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Guigal C, Simeone P, Denis JB, Jaloux C, Legré R, Mayoly A, Kachouh N, Bruder N, Velly L. Improvement in the perioperative satisfaction of the patient under loco-regional anesthesia by hypnosis or distraction with virtual reality. Minerva Anestesiol 2024; 90:340-342. [PMID: 38652453 DOI: 10.23736/s0375-9393.23.17813-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Chloe Guigal
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France -
- French National Center for Scientific Research, UMR7289, Institute of Neuroscience de la Timone, Aix Marseille University, Marseille, France
| | - Jean-Baptiste Denis
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Régis Legré
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Alice Mayoly
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Najib Kachouh
- Department of Hand and Limb Reconstructive Surgery, La Timone University Hospital, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- French National Center for Scientific Research, UMR7289, Institute of Neuroscience de la Timone, Aix Marseille University, Marseille, France
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Bernat M, Boyer A, Roche M, Richard C, Bouvet L, Remacle A, Antonini F, Poirier M, Pastene B, Hammad E, Fond G, Bruder N, Leone M, Zieleskiewicz L. Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients. Anaesthesia 2024; 79:309-317. [PMID: 38205529 DOI: 10.1111/anae.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Global warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk-benefit ratio of the widespread adoption of total intravenous anaesthesia.
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Affiliation(s)
- M Bernat
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - A Boyer
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Roche
- Pharmacy Department, Service Central des Opérations Pharmaceutiques, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - C Richard
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Bouvet
- Department of Anesthesia and Critical Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - A Remacle
- Departement of Medical Information, Hôpital Nord, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Poirier
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - B Pastene
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - E Hammad
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - G Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - N Bruder
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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Boussen S, Benard-Tertrais M, Ogéa M, Malet A, Simeone P, Antonini F, Bruder N, Velly L. Heart rate complexity helps mortality prediction in the intensive care unit: A pilot study using artificial intelligence. Comput Biol Med 2024; 169:107934. [PMID: 38183707 DOI: 10.1016/j.compbiomed.2024.107934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/10/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
BACKGROUND In intensive care units (ICUs), accurate mortality prediction is crucial for effective patient management and resource allocation. The Simplified Acute Physiology Score II (SAPS-2), though commonly used, relies heavily on comprehensive clinical data and blood samples. This study sought to develop an artificial intelligence (AI) model utilizing key hemodynamic parameters to predict ICU mortality within the first 24 h and assess its performance relative to SAPS-2. METHODS We conducted an analysis of select hemodynamic parameters and the structure of heart rate curves to identify potential predictors of ICU mortality. A machine-learning model was subsequently trained and validated on distinct patient cohorts. The AI algorithm's performance was then compared to the SAPS-2, focusing on classification accuracy, calibration, and generalizability. MEASUREMENTS AND MAIN RESULTS The study included 1298 ICU admissions from March 27th, 2015, to March 27th, 2017. An additional cohort from 2022 to 2023 comprised 590 patients, resulting in a total dataset of 1888 patients. The observed mortality rate stood at 24.0%. Key determinants of mortality were the Glasgow Coma Scale score, heart rate complexity, patient age, duration of diastolic blood pressure below 50 mmHg, heart rate variability, and specific mean and systolic blood pressure thresholds. The AI model, informed by these determinants, exhibited a performance profile in predicting mortality that was comparable, if not superior, to the SAPS-2. CONCLUSIONS The AI model, which integrates heart rate and blood pressure curve analyses with basic clinical parameters, provides a methodological approach to predict in-hospital mortality in ICU patients. This model offers an alternative to existing tools that depend on extensive clinical data and laboratory inputs. Its potential integration into ICU monitoring systems may facilitate more streamlined mortality prediction processes.
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Affiliation(s)
- Salah Boussen
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France; Laboratoire de Biomécanique Appliquée-Université Gustave-Eiffel, Aix-Marseille Université, UMR T24, 51 boulevard Pierre Dramard, 13015, Marseille, France.
| | - Manuela Benard-Tertrais
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Ogéa
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Arthur Malet
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre Simeone
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France; Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France
| | - François Antonini
- Intensive Care and Anesthesiology Department, Hôpital Nord Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Nicolas Bruder
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Lionel Velly
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université Assistance Publique Hôpitaux de Marseille, Marseille, France; Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France
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Bruder N, Chew M. Guidelines on postoperative delirium: Where do we go from here? Eur J Anaesthesiol 2024; 41:79-80. [PMID: 38164095 DOI: 10.1097/eja.0000000000001935] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Nicolas Bruder
- From the Department of Anaesthesiology and Intensive care, Hôpital de la Conception, Aix-Marseille University, Marseille, France (NB), the Department of Intensive care and Acute Medicine, Linköping University Hospital, Linköping, Sweden (MC)
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Simoncini E, Jarry A, Moussion A, Marcheschi A, Giordanino P, Lusenti C, Bruder N, Velly L, Boussen S. Predictive Modeling of COVID-19 Intensive Care Unit Patient Flows and Nursing Complexity: A Monte Carlo Simulation Study. Comput Inform Nurs 2024:00024665-990000000-00154. [PMID: 38252546 DOI: 10.1097/cin.0000000000001100] [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: 01/24/2024]
Abstract
This study aimed to develop a Monte Carlo simulation model to forecast the number of ICU beds needed for COVID-19 patients and the subsequent nursing complexity in a French teaching hospital during the first and second pandemic outbreaks. The model used patient data from March 2020 to September 2021, including age, sex, ICU length of stay, and number of patients on mechanical ventilation or extracorporeal membrane oxygenation. Nursing complexity was assessed using a simple scale with three levels based on patient status. The simulation was performed 1000 times to generate a scenario, and the mean outcome was compared with the observed outcome. The model also allowed for a 7-day forecast of ICU occupancy. The simulation output had a good fit with the actual data, with an R2 of 0.998 and a root mean square error of 0.22. The study demonstrated the usefulness of the Monte Carlo simulation model for predicting the demand for ICU beds and could help optimize resource allocation during a pandemic. The model's extrinsic validity was confirmed using open data from the French Public Health Authority. This study provides a valuable tool for healthcare systems to anticipate and manage surges in ICU demand during pandemics.
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Affiliation(s)
- Elsa Simoncini
- Author Affiliations: Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université (Ms Simoncini, Mrs Jarry, Mrs Moussion, Ms Marcheschi, Mrs Giordanino, Ms Lusenti, and Drs Bruder, Velly, and Boussen); Aix Marseille Université, IFSTTAR, LBA UMR_T 24 (Dr Boussen); and Institut des Neurociences de la Timone, CNRS UMR1106, Faculté de Médecine, Aix-Marseille Université (Dr Velly), France
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Chikh K, Tonon D, Triglia T, Lagier D, Buisson A, Alessi MC, Defoort C, Benatia S, Velly LJ, Bruder N, Martin JC. Early Metabolic Disruption and Predictive Biomarkers of Delayed-Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage. J Proteome Res 2024; 23:316-328. [PMID: 38148664 DOI: 10.1021/acs.jproteome.3c00575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of complications and death. Here, we set out to identify high-performance predictive biomarkers of DCI and its underlying metabolic disruptions using metabolomics and lipidomics approaches. This single-center prospective observational study enrolled 61 consecutive patients with severe aSAH; among them, 22 experienced a DCI. Nine patients without aSAH were included as validation controls. Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h after admission. We identified a panel of 20 metabolites that, together, showed high predictive performance for DCI. This panel of metabolites included lactate, cotinine, salicylate, 6 phosphatidylcholines, and 4 sphingomyelins. The interplay of the metabolome and the lipidome found between CSF and plasma in our patients underscores that aSAH and its associated DCI complications can extend beyond cerebral implications, with a peripheral dimension as well. As an illustration, early biological disruptions that might explain the subsequent DCI found systemic hypoxia driven mainly by higher blood lactate, arginine, and proline metabolism likely associated with vascular NO and disrupted ceramide/sphingolipid metabolism. We conclude that targeting early peripheral hypoxia preceding DCI could provide an interesting strategy for the prevention of vascular dysfunction.
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Affiliation(s)
- Karim Chikh
- Service de Biochimie et Biologie Moléculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite 69310, France
- Laboratoire CarMeN, Inserm U1060, INRAE U1397, Université de Lyon, Université Claude-Bernard Lyon1, Pierre-Bénite 69310, France
| | - David Tonon
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
- Service d'Anesthésie et Réanimation, Hôpital de La Timone, Marseille 13005, France
| | - Thibaut Triglia
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
- Service d'Anesthésie et Réanimation, Hôpital de La Timone, Marseille 13005, France
| | - David Lagier
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
- Service d'Anesthésie et Réanimation, Hôpital de La Timone, Marseille 13005, France
| | - Anouk Buisson
- Service de Biochimie et Biologie Moléculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite 69310, France
| | - Marie-Christine Alessi
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
| | - Catherine Defoort
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
| | - Sherazade Benatia
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
| | - Lionel J Velly
- Service d'Anesthésie et Réanimation, INT (Institut de Neurosciences de La Timone), Hôpital de La Timone, Aix Marseille Université, Marseille 13005, France
| | - Nicolas Bruder
- Service d'Anesthésie et Réanimation, Hôpital de La Timone, Marseille 13005, France
| | - Jean-Charles Martin
- Centre Cardiovasculaire et Nutrition (C2VN), INRAE, INSERM, Aix Marseille Université, Marseille 13005, France
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Boussen S, Denis JB, Simeone P, Lagier D, Bruder N, Velly L. ChatGPT and the stochastic parrot: artificial intelligence in medical research. Br J Anaesth 2023; 131:e120-e121. [PMID: 37516646 DOI: 10.1016/j.bja.2023.06.065] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/10/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023] Open
Affiliation(s)
- Salah Boussen
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Aix Marseille Université, IFSTTAR, LBA UMR_T 24, Marseille, France.
| | - Jean-Baptiste Denis
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106, Aix-Marseille Université, Marseille, France
| | - David Lagier
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106, Aix-Marseille Université, Marseille, France
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8
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Guilhaumou R, Chevrier C, Setti JL, Jouve E, Marsot A, Julian N, Blin O, Simeone P, Lagier D, Mokart D, Bruder N, Garnier M, Velly L. β-Lactam Pharmacokinetic/Pharmacodynamic Target Attainment in Intensive Care Unit Patients: A Prospective, Observational, Cohort Study. Antibiotics (Basel) 2023; 12:1289. [PMID: 37627709 PMCID: PMC10451857 DOI: 10.3390/antibiotics12081289] [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: 07/12/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The aims of this study were to describe pharmacokinetic/pharmacodynamic target attainment in intensive care unit (ICU) patients treated with continuously infused ß-lactam antibiotics, their associated covariates, and the impact of dosage adjustment. METHODS This prospective, observational, cohort study was performed in three ICUs. Four ß-lactams were continuously infused, and therapeutic drug monitoring (TDM) was performed at days 1, 4, and 7. The primary pharmacokinetic/pharmacodynamic target was an unbound ß-lactam plasma concentration four times above the bacteria's minimal inhibitory concentration during the whole dosing interval. The demographic and clinical covariates associated with target attainment were evaluated. RESULTS A total of 170 patients were included (426 blood samples). The percentages of empirical ß-lactam underdosing at D1 were 66% for cefepime, 43% for cefotaxime, 47% for ceftazidime, and 14% for meropenem. Indexed creatinine clearance was independently associated with treatment underdose if increased (adjusted odds ratio per unit, 1.01; 95% CI, 1.00 to 1.01; p = 0.014) or overdose if decreased (adjusted odds ratio per unit, 0.95; 95% CI, 0.94 to 0.97; p < 0.001). Pharmacokinetic/pharmacodynamic target attainment was significantly increased after ß-lactam dosage adjustment between day 1 and day 4 vs. no adjustment (53.1% vs. 26.2%; p = 0.018). CONCLUSIONS This study increases our knowledge on the optimization of ß-lactam therapy in ICU patients. A large inter- and intra-patient variability in plasmatic concentrations was observed, leading to inadequate exposure. A combined indexed creatinine clearance and TDM approach enables adequate dosing for better pharmacokinetic/pharmacodynamic target attainment.
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Affiliation(s)
- Romain Guilhaumou
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Constance Chevrier
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Jean Loup Setti
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Elisabeth Jouve
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Amélie Marsot
- Faculté de Pharmacie, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Nathan Julian
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Olivier Blin
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Pierre Simeone
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- Inst Neurosci Timone, INT, CNRS, Aix Marseille University, UMR7289, 13005 Marseille, France
| | - David Lagier
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- C2VN, Inserm 1263, Inra 1260, Aix Marseille Université, 13005 Marseille, France
| | - Djamel Mokart
- Department of Anaesthesiology and Critical Care Medicine, Institut Paoli-Calmette, 13009 Marseille, France
| | - Nicolas Bruder
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Marc Garnier
- Sorbonne University, GRC29, APHP, DMU DREAM, Rive Droite, Site Tenon, 75020 Paris, France
- Département d’Anesthésie-Réanimation et Médecine Périopératoire, CHU de Clermont-Ferrand, University Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Lionel Velly
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- Inst Neurosci Timone, INT, CNRS, Aix Marseille University, UMR7289, 13005 Marseille, France
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Sanz-Paz M, Zhu F, Bruder N, Kołątaj K, Fernández-Domínguez AI, Acuna GP. DNA Origami Assembled Nanoantennas for Manipulating Single-Molecule Spectral Emission. Nano Lett 2023. [PMID: 37338206 DOI: 10.1021/acs.nanolett.3c01818] [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] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The emission spectrum of a dye is given by the energy of all of the possible radiative transitions weighted by their probability. This spectrum can be altered with optical nanoantennas that are able to manipulate the decay rate of nearby emitters by modifying the local density of photonic states. Here, we make use of DNA origami to precisely place an individual dye at different positions around a gold nanorod and show how this affects the emission spectrum of the dye. In particular, we observe a strong suppression or enhancement of the transitions to different vibrational levels of the excitonic ground state, depending on the spectral overlap with the nanorod resonance. This reshaping can be used to experimentally extract the spectral dependence of the radiative decay rate enhancement. Furthermore, for some cases, we argue that the drastic alteration of the fluorescence spectrum could arise from the violation of Kasha's rule.
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Affiliation(s)
- María Sanz-Paz
- Department of Physics, University of Fribourg, Chemin du Musée 3, Fribourg CH-1700, Switzerland
| | - Fangjia Zhu
- Department of Physics, University of Fribourg, Chemin du Musée 3, Fribourg CH-1700, Switzerland
| | - Nicolas Bruder
- Department of Physics, University of Fribourg, Chemin du Musée 3, Fribourg CH-1700, Switzerland
| | - Karol Kołątaj
- Department of Physics, University of Fribourg, Chemin du Musée 3, Fribourg CH-1700, Switzerland
| | - Antonio I Fernández-Domínguez
- Departamento de Física Teórica de la Materia Condensada and Condensed Matter Physics Center (IFIMAC), Universidad Autónoma de Madrid, E-28049 Madrid, Spain
| | - Guillermo P Acuna
- Department of Physics, University of Fribourg, Chemin du Musée 3, Fribourg CH-1700, Switzerland
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Letournel E, Brunet L, Velly L, Morales T, Fuentes S, Blondel B, Prost S, Simeone P, Bruder N. Erector spinal plane block use for rehabilitation in spine surgery: is pain a good endpoint? Minerva Anestesiol 2023:S0375-9393.22.17106-3. [PMID: 36752607 DOI: 10.23736/s0375-9393.22.17106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Etienne Letournel
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France
| | - Lucie Brunet
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France.,UMR7289, Institut Neurosci Timone, CNRS, Aix Marseille University, Marseille, France
| | - Timothée Morales
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France
| | - Stephane Fuentes
- Spine Unit, Marseille University Hospital Timone, AP-HM, Marseille, France.,Department of Neurosurgery, Marseille University Hospital Timone, AP-HM, Marseille, France
| | - Benjamin Blondel
- Spine Unit, Marseille University Hospital Timone, AP-HM, Marseille, France.,Department of Orthopedic Surgery, Marseille University Hospital Timone, AP-HM, Marseille, France
| | - Solene Prost
- Spine Unit, Marseille University Hospital Timone, AP-HM, Marseille, France.,Department of Orthopedic Surgery, Marseille University Hospital Timone, AP-HM, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France.,Aix Marseille University, AP-HM, Marseille, France.,UMR7289, Institut Neurosci Timone, CNRS, Aix Marseille University, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Critical Care Medicine, Marseille University Hospital Timone, Marseille, France - .,Aix Marseille University, AP-HM, Marseille, France
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Berger B, Cungi PJ, Arzalier S, Lieutaud T, Velly L, Simeone P, Bruder N. Incidence of Burnout Syndrome among Anesthesiologists and Intensivists in France: The REPAR Study. Int J Environ Res Public Health 2023; 20:1771. [PMID: 36767139 PMCID: PMC9914122 DOI: 10.3390/ijerph20031771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Burnout syndrome (BOS) impacts health workers and has become a real public health issue. The primary objective of this observational study was to re-evaluate the incidence of BOS among anesthesiologists and intensivists (AI) in France, ten years after the SESMAT study, a French Physician Health Survey carried out among burnout salaried AI. The secondary objective was to investigate risks factors. METHODS The REPAR survey is an observational study carried in France among AI, residents, and seniors, whatever their main mode of practice, in the framework of a self-questionnaire distributed on the Internet from 11 April 2018 to 1 July 2018. BOS was assessed using the Copenhagen Burnout Inventory (CBI). A score above 50% on two of the dimensions (personal burnout and work-related burnout) indicated BOS, as a main criterion. In order to investigate risks factors, questions were about sociodemographic characteristics, professional and extraprofessional environments, personality and mood using the Major Depression Inventory (MDI). A significance threshold of p < 0.05 was retained. RESULTS Among 1519 questionnaires received, 1500 completed questionnaires were analyzed. There were 775 men (52%) and 721 women (48%), aged 23 to 74 years. Among those, 24% suffered from BOS, 9% showed depressive symptoms (MDI > 25) and 35% were considering changing jobs or stopping their studies. There was no significant difference with the SESMAT study for the general BOS score. After multivariate analysis, 12 variables were significantly associated with the main criterion. CONCLUSIONS Ten years after the SESMAT study, the incidence of BOS in AI has not decreased in the largest cohort of AI studied to date in France.
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Affiliation(s)
- Barnabé Berger
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
| | - Pierre-Julien Cungi
- Fédération Anesthésie Réanimation, Hôpital d’Instruction des Armées Sainte Anne, F-83000 Toulon, France
| | - Ségolène Arzalier
- Département d’Anesthésie–Réanimation, University Hospital of Caen, Avenue Côte-de-Nacre, F-14000 Caen, France
- Comité Vie Professionnelle Santé au Travail (CVP-ST), Société Française d’Anesthésie-Réanimation (SFAR), 74, Rue Raynouard, F-75016 Paris, France
| | - Thomas Lieutaud
- UMRESTTE, UMR-T9405, Université Gustave Eiffel, Université Claude Bernard de Lyon, CEDEX, F-69675 Bron, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille University, UMR7289, F-13005 Marseille, France
| | - Pierre Simeone
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille University, UMR7289, F-13005 Marseille, France
| | - Nicolas Bruder
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, F-13005 Marseille, France
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Bruder N, Higashida R, Santin-Janin H, Dubois C, Aldrich EF, Marr A, Roux S, Mayer SA. The REACT study: design of a randomized phase 3 trial to assess the efficacy and safety of clazosentan for preventing deterioration due to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. BMC Neurol 2022; 22:492. [PMID: 36539711 PMCID: PMC9763815 DOI: 10.1186/s12883-022-03002-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND For patients presenting with an aneurysmal subarachnoid hemorrhage (aSAH), delayed cerebral ischemia (DCI) is a significant cause of morbidity and mortality. The REACT study is designed to assess the safety and efficacy of clazosentan in preventing clinical deterioration due to DCI in patients with aSAH. METHODS REACT is a prospective, multicenter, randomized phase 3 study that is planned to enroll 400 patients with documented aSAH from a ruptured cerebral aneurysm, randomized 1:1 to 15 mg/hour intravenous clazosentan vs. placebo, in approximately 100 sites and 15 countries. Eligible patients are required to present at hospital admission with CT evidence of significant subarachnoid blood, defined as a thick and diffuse clot that is more than 4 mm in thickness and involves 3 or more basal cisterns. The primary efficacy endpoint is the occurrence of clinical deterioration due to DCI up to 14 days post-study drug initiation. The main secondary endpoint is the occurrence of clinically relevant cerebral infarction at Day 16 post-study drug initiation. Other secondary endpoints include the modified Rankin Scale (mRS) and the Glasgow Outcome Scale-Extended (GOSE) score at Week 12 post-aSAH, dichotomized into poor and good outcome. Radiological results and clinical endpoints are centrally evaluated by independent committees, blinded to treatment allocation. Exploratory efficacy endpoints comprise the assessment of cognition status at 12 weeks and quality of life at 12 and 24 weeks post aSAH. DISCUSSION In the REACT study, clazosentan is evaluated on top of standard of care to determine if it reduces the risk of clinical deterioration due to DCI after aSAH. The selection of patients with thick and diffuse clots is intended to assess the benefit/risk profile of clazosentan in a population at high risk of vasospasm-related ischemic complications post-aSAH. TRIAL REGISTRATION (ADDITIONAL FILE 1): ClinicalTrials.gov (NCT03585270). EU Clinical Trial Register (EudraCT Number: 2018-000241-39).
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Affiliation(s)
- Nicolas Bruder
- grid.5399.60000 0001 2176 4817Department of Anesthesia and Critical Care, Hôpital de la Timone, Aix-Marseille Université, 264 rue St-Pierre, 13005 Marseille, France
| | - Randall Higashida
- grid.413077.60000 0004 0434 9023Department of Neuro Interventional Radiology, University of California San Francisco Medical Center, San Francisco, USA
| | - Hugues Santin-Janin
- grid.508389.f0000 0004 6414 2411Biometry, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Cécile Dubois
- grid.508389.f0000 0004 6414 2411Biometry, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - E. François Aldrich
- grid.411024.20000 0001 2175 4264Department of Neurosurgery, University of Maryland, Baltimore, USA
| | - Angelina Marr
- grid.508389.f0000 0004 6414 2411Global Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Sébastien Roux
- grid.508389.f0000 0004 6414 2411Global Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Stephan A. Mayer
- grid.417052.50000 0004 0476 8324Neurocritical Care and Emergency Neurology Services, Westchester Medical Center Health Network, Valhalla, USA ,grid.260917.b0000 0001 0728 151XDepartment of Neurology and Neurosurgery, New York Medical College, New York, USA
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Bobot M, Heim X, Max H, Simeone P, Velly L, Bruder N, Forel JM, Carvelli J, Stein C, Hraiech S, Boucraut J, Gainnier M, Mege JL, Guervilly C, Jourde-Chiche N, Papazian L, Burtey S. MO333: Prevalence of COVID-Associated Renal Injury in ICU and Prognosis of Proximal Tubular Dysfunction in Acute Respiratory Distress Syndrome. Nephrol Dial Transplant 2022. [PMCID: PMC9383871 DOI: 10.1093/ndt/gfac068.043] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS During COVID-19, the renal impairment is the most frequent after lung impairment and is associated of poor prognosis particularly in the intensive care unit (ICU). In this work, we aim to assess the incidence of acute kidney injury (AKI) in COVID-19-related acute respiratory distress syndrome (ARDS) patients, the existence of an early renal dysfunction and its prognosis, and its specificity compared with patients with non-COVID ARDS. METHOD This a prospective and multicentric study led in four ICUs. Patients of 18 years and older in ICU with invasive mechanical ventilation for ARDS were enrolled. Precise evaluation of renal dysfunction markers, including urinary protein electrophoresis, was performed within 24 h after the onset of mechanical ventilation. RESULTS From March 2020 to September 2021, 131 patients in ICU for ARDS were enrolled, 98 COVID-19 ARDS and 33 ARDS from other causes. There was more tubular profile in COVID-19 patients (68% versus 24%; P = .001) and a more mixed, tubular and glomerular profile in non-COVID-19 patients (29% versus 14%; P = .001). COVID-19 patients displayed an important tubular proteinuria, tended to display more AKI (49% versus 31%; P = .07), and had a longer duration of mechanical ventilation (18 versus 10 days; P = .002) and longer ICU length of stay (23 versus 15 days; P = .013). In COVID-19 patients, tubular proteinuria was associated with poor renal prognosis with a significant association with the onset of KDIGO ≥ 2 AKI. CONCLUSION COVID-19 ARDS patients had a specific renal impairment with tubular dysfunction, which appeared to be of poor prognosis on kidney and disease evolution.
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Affiliation(s)
- Mickaël Bobot
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
- Aix-Marseille Université, C2VN, Marseille, France
| | - Xavier Heim
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Howard Max
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Pierre Simeone
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Lionel Velly
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Nicolas Bruder
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Julien Carvelli
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Claire Stein
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - José Boucraut
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Marc Gainnier
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Jean-Louis Mege
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Immunologie, Hôpital La Conception, Marseille, France
| | - Christophe Guervilly
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Noemie Jourde-Chiche
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Stephane Burtey
- Assistance Publique Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
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Bobot M, Tonon D, Peres N, Guervilly C, Lefèvre F, Carvelli J, Papazian L, Max H, Leone M, Lopez A, Bommel Y, Volff M, Velly L, Bruder N, Hraiech S, Simeone P, Bourenne J, Forel JM. MO303: Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically ill Patients With COVID-19. Nephrol Dial Transplant 2022. [PMCID: PMC9383862 DOI: 10.1093/ndt/gfac068.013] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Kidney failure is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe acute kidney injury (AKI) in critically ill COVID patients. METHOD Data from a prospectively collected database of consecutive patients hospitalized in six ICUs for COVID-19 was retrospectively analysed. The incidence and severity of AKI were monitored during the entire ICU stay. Patients older than 18 years hospitalized in for COVID-19-related ARDS requiring mechanical ventilation were included. RESULTS A total of 164 patients were included in the final analysis, 97 (59.1%) displayed AKI, of which 39 had severe stage 3 AKI and 21 (12.8%) requiring renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with ACEI exposure (P = .016), high blood pressure (P = .029), APACHE-II score (P = .004) and mortality at D28 (P = .008), D60 (P < .001) and D90 (P < .001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to CEI [OR: 4.238 (1.307–13.736); P = .016], APACHE II score (without age) [OR: 1.138 (1.044–1.241); P = .003] and iNO [OR: 5.694 (1.953–16.606); P = .001], protective factors were prone positioning [OR: 0.234 (0.057–0.967); P = .045] and dexamethasone [OR: 0.194 (0.053–0.713); P = .014]. CONCLUSION Dexamethasone seems to prevent the risk of severe AKI and RRT, and iNO seems associated with severe AKI and RRT in critically ill patients with COVID-19. iNO must be used with caution in COVID-19 related ARDS.
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Affiliation(s)
- Mickaël Bobot
- Assistance Publique—Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
- Aix-Marseille Université, C2VN, Marseille, France
| | - David Tonon
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Noémie Peres
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Christophe Guervilly
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Flora Lefèvre
- Assistance Publique—Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale—Hôpital de la Conception, Marseille, France
| | - Julien Carvelli
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la TImone, Marseille, France
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Howard Max
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation Polyvalente, Hôpital Nord, Marseille, France
| | - Alexandre Lopez
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation Polyvalente, Hôpital Nord, Marseille, France
| | - Youri Bommel
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Maxime Volff
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Lionel Velly
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Nicolas Bruder
- Assistance Publique Hôpitaux de Marseille, Service de Réanimation, Hôpital La Conception, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
| | - Pierre Simeone
- Assistance Publique Hôpitaux de Marseille, Département d'Anesthésie-Réanimation, Hôpital de la Timone, Marseille, France
| | - Jérémy Bourenne
- Assistance Publique Hôpitaux de Marseille, Réanimation des Urgences, Hôpital de la Timone, Marseille, France
| | - Jean-Marie Forel
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive Réanimation, Hôpital Nord, Marseille, France
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Affiliation(s)
- Nicolas Bruder
- Section of Anesthesia and Intensive Care, Hôpital de la Conception - AP-HM, Aix-Marseille University, Marseille, France -
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Boussen S, Cordier PY, Malet A, Simeone P, Cataldi S, Vaisse C, Roche X, Castelli A, Assal M, Pepin G, Cot K, Denis JB, Morales T, Velly L, Bruder N. Triage and monitoring of COVID-19 patients in intensive care using unsupervised machine learning. Comput Biol Med 2021; 142:105192. [PMID: 34998220 PMCID: PMC8719000 DOI: 10.1016/j.compbiomed.2021.105192] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We designed an algorithm to assess COVID-19 patients severity and dynamic intubation needs and predict their length of stay using the breathing frequency (BF) and oxygen saturation (SpO2) signals. METHODS We recorded the BF and SpO2 signals for confirmed COVID-19 patients admitted to the ICU of a teaching hospital during both the first and subsequent outbreaks of the pandemic in France. An unsupervised machine-learning algorithm (the Gaussian mixture model) was applied to the patients' data for clustering. The algorithm's robustness was ensured by comparing its results against actual intubation rates. We predicted intubation rates using the algorithm every hour, thus conducting a severity evaluation. We designed a S24 severity score that represented the patient's severity over the previous 24 h; the validity of MS24, the maximum S24 score, was checked against rates of intubation risk and prolonged ICU stay. RESULTS Our sample included 279 patients. . The unsupervised clustering had an accuracy rate of 87.8% for intubation recognition (AUC = 0.94, True Positive Rate 86.5%, true Negative Rate 90.9%). The S24 score of intubated patients was significantly higher than that of non-intubated patients at 48 h before intubation. The MS24 score allowed for the distinguishing between three severity levels with an increased risk of intubation: green (3.4%), orange (37%), and red (77%). A MS24 score over 40 was highly predictive of an ICU stay greater than 5 days at an accuracy rate of 81.0% (AUC = 0.87). CONCLUSIONS Our algorithm uses simple signals and seems to efficiently visualize the patients' respiratory situations, meaning that it has the potential to assist staffs' in decision-making. Additionally, real-time computation is easy to implement.
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Affiliation(s)
- Salah Boussen
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France; Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France.
| | - Pierre-Yves Cordier
- Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France; Intensive Care Unit, Laveran Military Teaching Hospital, 34, boulevard Laveran, 13384, Marseille, France
| | - Arthur Malet
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - Sophie Cataldi
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Camille Vaisse
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Xavier Roche
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Alexandre Castelli
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Mehdi Assal
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Guillaume Pepin
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Kevin Cot
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Jean-Baptiste Denis
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Timothée Morales
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France; Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France; Intensive Care Unit, Laveran Military Teaching Hospital, 34, boulevard Laveran, 13384, Marseille, France; Institut des Neurociences de la Timone, CNRS UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
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Chew MS, Longrois D, Bruder N. Occupational exposure and risk of transmission of SARS-CoV2 among European anaesthetists. Eur J Anaesthesiol 2021; 38:1272-1273. [PMID: 34735396 PMCID: PMC8635075 DOI: 10.1097/eja.0000000000001607] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle S Chew
- From the Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Sweden (MSC), Department of Anaesthesia and Intensive Care, Hôpital Bichat-Claude-Bernard, CHU de Paris (DL) and Department of Anaesthesia and Intensive Care, CHU Timone, Aix-Marseille University, France (NB)
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Choucha A, Boissonneau S, Beucler N, Graillon T, Ranque S, Bruder N, Fuentes S, Velly L, Dufour H. Meningoencephalitis with refractory intracranial hypertension : Consider Decompressive craniectomy. J Neurosurg Sci 2021; 67:248-256. [PMID: 34342197 DOI: 10.23736/s0390-5616.21.05397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The benefits of decompressive craniectomy (DC) have been demonstrated in malignant ischemic stroke and traumatic brain injuries with refractory intracranial hypertension (ICH) by randomized controlled trials. Some reports advocate the potential of DC in the context of ICH due to meningoencephalitis (ME) with focal cerebral edema but its interest remains controversial especially when there is diffuse cerebral edema. The aim of this study is to assess the benefits of DC in meningoencephalitis with malignant cerebral edema whether it is focal or diffuse. METHODS We report two cases successfully treated in our instution, plus we conducted a systematic literature review focused on cases of DC in ME in compliance with prisma guidelines. RESULTS the first patient is a 36-years-old woman who suffered from fulminant pneumococcal meningoencephalitis (ME) with refractory ICH following a transphenoidal removal of pituitary adenoma. The second patient is a 20-years-old man suffering from neuromeningeal cryptococcosis with refractory ICH. In both cases DC led to major clinical improvement with a GOS-E 8 at one year. These results are consistent with the literature review which reports a favorable outcome in 85% of cases. CONCLUSIONS DC appears to be a promising therapeutic option in cases of ME with refractory ICH. Thus, reliable criteria will have to be defined to guide us in our practice in emergency cases where DC has not been part of the therapeutic arsenal yet.
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Affiliation(s)
- Anis Choucha
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France -
| | - Sebastien Boissonneau
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Syst, Aix Marseille Univ, INSERM, INS, Marseille, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Teaching Hospital, Toulon, France
| | - Thomas Graillon
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France
| | - Stephane Ranque
- Aix Marseille Univ, IRD, APHM, SSA, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Nicolas Bruder
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Timone, Aix Marseille Univ, CNRS, INT, Marseille, France
| | - Stephane Fuentes
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Spine Unit, Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France
| | - Lionel Velly
- Inst Neurosci Timone, Aix Marseille Univ, CNRS, INT, Marseille, France.,Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, APHM, UH Timone, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France.,Inst Neurosci Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France
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19
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Affiliation(s)
- Pierre Simeone
- AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France.,CNRS, Institut des Neurosciences de la Timone, UMR7289, Aix Marseille University, Marseille, France
| | - Nicolas Bruder
- AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France -
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20
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Robba C, Poole D, McNett M, Asehnoune K, Bösel J, Bruder N, Chieregato A, Cinotti R, Duranteau J, Einav S, Ercole A, Ferguson N, Guerin C, Siempos II, Kurtz P, Juffermans NP, Mancebo J, Mascia L, McCredie V, Nin N, Oddo M, Pelosi P, Rabinstein AA, Neto AS, Seder DB, Skrifvars MB, Suarez JI, Taccone FS, van der Jagt M, Citerio G, Stevens RD. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med 2020; 46:2397-2410. [PMID: 33175276 PMCID: PMC7655906 DOI: 10.1007/s00134-020-06283-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
Purpose To provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI). Methods An international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular injury. The panel conducted systematic searches and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate evidence and formulate questions. A modified Delphi process was implemented with four rounds of voting in which panellists were asked to respond to questions (rounds 1–3) and then recommendation statements (final round). Strong recommendation, weak recommendation, or no recommendation were defined when > 85%, 75–85%, and < 75% of panellists, respectively, agreed with a statement. Results The GRADE rating was low, very low, or absent across domains. The consensus produced 36 statements (19 strong recommendations, 6 weak recommendations, 11 no recommendation) regarding airway management, non-invasive respiratory support, strategies for mechanical ventilation, rescue interventions for respiratory failure, ventilator liberation, and tracheostomy in brain-injured patients. Several knowledge gaps were identified to inform future research efforts. Conclusions This consensus provides guidance for the care of patients admitted to the ICU with ABI. Evidence was generally insufficient or lacking, and research is needed to demonstrate the feasibility, safety, and efficacy of different management approaches. Electronic supplementary material The online version of this article (10.1007/s00134-020-06283-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chiara Robba
- San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy
| | - Molly McNett
- Implementation Science, The Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Karim Asehnoune
- Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France
| | - Julian Bösel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Nicolas Bruder
- Anesthesiology-Intensive Care Department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - Arturo Chieregato
- Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raphael Cinotti
- Department of Anaesthesia and Critical Care, Hôpital Guillaume et René Laennec, University Hospital of Nantes, Saint-Herblain, France
| | - Jacques Duranteau
- Department of Anesthesiology and Perioperative Intensive Care Medicine, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Paris, France
| | - Sharon Einav
- Faculty of Medicine, Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University, Jerusalem, Israel
| | - Ari Ercole
- University of Cambridge Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK
| | - Niall Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Claude Guerin
- Medecine Intensive-Réanimation, Hopital Edouard Herriot, University of Lyon, Lyon, France
- INSERM 955, Créteil, France
| | - Ilias I Siempos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, USA
| | - Pedro Kurtz
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Olvg Hospital, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jordi Mancebo
- Servei Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain
| | - Luciana Mascia
- Alma Mater Studiorum, Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Victoria McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicolas Nin
- Department of Intensive Care Medicine, Hospital Español, Montevideo, Uruguay
| | - Mauro Oddo
- Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Paolo Pelosi
- San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | | | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Alberto Einstein, São Paulo, Brazil
| | - David B Seder
- Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Meilahden sairaala, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland
| | - Jose I Suarez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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21
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Payen JF, Richard M, Francony G, Audibert G, Barbier EL, Bruder N, Dahyot-Fizelier C, Geeraerts T, Gergele L, Puybasset L, Vigue B, Skaare K, Bosson JL, Bouzat P. Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol. BMJ Open 2020; 10:e040550. [PMID: 32820002 PMCID: PMC7443301 DOI: 10.1136/bmjopen-2020-040550] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Intracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI. METHODS AND ANALYSIS Multicentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2 group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2 group is managed to maintain PbtO2 ≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrials NCT02754063 on 28 April 2016 (pre-results).
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Affiliation(s)
- Jean-Francois Payen
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Marion Richard
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Gilles Francony
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, Lorraine University, Nancy University Hospital, Nancy, France
| | - Emmanuel L Barbier
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Nicolas Bruder
- Department of Anaesthesiology and Intensive Care, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, Poitiers University Hospital and Poitiers Hospital, Pharmacology of antimicrobial agents, INSERM U1070, Poitiers, France
| | - Thomas Geeraerts
- Department of Anaesthesia and Intensive Care, Toulouse University Hospital and Toulouse 3-Paul Sabatier University, Toulouse, France
| | - Laurent Gergele
- Department of Intensive care, Ramsay Sante, Hopital Privé de la Loire, Saint-Etienne, France
| | - Louis Puybasset
- Department of Anaesthesia and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Vigue
- Department of Anaesthesia and Intensive care, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique - Hopitaux de Paris, Le Kremlin Bicêtre, France
| | - Kristina Skaare
- Department of Public Health, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Jean Luc Bosson
- TIMC IMAG, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierre Bouzat
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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22
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Aldrich EF, Higashida R, Hmissi A, Le EJ, Macdonald RL, Marr A, Mayer SA, Roux S, Bruder N. Thick and diffuse cisternal clot independently predicts vasospasm-related morbidity and poor outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 2020; 134:1553-1561. [PMID: 32442971 DOI: 10.3171/2020.3.jns193400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity and mortality. The presence of thick, diffuse subarachnoid blood may portend a worse clinical course and outcome, independently of other known prognostic factors such as age, aneurysm size, and initial clinical grade. METHODS In this post hoc analysis, patients with aSAH undergoing surgical clipping (n = 383) or endovascular coiling (n = 189) were pooled from the placebo arms of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS)-2 and CONSCIOUS-3 randomized, double-blind, placebo-controlled phase 3 studies, respectively. Patients without and with thick, diffuse SAH (≥ 4 mm thick and involving ≥ 3 basal cisterns) on admission CT scans were compared. Clot size was centrally adjudicated. All-cause mortality and vasospasm-related morbidity at 6 weeks and Glasgow Outcome Scale-Extended (GOSE) scores at 12 weeks after aSAH were assessed. The effect of the thick and diffuse cisternal aSAH on vasospasm-related morbidity and mortality, and on poor clinical outcome at 12 weeks, was evaluated using logistic regression models. RESULTS Overall, 294 patients (51.4%) had thick and diffuse aSAH. Compared to patients with less hemorrhage burden, these patients were older (median age 55 vs 50 years) and more often had World Federation of Neurosurgical Societies (WFNS) grade III-V SAH at admission (24.1% vs 16.5%). At 6 weeks, all-cause mortality and vasospasm-related morbidity occurred in 36.1% (95% CI 30.6%-41.8%) of patients with thick, diffuse SAH and in 14.7% (95% CI 10.8%-19.5%) of those without thick, diffuse SAH. Individual event rates were 7.5% versus 2.5% for all-cause death, 19.4% versus 6.8% for new cerebral infarct, 28.2% versus 9.4% for delayed ischemic neurological deficit, and 24.8% versus 10.8% for rescue therapy due to cerebral vasospasm, respectively. Poor clinical outcome (GOSE score ≥ 4) was observed in 32.7% (95% CI 27.3%-38.3%) and 16.2% (95% CI 12.1%-21.1%) of patients with and without thick, diffuse SAH, respectively. CONCLUSIONS In a large, centrally adjudicated population of patients with aSAH, WFNS grade at admission and thick, diffuse SAH independently predicted vasospasm-related morbidity and poor 12-week clinical outcome. Patients with thick, diffuse cisternal SAH may be an important cohort to target in future clinical trials of treatment for vasospasm.
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Affiliation(s)
- E François Aldrich
- 1Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | - Randall Higashida
- 2Department of Neurointerventional Radiology, University of California San Francisco Medical Center, San Francisco, California
| | - Abdel Hmissi
- 3Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Elizabeth J Le
- 1Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | - R Loch Macdonald
- 4Department of Neurological Surgery, University of California San Francisco, Fresno, California.,5Department of Surgery, University of Toronto, Ontario, Canada
| | - Angelina Marr
- 3Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Stephan A Mayer
- 6Department of Neurology, Henry Ford Neuroscience Institute, Wayne State School of Medicine, Detroit, Michigan; and
| | - Sébastien Roux
- 3Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Nicolas Bruder
- 7Department of Anesthesia and Critical Care, Hôpital de la Timone, Aix-Marseille Université, Marseille, France
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23
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Demarez B, Amatore F, Lagarde S, Bruder N, Grob J, Richard M. Anti‐
N
‐methyl‐
D
‐aspartate receptor encephalitis during treatment with adalimumab for psoriasis. J Eur Acad Dermatol Venereol 2020; 34:e591-e593. [DOI: 10.1111/jdv.16456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B. Demarez
- Dermatology Department Aix‐Marseille UniversityAPHMHôpital Timone Marseille France
| | - F. Amatore
- Dermatology Department Aix‐Marseille UniversityAPHMHôpital Timone Marseille France
| | - S. Lagarde
- Epileptology Department Universitary Hospital TimoneAssistance Publique Hopitaux de MarseilleAPHM Marseille France
| | - N. Bruder
- Department of Anesthesiology and Intensive Care CHU TimoneAix‐Marseille University Marseille France
| | - J.J. Grob
- Dermatology Department Aix‐Marseille UniversityAPHMHôpital Timone Marseille France
| | - M.A. Richard
- Dermatology Department Aix‐Marseille UniversityAPHMHôpital Timone Marseille France
- CEReSS‐EA3279 Research Centrer in Health Services and Quality of Life Aix Marseille University Dermatology Department Universitary Hospital TimoneAssistance Publique Hôpitaux de MarseilleAPHM Marseille France
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24
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Graillon T, Cuny T, Castinetti F, Courbière B, Cousin M, Albarel F, Morange I, Bruder N, Brue T, Dufour H. Surgical indications for pituitary tumors during pregnancy: a literature review. Pituitary 2020; 23:189-199. [PMID: 31691893 DOI: 10.1007/s11102-019-01004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Surgical indications for pituitary tumors during pregnancy are rare, and are derived from a balance between expected benefits, particularly for maternal benefits, and anesthetic/surgical risks. METHODS A literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy. RESULTS Main benefits are expected in case of critical visual impairment and/or life-threatening endocrine disturbances. Multidisciplinary patient management is systematically required although nonobstetric surgery presents a reasonable risk during pregnancy. The risks of congenital malformation during the first trimester and those of premature birth during the third trimester make the second trimester the optimal period for surgery. In prolactin-secreting, nonsecreting, GH- and TSH-secreting PAs, transsphenoidal surgery (TS) is recommended in cases involving severe visual impairment, characterized by severe visual field deficit, visual acuity impairment, and abnormal optical coherence tomography findings, and when no other medical alternatives are possible and/or sufficient. Uncontrolled and severe Cushing's disease (CD) during pregnancy increases both maternal and fetal morbimortality, thus justifying TS or sometimes dopamine agonist therapy as a safer alternative. Finally, metyrapone, ketoconazole, or bilateral adrenalectomy could be recommended in certain cases after the failure of medical therapies and/or TS. Surgery is also required for suprasellar meningiomas, craniopharyngiomas, and pituitary cysts in the case of severe visual deficit. CONCLUSION Surgical indications for pituitary tumors are rare during pregnancy; therefore, surgery should be avoided when possible. Further, the second trimester should be considered as the optimal surgical period. Severe visual disturbance and uncontrolled CD are the main surgical indications during pregnancy.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
- Aix-Marseille Univ, INSERM, MMG, Marseille, France.
| | - Thomas Cuny
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Frédéric Castinetti
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Blandine Courbière
- Centre Clinico-Biologique d'AMP, Pôle Femmes-Parents-Enfants, Hôpital de La Conception, AP-HM, Marseille/Aix Marseille Univ, Avignon Univ, CNRS, IRD, IBME, Marseille, France
| | - Marie Cousin
- Cabinet d'Ophtalmologie, Saint-Rémy de Provence, France
| | - Frédérique Albarel
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Isabelle Morange
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Nicolas Bruder
- Anesthesiology-Intensive Care Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Thierry Brue
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
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25
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Mayer SA, Aldrich EF, Bruder N, Hmissi A, Macdonald RL, Viarasilpa T, Marr A, Roux S, Higashida RT. Thick and Diffuse Subarachnoid Blood as a Treatment Effect Modifier of Clazosentan After Subarachnoid Hemorrhage. Stroke 2019; 50:2738-2744. [PMID: 31394993 DOI: 10.1161/strokeaha.119.025682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- Clazosentan, an endothelin receptor antagonist, has been shown to reduce angiographic vasospasm and vasospasm-related morbidity after aneurysmal subarachnoid hemorrhage (SAH), although no effect on long-term functional outcome has been demonstrated. Thick clot on initial computed tomography is associated with an increased risk of vasospasm and delayed cerebral ischemia. In this post hoc analysis, we hypothesized that use of clazosentan in this subpopulation would provide stronger benefit. Methods- We analyzed SAH patients enrolled in the CONSCIOUS-2 and CONSCIOUS-3 studies (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage) and compared the effects of clazosentan 5 mg/h, 15 mg/h, and placebo starting the day after aneurysm repair. The analysis was performed separately based on the presence or absence of thick (≥4 mm) and diffuse (≥3 cisterns) SAH on admission computed tomography. The primary composite end point was all-cause mortality and vasospasm-related morbidity at 6 weeks, and the main secondary end point was the extended Glasgow Outcome Scale at 3 months, adjusted for admission clinical grade. Results- Of 1718 randomized patients, 919 (53%) had thick and diffuse SAH. The primary composite end point in this group occurred in 36% of placebo-treated patients (n=294), 30% patients treated with clazosentan 5 mg/h (n=514; relative risk, 0.82; 95% CI, 0.67-0.99), and 19% patients treated with clazosentan 15 mg/h (n=111; relative risk, 0.54; 95% CI, 0.36-0.80). Despite this, death or poor functional outcome (Glasgow Outcome Scale ≤4) occurred in 33% of placebo-treated patients, 34% of patients treated with clazosentan 5 mg/h (relative risk 1.02; 95% CI, 0.84-1.23), and 35% of patients treated with clazosentan 15 mg/h (relative risk 1.14; 95% CI, 0.88-1.48). Conclusions- In an enriched population with thick and diffuse SAH, clazosentan at a dose of 5 and 15 mg/h was able to significantly reduce vasospasm-related morbidity in a dose-dependent manner. The absence of an effect on long-term functional status likely reflects the complexity and multiplicity of factors that contribute to poor outcome after SAH. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00558311; NCT00940095.
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Affiliation(s)
- Stephan A Mayer
- From the Department of Neurology, Henry Ford Hospital, Detroit, MI (S.A.M., T.V.)
| | | | - Nicolas Bruder
- Hopital de la Timone-Aix-Marseille Université, France (N.B.)
| | - Abdel Hmissi
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland (A.H., A.M., S.R.)
| | - R Loch Macdonald
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, ON, Canada (R.L.M.)
| | - Tanuwong Viarasilpa
- From the Department of Neurology, Henry Ford Hospital, Detroit, MI (S.A.M., T.V.).,Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.V.)
| | - Angelina Marr
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland (A.H., A.M., S.R.)
| | - Sebastien Roux
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland (A.H., A.M., S.R.)
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26
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Vitte J, Amadei L, Gouitaa M, Mezouar S, Zieleskiewicz L, Albanese J, Bruder N, Lagier D, Mertès PM, Mège J, Schwartz LB, Leone M. Paired acute-baseline serum tryptase levels in perioperative anaphylaxis: An observational study. Allergy 2019; 74:1157-1165. [PMID: 30793322 DOI: 10.1111/all.13752] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/30/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well-defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination. METHODS A retrospective study was performed on 102 adult patients from the Aix-Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured. RESULTS Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than ([1.2×baseline tryptase] + 2] μg/L to be considered a clinically significant rise. In our cohort, this algorithm achieved 94% positive predictive value (PPV), 53% negative predictive value (NPV), 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis. CONCLUSION Total tryptase levels in serum discriminated between nonanaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm.
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Affiliation(s)
- Joana Vitte
- Aix‐Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection Marseille France
| | | | - Marion Gouitaa
- Aix‐Marseille Univ, APHM, Hôpital Nord Service de Pneumologie Marseille France
| | - Soraya Mezouar
- Aix‐Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection Marseille France
| | | | - Jacques Albanese
- Aix‐Marseille Univ, APHM, Hôpital de la Conception Service d'Anesthésie et de Réanimation Marseille France
| | - Nicolas Bruder
- Aix‐Marseille Univ, APHM, Hôpital de la Timone Service d'Anesthésie et de Réanimation Marseille France
| | - David Lagier
- Aix‐Marseille Univ, APHM, Hôpital de la Timone Service d'Anesthésie et de Réanimation Marseille France
| | - Paul M. Mertès
- Strasbourg Univ, HUS, Nouvel Hôpital Civil, FMTS Service d'Anesthésie Réanimation Strasbourg France
| | - Jean‐Louis Mège
- Aix‐Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection Marseille France
| | - Lawrence B. Schwartz
- Division of Rheumatology, Allergy and Immunology Virginia Commonwealth University Richmond Virginia, VA USA
| | - Marc Leone
- Aix‐Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection Marseille France
- Aix‐Marseille Univ, APHM, Hôpital Nord Marseille France
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27
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Higashida RT, Bruder N, Gupta R, Guzman R, Hmissi A, Marr A, Mayer SA, Roux S, Weidauer S, Aldrich EF. Reversal of Vasospasm with Clazosentan After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study. World Neurosurg 2019; 128:e639-e648. [PMID: 31054336 DOI: 10.1016/j.wneu.2019.04.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clazosentan, an endothelin-1 receptor antagonist, has been shown to prevent the development of large vessel angiographic vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). It has been hypothesized that clazosentan can also reverse established angiographic vasospasm. METHODS The REVERSE (resynchronization reverses remodeling in systolic left ventricular dysfunction) study was a prospective, multicenter, open-label, 2-stage pilot study of adult patients with aSAH who had received intravenous clazosentan (15 mg/hour) after developing moderate-to-severe angiographic vasospasm. The primary efficacy endpoint was the reversal of global cerebral vasospasm in large cerebral artery segments 3 hours after clazosentan initiation. The secondary endpoints included large artery vasospasm reversal at 24 hours and the maximum change in the angiographic cerebral circulation time. The change in vasospasm severity in the proximal and distal segments was investigated in an exploratory analysis. RESULTS The primary efficacy endpoint was met in 3 of 11 evaluable patients (27.3%; 95% confidence interval, 6.0-61.0). However, recruitment was stopped after stage 1 in accordance with the predefined interim analysis criteria. In the exploratory analysis, 50.0% and 77.8% of the patients showed a significant reversal of vasospasm or improvement to the admission state in ≥2 distal segments at 3 and 24 hours and 28.6% and 77.8% in ≥2 proximal segments, respectively. CONCLUSIONS Although the main analysis showed a reversal of large vessel vasospasm 3 hours after clazosentan initiation in a few patients, the exploratory analysis indicated a clear pharmacodynamic dilating effect on vasospastic cerebral vessels at 24 hours in most patients, in particular, in the distal arterial beds. This observation supported the inclusion of patients with established vasospasm in the ongoing REACT (prevention and treatment of vasospasm with clazosentan) trial.
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Affiliation(s)
- Randall T Higashida
- Department of Neuro Interventional Radiology, University of California, San Francisco, Medical Center, San Francisco, California, USA.
| | - Nicolas Bruder
- Department of Anesthesia and Critical Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Rajiv Gupta
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital, Basel, Switzerland
| | - Abdel Hmissi
- Global Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Angelina Marr
- Global Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Neuroscience Institute, Detroit, Michigan, USA
| | - Sébastien Roux
- Global Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Frankfurt, Germany
| | - E François Aldrich
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
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28
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Lagier D, Tonon D, Garrigue P, Guillet B, Giacomino L, Martin JC, Alessi MC, Bruder N, Velly LJ. Thromboxane-prostaglandin receptor antagonist, terutroban, prevents neurovascular events after subarachnoid haemorrhage: a nanoSPECT study in rats. Crit Care 2019; 23:42. [PMID: 30744667 PMCID: PMC6371436 DOI: 10.1186/s13054-019-2338-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/07/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022]
Abstract
Background Several lipid metabolites in cerebrospinal fluid are correlated with poor outcomes in aneurysmal subarachnoid haemorrhage. Most of these metabolites bind to ubiquitous thromboxane–prostaglandin (TP) receptors, causing vasoconstriction and inflammation. Here, we evaluated terutroban (TBN), a specific TP receptor antagonist, for the prevention of post-haemorrhage blood-brain barrier disruption, neuronal apoptosis and delayed cerebral hypoperfusion. Methods The rat double subarachnoid haemorrhage model was produced by twice injecting (days 1 and 2) autologous blood into the cisterna magna. Seventy-eight male Sprague-Dawley rats were assigned to experimental groups. Rats exposed to subarachnoid haemorrhage were allocated to no treatment (SAH group) or TBN treatment by gastric gavage during the first 5 days after haemorrhage (SAH+TBN group). Control rats received artificial cerebrospinal fluid injections (CSF group). Sham-operated rats with or without TBN administration were also studied. Body weight and Garcia neurological scores were assessed on day 2 and day 5. We used nanoscale single-photon emission computed tomography (nanoSPECT) to measure brain uptake of three radiolabelled agents: 99mTechnetium-diethylenetriaminepentacetate (99mTc-DTPA), which indicated blood-brain barrier permeability on day 3, 99mTechnetium-annexin V-128 (99mTc-Anx-V128), which indicated apoptosis on day 4, and 99mTechnetium-hexamethylpropyleneamineoxime (99mTc-HMPAO), which indicated cerebral perfusion on day 5. Basilar artery narrowing was verified histologically, and cerebral TP receptor agonists were quantified. Results 99mTc-DTPA uptake unveiled blood-brain barrier disruption in the SAH group. TBN mitigated this disruption in the brainstem area. 99mTc-Anx-V128 uptake was increased in the SAH group and TBN diminished this effect in the cerebellum. 99mTc-HMPAO uptake revealed a global decreased perfusion on day 5 in the SAH group that was significantly counteracted by TBN. TBN also mitigated basilar artery vasoconstriction, neurological deficits (on day 2), body weight loss (on day 5) and cerebral production of vasoconstrictors such as Thromboxane B2 and Prostaglandin F2α. Conclusions Based on in vivo nanoscale imaging, we demonstrated that TBN protected against blood-brain barrier disruption, exerted an anti-apoptotic effect and improved cerebral perfusion. Thus, TP receptor antagonists showed promising results in treating post-haemorrhage neurovascular events.
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Affiliation(s)
- David Lagier
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France. .,C2VN Inserm 1263, Inra 1260, Aix Marseille University, Marseille, France.
| | - David Tonon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France.,C2VN Inserm 1263, Inra 1260, Aix Marseille University, Marseille, France
| | - Philippe Garrigue
- CERIMED (European Center for Research in Medical Imaging), Aix Marseille University, Marseille, France
| | - Benjamin Guillet
- CERIMED (European Center for Research in Medical Imaging), Aix Marseille University, Marseille, France
| | - Laura Giacomino
- Department of Anaesthesiology and Critical Care Medicine, INT (Institut de Neurosciences de la Timone), University Hospital Timone, Aix Marseille University, Marseille, France
| | | | | | - Nicolas Bruder
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - Lionel J Velly
- Department of Anaesthesiology and Critical Care Medicine, INT (Institut de Neurosciences de la Timone), University Hospital Timone, Aix Marseille University, Marseille, France
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29
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Champey J, Mourey C, Francony G, Pavese P, Gay E, Gergele L, Manet R, Velly L, Bruder N, Payen JF. Strategies to reduce external ventricular drain-related infections: a multicenter retrospective study. J Neurosurg 2018; 130:2034-2039. [PMID: 29932377 DOI: 10.3171/2018.1.jns172486] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/02/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various strategies have been proposed to reduce the incidence of external ventricular drain (EVD)-related infections. The authors retrospectively studied the impact of EVD care management on EVD-related infections at 3 French university hospital intensive care units. METHODS Between 2010 and 2014, 462 consecutive adult patients with no evidence of a preexisting CSF infection received EVDs as part of their care at one of the following sites: Grenoble (221 patients), Saint-Etienne (130 patients), and Marseille (111 patients). Written protocols describing the EVD placement procedure, management, and removal were implemented at the 3 sites. Daily CSF sampling and intraventricular administration of antibiotics prior to EVD removal were performed at the Grenoble site only. EVD-related infection was considered for any confirmed ventriculostomy-related infection (VRI) and ventriculitis. VRI was defined as one or more positive CSF cultures or Gram stain with CSF pleocytosis and biochemical abnormalities. Ventriculitis was defined as CSF pleocytosis and biochemical abnormalities with degradation of neurological status and fever. RESULTS A total of 6945 EVD days were observed in the entire population. In the Grenoble cohort, the mean cumulative incidence of EVD-related infections was significantly lower than that in the 2 other cohorts: 1.4% (95% CI 0.0%-2.9%) versus 9.2% (95% CI 4.2%-14.2%) and 7.2% (95% CI 2.4%-12.0%) at Saint-Etienne and Marseille, respectively (p < 0.01). Accounting for the duration of external ventricular drainage at each site, the risk for EVD-related CSF infections was significantly higher at Saint-Etienne and Marseille than at Grenoble, with ORs of 15.9 (95% CI 3.6-71.4, p < 0.001) and 10.0 (95% CI 2.2-45.5, p = 0.003), respectively. CONCLUSIONS These findings indicate that it is possible to attain a low incidence of EVD-related infections, provided that an EVD care bundle, which can include routine daily CSF sampling, is implemented and strongly adhered to.
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Affiliation(s)
| | | | | | | | | | | | | | - Lionel Velly
- 6Pôle Anesthésie Réanimation, CHU La Timone, Marseille
| | | | - Jean-François Payen
- 1Pôle Anesthésie Réanimation
- 7Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; and
- 8INSERM, U1216, Grenoble, France
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30
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Boussen S, Spiegler A, Benar C, Carrère M, Bartolomei F, Metellus P, Voituriez R, Velly L, Bruder N, Trébuchon A. Time rescaling reproduces EEG behavior during transition from propofol anesthesia-induced unconsciousness to consciousness. Sci Rep 2018; 8:6015. [PMID: 29662089 PMCID: PMC5902625 DOI: 10.1038/s41598-018-24405-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/03/2018] [Indexed: 02/02/2023] Open
Abstract
General anesthesia (GA) is a reversible manipulation of consciousness whose mechanism is mysterious at the level of neural networks leaving space for several competing hypotheses. We recorded electrocorticography (ECoG) signals in patients who underwent intracranial monitoring during awake surgery for the treatment of cerebral tumors in functional areas of the brain. Therefore, we recorded the transition from unconsciousness to consciousness directly on the brain surface. Using frequency resolved interferometry; we studied the intermediate ECoG frequencies (4-40 Hz). In the theoretical study, we used a computational Jansen and Rit neuron model to simulate recovery of consciousness (ROC). During ROC, we found that f increased by a factor equal to 1.62 ± 0.09, and δf varied by the same factor (1.61 ± 0.09) suggesting the existence of a scaling factor. We accelerated the time course of an unconscious EEG trace by an approximate factor 1.6 and we showed that the resulting EEG trace match the conscious state. Using the theoretical model, we successfully reproduced this behavior. We show that the recovery of consciousness corresponds to a transition in the frequency (f, δf) space, which is exactly reproduced by a simple time rescaling. These findings may perhaps be applied to other altered consciousness states.
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Affiliation(s)
- S Boussen
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France.
- Aix Marseille Université, IFSTTAR, LBA UMR_T 24, 13916, Marseille, France.
| | - A Spiegler
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - C Benar
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - M Carrère
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - F Bartolomei
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
- Clinical Electrophysiology Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - P Metellus
- Neurosurgery Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - R Voituriez
- Laboratoire Jean Perrin-UMR 8237 CNRS Université Pierre et Marie Curie, 75005, Paris, France
| | - L Velly
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
- Institut des Neurciences de la Timone, CNRS UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - N Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
| | - A Trébuchon
- Institut de Neurosciences des Systèmes - Inserm UMR1106 - Aix-Marseille Université - Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
- Clinical Electrophysiology Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
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31
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Velly L, Perlbarg V, Boulier T, Adam N, Delphine S, Luyt CE, Battisti V, Torkomian G, Arbelot C, Chabanne R, Jean B, Di Perri C, Laureys S, Citerio G, Vargiolu A, Rohaut B, Bruder N, Girard N, Silva S, Cottenceau V, Tourdias T, Coulon O, Riou B, Naccache L, Gupta R, Benali H, Galanaud D, Puybasset L, Constantin JM, Chastre J, Amour J, Vezinet C, Rouby JJ, Raux M, Langeron O, Degos V, Bolgert F, Weiss N, Similowski T, Demoule A, Duguet A, Tollard E, Veber B, Lotterie JA, SANCHEZ-PENA P, Génestal M, Patassini M. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol 2018; 17:317-326. [DOI: 10.1016/s1474-4422(18)30027-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023]
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32
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Geeraerts T, Velly L, Abdennour L, Asehnoune K, Audibert G, Bouzat P, Bruder N, Carrillon R, Cottenceau V, Cotton F, Courtil-Teyssedre S, Dahyot-Fizelier C, Dailler F, David JS, Engrand N, Fletcher D, Francony G, Gergelé L, Ichai C, Javouhey É, Leblanc PE, Lieutaud T, Meyer P, Mirek S, Orliaguet G, Proust F, Quintard H, Ract C, Srairi M, Tazarourte K, Vigué B, Payen JF. Management of severe traumatic brain injury (first 24hours). Anaesth Crit Care Pain Med 2017; 37:171-186. [PMID: 29288841 DOI: 10.1016/j.accpm.2017.12.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The latest French Guidelines for the management in the first 24hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie et de réanimation [SFAR]) in partnership with the Association de neuro-anesthésie-réanimation de langue française (ANARLF), The French Society of Emergency Medicine (Société française de médecine d'urgence (SFMU), the Société française de neurochirurgie (SFN), the Groupe francophone de réanimation et d'urgences pédiatriques (GFRUP) and the Association des anesthésistes-réanimateurs pédiatriques d'expression française (ADARPEF). The method used to elaborate these guidelines was the Grade® method. After two Delphi rounds, 32 recommendations were formally developed by the experts focusing on the evaluation the initial severity of traumatic brain injury, the modalities of prehospital management, imaging strategies, indications for neurosurgical interventions, sedation and analgesia, indications and modalities of cerebral monitoring, medical management of raised intracranial pressure, management of multiple trauma with severe traumatic brain injury, detection and prevention of post-traumatic epilepsia, biological homeostasis (osmolarity, glycaemia, adrenal axis) and paediatric specificities.
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Affiliation(s)
- Thomas Geeraerts
- Pôle anesthésie-réanimation, Inserm, UMR 1214, Toulouse neuroimaging center, ToNIC, université Toulouse 3-Paul Sabatier, CHU de Toulouse, 31059 Toulouse, France.
| | - Lionel Velly
- Service d'anesthésie-réanimation, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Lamine Abdennour
- Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Karim Asehnoune
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - Gérard Audibert
- Département d'anesthésie-réanimation, hôpital Central, CHU de Nancy, 54000 Nancy, France
| | - Pierre Bouzat
- Pôle anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - Nicolas Bruder
- Service d'anesthésie-réanimation, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Romain Carrillon
- Service d'anesthésie-réanimation, hôpital neurologique Pierre-Wertheimer, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France
| | - Vincent Cottenceau
- Service de réanimation chirurgicale et traumatologique, SAR 1, hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - François Cotton
- Service d'imagerie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite cedex, France
| | - Sonia Courtil-Teyssedre
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France
| | | | - Frédéric Dailler
- Service d'anesthésie-réanimation, hôpital neurologique Pierre-Wertheimer, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France
| | - Jean-Stéphane David
- Service d'anesthésie réanimation, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France
| | - Nicolas Engrand
- Service d'anesthésie-réanimation, Fondation ophtalmologique Adolphe de Rothschild, 75940 Paris cedex 19, France
| | - Dominique Fletcher
- Service d'anesthésie réanimation chirurgicale, hôpital Raymond-Poincaré, université de Versailles Saint-Quentin, AP-HP, Garches, France
| | - Gilles Francony
- Pôle anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble cedex 9, France
| | - Laurent Gergelé
- Département d'anesthésie-réanimation, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Carole Ichai
- Service de réanimation médicochirurgicale, UMR 7275, CNRS, Sophia Antipolis, hôpital Pasteur, CHU de Nice, 06000 Nice, France
| | - Étienne Javouhey
- Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France
| | - Pierre-Etienne Leblanc
- Département d'anesthésie-réanimation, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France; Équipe TIGER, CNRS 1072-Inserm 5288, service d'anesthésie, centre hospitalier de Bourg en Bresse, centre de recherche en neurosciences, Lyon, France
| | - Thomas Lieutaud
- UMRESTTE, UMR-T9405, IFSTTAR, université Claude-Bernard de Lyon, Lyon, France; Service d'anesthésie-réanimation, hôpital universitaire Necker-Enfants-Malades, université Paris Descartes, AP-HP, Paris, France
| | - Philippe Meyer
- EA 08 Paris-Descartes, service de pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, 75743 Paris cedex 15, France
| | - Sébastien Mirek
- Service d'anesthésie-réanimation, CHU de Dijon, Dijon, France
| | - Gilles Orliaguet
- EA 08 Paris-Descartes, service de pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, 75743 Paris cedex 15, France
| | - François Proust
- Service de neurochirurgie, hôpital Hautepierre, CHU de Strasbourg, 67098 Strasbourg, France
| | - Hervé Quintard
- Service de réanimation médicochirurgicale, UMR 7275, CNRS, Sophia Antipolis, hôpital Pasteur, CHU de Nice, 06000 Nice, France
| | - Catherine Ract
- Département d'anesthésie-réanimation, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France; Équipe TIGER, CNRS 1072-Inserm 5288, service d'anesthésie, centre hospitalier de Bourg en Bresse, centre de recherche en neurosciences, Lyon, France
| | - Mohamed Srairi
- Pôle anesthésie-réanimation, Inserm, UMR 1214, Toulouse neuroimaging center, ToNIC, université Toulouse 3-Paul Sabatier, CHU de Toulouse, 31059 Toulouse, France
| | - Karim Tazarourte
- SAMU/SMUR, service des urgences, hospices civils de Lyon, hôpital Édouard-Herriot, 69437 Lyon cedex 03, France
| | - Bernard Vigué
- Département d'anesthésie-réanimation, hôpital de Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France; Équipe TIGER, CNRS 1072-Inserm 5288, service d'anesthésie, centre hospitalier de Bourg en Bresse, centre de recherche en neurosciences, Lyon, France
| | - Jean-François Payen
- Pôle anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble cedex 9, France
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Boissonneau S, Tabouret É, Graillon T, Meyer M, Velly L, Girard N, Brunel H, Bruder N, Fuentes S, Dufour H. Rational use of systematic postoperative CT scans after neurosurgical craniotomy. J Neurosurg Sci 2017; 64:335-340. [PMID: 28959872 DOI: 10.23736/s0390-5616.17.04082-6] [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: 11/08/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the relevance of a systematic postoperative CT scan after neurosurgical craniotomy and to identify predictive factors of complications. METHODS This retrospective analysis included all the patients at our institution who benefited from a cerebral postoperative CT scan within 24 hours post-craniotomy. Patient characteristics and neuroimaging abnormalities were recorded. Predictive factors were identified using a recursive partitioning analysis. RESULTS A total of 633 patients were included. Of these, 17.9% of patients suffered from postoperative complications and 7.4% of them required a new surgery. The decision for reoperation was based on the neurological deterioration and the CT scan, but never on the CT scan alone. The mortality rate was 1.1%. The risk to be reoperated was correlated to the occurrence of a new postoperative neurological deficit (P<0.001, HR=4.60) and in situ hemorrhage (P<0.001, HR=4.19). The risk of postoperative hematoma was correlated to the supratentorial location versus infratentorial (P=0.027, HR=2.50). With clinical factors, such as location and etiology of the lesion, schedule type of surgery, and the age of patients, we proposed six classes with the risk to present with hemorrhage or midline shift on postoperative CT scans. CONCLUSIONS The post-craniotomy CT scan did not impact patient management as an independent decisional tool. We identified several variables associated with the risk of clinical modification that can impact the decision to reoperate and allow establishment of a risk score. This score could be an interesting tool in order to reduce the systematic use of CT scans in the post-surgical period but has to be validated in a prospective study.
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Affiliation(s)
- Sébastien Boissonneau
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France -
| | - Émeline Tabouret
- Department of Neuro-Oncology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,INSERM Unit of Research UMR S911, Biologic Oncology and Oncologic Pharmacology Research Center (CRO2), Faculty of Medical and Paramedical Sciences, Aix-Marseille University, Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M), National Center of Scientific Research (CNRS), Aix-Marseille University, Marseille, France
| | - Mikael Meyer
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Intensive Care, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Nadine Girard
- Service of Neuroradiology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Hervé Brunel
- Service of Neuroradiology, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Intensive Care, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France.,Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M), National Center of Scientific Research (CNRS), Aix-Marseille University, Marseille, France
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Satori D, Setti J, Marsot A, Triglia T, Bruder N, Blin O, Velly L, Guilhaumou R. Suivi thérapeutique pharmacologique des beta-lactamines administrées en perfusion continue en réanimation. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.138] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boussen S, Barral PA, Triglia T, Velly L, Collart F, Bruder N. A Sudden Cheek Swelling After a Periaortic Graft Infection. Ann Thorac Surg 2017; 103:e195. [PMID: 28109389 DOI: 10.1016/j.athoracsur.2016.09.029] [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: 07/10/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Salah Boussen
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France.
| | - Pierre-Antoine Barral
- Department of Radiology, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Thibaut Triglia
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
| | - Nicolas Bruder
- Department of Anesthesiology and Critical Care Medicine, Aix-Marseille University, APHM, University Hospital Timone, Marseille, France
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Affiliation(s)
- Nicolas Bruder
- Department of Anaesthesiology and Critical Care, CHU Timone, Aix-Marseille Univ, AP-HM, Marseille, France -
| | - Salah Boussen
- Department of Anaesthesiology and Critical Care, CHU Timone, Aix-Marseille Univ, AP-HM, Marseille, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care, CHU Timone, Aix-Marseille Univ, AP-HM, Marseille, France
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Chiang CC, Huang WC, Lilot M, Lin KC, Lin SC, Cheng CC, Kang PL, Wann SR, Mar GY, Liu CP, Carranza ML, Fernandez HS, Roman JAS, Neidecker J, Lucena F, Garcia AC, Vazquez AL, Serrano AL, Moreira LS, Vidal-Perez R, Herranz UA, Acuna JMG, Gil CP, Allut JLG, Fellahi JL, Sedes PR, Lopez CM, Paz ES, Rodriguez CG, Gonzalez-Juanatey JR, Vallejo-Baez A, de la Torre-Prados MV, Nuevo-Ortega P, Fernández-Porcel A, Cámara-Sola E, Escoresca-Ortega A, Tsvetanova-Spasova T, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Aron J, Marharaj R, Gervasio K, Bottiroli M, Mondino M, De Caria D, Gutiérrez-Pizarraya A, Calini A, Montrasio E, Milazzo F, Gagliardone MP, Vallejo-Báez A, de la Torre-Prados MV, Nuevo-Ortega P, Fernández-Porcel A, Cámara-Sola E, Tsvetanova-Spasova T, Charris-Castro L, Rueda-Molina C, Salido-Díaz L, García-Alcántara A, Moreira LS, Vidal-Perez R, Anido U, Gil CP, Acuna JMG, Sedes PR, Lopez CM, Corcia-Palomo Y, Paz ES, Allut JLG, Rodriguez CG, Gonzalez-Juanatey JR, Hamdaoui Y, Khedher A, Cheikh-Bouhlel M, Ayachi J, Meddeb K, Sma N, Fernandez-Delgado E, Fraj N, Aicha NB, Romdhani S, Bouneb R, Chouchene I, Boussarsar M, Dela Cruz MPRDL, Bernardo JM, Galfo F, Dyson A, Garnacho-Montero J, Singer M, Marino A, Dyson A, Singer M, Chao CC, Hou P, Huang WC, Hung CC, Chiang CH, Hung WT, Roger C, Lin KC, Lin SC, Liou YJ, Hung SM, Lin YS, Cheng CC, Kuo FY, Chiou KR, Chen CJ, Yan LS, Muller L, Liu CY, Wang HH, Kang PL, Chen HL, Ho CK, Mar GY, Liu CP, Grewal S, Gopal S, Corbett C, Elotmani L, Wilson A, Capps J, Ayoub W, Lomas A, Ghani S, Moore J, Atkinson D, Sharman M, Swinnen W, Pauwels J, Lipman J, Mignolet K, Pannier E, Koch A, Sarens T, Temmerman W, Elmenshawy AM, Fayed AM, Elboriuny M, Hamdy E, Zakaria E, Lefrant JY, Falk AC, Petosic A, Olafsen K, Wøien H, Flaatten H, Sunde K, Agra JJC, Cabrera JLS, Santana JDM, Alzola LM, Roberts JA, Pérez HR, Pires TC, Calderón H, Pereira A, Castro S, Granja C, Norkiene I, Urbanaviciute I, Kezyte G, Ringaitiene D, Muñoz-Bermúdez R, 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I, Elbahr M, Ismail M, Mahmoud T, Kauts V, Bousselmi K, Khalil E, Casey W, Zaky SH, Rizk A, Elghonemi MO, Similowski T, Ahmed R, Vieira JCF, Souza RB, Liberatore AMA, Koh IHJ, Ospina-Tascón GA, Marin AFG, Echeverry GJ, Bermudez WF, Madriñan-Navia HJ, Rasmussen BS, Valencia JD, Quiñonez E, Marulanda A, Arango-Dávila CA, Bruhn A, Hernandez G, De Backer D, Cortes DO, Su F, Vincent JL, Maltesen RG, Creteur J, Tullo L, Mirabella L, Di Molfetta P, Cinnella G, Dambrosio M, Lujan CV, irigoyen JL, Cartanya ferré M, García RC, Hanifa M, Mukhtar A, Ahmed M, El Ayashi M, Hasanin A, Ayman E, Salem M, Eladawy A, Fathy S, Nassar H, Zaghlol A, Pedersen S, Arzapalo MFA, Valsø Å, Sunde K, Rustøen T, Schou-Bredal I, Skogstad L, Tøien K, Padilla C, Palmeiro Y, Egbaria W, Kristensen SR, Kigli R, Maertens B, Blot K, Blot S, Santana-Santos E, dos Santos ER, Ferretti-Rebustini REDL, dos Santos RDCCDO, Verardino RGS, Bortolotto LA, Wimmer R, Doyle AM, Naldrett I, Tillman J, Price S, Shrestha S, Pearson P, 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ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Boussen S, Velly L, Benar C, Metellus P, Bruder N, Trébuchon A. In Vivo Tumour Mapping Using Electrocorticography Alterations During Awake Brain Surgery: A Pilot Study. Brain Topogr 2016; 29:766-82. [PMID: 27324381 DOI: 10.1007/s10548-016-0502-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
During awake brain surgery for tumour resection, in situ EEG recording (ECoG) is used to identify eloquent areas surrounding the tumour. We used the ECoG setup to record the electrical activity of cortical and subcortical tumours and then performed frequency and connectivity analyses in order to identify ECoG impairments and map tumours. We selected 16 patients with cortical (8) and subcortical (8) tumours undergoing awake brain surgery. For each patient, we computed the spectral content of tumoural and healthy areas in each frequency band. We computed connectivity of each electrode using connectivity markers (linear and non-linear correlations, phase-locking and coherence). We performed comparisons between healthy and tumour electrodes. The ECoG alterations were used to implement automated classification of the electrodes using clustering or neural network algorithms. ECoG alterations were used to image cortical tumours.Cortical tumours were found to profoundly alter all frequency contents (normalized and absolute power), with an increase in the δ activity and a decreases for the other bands (P < 0.05). Cortical tumour electrodes showed high level of connectivity compared to surrounding electrodes (all markers, P < 0.05). For subcortical tumours, a relative decrease in the γ1 band and in the alpha band in absolute amplitude (P < 0.05) were the only abnormalities. The neural network algorithm classification had a good performance: 93.6 % of the electrodes were classified adequately on a test subject. We found significant spectral and connectivity ECoG changes for cortical tumours, which allowed tumour recognition. Artificial neural algorithm pattern recognition seems promising for electrode classification in awake tumour surgery.
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Affiliation(s)
- Salah Boussen
- Department of Anaesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Cedex 5 Marseille, France. .,IFSTTAR, LBA UMR T 24, Aix Marseille Université, 13916, Marseille, France.
| | - Lionel Velly
- Department of Anaesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Cedex 5 Marseille, France
| | - Christian Benar
- Institut de Neurosciences des Systèmes - Inserm UMR1106, Aix-Marseille Université Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France
| | - Philippe Metellus
- Neurosurgery Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France.,CRO2 (oncology and oncopharmacology research center) INSERM UMRS 911, Aix Marseille Université, Marseille, France
| | - Nicolas Bruder
- Department of Anaesthesiology and Intensive Care, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Cedex 5 Marseille, France
| | - Agnès Trébuchon
- Institut de Neurosciences des Systèmes - Inserm UMR1106, Aix-Marseille Université Faculté de Médecine, 27, Boulevard Jean Moulin, 13005, Marseille, France.,Clinical Electrophysiology Department, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, 264 rue Saint-Pierre, 13005, Marseille, France
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Seng P, Boushab BM, Romain F, Gouriet F, Bruder N, Martin C, Paganelli F, Bernit E, Le Treut YP, Thomas P, Papazian L, Raoult D, Stein A. Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature. Int J Infect Dis 2016; 45:65-71. [PMID: 26921549 DOI: 10.1016/j.ijid.2016.02.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [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: 01/11/2016] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases. METHODS A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes. RESULTS Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%. CONCLUSIONS R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.
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Affiliation(s)
- Piseth Seng
- Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France.
| | - Boushab Mohamed Boushab
- Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France
| | - Fanny Romain
- Service d'Informatique Médicale, Hôpital de la Conception, Marseille, France
| | | | - Nicolas Bruder
- Département d'Anesthésie-réanimation et Soins Intensif, Hôpital de la Timone, Marseille, France
| | - Claude Martin
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France
| | | | - Emmanuelle Bernit
- Département de Médecine Interne, Hôpital de la Conception, Marseille, France
| | - Yves Patrice Le Treut
- Département de Chirurgie Digestive et Transplantation Hépatique, Hôpital de la Conception, Marseille, France
| | - Pascal Thomas
- Département de Chirurgie Thoracique, Transplantation Pulmonaire et Maladies Respiratoires, Hôpital Nord, Marseille, France
| | - Laurent Papazian
- Réanimation Médicale Détresses Respiratoires - Infections Sévères, Hôpital Nord, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Andreas Stein
- Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France
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Bruder N, Velly L. Near-infrared spectroscopy for monitoring brain oxygenation: to trust or not to trust? Minerva Anestesiol 2015; 81:835-836. [PMID: 25634483] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- N Bruder
- Department of Anesthesiology and Intensive Care, CHU Timone, Aix-Marseille University, Marseille, France -
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Maurice-Szamburski A, Auquier P, Viarre-Oreal V, Cuvillon P, Carles M, Ripart J, Honore S, Triglia T, Loundou A, Leone M, Bruder N. Effect of sedative premedication on patient experience after general anesthesia: a randomized clinical trial. JAMA 2015; 313:916-25. [PMID: 25734733 DOI: 10.1001/jama.2015.1108] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Sedative premedication is widely administered before surgery, but little clinical evidence supports its use. OBJECTIVE To assess the efficacy of sedative premedication on perioperative patient experience. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial, the PremedX study, enrolled 1062 adult patients who were younger than 70 years and had been scheduled for various elective surgeries under general anesthesia at 5 French teaching hospitals (in Marseille, Montpellier, Nimes, and Nice) between January 2013 and June 2014. Neurosurgery, obstetrical, cardiac, and outpatient surgery were excluded. INTERVENTIONS Patients were randomized to 3 groups of 354 participants each to receive 2.5 mg of lorazepam, no premedication, or placebo. MAIN OUTCOMES AND MEASURES The primary outcome was perioperative patient experience assessed 24 hours after surgery with a validated questionnaire (Evaluation du Vécu de l'Anesthésie Generale; EVAN-G) describing 6 domains of satisfaction and a global index (score range, 0-100; high scores represent high satisfaction); secondary outcomes included time to extubation and early cognitive recovery. A subgroup analysis was planned a priori in patients with a high level of preoperative anxiety. RESULTS Premedication with lorazepam did not improve the EVAN-G mean global index for overall level of patient satisfaction (72 [95% CI, 70-73]; n = 330) compared with no premedication (73 [95% CI, 71-74]; n = 319) or placebo (71 [95% CI, 70-73]; n = 322) (P = .38). Among patients with heightened preoperative anxiety, there were no significant differences found in the EVAN-G mean global index between the lorazepam group (68 [95% CI, 65-72]; n = 87) and the no premedication group (73 [95% CI, 69-77]; n = 57) or the placebo group (70 [95% CI, 67-72]; n = 87) (P = .18). Time to extubation was 17 minutes (95% CI, 14-20 minutes) in the lorazepam group, 12 minutes (95% CI, 11-13 minutes) for the no premedication group, and 13 minutes (95% CI, 12-14 minutes) for the placebo group (P < .001) and the rate of early cognitive recovery was 51% (95% CI, 45%-56%), 71% (95% CI, 66%-76%), and 64% (95% CI, 59%-69%), respectively (P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing elective surgery under general anesthesia, sedative premedication with lorazepam compared with placebo or no premedication did not improve the self-reported patient experience the day after surgery, but was associated with modestly prolonged time to extubation and a lower rate of early cognitive recovery. The findings suggest a lack of benefit with routine use of lorazepam as sedative premedication in patients undergoing general anesthesia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01901003.
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Affiliation(s)
| | - Pascal Auquier
- Laboratoire Universitaire EA 3279, Santé Publique et Maladies Chroniques, Université Aix-Marseille, Marseille, France
| | | | - Philippe Cuvillon
- Service d'Anesthésie, Institut du Cancer, Université Montpellier 1, Montpellier, France
| | - Michel Carles
- Service d'Anesthésie Réanimation, Hôpital Archet, Université Nice Sophia-Antipolis, Nice, France
| | - Jacques Ripart
- Service d'Anesthésie, Pôle ARDU, Hôpital Universitaire Carémeau, Nîmes, Université Montpellier 1, Montpellier, France
| | - Stéphane Honore
- Expertise Pharmaceutique, Hôpital de la Timone Adulte, Université Aix, Marseille, France
| | - Thibaut Triglia
- Service d'Anesthésie Réanimation, Hôpital de la Timone Adulte, Marseille, France
| | - Anderson Loundou
- Unité d'Aide Méthodologique, Direction de la Recherche Clinique, AP-HM, Marseille, France
| | - Marc Leone
- Service d'Anesthésie Réanimation, Hôpital Nord, Pavillon de l'Etoile, Université Aix-Marseille, Marseille, France
| | - Nicolas Bruder
- Service d'Anesthésie Réanimation, Hôpital de la Timone Adulte, Marseille, France
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Leone M, Bechis C, Baumstarck K, Ouattara A, Collange O, Augustin P, Annane D, Arbelot C, Asehnoune K, Baldési O, Bourcier S, Delapierre L, Demory D, Hengy B, Ichai C, Kipnis E, Brasdefer E, Lasocki S, Legrand M, Mimoz O, Rimmelé T, Aliane J, Bertrand PM, Bruder N, Klasen F, Friou E, Lévy B, Martinez O, Peytel E, Piton A, Richter E, Toufik K, Vogler MC, Wallet F, Boufi M, Allaouchiche B, Constantin JM, Martin C, Jaber S, Lefrant JY. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med 2015; 41:667-76. [PMID: 25731634 DOI: 10.1007/s00134-015-3690-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/05/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI. METHODS A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes. RESULTS The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p < 0.001) between patients with a score from 0 to 2 and those with a score of 3 and 4. CONCLUSION Acute mesenteric ischemia in ICU patients was associated with a 58 % ICU death rate. Age and SOFA severity score at diagnosis were risk factors for mortality. Plasma lactate concentration over 2.7 mmol/l was also an independent risk factor, but values in the normal range did not exclude the diagnosis of AMI.
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Affiliation(s)
- Marc Leone
- Service d'anesthésie et de réanimation, hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Chemin des Bourrely, 13015, Marseille, France,
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Tabouret E, Boucard C, Barrie M, Autran D, Bruder N, Chinot O. SM-08 * NEURO-ONCOLOGICAL PATIENTS ADMITTED IN INTENSIVE-CARE UNIT (ICU): PATIENT'S CHARACTERISTICS, PREDICTIVE FACTORS OF DEATH IN ICU AND FUNCTIONAL OUTCOME. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou277.7] [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: 11/13/2022] Open
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Fluchere F, Witjas T, Eusebio A, Bruder N, Giorgi R, Leveque M, Peragut JC, Azulay JP, Regis J. Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease. J Neurol Neurosurg Psychiatry 2014; 85:1167-73. [PMID: 24249783 DOI: 10.1136/jnnp-2013-305323] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the short-term (1 year) and long-term (5 years) outcome of patients with Parkinson's disease (PD) with subthalamic nucleus (STN) stimulation operated upon under controlled general anaesthesia (GA). METHODS 213 consecutive patients with PD were included between January 2000 and March 2009 and operated upon under a particular type of GA with close control of the level of sedation allowing intraoperative recordings. 188 patients were assessed 1 year postoperatively. 65 patients also completed the long-term observation period and were evaluated 5 years postoperatively. RESULTS The Unified PD Rating Scale III score in the 'Off drug--On stim' condition was improved at 1 year and 5 years by 61% and 37%, respectively, (p<0.001). Motor complications decreased at short-term and long-term by 68% and 65%, respectively, for dyskinesia and by 52% and 48%, respectively, for fluctuations, (p<0.001). Dopaminergic treatment could also be reduced at short-term and long-term by 46% and 49%, respectively (p<0.001). There was no significant modification of mood and cognition assessments (Mattis scale and Beck depression inventory) at 1 year and 5 years. Concerning the main adverse events related to the surgery, we report four haematomas (1.9%) with two deaths (0.9%), eight cases of transient confusion (3.7%) and no epileptic seizure. CONCLUSIONS Our results confirm that STN stimulation performed under controlled GA is efficient and has similar short-term and long-term motor effects than intervention under local anaesthesia. Furthermore, this specific procedure is not associated with more adverse events. The success of such an intervention requires strict anaesthetic monitoring and accurate STN identification.
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Affiliation(s)
- F Fluchere
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
| | - T Witjas
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
| | - A Eusebio
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
| | - N Bruder
- Department of Anesthesiology, APHM, La Timone, Aix-Marseille Univ, Marseille, Cedex, France
| | - R Giorgi
- Service de Santé Publique et d'Information Médicale and LERTIM, APHM, La Timone, Aix-Marseille Univ, Marseille, Cedex, France
| | - M Leveque
- Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
| | - J-C Peragut
- Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
| | - J-P Azulay
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
| | - J Regis
- Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
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Duclos G, Dumont JC, Ranque S, Zieleskiewicz L, Bruder N. [Meningitis to Candida albicans at the adult, use of the new diagnosis methods]. ACTA ACUST UNITED AC 2014; 33:533-5. [PMID: 25127852 DOI: 10.1016/j.annfar.2014.07.002] [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: 03/26/2014] [Accepted: 07/09/2014] [Indexed: 11/15/2022]
Abstract
Candida albicans or non-albicans are a frequent source of infection but seldom displayed in cerebrospinal fluid although responsible of an important number of nosocomial meningitis. Diagnosis is difficult which often delays treatment, which in turn hinders prognostic. This clinical case shows a patient afflicted with a deadly C. albicans meningitis and allows us to focus on new diagnostic tools and advice against this infection.
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Affiliation(s)
- G Duclos
- Département d'anesthésie-réanimation, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France.
| | - J-C Dumont
- Département d'anesthésie-réanimation, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Ranque
- Laboratoire de mycologie médicale, hôpital de la Timone, université Aix-Marseille - Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - L Zieleskiewicz
- Département d'anesthésie-réanimation, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France
| | - N Bruder
- Département d'anesthésie-réanimation, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
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Leone M, Bechis C, Baumstarck K, Lefrant JY, Albanèse J, Jaber S, Lepape A, Constantin JM, Papazian L, Bruder N, Allaouchiche B, Bézulier K, Antonini F, Textoris J, Martin C. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med 2014; 40:1399-408. [PMID: 25091790 DOI: 10.1007/s00134-014-3411-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/17/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND In patients with severe sepsis, no randomized clinical trial has tested the concept of de-escalation of empirical antimicrobial therapy. This study aimed to compare the de-escalation strategy with the continuation of an appropriate empirical treatment in those patients. METHODS This was a multicenter non-blinded randomized noninferiority trial of patients with severe sepsis who were randomly assigned to de-escalation or continuation of empirical antimicrobial treatment. Recruitment began in February 2012 and ended in April 2013 in nine intensive care units (ICUs) in France. Patients with severe sepsis were assigned to de-escalation (n = 59) or continuation of empirical antimicrobial treatment (n = 57). The primary outcome was to measure the duration of ICU stay. We defined a noninferiority margin of 2 days. If the lower boundary of the 95 % confidence interval (CI) for the difference in patients assigned to the de-escalation group was less than 2 days, as compared with that of patients assigned to the continuation group, de-escalation was considered to be noninferior to the continuation strategy. Secondary outcomes included mortality at 90 days, occurrence of organ failure, number of superinfections, and number of days with antibiotics during the ICU stay. RESULTS The median duration of ICU stay was 9 [interquartile range (IQR) 5-22] days in the de-escalation group and 8 [IQR 4-15] days in the continuation group, respectively (P = 0.71). The mean difference was 3.4 (95 % CI -1.7 to 8.5). A superinfection occurred in 16 (27 %) patients in the de-escalation group and six (11 %) patients in the continuation group (P = 0.03). The numbers of antibiotic days were 9 [7-15] and 7.5 [6-13] in the de-escalation group and continuation group, respectively (P = 0.03). Mortality was similar in both groups. CONCLUSION As compared to the continuation of the empirical antimicrobial treatment, a strategy based on de-escalation of antibiotics resulted in prolonged duration of ICU stay. However, it did not affect the mortality rate.
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Affiliation(s)
- Marc Leone
- Service d'anesthésie et de réanimation, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France,
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Pellegrini L, Bennis Y, Velly L, Grandvuillemin I, Pisano P, Bruder N, Guillet B. Erythropoietin protects newborn rat against sevoflurane-induced neurotoxicity. Paediatr Anaesth 2014; 24:749-59. [PMID: 24725211 DOI: 10.1111/pan.12372] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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] [Accepted: 01/22/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Recent data on newborn animals exposed to anesthetics have raised safety concerns regarding anesthesia practices in young children. Indeed, studies on rodents have demonstrated a widespread increase in brain apoptosis shortly after exposure to sevoflurane, followed by long-term neurologic impairment. In this context, we aimed to evaluate the protective effect of rh-EPO, a potent neuroprotective agent, in rat pups exposed to sevoflurane. MATERIAL AND METHODS At postnatal day 7, 75 rat pups were allocated into three groups: SEVO + EPO (n = 27) exposed to sevoflurane 2 vol% (0.5 MAC) for 6 h in an air/O2 mixture (60/40) + 5000 UI.kg(-1) rh-EPO IP; SEVO (n = 27) exposed to sevoflurane + vehicle IP; and CONTROL (n = 21) exposed to the mixture without sevoflurane + vehicle IP. Three days after anesthesia (D10), apoptosis was quantified on brain extract with TUNEL method and caspase 3. NGF and BDNF expression was determined by Western blotting. Rats reaching adulthood were evaluated in terms of exploration capacities (object exploration duration) together with spatial and object learning (water maze and novel object test). RESULTS Sevoflurane exposure impaired normal behavior in adult rats by reducing the exploratory capacities during the novel object test and impaired both spatial and object learning capacities in adult rats (water maze, ratio time to find platform 3rd trial/1st trial: 1.1 ± 0.2 vs 0.4 ± 0.1; n = 9, SEVO vs CONTROL; P = 0.01). Rh-EPO reduced sevoflurane-induced behavior and learning abnormalities in adult rats (water maze, ratio time to find platform 3rd trial/1st trial: 0.3 ± 0.1 vs 1.1 ± 0.2; n = 9, SEVO + EPO vs SEVO; P = 0.01). Three days after anesthesia, rh-EPO prevented sevoflurane-induced brain apoptosis (5 ± 3 vs 35 ± 6 apoptotic cells·mm(-2) ; n = 6, SEVO + EPO vs SEVO; P = 0.01) and elevation of caspase three level and significantly increased the brain expression of BDNF and NGF (n = 6, SEVO + EPO vs SEVO; P = 0.01). CONCLUSION Six hours of sevoflurane anesthesia in newborn rats induces significant long-term cognitive impairment. A single administration of rh-EPO immediately after postnatal exposure to sevoflurane reduces both early activation of apoptotic phenomenon and late onset of neurologic disorders.
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Affiliation(s)
- Lionel Pellegrini
- Department of Anesthesia, APHM, CHU Timone, Marseille, France; INSERM UMR_S 1076, Aix-Marseille University, Marseille, France
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Lagier D, Guillet B, Velly L, Bruder N, Alessi M. Efficacy of terutroban in preventing delayed cerebral ischemia after subarachnoid hemorrhage: a functional isotope imaging study on a rat model. Crit Care 2014. [PMCID: PMC4069419 DOI: 10.1186/cc13651] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Maurice-Szamburski A, Loundou A, Capdevila X, Bruder N, Auquier P. Validation of the French version of the Amsterdam preoperative anxiety and information scale (APAIS). Health Qual Life Outcomes 2013; 11:166. [PMID: 24099176 PMCID: PMC3850964 DOI: 10.1186/1477-7525-11-166] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/02/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most patients are anxious before surgery. The level of preoperative anxiety depends on several factors and merits an objective evaluation. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-report questionnaire comprising six questions that have been developed and validated to evaluate the preoperative anxiety of patients. This global index assesses three separate areas: anxiety about anaesthesia, anxiety about surgery, and the desire for information. The purpose of this study was to translate the APAIS into French and to evaluate the psychometric properties of the French version of the APAIS. METHODS The process consisted of two steps. The first step involved the production of a French version of the APAIS that was semantically equivalent to the original version. In the second step, we evaluated the psychometric properties of the French version, including the internal consistency and reliability, the differential item functioning, and the external validity. Participants older than 18, undergoing elective surgery (except obstetric), able to understand and read French, and able to complete a self-report questionnaire were eligible for inclusion in the study. A forward-backward translation was performed. The psychometric evaluation covered three domains: internal validity, external validity, and acceptability. Within 4-48 h after surgery, the patients were asked to complete the "Evaluation du Vécu de l'ANesthésie" questionnaire" (EVAN) questionnaire, which is a validated, multi-dimensional questionnaire that assesses the patient's experiences in the perioperative period. RESULTS A database with 175 patients was created. The principal component factor analysis revealed the same three-dimensional structure as the original scale. The confirmatory factor analysis showed a strong fit with a root mean square error of approximation of 0.069 and a comparative fit index of 1.00. The amount of differential item functioning (DIF) between the subgroups of patients (i.e., based on age, gender, type of anaesthesia or surgery, premedication, ASA physical status, and ambulatory course) was low. The APAIS was strongly correlated with the dimensions of the EVAN. Each dimension had a low proportion of missing values (ranging from 0.6 to 2.9%), which indicates good acceptability of the questionnaire. CONCLUSIONS The French version of the APAIS is valid and reliable. The availability of this tool enables the evaluation of anxiety in French patients undergoing anaesthesia.
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Affiliation(s)
- Axel Maurice-Szamburski
- Service d’Anesthésie Réanimation Pr BRUDER, Hôpital TIMONE Adulte, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - Anderson Loundou
- Unité d’aide méthodologique, Direction de la Recherche Clinique AP-HM, Marseille, France
| | - Xavier Capdevila
- Service d’Anesthésie Réanimation, Hôpital Lapeyronie and Inserm U 1046, Montpellier, France
| | - Nicolas Bruder
- Service d’Anesthésie Réanimation Pr BRUDER, Hôpital TIMONE Adulte, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - Pascal Auquier
- Santé publique, EA3279, Faculté de Médecine, Marseille, France
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