesiology and Intensive Care Medicine, Begin Military Hospital, Saint-Mandé, France
| | - Alexandre Salvadori
- Department of Anesthesiology and Intensive Care Medicine, Begin Military Hospital, Saint-Mandé, France
| | - Jérôme Planchon
- Department of Anesthesiology and Intensive Care Medicine, Begin Military Hospital, Saint-Mandé, France
| | - Lyse Bordier
- Department of Endocrinology, Begin Military Hospital, Saint-Mandé, France
| | - Jean-Pierre Tourtier
- Department of Anesthesiology and Intensive Care Medicine, Begin Military Hospital, Saint-Mandé, France
| | - Clément Dubost
- Department of Anesthesiology and Intensive Care Medicine, Begin Military Hospital, Saint-Mandé, France
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15
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Conan P, Ficko C, Charton F, Martinez T, Dubost C, Boutonnet M, Pasquier P, De rudnicki S, Libert N. Paludisme grave pris en charge sur le terrain et paludisme grave d’importation : une étude cas-témoins rétrospective multicentrique. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Weinmann AV, Beaucreux C, Kearns K, Dubost C. Keep an Eye on the Intracranial Pressure, Thanks to the Optic Nerve Sheath Diameter. Indian J Crit Care Med 2018; 22:460-462. [PMID: 29962750 PMCID: PMC6020633 DOI: 10.4103/ijccm.ijccm_446_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neurological examination on sedated patients is challenging and no gold standard monitoring is currently available. We report the case of a patient deeply sedated for the management of acute respiratory distress syndrome secondary to pneumonia. Delay in awakening led to cerebral exploration by transcranial Doppler (TCD) and measurement of optic nerve sheath diameter (ONSD). Abnormal values of ONSD prompted immediate brain computed tomography scan that confirmed high intracranial pressure (ICP) due to multiple deep parenchymal hematomas. Despite raised ICP, values obtained by TCD were normal, thanks to the persistence of cerebral autoregulation. This case highlights the interest of combining noninvasive techniques for neurological examination, especially for sedated patients.
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17
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Larréché S, Bousquet A, Soler C, Mac Nab C, de Briel D, Delaune D, Bigaillon C, Pasquier P, Dubost C, Demoures T, Malgras B, Ausset S, de Rudnicki S, Leclerc T, de Loynes B, Bonnet S, Mocellin N, Ficko C, Haus R, Hersan O, Rigal S, Mérens A. Microbiology of French military casualties repatriated from overseas for an open traumatic injury. Med Mal Infect 2018; 48:403-409. [PMID: 29709404 DOI: 10.1016/j.medmal.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study aimed to describe the microbiological epidemiology of repatriated French soldiers with an open traumatic injury, and to measure the proportion of multidrug-resistant bacteria (MDRB). METHODS Retrospective study including all French soldiers repatriated in 2011 and 2012 in Parisian military hospitals for open traumatic injury. Results of clinical samples and MDRB screening were collected. The antibiotic susceptibility was assessed using the agar disk diffusion method. Characterization of resistance mechanisms was performed using PCR. Genotyping of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) isolates was performed using rep-PCR. RESULTS A total of 139 patients were included; 70% of them were repatriated from Afghanistan. At admission, 24/88 were positive for MDRB (28%), mainly ESBL-E but no carbapenemase-producing Enterobacteriaceae and vancomycin-resistant Enterococcus faecium were identified. Forty-five patients had lesion sample collection, and 28/45 had a positive culture. The most frequently isolated pathogens were Enterobacter cloacae, Pseudomonas aeruginosa, and Escherichia coli. For eight patients, a MDRB was isolated from the wound, mainly ESBL-E (7/8) but also one methicillin-resistant Staphylococcus aureus and one imipenem-resistant Acinetobacter baumannii. Among ESBL-E, the PCR evidenced the high prevalence of CTX-M15 enzymes. Rep-PCR performed on the 23 ESBL-producing E. coli isolates highlighted numerous profiles. CONCLUSIONS Controlling the spread of ESBL-E is currently challenging for French Armed Forces. Despite any evidence of an epidemic clone, a high-level compliance with hygiene precautions is required throughout the chain of care to avoid cross contamination.
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Affiliation(s)
- S Larréché
- Microbiologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - A Bousquet
- Microbiologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - C Soler
- Microbiologie, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Mac Nab
- Microbiologie, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - D de Briel
- Microbiologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Microbiologie, hôpitaux civils de Colmar, 39, avenue de la Liberté, 68024 Colmar, France
| | - D Delaune
- Microbiologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - C Bigaillon
- Microbiologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - P Pasquier
- Anesthésie-réanimation, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Anesthésie-réanimation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France
| | - C Dubost
- Anesthésie-réanimation, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - T Demoures
- Chirurgie orthopédique, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - B Malgras
- École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France; Chirurgie viscérale, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - S Ausset
- Anesthésie-réanimation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France
| | - S de Rudnicki
- Anesthésie-réanimation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - T Leclerc
- École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France; Centre de traitement des brulés, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - B de Loynes
- Chirurgie orthopédique, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - S Bonnet
- École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France; Chirurgie viscérale, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Chirurgie viscérale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - N Mocellin
- Chirurgie viscérale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Ficko
- Maladies infectieuses et tropicales, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - R Haus
- Direction centrale du service de santé des armées, 158, cours des Maréchaux, 94300 Vincennes, France
| | - O Hersan
- Direction centrale du service de santé des armées, 158, cours des Maréchaux, 94300 Vincennes, France
| | - S Rigal
- École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France; Chirurgie orthopédique, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - A Mérens
- Microbiologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France
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18
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Laitselart P, Saguin E, Plantamura J, Lahutte B, Delacour H, Dubost C. Severe Sympathomimetic Toxidrome in a French Soldier: How Caffeine Overdose Can Lead to Severe Consequences. Mil Med 2017; 183:e179-e181. [DOI: 10.1093/milmed/usx062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/26/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Emeric Saguin
- Begin Military Hospital, 69, Avenue de Paris, 94163 Saint-Mandé, France
| | - Julie Plantamura
- Begin Military Hospital, 69, Avenue de Paris, 94163 Saint-Mandé, France
| | - Bertrand Lahutte
- Begin Military Hospital, 69, Avenue de Paris, 94163 Saint-Mandé, France
| | - Hervé Delacour
- Begin Military Hospital, 69, Avenue de Paris, 94163 Saint-Mandé, France
| | - Clément Dubost
- Begin Military Hospital, 69, Avenue de Paris, 94163 Saint-Mandé, France
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19
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Dubost C, Kearns K, Bordier E, Ould-Ahmed M. [Specificities of the practice of anesthesia and intensive care in external operations]. Rev Prat 2016; 66:796-798. [PMID: 30512307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Clément Dubost
- Pôle anesthésie, réanimation, urgences et bloc opératoire, hôpital d'instruction des armées Bégin, Saint-Mandé, France
| | - Kevin Kearns
- Pôle anesthésie, réanimation, urgences et bloc opératoire, hôpital d'instruction des armées Bégin, Saint-Mandé, France
| | - Emmanuel Bordier
- Pôle anesthésie, réanimation, urgences et bloc opératoire, hôpital d'instruction des armées Bégin, Saint-Mandé, France
| | - Mehdi Ould-Ahmed
- Pôle anesthésie, réanimation, urgences et bloc opératoire, hôpital d'instruction des armées Bégin, Saint-Mandé, France
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Kearns K, Dubost C, Pissot M, Salvadori A. Central venous pressure and peripheral venous pressure, however correlated are still both in the gray-area. Indian J Crit Care Med 2016; 20:58-9. [PMID: 26955221 PMCID: PMC4759999 DOI: 10.4103/0972-5229.173698] [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: 12/04/2022] Open
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Dubost C, Pasquier P, Kearns K, Ficko C, Rapp C, Wolff M, Richard JC, Diehl JL, Le Tulzo Y, Mérat S. Preparation of an intensive care unit in France for the reception of a confirmed case of Ebola virus infection. Anaesth Crit Care Pain Med 2015; 34:349-55. [PMID: 26620545 PMCID: PMC7104235 DOI: 10.1016/j.accpm.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022]
Abstract
The current Ebola Virus Disease (EVD) outbreak in West Africa is a major challenge for the worldwide medical community. On April 29th 2015, the World Health Organization (WHO) declared 26,277 infected cases; among them, 10,884 have deceased. The epidemic is still ongoing, particularly in Sierra Leone. It is now clear that northern countries will be implicated in the care of EVD patients, both in the field and back at home. Because of the severity of EVD, a fair amount of patients may require intensive care. It is highly probable that intensive care would be able to significantly reduce the mortality linked with EVD. The preparation of a modern Intensive Care Unit (ICU) to treat an EVD patient in good conditions requires time and specific equipment. The cornerstone of this preparation includes two main goals: treating the patient and protecting healthcare providers. Staff training is time consuming and must be performed far in advance of patient arrival. To be efficient, preparation should be planned at a national level with help from public authorities, as was the case in France during the summer of 2014. Due to the severity of the disease, the high risk of transmission and scarce knowledge on EVD treatment, our propositions are necessarily original and innovative. Our review includes four topics: a brief report on the actual outbreak, where to receive and hospitalize the patients, the specific organization of the ICU and finally ethical aspects.
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Affiliation(s)
- Clément Dubost
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Pierre Pasquier
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Kévin Kearns
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Cécile Ficko
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Christophe Rapp
- Infectious disease, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
| | - Michel Wolff
- Intensive care medicine, Bichat University Hospital Bichat, 46, rue Henri-Huchard, 75877 Paris, France.
| | - Jean-Christophe Richard
- Intensive care medicine, hôpital de la Croix-Rousse, 93, grande rue de la Croix-Rousse, 69317 Lyon, France.
| | - Jean-Luc Diehl
- Intensive care medicine, European Hospital Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France.
| | - Yves Le Tulzo
- Intensive care medicine, University Hospital of Rennes Pointchaillou, 33053 Rennes, France.
| | - Stéphane Mérat
- Anaesthesiology and intensive care medicine, Begin Military Hospital, 69, avenue de Paris, 94163 Saint-Mande, France.
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Martinez T, Pasquier P, Swiech A, Kearns K, Dubost C, Mérat S. Lung Ultrasound for Chest Tube Insertion. Am J Emerg Med 2015; 33:1095-6. [DOI: 10.1016/j.ajem.2015.04.022] [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] [Received: 02/02/2015] [Revised: 03/11/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022] Open
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Dubost C, Ausset S, Vincent C, Gozlan C, Auroy Y, N'Guyen L, Lienhart A, Benhamou D. Hospital audit of delayed transfusion after orthopaedic surgery. Anaesth Crit Care Pain Med 2015; 34:321-5. [PMID: 26112174 DOI: 10.1016/j.accpm.2015.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES To understand the mechanisms related to both the onset and correction of severe anaemia after orthopaedic surgery, we analysed all the full blood counts (FBCs) for patients on one orthopaedic ward during a one-year period in an academic hospital. METHODS FBCs were screened and the medical records of those patients for whom a postoperative haemoglobin (Hb) concentration below 8 g/dL was recorded at least once were reviewed. The onset of postoperative anaemia was determined by calculating the various time intervals delineated by surgery, the time at which the transfusion threshold was reached and the time at which the lowest Hb level (nadir) and transfusion (if any) occurred. RESULTS A total of 6573 FBCs drawn from 1255 patients were screened. The medical records of 74 consecutive patients with at least one Hb value < 8 g/dL were analysed. The postoperative Hb nadir was 7.4 (± 0.6) g/dL (mean - SD). The medians (IQR 25-75) of the calculated intervals were: (surgery - nadir): 72 (48-144) h, (nadir - transfusion): 7 (5-21) h and (transfusion threshold - transfusion): 26 (11-51) h. CONCLUSIONS Delayed transfusion (defined as > 12 hours between the time at which the transfusion threshold was reached and actual transfusion) was observed in 57% of severely anaemic patients after orthopaedic surgery.
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Affiliation(s)
- Clément Dubost
- Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - Sylvain Ausset
- Département d'anesthésie-réanimation, hôpital d'instruction des Armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - César Vincent
- Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - Charles Gozlan
- Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - Yves Auroy
- Département d'anesthésie-réanimation, hôpital d'instruction des Armées du Val-de-Grace, 74, boulevard de Port-Royal, 75230 Paris, France
| | - Loan N'Guyen
- Service d'hémovigilance, hôpital de la Pitié-Salpétrière, 47-81, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - André Lienhart
- Département d'anesthésie-réanimation, hôpital Saint-Antoine, AP-HP, 184, faubourg Saint-Antoine, 75571 Paris, France
| | - Dan Benhamou
- Département d'anesthésie-réanimation, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
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Pasquier P, Dubost C, Malgras B, Kearns K, Mérat S. The shock index for pre-hospital identification of trauma patients with early acute coagulopathy and massive bleeding. Crit Care 2015; 19:152. [PMID: 25887371 PMCID: PMC4376331 DOI: 10.1186/s13054-015-0839-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pierre Pasquier
- Intensive Care Unit, Bégin Military Teaching Hospital, 69 avenue de Paris, 96160, Saint-Mandé, France.
| | - Clément Dubost
- Intensive Care Unit, Bégin Military Teaching Hospital, 69 avenue de Paris, 96160, Saint-Mandé, France.
| | - Brice Malgras
- Department of Surgery, Val-de-Grâce Military Teaching Hospital, 74 boulevard de Port Royal, 75005, Paris, France.
| | - Kevin Kearns
- Intensive Care Unit, Bégin Military Teaching Hospital, 69 avenue de Paris, 96160, Saint-Mandé, France.
| | - Stéphane Mérat
- Intensive Care Unit, Bégin Military Teaching Hospital, 69 avenue de Paris, 96160, Saint-Mandé, France.
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Dubost C, Bouglé A, Hallynck C, Le Dorze M, Roulleau P, Baujard C, Benhamou D. Comparison of monitoring performance of bioreactance versus esophageal Doppler in pediatric patients. Indian J Crit Care Med 2015; 19:3-8. [PMID: 25624643 PMCID: PMC4296408 DOI: 10.4103/0972-5229.148630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Cardiac output (CO) monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom® is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity). Nicom® may be a useful monitor for pediatric patients. Subjects and Methods: Pediatric patients undergoing major abdominal surgery under general anesthesia with cardiac monitoring by transesophageal Doppler (TED) were included. Continuously recorded hemodynamic variables obtained from both bioreactance and TED were compared. Data were analyzed using the Bland–Altman method. Results: A total of 113 pairs of cardiac index (CI) measurments from 16 patients were analyzed. Mean age was 59 months (95% CI: 42-75) and mean weight was 17 kg (95% CI: 15–20). In the overall population, Bland–Altman analysis revealed a bias of 0.4 L/min/m2, precision of 1.55 L/min/m2, limits of agreement of −1.1 to 1.9 L/min/m2 and a percentage error of 47%. For children weighing >15 kg, results were: Bias 0.51 L/min/m2, precision 1.17 L/min/m2, limits of agreement −0.64 to 1.66 L/min/m2 and percentage error 34%. Conclusion: Simultaneous CI estimations made by bioreactance and TED showed high percentage of errors that is not clinically acceptable. Bioreactance cannot be considered suitable for monitoring pediatric patients.
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Affiliation(s)
- Clément Dubost
- Départment of Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Adrien Bouglé
- Surgical Intensive Care Unit, Institut of Cardiology, Groupe Hospitalier Pitié-Salpêtrière, Réanimation Médicale Polyvalente, Paris, France
| | - Calliope Hallynck
- Départment of Anesthésie-Réanimation, Hôpital Saint-Antoine, Paris, France
| | - Matthieu Le Dorze
- Départment of Anesthésie-Réanimation, Hôpital Lariboisière, Paris, France
| | - Philippe Roulleau
- Départment Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Catherine Baujard
- Départment Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Dan Benhamou
- Départment Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Pasquier P, Ficko C, Mérens A, Dubost C. Preparing an ICU room to welcome a critically ill patient with Ebola virus disease. Intensive Care Med 2014; 41:118-9. [PMID: 25431367 DOI: 10.1007/s00134-014-3562-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Pierre Pasquier
- Intensive Care Unit, Bégin Military Teaching Hospital, Saint-Mandé, France,
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Pasquier P, Dubost C, Boutonnet M, Chrisment A, Villevieille T, Batjom E, Bordier E, Ausset S, Puidupin M, Martinez JY, Bay C, Escarment J, Pons F, Lenoir B, Mérat S. Predeployment training for forward medicalisation in a combat zone: the specific policy of the French Military Health Service. Injury 2014; 45:1307-11. [PMID: 24952973 DOI: 10.1016/j.injury.2014.05.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/22/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To improve the mortality rate on the battlefield, and especially the potentially survivable pre-Medical Treatment Facility deaths, Tactical Combat Casualty Care (TCCC) is now considered as a reference for management of combat casualty from the point of injury to the first medical treatment facility. TCCC comprises of a set of trauma management guidelines designed for use on the battlefield. The French Military Health Service also standardised a dedicated training programme, entitled "Sauvetage au Combat" (SC) ("forward combat casualty care"), with the characteristic of forward medicalisation on the battlefield, the medical team being projected as close as possible to the casualty at the point of injury. The aim of our article is to describe the process and the result of the SC training. MATERIALS AND METHODS Records from the French Military Health Service Academy - École du Val-de-Grâce administration, head of the SC teaching programme, defining its guidelines, and supporting its structure and its execution, were examined and analyzed, since the standardisation of the SC training programme in 2008. The total number of trainees was listed following the different courses (SC1, SC2, SC3). RESULTS At the end of 2013, every deployed combatant underwent SC1 courses (confidential data), 785 health-qualified combatants were graduated for SC2 courses and 672 Role 1 physician-nurse pairs for SC3 courses. CONCLUSION The SC concept and programmes were defined in France in 2007 and are now completely integrated into the predeployment training of all combatants but also of French Military Health Service providers. Finally, SC teaching programmes enhance the importance of teamwork in forward combat medicalisation settings.
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Affiliation(s)
- Pierre Pasquier
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Clément Dubost
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Percy (Military Teaching Hospital), Clamart, France.
| | - Anne Chrisment
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Thierry Villevieille
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Emmanuel Batjom
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Emmanuel Bordier
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
| | - Sylvain Ausset
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Percy (Military Teaching Hospital), Clamart, France.
| | - Marc Puidupin
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Desgenettes (Military Teaching Hospital), Lyon, France.
| | - Jean-Yves Martinez
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Desgenettes (Military Teaching Hospital), Lyon, France.
| | - Christian Bay
- Tactical Care Training Department, French Military Health Service Academy - École du Val-de-Grâce, Paris, France.
| | - Jacques Escarment
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Desgenettes (Military Teaching Hospital), Lyon, France.
| | - François Pons
- French Military Health Service Academy - École du Val-de-Grâce, Paris, France.
| | - Bernard Lenoir
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Percy (Military Teaching Hospital), Clamart, France.
| | - Stéphane Mérat
- Department of Anesthesiology and Intensive Care Unit, Hôpital d'Instruction des Armées Bégin (Military Teaching Hospital), Saint-Mandé, France.
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Dubost C, Pasquier P, Salvadori A, Mérat S, Benhamou D, Geeraerts T. Cerebrospinal fluid pressure after epidural blood patching. Int J Obstet Anesth 2014; 23:286. [PMID: 24934310 DOI: 10.1016/j.ijoa.2014.04.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- C Dubost
- Department of Anesthesiology and Intensive Care, Begin Military Hospital, Saint-Mande, France.
| | - P Pasquier
- Department of Anesthesiology and Intensive Care, Begin Military Hospital, Saint-Mande, France
| | - A Salvadori
- Department of Anesthesiology and Intensive Care, Begin Military Hospital, Saint-Mande, France
| | - S Mérat
- Department of Anesthesiology and Intensive Care, Begin Military Hospital, Saint-Mande, France
| | - D Benhamou
- Department of Anesthesiology and Intensive Care, Bicêtre University Hospital, University Hospitals Paris-South, Kremin-Bicêtre, France
| | - T Geeraerts
- Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Toulouse, France
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Schaal JV, Pasquier P, Renner J, Dubost C, Mérat S. Ultrasounds for prehospital recognition of tension pneumothorax. Injury 2014; 45:1019. [PMID: 24332162 DOI: 10.1016/j.injury.2013.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/17/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Jean-Vivien Schaal
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Percy, 101 Avenue Henri Barbusse, 92140 Clamart, France.
| | - Pierre Pasquier
- Emergency and Intensive Care Department, Military Teaching Hospital Bégin, 69 Avenue de Paris, 94163 Saint-Mandé, France
| | - Julie Renner
- Emergency and Intensive Care Department, Military Teaching Hospital Bégin, 69 Avenue de Paris, 94163 Saint-Mandé, France
| | - Clément Dubost
- Emergency and Intensive Care Department, Military Teaching Hospital Bégin, 69 Avenue de Paris, 94163 Saint-Mandé, France
| | - Stéphane Mérat
- Emergency and Intensive Care Department, Military Teaching Hospital Bégin, 69 Avenue de Paris, 94163 Saint-Mandé, France
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Pasquier P, Malgras B, Savoie PH, Chrisment A, Dubost C, Mérat S. Application of negative-pressure wound therapy for the management of battlefield scrotum trauma. Injury 2013; 44:1250-1. [PMID: 23726143 DOI: 10.1016/j.injury.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/11/2013] [Indexed: 02/02/2023]
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Dubourg J, Messerer M, Karakitsos D, Rajajee V, Antonsen E, Javouhey E, Cammarata A, Cotton M, Daniel RT, Denaro C, Douzinas E, Dubost C, Berhouma M, Kassai B, Rabilloud M, Gullo A, Hamlat A, Kouraklis G, Mannanici G, Marill K, Merceron S, Poularas J, Ristagno G, Noble V, Shah S, Kimberly H, Cammarata G, Moretti R, Geeraerts T. Individual patient data systematic review and meta-analysis of optic nerve sheath diameter ultrasonography for detecting raised intracranial pressure: protocol of the ONSD research group. Syst Rev 2013; 2:62. [PMID: 23919384 PMCID: PMC3751128 DOI: 10.1186/2046-4053-2-62] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 06/20/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The purpose of the optic nerve sheath diameter (ONSD) research group project is to establish an individual patient-level database from high quality studies of ONSD ultrasonography for the detection of raised intracranial pressure (ICP), and to perform a systematic review and an individual patient data meta-analysis (IPDMA), which will provide a cutoff value to help physicians making decisions and encourage further research. Previous meta-analyses were able to assess the diagnostic accuracy of ONSD ultrasonography in detecting raised ICP but failed to determine a precise cutoff value. Thus, the ONSD research group was founded to synthesize data from several recent studies on the subject and to provide evidence on the diagnostic accuracy of ONSD ultrasonography in detecting raised ICP. METHODS This IPDMA will be conducted in different phases. First, we will systematically search for eligible studies. To be eligible, studies must have compared ONSD ultrasonography to invasive intracranial devices, the current reference standard for diagnosing raised ICP. Subsequently, we will assess the quality of studies included based on the QUADAS-2 tool, and then collect and validate individual patient data. The objectives of the primary analyses will be to assess the diagnostic accuracy of ONSD ultrasonography and to determine a precise cutoff value for detecting raised ICP. Secondly, we will construct a logistic regression model to assess whether patient and study characteristics influence diagnostic accuracy. DISCUSSION We believe that this IPD MA will provide the most reliable basis for the assessment of diagnostic accuracy of ONSD ultrasonography for detecting raised ICP and to provide a cutoff value. We also hope that the creation of the ONSD research group will encourage further study. TRIAL REGISTRATION PROSPERO registration number: CRD42012003072.
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Affiliation(s)
- Julie Dubourg
- Université Claude Bernard Lyon 1, 69003 Lyon, France.
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Dubost C, Arnaud FX, Geeraerts T. Cerebrospinal fluid hypovolemia. J Neurosurg 2013; 118:704-5. [PMID: 23289818 DOI: 10.3171/2012.11.jns121723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The invasive monitoring of intracranial pressure is useful in circumstances associated with high-risk of raised intracranial pressure. However the placement of intracranial probe is not always possible and non-invasive assessment of intracranial pressure may be useful, particularly in case of emergencies. Transcranial Doppler measurements allow the estimation of perfusion pressure with the pulsatility index. Recently, new ultrasonographic methods of cerebral monitoring have been developed: the diameter of the optic nerve sheath diameter, a surrogate marker of raised intracranial pressure and the estimation of median shift line deviation.
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Affiliation(s)
- C Dubost
- Département d'anesthésie-réanimation, HIA Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris 05, France
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Dubost C, Geeraerts T. Possible Pitfalls When Measuring the Optic Nerve Sheath with Sonography. J Surg Res 2012; 173:e43-4; author reply e44-5. [DOI: 10.1016/j.jss.2011.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/22/2011] [Accepted: 07/18/2011] [Indexed: 11/26/2022]
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Schaal JV, Dubost C, De Rudnicki S, Merat S, Auroy Y. Intratracheal instillation of epinephrine in life-threatening hemoptysis. Minerva Anestesiol 2011; 77:758. [PMID: 21709665] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Dubost C, Le Gouez A, Zetlaoui PJ, Benhamou D, Mercier FJ, Geeraerts T. Increase in optic nerve sheath diameter induced by epidural blood patch: a preliminary report. Br J Anaesth 2011; 107:627-30. [PMID: 21693468 DOI: 10.1093/bja/aer186] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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
BACKGROUND Post-dural puncture headache (PDPH) might be related to cerebrospinal fluid hypotension. Studies in brain-injured patients have shown a good relationship between optic nerve sheath diameter (ONSD) measured by ocular sonography and invasively measured intracranial pressure (ICP). The aim of this study was to evaluate changes in ONSD after lumbar epidural blood patch (EBP). METHODS Consecutive subjects receiving an EBP for PDPH were included. ONSD and pain measurements were performed before (T(0)), 10 min (M(10)), 2 h (H(2)), and 20 h (H(20)) after the EBP. RESULTS Ten subjects were included. ONSD [median (inter-quartile range)] increased with time after EBP, from 4.8 mm (4.5-5.1) at T(0) to 5.2 mm (4.9-5.7) at M(10) (P=0.005 vs T(0)), 5.5 mm (5.1-6.0) at H(2) (P=0.007 vs T(0)), and 5.8 mm (5.2-6.3) at H(20) (P=0.02 vs T(0)). EBP was clinically successful in nine of 10 subjects. In subjects in whom EBP was successful, ONSD significantly increased at M(10) and T(2) compared with T(0) (P=0.004 and 0.008, respectively) but did not reach statistical significance at H(20) (P=0.06). In the subject in whom EBP failed, a small increase in ONSD was observed over time. CONCLUSIONS In this preliminary report, EBP was followed by ONSD enlargement in subjects with successful EBP, but not in the subject with EBP failure. Since ONSD is a surrogate marker of ICP, this suggests that a sustained increase in ICP is associated with successful EBP.
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Affiliation(s)
- C Dubost
- AP-HP and University Paris-Sud, University Hospital Antoine Béclère, Department of Anaesthesiology and Critical Care, Clamart, France
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Dubost C, Vest P, Pelletier C, Mégarbane B, Rousseau JM. [Milnacipram intoxication during multi-intoxication: interest of toxicologic screening]. Ann Fr Anesth Reanim 2010; 29:169. [PMID: 20074893 DOI: 10.1016/j.annfar.2009.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 05/28/2023]
Affiliation(s)
- C Dubost
- Service d'anesthésie-réanimation, hôpital d'instruction des Armées Bégin, 69 avenue-de-Paris, Saint-Mandé, France
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Libert N, Schérier S, Dubost C, Franck L, Rouquette I, Tortosa JC, Rousseau JM. Prise en charge anesthésique d’un accouchement chez une patiente atteinte d’un déficit en inhibiteur de C1 estérase. ACTA ACUST UNITED AC 2009; 28:375-80. [DOI: 10.1016/j.annfar.2009.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
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Geeraerts T, Dubost C. Theme: Neurology - Optic nerve sheath diameter measurement as a risk marker for significant intracranial hypertension. Biomark Med 2009; 3:129-37. [DOI: 10.2217/bmm.09.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Raised intracranial pressure (ICP) is a frequent condition in many medical and surgical situations and is often difficult to detect. Noninvasive estimates of raised ICP are of interest to allow rapid detection of significant intracranial hypertension. In the anterior part of the optic nerve, the sheath is distensible and can inflate in the case of raised pressure in the cerebrospinal fluid. Measurement of optic nerve sheath diameter using ocular sonography or MRI has been shown to correctly estimate the risk of raised ICP in various settings, including traumatic brain injury. Ocular sonography is simple, rapid, noninvasive and can be performed at the patient’s bedside, but it requires training and experience. The cut-off value for ICP greater than 20 mmHg is 5.8 mm, with a 90% probability of correct diagnosis. When raised ICP is suspected, but invasive ICP monitoring cannot be used or is not clearly recommended, this estimation of the risk of raised ICP may be of great clinical value, aiding in the detection of patients at risk of raised ICP.
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Affiliation(s)
- Thomas Geeraerts
- Département d’Anesthésie-Réanimation, Centre Hospitalier Universitaire Antoine Béclère, 157 rue de la Porte de Trivaux, BP 405, 92141 Clamrt Cedex, France
- AP-HP & University Paris-Sud, University Hospital Antoine Béclère, Department of Anesthesiology & Critical Care, Clamart, France
| | - Clément Dubost
- AP-HP & University Paris-Sud, University Hospital Antoine Béclère, Department of Anesthesiology & Critical Care, Clamart, France
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Batjom E, Franck L, Dubost C, Rouquette-Vincenti I. [When an antibiotic becomes toxic]. Ann Fr Anesth Reanim 2009; 28:105-106. [PMID: 19101108 DOI: 10.1016/j.annfar.2008.11.006] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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D’allaines F, Lenègre J, Dubost C, Scébat L, Mathivat M. L’anastomose veineuse azygo-pulmonaire dans le traitement du rétrécissement mitral œdémateux. Cardiology 2008. [DOI: 10.1159/000164914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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42
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Dragin N, Smani M, Arnaud-Dabernat S, Dubost C, Moranvillier I, Costet P, Daniel JY, Peuchant E. Acute oxidative stress is associated with cell proliferation in the mouse liver. FEBS Lett 2006; 580:3845-52. [PMID: 16797015 DOI: 10.1016/j.febslet.2006.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 06/01/2006] [Indexed: 12/18/2022]
Abstract
Oxidative stress is known to produce tissue injury and to activate various signaling pathways. To investigate the molecular events linked to acute oxidative stress in mouse liver, we injected a toxic dose of paraquat. Liver necrosis was first observed, followed by histological marks of cell proliferation. Concomitantly, activation of the MAP kinase pathway and increased levels of the anti-apoptotic protein Bcl-XL were observed. Gene expression profiles revealed that the differentially expressed genes were potentially involved in cell proliferation. These data suggest that paraquat-induced acute oxidative stress triggers the activation of regeneration-related events in the liver.
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Affiliation(s)
- Nadine Dragin
- EA 3674 - Laboratoire de Biologie de la Différenciation et du Développement, Université de Bordeaux 2, 146 Rue Léo-Saignat, 33076 Bordeaux Cedex, France
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Affiliation(s)
- C Dubost
- American Hospital of Paris, 92202 Neuilly, France
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Dubost C, Chaubin F. [Aortic aneurysms. Technique--indications--results. 1958]. Ann Chir 1998; 51:531-6. [PMID: 9432953] [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: 02/05/2023]
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Dubost C, Blondeau P, Lenfant C, Passelecq J, Guéry J, Weiss M, de Balsac H. [Twenty four open heart interventions under extracorporeal circulation. 1957]. Ann Chir 1998; 51:505-23. [PMID: 9432950] [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: 02/05/2023]
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Sarfati E, Billotey C, Halimi B, Fritsch S, Cattan P, Dubost C. Early localization and reoperation for persistent primary hyperparathyroidism. Br J Surg 1997; 84:98-100. [PMID: 9043469] [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: 02/03/2023]
Abstract
BACKGROUND Reoperation for persistent primary hyperparathyroidism is often performed after a delay of 4-6 months. Success can be expected in over 90 per cent of cases but exploration is technically difficult and there is the possibility of creating permanent hypoparathyroidism and vocal cord paralysis. This is a study of early localization and reoperation. METHODS In a consecutive series of 273 patients who had surgery for primary hyperparathyroidism, three remained hypercalcaemic and in three the abnormal parathyroid was not found at initial exploration. They underwent early (6-48 h) single-tracer 99mTc Sestamibi scintigraphy with factor analysis of dynamic structures (FADS) and single photon emission computed tomography (SPECT) followed by reoperation within 24-72 h. RESULTS Scintigraphy with FADS and SPECT was helpful in all six patients, who were cured by reoperation with no morbidity or symptomatic hypocalcaemia. CONCLUSION Reoperation for persistent primary hyperparathyroidism is possible and may be easier within days of an initially unsuccessful procedure. With the intact 1-84 parathyroid hormone measurement, the diagnosis is accurate. Single-tracer 99mTc Sestamibi scintigraphy with FADS and SPECT is non-invasive, easily and rapidly performed, and was accurate in these six patients.
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Affiliation(s)
- E Sarfati
- Department of Surgery, Hôpital Saint Louis, Paris, France
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Sarfati E, Billotey C, Halimi B, Fritsch S, Cattan P, Dubost C. Early localization and reoperation for persistent primary hyperparathyroidism. Br J Surg 1997. [DOI: 10.1046/j.1365-2168.1997.02413.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sarfati E, Billotey C, Halimi B, Fritsch S, Cattan P, Dubost C. Early localization and reoperation for persistent primary hyperparathyroidism. Br J Surg 1997. [DOI: 10.1002/bjs.1800840137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sarfati E, Dubost C. Posterior mediastinal parathyroid adenoma and hyperparathyroid crisis. Surgery 1994; 115:661-2. [PMID: 8031378] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Gagné ER, Ureña P, Leite-Silva S, Zingraff J, Chevalier A, Sarfati E, Dubost C, Drüeke TB. Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol 1992; 3:1008-17. [PMID: 1450363 DOI: 10.1681/asn.v341008] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.7] [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] Open
Abstract
A retrospective study was performed in chronic hemodialysis patients comparing total parathyroidectomy (PTX) followed by immediate autografting (IA) (total PTX+IA) with subtotal parathyroidectomy (subtotal PTX). One hundred six patients with severe, uncontrolled hyperparathyroidism were referred to this center and underwent surgery during the period from 1980 to 1990. Long-term follow-up after PTX was available in 49 of them: 28 patients had total PTX+IA and 21 had subtotal PTX. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, immediate postoperative results, and long-term parathyroid status, as evaluated by an RIA measuring intact immunoreactive parathyroid hormone (intact iPTH; normal values, 15 to 65 pg/mL). The initial degree of hyperparathyroidism was comparable in the two groups. An excellent short-term control of hyperparathyroidism was achieved in the great majority (95%) of patients with either surgical procedure. However, long-term normalization of parathyroid gland activity was achieved in only one third of patients whereas 33% had elevated intact iPTH levels (> 130 pg/mL; i.e., higher than twice the upper range of normal) and 32% had low intact iPTH levels (< 15 pg/mL), consistent with permanent hypoparathyroidism. No difference was found in the immediate failure rates: 0 of 28 cases after total PTX+IA compared with 2 of 21 cases after subtotal PTX. Similarly, long-term intact iPTH levels were comparable: 400 +/- 105 versus 212 +/- 82 pg/mL (mean +/- SE; P = not significant). Interestingly, long-term serum intact iPTH levels were higher in patients with nodular (N = 18) than with diffusely (N = 26) hyperplastic glands: 556 +/- 146 versus 126 +/- 52 pg/mL (P < 0.001) and recurrence of hyperparathyroidism was more frequent with nodular hyperplasia (11 of 18) than with diffuse hyperplasia (4 of 26) (P < 0.02). In conclusion, although excellent short-term results were obtained with both procedures, satisfactory long-term control of parathyroid gland function was achieved in only one third of the patients, the other two third remaining either hypoparathyroid or developing recurrent hyperparathyroidism. Last, the histological subtype of parathyroid glands was partially predictive of the recurrence of hyperparathyroidism.
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Affiliation(s)
- E R Gagné
- Département de Néphrologie, Hôpital Necker, Paris, France
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