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Dahyot-Fizelier C, Lasocki S, Kerforne T, Perrigault PF, Geeraerts T, Asehnoune K, Cinotti R, Launey Y, Cottenceau V, Laffon M, Gaillard T, Boisson M, Aleyrat C, Frasca D, Mimoz O. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. Lancet Respir Med 2024; 12:375-385. [PMID: 38262428 DOI: 10.1016/s2213-2600(23)00471-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Patients with acute brain injury are at high risk of ventilator-associated pneumonia (VAP). The benefit of short-term antibiotic prophylaxis remains debated. We aimed to establish the effect of an early, single dose of the antibiotic ceftriaxone on the incidence of early VAP in patients with severe brain injury who required mechanical ventilation. METHODS PROPHY-VAP was a multicentre, randomised, double-blind, placebo-controlled, assessor-masked, superiority trial conducted in nine intensive care units in eight French university hospitals. We randomly assigned comatose (Glasgow Coma Scale score [GCS] ≤12) adult patients (age ≥18 years) who required mechanical ventilation for at least 48 h after acute brain injury to receive intravenous ceftriaxone 2 g or placebo once within the 12 h following tracheal intubation. Participants did not receive selective oropharyngeal and digestive tract decontamination. The primary outcome was the proportion of patients developing early VAP from the 2nd to the 7th day of mechanical ventilation, confirmed by masked assessors. The analysis was reported in the modified intention-to-treat population, which comprised all randomly assigned patients except those who withdrew or did not give consent to continue and those who did not receive the allocated treatment because they met a criterion for non-eligibility. The trial is registered with ClinicalTrials.gov, NCT02265406. FINDINGS From Oct 14, 2015, to May 27, 2020, 345 patients were randomly assigned (1:1) to receive ceftriaxone (n=171) or placebo (n=174); 330 received the allocated intervention and 319 were included in the analysis (162 in the ceftriaxone group and 157 in the placebo group). 166 (52%) participants in the analysis were men and 153 (48%) were women. 15 patients did not receive the allocated intervention after randomisation and 11 withdrew their consent. Adjudication confirmed 93 cases of VAP, including 74 early infections. The incidence of early VAP was lower in the ceftriaxone group than in the placebo group (23 [14%] vs 51 [32%]; hazard ratio 0·60 [95% CI 0·38-0·95], p=0·030), with no microbiological impact and no adverse effects attributable to ceftriaxone. INTERPRETATION In patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation. FUNDING French Ministry of Social Affairs and Health.
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Affiliation(s)
- Claire Dahyot-Fizelier
- UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France; Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
| | - Sigismond Lasocki
- Intensive Care Unit, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Thomas Kerforne
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
| | - Pierre-Francois Perrigault
- Anaesthesia and Intensive Care Department, Centre Hospitalier Universitaire de Montpellier, Montpellier Université, Montpellier, France
| | - Thomas Geeraerts
- Anaesthesia and Critical Care Unit, Centre Hospitalier Universitaire de Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Karim Asehnoune
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Raphaël Cinotti
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Yoann Launey
- Department of Anaesthesia and Critical Care Medicine, Critical Care Unit, Centre Hospitalier Universitaire de Rennes, Université de Rennes, Rennes, France
| | - Vincent Cottenceau
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marc Laffon
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Thomas Gaillard
- Intensive Care Unit, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Matthieu Boisson
- UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France; Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
| | - Camille Aleyrat
- Direction de la Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Denis Frasca
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; Direction de la Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Mimoz
- UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France; Service des Urgences Adultes, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Huet O, Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Bouglé A, Kerforne T, Lasocki S, Eljezi V, Dessertaine G, Amour J, Chapalain X. Prevention of post-operative delirium using an overnight infusion of dexmedetomidine in patients undergoing cardiac surgery: a pragmatic, randomized, double-blind, placebo-controlled trial. Crit Care 2024; 28:64. [PMID: 38419119 PMCID: PMC10902989 DOI: 10.1186/s13054-024-04842-1] [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: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND After cardiac surgery, post-operative delirium (PoD) is acknowledged to have a significant negative impact on patient outcome. To date, there is no valuable and specific treatment for PoD. Critically ill patients often suffer from poor sleep condition. There is an association between delirium and sleep quality after cardiac surgery. This study aimed to establish whether promoting sleep using an overnight infusion of dexmedetomidine reduces the incidence of delirium after cardiac surgery. METHODS Randomized, pragmatic, multicentre, double-blind, placebo controlled trial from January 2019 to July 2021. All adult patients aged 65 years or older requiring elective cardiac surgery were randomly assigned 1:1 either to the dexmedetomidine group or the placebo group on the day of surgery. Dexmedetomidine or matched placebo infusion was started the night after surgery from 8 pm to 8 am and administered every night while the patient remained in ICU, or for a maximum of 7 days. Primary outcome was the occurrence of postoperative delirium (PoD) within the 7 days after surgery. RESULTS A total of 348 patients provided informed consent, of whom 333 were randomized: 331 patients underwent surgery and were analysed (165 assigned to dexmedetomidine and 166 assigned to placebo). The incidence of PoD was not significantly different between the two groups (12.6% vs. 12.4%, p = 0.97). Patients treated with dexmedetomidine had significantly more hypotensive events (7.3% vs 0.6%; p < 0.01). At 3 months, functional outcomes (Short-form 36, Cognitive failure questionnaire, PCL-5) were comparable between the two groups. CONCLUSION In patients recovering from an elective cardiac surgery, an overnight infusion of dexmedetomidine did not decrease postoperative delirium. Trial registration This trial was registered on ClinicalTrials.gov (number: NCT03477344; date: 26th March 2018).
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Affiliation(s)
- Olivier Huet
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France.
| | - Thomas Gargadennec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Jean-Ferréol Oilleau
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
| | - Bertrand Rozec
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
| | - Nicolas Nesseler
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, University Hospital of Rennes, Rennes, France
| | - Adrien Bouglé
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Thomas Kerforne
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine CHU de POITIERS, Poitiers, France
| | - Sigismond Lasocki
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, CHU de ANGERS, I, Angers, France
| | - Vedat Eljezi
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Géraldine Dessertaine
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Amour
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital Privé Jacques Cartier, Massy, France
| | - Xavier Chapalain
- Department of Anaesthesia, Intensive Care Medicine and Peri-Operative Medicine, Hôpital de la cavale Blanche, CHRU de Brest, Brest, France
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Carré J, Kerforne T, Hauet T, Macchi L. Tissue Injury Protection: The Other Face of Anticoagulant Treatments in the Context of Ischemia and Reperfusion Injury with a Focus on Transplantation. Int J Mol Sci 2023; 24:17491. [PMID: 38139319 PMCID: PMC10743711 DOI: 10.3390/ijms242417491] [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: 11/17/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Organ transplantation has enhanced the length and quality of life of patients suffering from life-threatening organ failure. Donors deceased after brain death (DBDDs) have been a primary source of organs for transplantation for a long time, but the need to find new strategies to face organ shortages has led to the broadening of the criteria for selecting DBDDs and advancing utilization of donors deceased after circulatory death. These new sources of organs come with an elevated risk of procuring organs of suboptimal quality. Whatever the source of organs for transplant, one constant issue is the occurrence of ischemia-reperfusion (IR) injury. The latter results from the variation of oxygen supply during the sequence of ischemia and reperfusion, from organ procurement to the restoration of blood circulation, triggering many deleterious interdependent processes involving biochemical, immune, vascular and coagulation systems. In this review, we focus on the roles of thrombo-inflammation and coagulation as part of IR injury, and we give an overview of the state of the art and perspectives on anticoagulant therapies in the field of transplantation, discussing benefits and risks and proposing a strategic guide to their use during transplantation procedures.
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Affiliation(s)
- Julie Carré
- Service D’Hématologie Biologique, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France;
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
| | - Thomas Kerforne
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
- Service D’Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
- FHU Survival Optimization in Organ Transplantation (SUPORT), 86000 Poitiers, France
| | - Thierry Hauet
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
- FHU Survival Optimization in Organ Transplantation (SUPORT), 86000 Poitiers, France
- Service de Biochimie, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
| | - Laurent Macchi
- Service D’Hématologie Biologique, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France;
- INSERM 1313 Ischémie Reperfusion, Métabolisme, Inflammation Stérile en Transplantation (IRMETIST), Université de Poitiers, 86000 Poitiers, France; (T.K.); (T.H.)
- FHU Survival Optimization in Organ Transplantation (SUPORT), 86000 Poitiers, France
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Rayar M, Allain G, Kerforne T. [Surgical aspects of multi-organ harvesting for transplantation]. Soins 2023; 68:33-36. [PMID: 37657868 DOI: 10.1016/j.soin.2023.07.008] [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] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
The aim of multi-organ harvesting is to remove and condition organs so that they can be transplanted. It is an extremely well codified surgical procedure, performed in a precise order. It is unique in that it involves different teams, each with its own specialization.
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Affiliation(s)
- Michel Rayar
- Service de chirurgie hépatobiliaire et digestif, centre hospitalier universitaire de Rennes, site Pontchaillou, 2 rue Henri-le-Guilloux, 35000 Rennes, France; Institut NuMeCan, UMR 1241, Inserm, université de Rennes 1, campus santé, 2 avenue du Pr Léon-Bernard, 35000 Rennes, France.
| | - Géraldine Allain
- Service de chirurgie cardiothoracique et vasculaire, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Unité Irmetist, Inserm U1313, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 6 rue de la Milétrie, 86073 Poitiers, France
| | - Thomas Kerforne
- Unité Irmetist, Inserm U1313, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 6 rue de la Milétrie, 86073 Poitiers, France; Service d'anesthésie-réanimation et médecine périopératoire, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France
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Bernat JL, Domínguez-Gil B, Glazier AK, Gardiner D, Manara AR, Shemie S, Porte RJ, Martin DE, Opdam H, McGee A, López Fraga M, Rayar M, Kerforne T, Bušić M, Romagnoli R, Zanierato M, Tullius SG, Miñambres E, Royo-Villanova M, Delmonico FL. Understanding the Brain-based Determination of Death When Organ Recovery Is Performed With DCDD In Situ Normothermic Regional Perfusion. Transplantation 2023; 107:1650-1654. [PMID: 37170405 DOI: 10.1097/tp.0000000000004642] [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: 05/13/2023]
Affiliation(s)
- James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Alexandra K Glazier
- New England Donor Services, Waltham, MA. Health Services, Policy and Practice, Brown University, Providence, RI
| | - Dale Gardiner
- Medical Directorate, Deceased Organ Donation for NHS Blood and Transplant, Nottingham, United Kingdom
| | - Alexander R Manara
- Intensive Care Medicine, The Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sam Shemie
- Pediatric Critical Care Medicine, McGill University Health Centre, Montreal, QB, Canada
| | - Robert J Porte
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dominique E Martin
- Health Ethics and Professionalism School of Medicine, Faculty of Health Deakin University, Geelong, VIC, Australia
| | - Helen Opdam
- Australian Organ and Tissue Authority, Austin Hospital, and Warringal Private Hospital Intensive Care Unit, Melbourne, VIC, Australia
| | - Andrew McGee
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Marta López Fraga
- Quality of Medicines and Healthcare, Council of Europe, European Committee on Organ Transplantation (CD-P-TO), Strasbourg, France
| | - Michel Rayar
- Service de chirurgie Hépatobiliaire et Digestif CHU Pontchaillou, Rennes, France
| | - Thomas Kerforne
- Service d'Anesthésie-Réanimation et Médecine Périopératoire-CHU de Poitiers, Poitiers, France
| | - Mirela Bušić
- SoHO Standards Department of Biological Standardisation, OMCL Network and HealthCare (DBO) EDQM, Council of Europe, Strasbourg, France
| | - Renato Romagnoli
- General Surgery 2U - Liver Transplant Center, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Marinella Zanierato
- Department of Anesthesia and Critical Care, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Stefan G Tullius
- Transplant Surgery, Harvard Medical School, Division of Transplant Surgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eduardo Miñambres
- Donor Transplant Coordination Unit and Service of Intensive Care, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, Universidad de Cantabria, Santander, Spain
| | - Mario Royo-Villanova
- Donor Transplant Coordination Unit and Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francis L Delmonico
- New England Donor Services, Department of Surgery, Harvard Medical School at the Massachusetts General Hospital, Boston, MA
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Lepoittevin M, Blancart-Remaury Q, Kerforne T, Pellerin L, Hauet T, Thuillier R. Comparison between 5 extractions methods in either plasma or serum to determine the optimal extraction and matrix combination for human metabolomics. Cell Mol Biol Lett 2023; 28:43. [PMID: 37210499 DOI: 10.1186/s11658-023-00452-x] [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: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Although metabolomics continues to expand in many domains of research, methodological issues such as sample type, extraction and analytical protocols have not been standardized, impeding proper comparison between studies and future research. METHODS In the present study, five solvent-based and solid-phase extraction methods were investigated in both plasma and serum. All these extracts were analyzed using four liquid chromatography coupled with high resolution mass spectrometry (LC-MS) protocols, either in reversed or normal-phase and with both types of ionization. The performances of each method were compared according to putative metabolite coverage, method repeatability and also extraction parameters such as overlap, linearity and matrix effect; in both untargeted (global) and targeted approaches using fifty standard spiked analytes. RESULTS Our results verified the broad specificity and outstanding accuracy of solvent precipitation, namely methanol and methanol/acetonitrile. We also reveal high orthogonality between methanol-based methods and SPE, providing the possibility of increased metabolome coverage, however we highlight that such potential benefits must be weighed against time constrains, sample consumption and the risk of low reproducibility of SPE method. Furthermore, we highlighted the careful consideration about matrix choice. Plasma showed the most suitable in this metabolomics approach combined with methanol-based methods. CONCLUSIONS Our work proposes to facilitate rational design of protocols towards standardization of these approaches to improve the impact of metabolomics research.
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Affiliation(s)
- Maryne Lepoittevin
- Inserm Unit IRMETIST, UMR U1313, University of Poitiers, Faculty of Medicine and Pharmacy, 86073, Poitiers, France
| | | | - Thomas Kerforne
- Inserm Unit IRMETIST, UMR U1313, University of Poitiers, Faculty of Medicine and Pharmacy, 86073, Poitiers, France
- Cardio-Thoracic and Vascular Surgery Intensive Care Unit, Coordination of P.M.O. CHU Poitiers, 86021, Poitiers, France
| | - Luc Pellerin
- Inserm Unit IRMETIST, UMR U1313, University of Poitiers, Faculty of Medicine and Pharmacy, 86073, Poitiers, France
- Biochemistry Department CHU Poitiers, 86021, Poitiers, France
| | - Thierry Hauet
- Inserm Unit IRMETIST, UMR U1313, University of Poitiers, Faculty of Medicine and Pharmacy, 86073, Poitiers, France
- Biochemistry Department CHU Poitiers, 86021, Poitiers, France
- University Hospital Federation SUPPORT Tours Poitiers Limoges, 86021, Poitiers, France
| | - Raphael Thuillier
- Inserm Unit IRMETIST, UMR U1313, University of Poitiers, Faculty of Medicine and Pharmacy, 86073, Poitiers, France.
- Biochemistry Department CHU Poitiers, 86021, Poitiers, France.
- University Hospital Federation SUPPORT Tours Poitiers Limoges, 86021, Poitiers, France.
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Marie D, Dahyot-Fizelier C, Barrau S, Boisson M, Frasca D, Jamet A, Chauvet S, Ferrand N, Pichot A, Mimoz O, Kerforne T. Impact of Radial Arterial Location on Catheter Lifetime in ICU Surgical Intensive Care. Crit Care Explor 2023; 5:e0905. [PMID: 37091478 PMCID: PMC10115551 DOI: 10.1097/cce.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
The use of arterial catheters is frequent in intensive care for hemodynamic monitoring of patients and for blood sampling, but they are often removed because of dysfunction. The primary objective is to compare the prevalence of radial arterial catheter dysfunction according to location in relation to the radiocarpal joint in intensive care patients. DESIGN Prospective randomized, controlled, single-center study. SETTING The surgical ICU of the university hospital of Poitiers in France. PATIENTS From January 2016 to April 2017, all patients over 18 years old admitted to the surgical ICU and requiring an arterial catheter were included. INTERVENTIONS Randomization into two groups: catheter placed near the wrist (within 4 cm of the radiocarpal joint) and catheter placed away the wrist. The primary endpoint was the prevalence of dysfunction. We also compared the prevalence of infection and colonization. MEASUREMENTS AND MAIN RESULTS One hundred seven catheters were analyzed (14 failed placements with no difference between the two groups, and 16 catheters excluded for missing data), with 58 catheters in near the wrist group and 49 in away the wrist group. We did not find any significant difference in the number of catheter dysfunctions between the two groups (p = 0.56). The prevalence density of catheter dysfunction was 30.5 of 1,000 catheter days for near the wrist group versus 26.7 of 1,000 catheter days for away the wrist group. However, we observed a significant difference in terms of catheter-related infection in favor of away the wrist group (p = 0.04). In addition, distal positioning of the catheter was judged easier by the physicians. CONCLUSIONS The distal or proximal position of the arterial catheter in the radial position has no influence on the occurrence of dysfunction. However, there may be an association with the prevalence of infections.
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Affiliation(s)
- Damien Marie
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Claire Dahyot-Fizelier
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- CHU de Poitiers, service des urgences, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Stéphanie Barrau
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Boisson
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Denis Frasca
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Angeline Jamet
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Stéphane Chauvet
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Nathan Ferrand
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Amélie Pichot
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Olivier Mimoz
- CHU de Poitiers, service des urgences, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Thomas Kerforne
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- INSERM U1082 (IRTOMIT), Poitiers, France
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Ducousso H, Vallée M, Kerforne T, Castilla I, Duthe F, Saulnier PJ, Ragot S, Thierry A. Paving the Way for Personalized Medicine in First Kidney Transplantation: Interest of a Creatininemia Latent Class Analysis in Early Post-transplantation. Transpl Int 2023; 36:10685. [PMID: 36873744 PMCID: PMC9977818 DOI: 10.3389/ti.2023.10685] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/10/2023] [Indexed: 02/18/2023]
Abstract
Plasma creatinine is a marker of interest in renal transplantation but data on its kinetics in the first days following transplantation are scarce. The aim of this study was to identify clinically relevant subgroups of creatinine trajectories following renal transplantation and to test their association with graft outcome. Among 496 patients with a first kidney transplant included in the French ASTRE cohort at the Poitiers University hospital, 435 patients from donation after brain death were considered in a latent class modeling. Four distinct classes of creatinine trajectories were identified: "poor recovery" (6% of patients), "intermediate recovery" (47%), "good recovery" (10%) and "optimal recovery" (37%). Cold ischemia time was significantly lower in the "optimal recovery" class. Delayed graft function was more frequent and the number of hemodialysis sessions was higher in the "poor recovery" class. Incidence of graft loss was significantly lower in "optimal recovery" patients with an adjusted risk of graft loss 2.42 and 4.06 times higher in "intermediate recovery" and "poor recovery" patients, respectively. Our study highlights substantial heterogeneity in creatinine trajectories following renal transplantation that may help to identify patients who are more likely to experience a graft loss.
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Affiliation(s)
- Héloïse Ducousso
- Department of Urology, University of Poitiers, CHU Poitiers, Poitiers, France
| | - Maxime Vallée
- Department of Urology, University of Poitiers, CHU Poitiers, Poitiers, France
| | - Thomas Kerforne
- Department of Intensive Care, University of Poitiers, CHU Poitiers, Poitiers, France
| | - Ines Castilla
- Clinical Investigation Centre CIC1402, Poitiers University, Institut National de la santé et de la recherche médicale (INSERM), CHU Poitiers, Poitiers, France
| | - Fabien Duthe
- Department of Urology, University of Poitiers, CHU Poitiers, Poitiers, France
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402, Poitiers University, Institut National de la santé et de la recherche médicale (INSERM), CHU Poitiers, Poitiers, France
| | - Stéphanie Ragot
- Clinical Investigation Centre CIC1402, Poitiers University, Institut National de la santé et de la recherche médicale (INSERM), CHU Poitiers, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology, Dialysis and Transplantation, University of Poitiers, CHU Poitiers, Poitiers, France
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9
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Lepoittevin M, Giraud S, Kerforne T, Allain G, Thuillier R, Hauet T. How to improve results after DCD (donation after circulation death). Presse Med 2022; 51:104143. [PMID: 36216034 DOI: 10.1016/j.lpm.2022.104143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
The shortage of organs for transplantation has led health professionals to look for alternative sources of donors. One of the avenues concerns donors who have died after circulatory arrest. This is a special situation because the organs from these donors are exposed to warm ischaemia-reperfusion lesions that are unavoidable during the journey of the organs from the donor to the moment of transplantation in the recipient. We will address and discuss the key issues from the perspective of team organization, legislation and its evolution, and the ethical framework. In a second part, the avenues to improve the quality of organs will be presented following the itinerary of the organs between the donor and the recipient. The important moments from the point of view of therapeutic strategy will be put into perspective. New connections between key players involved in pathophysiological mechanisms and implications for innate immunity and injury processes are among the avenues to explore. Technological developments to improve the quality of organs from these recipients will be analyzed, such as perfusion techniques with new modalities of temperatures and oxygenation. New molecules are being investigated for their potential role in protecting these organs and an analysis of potential prospects will be proposed. Finally, the important perspectives that seem to be favored will be discussed in order to reposition the use of deceased donors after circulatory arrest. The use of these organs has become a routine procedure and improving their quality and providing the means for their evaluation is absolutely inevitable.
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Affiliation(s)
- Maryne Lepoittevin
- Unité UMR U1082, F-86000 Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
| | - Sébastien Giraud
- Unité UMR U1082, F-86000 Poitiers, France; Service de Biochimie, Pôle Biospharm, Centre Hospitalier Universitaire, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France
| | - Thomas Kerforne
- Unité UMR U1082, F-86000 Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France; CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France
| | - Géraldine Allain
- Unité UMR U1082, F-86000 Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France; CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France
| | - Raphaël Thuillier
- Unité UMR U1082, F-86000 Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France; Service de Biochimie, Pôle Biospharm, Centre Hospitalier Universitaire, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France
| | - Thierry Hauet
- Unité UMR U1082, F-86000 Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France; Fédération Hospitalo-Universitaire « Survival Optimization in Organ Transplantation », CHU de Poitiers, 2 rue de la Milétrie - CS 90577, 86021 Poitiers Cedex, France.
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10
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Lepoittevin M, Giraud S, Kerforne T, Barrou B, Badet L, Bucur P, Salamé E, Goumard C, Savier E, Branchereau J, Battistella P, Mercier O, Mussot S, Hauet T, Thuillier R. Preservation of Organs to Be Transplanted: An Essential Step in the Transplant Process. Int J Mol Sci 2022; 23:ijms23094989. [PMID: 35563381 PMCID: PMC9104613 DOI: 10.3390/ijms23094989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 12/23/2022] Open
Abstract
Organ transplantation remains the treatment of last resort in case of failure of a vital organ (lung, liver, heart, intestine) or non-vital organ (essentially the kidney and pancreas) for which supplementary treatments exist. It remains the best alternative both in terms of quality-of-life and life expectancy for patients and of public health expenditure. Unfortunately, organ shortage remains a widespread issue, as on average only about 25% of patients waiting for an organ are transplanted each year. This situation has led to the consideration of recent donor populations (deceased by brain death with extended criteria or deceased after circulatory arrest). These organs are sensitive to the conditions of conservation during the ischemia phase, which have an impact on the graft’s short- and long-term fate. This evolution necessitates a more adapted management of organ donation and the optimization of preservation conditions. In this general review, the different aspects of preservation will be considered. Initially done by hypothermia with the help of specific solutions, preservation is evolving with oxygenated perfusion, in hypothermia or normothermia, aiming at maintaining tissue metabolism. Preservation time is also becoming a unique evaluation window to predict organ quality, allowing repair and/or optimization of recipient choice.
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Affiliation(s)
- Maryne Lepoittevin
- Biochemistry Department, CHU Poitiers, 86021 Poitiers, France; (M.L.); (S.G.); (R.T.)
- Faculty of Medicine and Pharmacy, University of Poitiers, 86073 Poitiers, France;
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
| | - Sébastien Giraud
- Biochemistry Department, CHU Poitiers, 86021 Poitiers, France; (M.L.); (S.G.); (R.T.)
- Faculty of Medicine and Pharmacy, University of Poitiers, 86073 Poitiers, France;
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
| | - Thomas Kerforne
- Faculty of Medicine and Pharmacy, University of Poitiers, 86073 Poitiers, France;
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
- Cardio-Thoracic and Vascular Surgery Intensive Care Unit, Coordination of P.M.O., CHU Poitiers, 86021 Poitiers, France
| | - Benoit Barrou
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
- Sorbonne Université Campus Pierre et Marie Curie, Faculté de Médecine, 75005 Paris, France
- Service Médico-Chirurgical de Transplantation Rénale, APHP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
| | - Lionel Badet
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Faculté de Médecine, Campus Lyon Santé Est, Université Claude Bernard, 69622 Lyon, France
- Service d’Urologie et Transplantation, Hospices Civils de Lyon, Hôpital Edouard-Herriot, 69003 Lyon, France
| | - Petru Bucur
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Chirurgie Digestive et Endocrinienne, Transplantation Hépatique, CHU de Tours, 37170 Chambray les Tours, France
- Groupement d’Imagerie Médicale, CHU de Tours, 37000 Tours, France
- University Hospital Federation SUPORT Tours Poitiers Limoges, 86021 Poitiers, France
| | - Ephrem Salamé
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Chirurgie Digestive et Endocrinienne, Transplantation Hépatique, CHU de Tours, 37170 Chambray les Tours, France
- Groupement d’Imagerie Médicale, CHU de Tours, 37000 Tours, France
- University Hospital Federation SUPORT Tours Poitiers Limoges, 86021 Poitiers, France
| | - Claire Goumard
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique et Transplantation Hépatique, APHP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Eric Savier
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique et Transplantation Hépatique, APHP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Julien Branchereau
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service d’Urologie et de Transplantation, CHU de Nantes, 44000 Nantes, France
| | - Pascal Battistella
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Cardiologie et Maladies Vasculaires, CHU de Montpellier, CEDEX 5, 34295 Montpellier, France
| | - Olaf Mercier
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Centre Chirurgical Marie LANNELONGUE, 92350 Le Plessis Robinson, France
| | - Sacha Mussot
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Centre Chirurgical Marie LANNELONGUE, 92350 Le Plessis Robinson, France
| | - Thierry Hauet
- Biochemistry Department, CHU Poitiers, 86021 Poitiers, France; (M.L.); (S.G.); (R.T.)
- Faculty of Medicine and Pharmacy, University of Poitiers, 86073 Poitiers, France;
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
- Société Francophone de Transplantation et de l’Ecole Francophone pour le Prélèvement Multi-Organes, 75013 Paris, France; (P.B.); (E.S.); (C.G.); (E.S.); (J.B.); (P.B.); (O.M.); (S.M.)
- University Hospital Federation SUPORT Tours Poitiers Limoges, 86021 Poitiers, France
- Correspondence:
| | - Raphael Thuillier
- Biochemistry Department, CHU Poitiers, 86021 Poitiers, France; (M.L.); (S.G.); (R.T.)
- Faculty of Medicine and Pharmacy, University of Poitiers, 86073 Poitiers, France;
- INSERM U1313, IRMETIST, 86021 Poitiers, France; (B.B.); (L.B.)
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11
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Gargadennec T, Oilleau JF, Rozec B, Nesseler N, Lasocki S, Futier E, Amour J, Durand M, Bougle A, Kerforne T, Consigny M, Eddi D, Huet O. Dexmedetomidine after Cardiac Surgery for Prevention of Delirium (EXACTUM) trial protocol: a multicentre randomised, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e058968. [PMID: 35396310 PMCID: PMC8996049 DOI: 10.1136/bmjopen-2021-058968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Incidence of delirium after cardiac surgery remains high and delirium has a significant burden on short-term and long-term outcomes. Multiple causes can trigger delirium occurence, and it has been hypothesised that sleep disturbances can be one of them. Preserving the circadian rhythm with overnight infusion of low-dose dexmedetomidine has been shown to lower the occurrence of delirium in older patients after non-cardiac surgery. However, these results remain controversial. The aim of this study was to demonstrate the usefulness of sleep induction by overnight infusion of dexmedetomidine to prevent delirium after cardiac surgery. METHODS AND ANALYSIS Dexmedetomidine after Cardiac Surgery for Prevention of Delirium is an investigator-initiated, randomised, placebo-controlled, parallel, multicentre, double-blinded trial. Nine centres in France will participate in the study. Patients aged 65 years or older and undergoing cardiac surgery will be enrolled in the study. The intervention starts on day 0 (the day of surgery) until intensive care unit (ICU) discharge; the treatment is administered from 20:00 to 08:00 on the next day. Infusion rate is modified by the treating nurse or the clinician with an objective of Richmond Agitation and Sedation Scale score from -1 to +1. The primary outcome is delirium occurrence evaluated with confusion assessment method for the ICU two times per day during 7 days following surgery. Secondary outcomes include incidence of agitation related events, self-evaluated quality of sleep, cognitive evaluation 3 months after surgery and quality of life 3 months after surgery. The sample size is 348. ETHICS AND DISSEMINATION The study was approved for all participating centers by the French Central Ethics Committee (Comité de Protection des Personnes Ile de France VI, registration number 2018-000850-22). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03477344.
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Affiliation(s)
- Thomas Gargadennec
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
| | - Jean-Ferréol Oilleau
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
| | - Bertrand Rozec
- Intensive Care Unit, Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital Centre Nantes, Nantes, France
- CNRS, INSERM, l'institut du thorax, Université de Nantes, Nantes, France
| | - Nicolas Nesseler
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, Angers, France
- Université Angers Faculté des Sciences, Angers, France
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie Réanimation, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
- CNRS, Inserm U-1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien Amour
- Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiothoracic Surgery (IPRA), Jacques Cartier Private Hospital, Massy, France
| | - Michel Durand
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Adrien Bougle
- Sorbonne Universite, Paris, France
- Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, GRC 29, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Thomas Kerforne
- Faculté de Médecine, INSERM U1082, Ischémie Reperfusion en Transplantation Modélisation et Innovations Thérapeutiques, Université de Poitiers, Poitiers, France
- Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU Poitiers, Poitiers, France
| | - Maëlys Consigny
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Dauphou Eddi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Olivier Huet
- Département d'Anesthésie et Réanimation Chirurgicale, CHU Brest, Brest, France
- Université de Bretagne Occidentale, Brest, France
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12
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Brulé N, Canet E, Péré M, Feuillet F, Hourmant M, Asehnoune K, Rozec B, Duveau A, Dube L, Pierrot M, Humbert S, Tirot P, Boyer JM, Martin-Lefevre L, Labadie F, Robert R, Benard T, Kerforne T, Thierry A, Lesieur O, Vincent JF, Lesouhaitier M, Larmet R, Vigneau C, Goepp A, Bouju P, Quentin C, Egreteau PY, Huet O, Renault A, Le Meur Y, Venhard JC, Buchler M, Michel O, Voellmy MH, Herve F, Schnell D, Courte A, Glotz D, Amrouche L, Hazzan M, Kamar N, Moal V, Bourenne J, Le Quintrec-Donnette M, Morelon E, Boulain T, Grimbert P, Heng AE, Merville P, Garin A, Hiesse C, Fermier B, Mousson C, Guyot-Colosio C, Bouvier N, Rerolle JP, Durrbach A, Drouin S, Caillard S, Frimat L, Girerd S, Albano L, Rostaing L, Bertrand D, Hertig A, Westeel PF, Montini F, Delpierre E, Dorez D, Alamartine E, Ouisse C, Sebille V, Reignier J. Impact of targeted hypothermia in expanded-criteria organ donors on recipient kidney-graft function: study protocol for a multicentre randomised controlled trial (HYPOREME). BMJ Open 2022; 12:e052845. [PMID: 35351701 PMCID: PMC8961135 DOI: 10.1136/bmjopen-2021-052845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Expanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and mortality. HYPOREME will be a multicentre randomised controlled trial (RCT) comparing targeted hypothermia to normothermia in ECDs, in a country where the use of machine perfusion for organ storage is the standard of care. We hypothesise that hypothermia will decrease the incidence of DGF. METHODS AND ANALYSIS HYPOREME is a multicentre RCT comparing the effect on kidney function in recipients of targeted hypothermia (34°C-35°C) and normothermia (36.5°C-37.5°C) in the ECDs. The temperature intervention starts from randomisation and is maintained until aortic clamping in the operating room. We aim to enrol 289 ECDs in order to analyse the kidney function of 516 recipients in the 53 participating centres. The primary outcome is the occurrence of DGF in kidney recipients, defined as a requirement for renal replacement therapy within 7 days after transplantation (not counting a single session for hyperkalemia during the first 24 hours). Secondary outcomes include the proportion of patients with individual organs transplanted in each group; the number of organs transplanted from each ECD and the vital status and kidney function of the recipients 7 days, 28 days, 3 months and 1 year after transplantation. An interim analysis is planned after the enrolment of 258 kidney recipients. ETHICS AND DISSEMINATION The trial was approved by the ethics committee of the French Intensive Care Society (CE-SRLF-16-07) on 26 April 2016 and by the competent French authorities on 20 April 2016 (Comité de Protection des Personnes-TOURS-Région Centre-Ouest 1, registration #2016-S3). Findings will be published in peer-reviewed journals and presented during national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT03098706.
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Affiliation(s)
- Noëlle Brulé
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Morgane Péré
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Fanny Feuillet
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- INSERM SPHERE U1246 Methods for Patient-centered Outcomes and Health Research, Université de Nantes, Université de Tours, Nantes, PAYS-DE-LA-LOIRE, France
| | - Maryvonne Hourmant
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karim Asehnoune
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Rozec
- Service de Réanimation en Chirurgie Cardio-thoracique et Vasculaire, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Agnes Duveau
- Service de Néphrologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Laurent Dube
- Service de Coordination des prélèvements d'organe, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc Pierrot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Stanislas Humbert
- Service de Réanimation Polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
| | - Jean-Marc Boyer
- Service de Réanimation, Centre Hospitalier de Laval, Laval, France
| | - Laurent Martin-Lefevre
- Service de Médecine Intensive Réanimation, Centre Hospitalier Departemental Les Oudairies, La Roche-sur-Yon, Pays de la Loire, France
| | - François Labadie
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Nazaire, Saint Nazaire, Pays de la Loire, France
| | - René Robert
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ALIVE Research Group, INSERM, University of Poitiers, Poitiers, Poitou-Charentes, France
| | - Thierry Benard
- Service de Réanimation Neurochirurgicale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Kerforne
- Service d'Anesthésie-Réanimation Cardio-Thoracique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Antoine Thierry
- Service de Néphrologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Lesieur
- Service de Réanimation, Centre Hospitalier de la Rochelle, La Rochelle, Nouvelle-Aquitaine, France
| | - Jean-François Vincent
- Service de Réanimation, Centre Hospitalier de Saintes, Saintes, Poitou-Charentes, France
| | - Mathieu Lesouhaitier
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Raphaelle Larmet
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Cecile Vigneau
- Service de Néphrologie, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Angelique Goepp
- Service de Réanimation, Centre Hospitalier Bretagne Atlantique de Vannes, Vannes, France
| | - Pierre Bouju
- Service de Réanimation, Centre Hospitalier de Bretagne Sud, Lorient, Lorient, France
| | - Charlotte Quentin
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint-Malo, Saint-Malo, Bretagne, France
| | - Pierre-Yves Egreteau
- Service de Réanimation Polyvalente, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Olivier Huet
- Service de Réanimation Chirurgicale, Hôpital La Cavale Blanche, CHU de Brest, Brest, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, CHRU de Brest, Brest, Bretagne, France
| | - Yannick Le Meur
- Service de Néphrologie, Hôpital La Cavale Blanche, CHU de Brest, Brest, France
| | - Jean-Christophe Venhard
- Coordination des prélèvements d'organes et de tissus, Pôle Anesthésie Réanimations, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Mathias Buchler
- Service de Néphrologie, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Olivier Michel
- Service de Réanimation Polyvalente, Centre Hospitalier Jacques Cœur, Bourges, Centre-Val de Loire, France
| | - Marie-Hélène Voellmy
- Service de Coordination des prélèvements, Centre Hospitalier Jacques Cœur, Bourges, Centre-Val de Loire, France
| | - Fabien Herve
- Service de Réanimation Polyvalente, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France
| | - David Schnell
- Service de Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Angouleme, France
| | - Anne Courte
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, Bretagne, France
| | - Denis Glotz
- Service de Néphrologie, Hôpital Saint-Louis, Université de Paris, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Lucile Amrouche
- Service de Néphrologie, Hôpital Necker, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Hazzan
- University of Lille, Inserm, CHU Lille, U1286-Infinite-Institute for Translational Research in Inflammation, CHRU de Lille, Lille, Hauts-de-France, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'organes, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043- CNRS 5282, Toulouse, France, Toulouse, Midi-Pyrénées, France
| | - Valerie Moal
- Centre de Néphrologie et Transplantation Rénale, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Conception, Marseille, France
| | - Jeremy Bourenne
- Médecine Intensive Réanimation, Réanimation des Urgences, Aix-Marseille Université, CHU La Timone 2, Marseille, France
| | - Moglie Le Quintrec-Donnette
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Emmanuel Morelon
- Service d'Urologie et de Chirurgie de la Transplantation, Pôle Chirurgie, Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Thierry Boulain
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans Hôpital de La Source, Orléans, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, Créteil, France
| | - Anne Elisabeth Heng
- Service de Néphrologie et Immunologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Merville
- Service de Nephrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine-Limousin-Poitou, France
| | - Aude Garin
- Service de Réanimation Polyvalente, Centre Hospitalier de Dreux, Dreux, France
| | - Christian Hiesse
- Service de Néphrologie, Hôpital Foch, Suresnes, Suresnes, France
| | - Brice Fermier
- Service de Réanimation, Centre Hospitalier de Blois, Blois, Centre-Val de Loire, France
| | - Christiane Mousson
- Service de Néphrologie, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Charlotte Guyot-Colosio
- Service de Néphrologie, Centre Hospitalier Universitaire de Reims, Reims, Champagne-Ardenne, France
| | - Nicolas Bouvier
- Service de Néphrologie, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Jean-Philippe Rerolle
- Service de Néphrologie, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Antoine Durrbach
- Service de Néphrologie, Hôpital Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Sarah Drouin
- Service Médico-Chirurgical de Transplantation Rénale, APHP Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, Île-de-France, France
| | - Sophie Caillard
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, Alsace, France
| | - Luc Frimat
- Nephrology Department, CHRU Nancy, Université de Lorraine, Nancy, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation, Hôpital Brabois, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Laetitia Albano
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Dominique Bertrand
- Service de Néphrologie, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Alexandre Hertig
- Service de Néphrologie, Hôpital Tenon, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Florent Montini
- Service de Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Eric Delpierre
- Service de Réanimation, Grand Hôpital de l'Est Francilien, Marne La vallée, France
| | - Dider Dorez
- Service de Réanimation Polyvalente, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Eric Alamartine
- Service de Néphrologie Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Rhône-Alpes, France
| | - Carole Ouisse
- Service de Médecine Intensive Réanimation, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Veronique Sebille
- Direction de la Recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- INSERM SPHERE U1246 Methods for Patient-centered Outcomes and Health Research, Université de Nantes, Université de Tours, Nantes, PAYS-DE-LA-LOIRE, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Gaudriot B, Oilleau JF, Kerforne T, Ecoffey C, Huet O, Mansour A, Verhoye JP, Massart N, Nesseler N. The impact of iron store on red blood cell transfusion: a multicentre prospective cohort study in cardiac surgery. BMC Anesthesiol 2022; 22:74. [PMID: 35313823 PMCID: PMC8935744 DOI: 10.1186/s12871-022-01616-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Anaemia is common prior to cardiac surgery and contributes to perioperative morbidity. Iron deficiency is the main cause of anaemia but its impact remains controversial in the surgical setting. We aimed to estimate the impact of iron deficiency on in-hospital perioperative red blood cell transfusion for patients undergoing elective and urgent cardiac surgery. Secondary objectives were to identify risk factors associated with in-hospital red blood cell transfusion. Methods We conducted a prospective multicentre observational study in three university hospitals performing cardiac surgery. We determined iron status prior to surgery and collected all transfusion data to compare iron-deficient and iron-replete patients during hospital stay. We performed a multivariable logistic regression to compare transfusion among groups. Results Five hundred and two patients were included. A trend of low haemoglobin levels associated with iron deficiency persisted until discharge. Red blood cell transfusion was significantly higher in the group of iron deficient patients during surgery (22% vs 13%, p = 0.017), however the incidence during the whole hospital stay was 31% in the iron-deficient group, not significantly different with the non-deficient group (26%, p = 0.28). Iron deficiency was not independently associated with in-hospital red blood cell transfusion (adjusted OR = 0.85 [0.53–1.36], p = 0.49). Conclusions In-hospital red blood cell transfusion was not significantly higher in iron-deficient patients and iron deficiency was not associated with in-hospital red blood cell transfusion in patients undergoing elective and urgent cardiac surgery. Iron deficiency was the main cause of anaemia and anaemia was a strong driver of red blood cell transfusion. Further studies should identify sub-population of iron-deficient patients which may benefit from preoperative iron deficiency management and explore the long-term impact of lower haemoglobin levels at discharge in the iron deficient population.
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Affiliation(s)
- Baptiste Gaudriot
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France. .,Service d'Anesthésie-Réanimation CTCV, Centre Cardio-Pneumologique, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Cedex 9, Rennes, France.
| | - Jean-Ferreol Oilleau
- Department of Anaesthesia and Critical Care, Brest University Hospital, 29000, Brest, France
| | - Thomas Kerforne
- Department of Anaesthesia and Critical Care, INSERM U-1082, Poitiers University Hospital, 86000, Poitiers, France
| | - Claude Ecoffey
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France.,Univ Rennes, CHU de Rennes, 35000, Rennes, France
| | - Olivier Huet
- Department of Anaesthesia and Critical Care, Brest University Hospital, 29000, Brest, France.,Brest University, 29000, Brest, France
| | - Alexandre Mansour
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France.,Univ Rennes, CHU de Rennes, 35000, Rennes, France
| | - Jean-Philippe Verhoye
- Univ Rennes, CHU de Rennes, 35000, Rennes, France.,Thoracic and Cardiovascular Surgery, University Hospital of Rennes, Univ Rennes 1, 35000, Rennes, France
| | - Nicolas Massart
- Intensive Care Unit, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France
| | - Nicolas Nesseler
- Department of Anaesthesia and Critical Care, University Hospital of Rennes, 35000, Rennes, France.,Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, F-35000, Rennes, France
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Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
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Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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Roxburgh T, Li A, Guenancia C, Pernollet P, Bouleti C, Alos B, Gras M, Kerforne T, Frasca D, Le Gal F, Christiaens L, Degand B, Garcia R. Virtual Reality for Sedation During Atrial Fibrillation Ablation in Clinical Practice: Observational Study. J Med Internet Res 2021; 23:e26349. [PMID: 34042589 PMCID: PMC8193475 DOI: 10.2196/26349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 05/04/2021] [Indexed: 01/02/2023] Open
Abstract
Background Connected devices are dramatically changing many aspects in health care. One such device, the virtual reality (VR) headset, has recently been shown to improve analgesia in a small sample of patients undergoing transcatheter aortic valve implantation. Objective We aimed to investigate the feasibility and effectiveness of VR in patients undergoing atrial fibrillation (AF) ablation under conscious sedation. Methods All patients who underwent an AF ablation with VR from March to May 2020 were included. Patients were compared to a consecutive cohort of patients who underwent AF ablation in the 3 months prior to the study. Primary efficacy was assessed by using a visual analog scale, summarizing the overall pain experienced during the ablation. Results The AF cryoablation procedure with VR was performed for 48 patients (mean age 63.0, SD 10.9 years; n=16, 33.3% females). No patient refused to use the device, although 14.6% (n=7) terminated the VR session prematurely. Preparation of the VR headset took on average 78 (SD 13) seconds. Compared to the control group, the mean perceived pain, assessed with the visual analog scale, was lower in the VR group (3.5 [SD 1.5] vs 4.3 [SD 1.6]; P=.004), and comfort was higher in the VR group (7.5 [SD 1.6] vs 6.8 [SD 1.7]; P=.03). On the other hand, morphine consumption was not different between the groups. Lastly, complications, as well as procedure and fluoroscopy duration, were not different between the two groups. Conclusions We found that VR was associated with a reduction in the perception of pain in patients undergoing AF ablation under conscious sedation. Our findings demonstrate that VR can be easily incorporated into the standard ablation workflow.
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Affiliation(s)
- Thomas Roxburgh
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Anthony Li
- Cardiology Clinical Academic Group, St George's, University of London, London, United Kingdom
| | | | - Patrice Pernollet
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Claire Bouleti
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Benjamin Alos
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Gras
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Thomas Kerforne
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Denis Frasca
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - François Le Gal
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Luc Christiaens
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Bruno Degand
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
| | - Rodrigue Garcia
- Department of Anesthesia and Critical Care, University Hospital of Poitiers, Poitiers, France
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16
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Guenezan J, Kerforne T, Boisson M, Dahyot-Fizelier C, Mimoz O. Benefit from extending infusion set replacement intervals of central venous and arterial catheters in hospitalised patients. Anaesth Crit Care Pain Med 2021; 40:100884. [PMID: 33971374 DOI: 10.1016/j.accpm.2021.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jérémy Guenezan
- Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France
| | - Thomas Kerforne
- Université de Poitiers, Poitiers, France; Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France
| | - Matthieu Boisson
- Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France; Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France
| | - Claire Dahyot-Fizelier
- Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France; Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France
| | - Olivier Mimoz
- Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France.
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17
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Marjanovic N, Boisson M, Asehnoune K, Foucrier A, Lasocki S, Ichai C, Leone M, Pottecher J, Lefrant JY, Falcon D, Veber B, Chabanne R, Drevet CM, Pili-Floury S, Dahyot-Fizelier C, Kerforne T, Seguin S, de Keizer J, Frasca D, Guenezan J, Mimoz O. Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated: The AGATE Multicenter Randomized Controlled Study. Chest 2021; 160:499-508. [PMID: 33727034 DOI: 10.1016/j.chest.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. RESEARCH QUESTION Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma? STUDY DESIGN AND METHODS In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age ≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for ≥ 48 h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants. RESULTS A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71). No serious adverse events related to the use of the pneumatic device were noted. INTERPRETATION Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Nicolas Marjanovic
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM CIC1402 Team 5 Acute Lung Injury and Ventilatory Support, Pharmacologie des Agents anti-infectieux, France
| | - Matthieu Boisson
- Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Karim Asehnoune
- Service d'Anesthésie-Réanimation chirurgicale, CHU de Nantes, France
| | | | | | - Carole Ichai
- Service de Réanimation Polyvalente, CHU de Nice, France
| | - Marc Leone
- Aix Marseille Université, Service d'Anesthésie et de Réanimation, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Jean-Yves Lefrant
- EA 2992 IMAGINE, Université de Montpellier, Montpellier, France; Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes, France
| | | | - Benoit Veber
- Surgical Intensive Care Unit, Rouen University Hospital, France
| | - Russell Chabanne
- Department of Perioperative Medicine, Neurocritical Care Unit, Neuro-Anesthesiology Clinic, CHU de Clermont-Ferrand, France
| | | | - Sébastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, CHU de Besancon, Besançon, France; EA3920 and SFR-FED 4234 INSERM, Université de Franche-Comté, Besançon, France
| | - Claire Dahyot-Fizelier
- Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Thomas Kerforne
- Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Sabrina Seguin
- Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Joe de Keizer
- Plateforme Méthodologie-Biostatistique-Data-Management, CHU de Poitiers, France
| | - Denis Frasca
- Université de Poitiers, Faculté de Médecine, Poitiers, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France; INSERM U1246, Methods in Patients-centered outcomes and Health Research-SPHERE, Nantes, France
| | - Jérémy Guenezan
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France
| | - Olivier Mimoz
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France.
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18
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Lasocki S, Asfar P, Jaber S, Ferrandiere M, Kerforne T, Asehnoune K, Montravers P, Seguin P, Peoc'h K, Gergaud S, Nagot N, Lefebvre T, Lehmann S. Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial. Crit Care 2021; 25:62. [PMID: 33588893 PMCID: PMC7885380 DOI: 10.1186/s13054-020-03430-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 09/06/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. METHODS In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was < 20 μg/l and with intravenous iron and erythropoietin for 20 ≤ hepcidin < 41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day 90 mortality and 1-year survival. RESULTS Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). A total of 220 patients (55%) had ID at discharge (i.e., a hepcidin < 41 μg/l). Primary endpoint was not different (medians (IQR) post-ICU LOS 33(13;90) vs. 33(11;90) days for intervention and control, respectively, median difference - 1(- 3;1) days, p = 0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference - 8.7 (- 15.1 to - 2.3)%, p = 0.008, OR 95% IC, 0.46, 0.22-0.94, p = 0.035), and one-year survival was improved (p = 0.04). CONCLUSION Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay. TRIAL REGISTRATION www.clinicaltrial.gov NCT02276690 (October 28, 2014; retrospectively registered).
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Affiliation(s)
- Sigismond Lasocki
- Département Anesthésie Réanimation, CHU Angers, Université D'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Pierre Asfar
- Département Médecine Intensive Réanimation, CHU Angers, Université D'Angers, Angers, France
| | - Samir Jaber
- Département Anesthésie Réanimation, Université de Montpellier, Montpellier, France
| | - Martine Ferrandiere
- Département Anesthésie Réanimation, CHU de Tours, Université de Tours, Tours, France
| | - Thomas Kerforne
- Service D'anesthésie-réanimation, CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - Karim Asehnoune
- Département Anesthésie Réanimation, CHU de Nantes, Université de Nantes, Nantes, France
| | - Philippe Montravers
- Département Anesthésie Réanimation, APHP, HUPNSV, CHU Bichat, Université Paris Diderot Sorbonne, Paris, France
| | - Philippe Seguin
- Département Anesthésie Réanimation, CHU de Rennes, Université de Rennes, Rennes, France
| | - Katell Peoc'h
- INSERM U1149, UFR de Médecine Bichat, Centre de Recherche Sur L'Inflammation, Université de Paris, Paris, France.,APHP Nord Hôpital Universitaire Louis Mourier, Assistance Publique des Hôpitaux de Paris, Colombes, France.,Laboratoire D'Excellence GR-Ex Ou Laboratory of Excellence GR-Ex, Paris, France
| | - Soizic Gergaud
- Département Anesthésie Réanimation, CHU Angers, Université D'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Nicolas Nagot
- Département D'information médicale, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Thibaud Lefebvre
- INSERM U1149, UFR de Médecine Bichat, Centre de Recherche Sur L'Inflammation, Université de Paris, Paris, France
| | - Sylvain Lehmann
- Laboratoire de Biochimie Protéomique Clinique Et IRMB INSERM, CHU de Montpellier, Université de Montpellier, Montpellier, France
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19
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Giraud S, Kerforne T, Zely J, Ameteau V, Couturier P, Tauc M, Hauet T. The inhibition of eIF5A hypusination by GC7, a preconditioning protocol to prevent brain death-induced renal injuries in a preclinical porcine kidney transplantation model. Am J Transplant 2020; 20:3326-3340. [PMID: 32400964 DOI: 10.1111/ajt.15994] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/13/2020] [Revised: 04/07/2020] [Accepted: 04/29/2020] [Indexed: 01/25/2023]
Abstract
The eIF5A hypusination inhibitor GC7 (N1-guanyl-1,7-diaminoheptane) was shown to protect from ischemic injuries. We hypothesized that GC7 could be useful for preconditioning kidneys from donors before transplantation. Using a preclinical porcine brain death (BD) donation model, we carried out in vivo evaluation of GC7 pretreatment (3 mg/kg iv, 5 minutes after BD) at the beginning of the 4h-donor management, after which kidneys were collected and cold-stored (18h in University of Wisconsin solution) and 1 was allotransplanted. Groups were defined as following (n = 6 per group): healthy (CTL), untreated BD (Vehicle), and GC7-treated BD (Vehicle + GC7). At the end of 4h-management, GC7 treatment decreased BD-induced markers, as radical oxygen species markers. In addition, GC7 increased expression of mitochondrial protective peroxisome proliferator-activated receptor-gamma coactivator-1-alpha (PGC1α) and antioxidant proteins (superoxyde-dismutase-2, heme oxygenase-1, nuclear factor [erythroid-derived 2]-like 2 [NRF2], and sirtuins). At the end of cold storage, GC7 treatment induced an increase of NRF2 and PGC1α mRNA and a better mitochondrial integrity/homeostasis with a decrease of dynamin- related protein-1 activation and increase of mitofusin-2. Moreover, GC7 treatment significantly improved kidney outcome during 90 days follow-up after transplantation (fewer creatininemia and fibrosis). Overall, GC7 treatment was shown to be protective for kidneys against BD-induced injuries during donor management and subsequently appeared to preserve antioxidant defenses and mitochondria homeostasis; these protective effects being accompanied by a better transplantation outcome.
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Affiliation(s)
- Sebastien Giraud
- INSERM UMR-1082 IRTOMIT, Poitiers, France.,Service de Biochimie, CHU de Poitiers, Poitiers, France
| | - Thomas Kerforne
- INSERM UMR-1082 IRTOMIT, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.,Service d'Anesthésie-Réanimation, CHU de Poitiers, Poitiers, France
| | - Jeremy Zely
- INSERM UMR-1082 IRTOMIT, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.,Service d'Anesthésie-Réanimation, CHU de Poitiers, Poitiers, France
| | - Virginie Ameteau
- INSERM UMR-1082 IRTOMIT, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Pierre Couturier
- INSERM UMR-1082 IRTOMIT, Poitiers, France.,Service de Biochimie, CHU de Poitiers, Poitiers, France.,MOPICT 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique', Domaine Expérimental du Magneraud, Surgères, France
| | - Michel Tauc
- Université Cote d'Azur, LP2M, CNRS-7370, Nice, France
| | - Thierry Hauet
- INSERM UMR-1082 IRTOMIT, Poitiers, France.,Service de Biochimie, CHU de Poitiers, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.,MOPICT 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique', Domaine Expérimental du Magneraud, Surgères, France.,FHU SUPORT 'SUrvival oPtimization in ORgan Transplantation', Poitiers, France
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20
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Danion J, Thuillier R, Allain G, Bruneval P, Tomasi J, Pinsard M, Hauet T, Kerforne T. Evaluation of Liver Quality after Circulatory Death Versus Brain Death: A Comparative Preclinical Pig Model Study. Int J Mol Sci 2020; 21:ijms21239040. [PMID: 33261172 PMCID: PMC7730280 DOI: 10.3390/ijms21239040] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/14/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023] Open
Abstract
The current organ shortage in hepatic transplantation leads to increased use of marginal livers. New organ sources are needed, and deceased after circulatory death (DCD) donors present an interesting possibility. However, many unknown remains on these donors and their pathophysiology regarding ischemia reperfusion injury (IRI). Our hypothesis was that DCD combined with abdominal normothermic regional recirculation (ANOR) is not inferior to deceased after brain death (DBD) donors. We performed a mechanistic comparison between livers from DBD and DCD donors in a highly reproducible pig model, closely mimicking donor conditions encountered in the clinic. DCD donors were conditioned by ANOR. We determined that from the start of storage, pro-lesion pathways such as oxidative stress and cell death were induced in both donor types, but to a higher extent in DBD organs. Furthermore, pro-survival pathways, such as resistance to hypoxia and regeneration showed activation levels closer to healthy livers in DCD-ANOR rather than in DBD organs. These data highlight critical differences between DBD and DCD-ANOR livers, with an apparent superiority of DCD in terms of quality. This confirms our hypothesis and further confirms previously demonstrated benefits of ANOR. This encourages the expended use of DCD organs, particularly with ANOR preconditioning.
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Affiliation(s)
- Jérôme Danion
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU de Poitiers, Service de Chirurgie Générale et Endocrinienne, F-86021 Poitiers, France
| | - Raphael Thuillier
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Biochimie, F-86021 Poitiers, France
| | - Géraldine Allain
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France;
| | - Patrick Bruneval
- Hôpital Européen Georges Pompidou, Service D’anatomie Pathologique, F-75015 Paris, France;
- Faculté de Médecine, Université Paris-Descartes, F-75006 Paris, France
| | - Jacques Tomasi
- CHU Poitiers, Service de Chirurgie Cardiothoracique et Vasculaire, F-86021 Poitiers, France;
| | - Michel Pinsard
- CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France;
| | - Thierry Hauet
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Biochimie, F-86021 Poitiers, France
- Fédération Hospitalo-Universitaire SUPORT, F-86000 Poitiers, France
- IBiSA Plateforme ‘Plate-Forme MOdélisation Préclinique—Innovation Chirurgicale et Technologique (MOPICT)’, Domaine Expérimental du Magneraud, F-17700 Surgères, France
- Pr. Thierry HAUET, INSERM U1082, CHU de Poitiers, 2 rue de la Miletrie, CEDEX BP 577, 86021 Poitiers, France
- Correspondence: ; Tel.: +33-5-49-44-48-29; Fax: +33-5-49-44-38-34
| | - Thomas Kerforne
- Inserm U1082, F-86000 Poitiers, France; (J.D.); (R.T.); (G.A.); (T.K.)
- Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
- CHU Poitiers, Service de Réanimation Chirurgie Cardio-Thoracique et Vasculaire, Coordination des P.M.O., F-86021 Poitiers, France;
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21
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Bidegain N, Degand B, Bouleti C, Christiaens L, Tavernier M, Kerforne T, Ingrand P, Garcia R. Severe sleep apnea is associated with atrial fibrillation burden in pacemaker recipients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
New generation pacemaker allow the assessment day by day of sleep disordered breathing (SDB) based on impedance measurement. A recent study demonstrated that incidence of AF is higher in case of severe SA monitored by pacemaker
Purpose
The aim was to compare the atrial fibrillation (AF) burden between patients with severe and non-severe sleep apnea (SA) detected with pacemakers monitoring (SDB).
Methods
This retrospective study was carried out at our University Hospital. We included all patients with Microport CRM pacemaker implanted from 2013 to 2016 at our university hospital. Exclusion criteria were inactivation of sleep apnea monitoring (SAM), history of sleep apnea, missing data or invalid data. AF burden was assessed according to Fallback mode switch (FMS) duration. Respiratory disturbance index (RDI) was calculated as the average number of events (ventilation pause and reductions) per number of hours of monitoring. Patients with RDI<20/h were compared with patients with RDI≥20/h (considered as severe SA group).
Results
404 patients (mean age = 79.7±10 years; 52.0% men) were included. The most prevalent indication for cardiac pacing was atrioventricular block in 57%. Mean RDI was 18.9 events per hour. 234 (58%) of them had a mean RDI <20 and 170 (42%) had a mean RDI ≥20. Compared to patients with mean RDI<20, those with mean RDI ≥20 were youngers (78.6±10 years Vs 81.8±8 years; p=0.02), were more likely to be male (58.2% Vs 47.5%: p=0.035) and had more heart failure history (28.8% Vs 19.2%: p=0.03). BMI was not different between groups (26.3±5. vs 26.3±4; P=0.33). Mean follow-up was 27 months. Patients with RDI ≥20 had a mean Atrial fibrillation duration longer than patients with RDI <20 (631 min Vs 291 min respectively; p=0.014). RDI was correlated with FMS (r=0.26; p=0.0004). The stroke rate tended to be higher in the RDI ≥20 group (2.1% vs 5.4%) (p=0.12).
Conclusion
Severe SA detected by pacemaker was associated with longer AF duration. We did not find higher occurrence of stroke in the severe SA group.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Bidegain
- University Hospital of Poitiers, Poitiers, France
| | - B Degand
- University Hospital of Poitiers, Poitiers, France
| | - C Bouleti
- University Hospital of Poitiers, Poitiers, France
| | | | - M Tavernier
- University Hospital of Poitiers, Poitiers, France
| | - T Kerforne
- University Hospital of Poitiers, Poitiers, France
| | - P Ingrand
- University Hospital of Poitiers, Poitiers, France
| | - R Garcia
- University Hospital of Poitiers, Poitiers, France
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22
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L'Her E, Jaber S, Verzilli D, Jacob C, Huiban B, Futier E, Kerforne T, Pateau V, Bouchard PA, Consigny M, Lellouche F. Automated closed-loop versus standard manual oxygen administration after major abdominal or thoracic surgery: an international multicentre randomised controlled study. Eur Respir J 2020; 57:13993003.00182-2020. [DOI: 10.1183/13993003.00182-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/17/2020] [Indexed: 11/05/2022]
Abstract
IntroductionHypoxaemia and hyperoxaemia may occur after surgery, with related complications. This multicentre randomised trial evaluated the impact of automated closed-loop oxygen administration after high-risk abdominal or thoracic surgeries in terms of optimising the oxygen saturation measured by pulse oximetry time within target range.MethodsAfter extubation, patients with an intermediate to high risk of post-operative pulmonary complications were randomised to “standard” or “automated” closed-loop oxygen administration. The primary outcome was the percentage of time within the oxygenation range, during a 3-day frame. The secondary outcomes were the time with hypoxaemia and hyperoxaemia under oxygen.ResultsAmong the 200 patients, time within range was higher in the automated group, both initially (≤3 h; 91.4±13.7% versus 40.2±35.1% of time, difference +51.0% (95% CI −42.8–59.2%); p<0.0001) and during the 3-day period (94.0±11.3% versus 62.1±23.3% of time, difference +31.9% (95% CI 26.3–37.4%); p<0.0001). Periods of hypoxaemia were reduced in the automated group (≤3 days; 32.6±57.8 min (1.2±1.9%) versus 370.5±594.3 min (5.0±11.2%), difference −10.2% (95% CI −13.9–−6.6%); p<0.0001), as well as hyperoxaemia under oxygen (≤3 days; 5.1±10.9 min (4.8±11.2%) versus 177.9±277.2 min (27.0±23.8%), difference −22.0% (95% CI −27.6–−16.4%); p<0.0001). Kaplan–Meier analysis depicted a significant difference in terms of hypoxaemia (p=0.01) and severe hypoxaemia (p=0.0003) occurrence between groups in favour of the automated group. 25 patients experienced hypoxaemia for >10% of the entire monitoring time during the 3 days within the standard group, as compared to the automated group (p<0.0001).ConclusionAutomated closed-loop oxygen administration promotes greater time within the oxygenation target, as compared to standard manual administration, thus reducing the occurrence of hypoxaemia and hyperoxaemia.
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23
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Boisson M, Corbi P, Kerforne T, Camilleri L, Debauchez M, Demondion P, Eljezi V, Flecher E, Lepelletier D, Leprince P, Nesseler N, Nizou JY, Roussel JC, Rozec B, Ruckly S, Lucet JC, Timsit JF, Mimoz O. Multicentre, open-label, randomised, controlled clinical trial comparing 2% chlorhexidine-70% isopropanol and 5% povidone iodine-69% ethanol for skin antisepsis in reducing surgical-site infection after cardiac surgery: the CLEAN 2 study protocol. BMJ Open 2019; 9:e026929. [PMID: 31213447 PMCID: PMC6596966 DOI: 10.1136/bmjopen-2018-026929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Surgical-site infection (SSI) is the second most frequent cause of healthcare-associated infection worldwide and is associated with increased morbidity, mortality and healthcare costs. Cardiac surgery is clean surgery with low incidence of SSI, ranging from 2% to 5%, but with potentially severe consequences.Perioperative skin antisepsis with an alcohol-based antiseptic solution is recommended to prevent SSI, but the superiority of chlorhexidine (CHG)-alcohol over povidone iodine (PVI)-alcohol, the two most common alcohol-based antiseptic solutions used worldwide, is controversial. We aim to evaluate whether 2% CHG-70% isopropanol is more effective than 5% PVI-69% ethanol in reducing the incidence of reoperation after cardiac surgery. METHODS AND ANALYSIS The CLEAN 2 study is a multicentre, open-label, randomised, controlled clinical trial of 4100 patients undergoing cardiac surgery. Patients will be randomised in 1:1 ratio to receive either 2% CHG-70% isopropanol or 5% PVI-69% ethanol for perioperative skin preparation. The primary endpoint is the proportion of patients undergoing any re-sternotomy between day 0 and day 90 after initial surgery and/or any reoperation on saphenous vein/radial artery surgical site between day 0 and day 30 after initial surgery. Data will be analysed on the intention-to-treat principle. ETHICS AND DISSEMINATION This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2017-005169-33 and NCT03560193.
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Affiliation(s)
- Matthieu Boisson
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM U1070, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
| | - Pierre Corbi
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Kerforne
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Camilleri
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathieu Debauchez
- Cardiothoracic Surgery Unit, Institut Mutualiste Montsouris, Paris, France
| | - Pierre Demondion
- Cardiothoracic Surgery Unit, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Vedat Eljezi
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Erwan Flecher
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Didier Lepelletier
- Infection Control Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pascal Leprince
- Cardiothoracic Surgery Unit, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Nicolas Nesseler
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Bertrand Rozec
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphane Ruckly
- INSERM UMR 1137, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
| | - Jean-Christophe Lucet
- Infection Control Unit, Hopital Bichat - Claude-Bernard, Paris, France
- Iame, INSERM, Paris, France
| | - Jean-François Timsit
- INSERM UMR 1137, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, Hopital Bichat - Claude-Bernard, Paris, France
| | - Olivier Mimoz
- INSERM U1070, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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24
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Kerforne T, Allain G, Giraud S, Bon D, Ameteau V, Couturier P, Hebrard W, Danion J, Goujon JM, Thuillier R, Hauet T, Barrou B, Jayle C. Defining the optimal duration for normothermic regional perfusion in the kidney donor: A porcine preclinical study. Am J Transplant 2019; 19:737-751. [PMID: 30091857 DOI: 10.1111/ajt.15063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/25/2023]
Abstract
Kidneys from donation after circulatory death (DCD) are highly sensitive to ischemia-reperfusion injury and thus require careful reconditioning, such as normothermic regional perfusion (NRP). However, the optimal NRP protocol remains to be characterized. NRP was modeled in a DCD porcine model (30 minutes of cardiac arrest) for 2, 4, or 6 hours compared to a control group (No-NRP); kidneys were machine-preserved and allotransplanted. NRP appeared to permit recovery from warm ischemia, possibly due to an increased expression of HIF1α-dependent survival pathway. At 2 hours, blood levels of ischemic injury biomarkers increased: creatinine, lactate/pyruvate ratio, LDH, AST, NGAL, KIM-1, CD40 ligand, and soluble-tissue-factor. All these markers then decreased with time; however, AST, NGAL, and KIM-1 increased again at 6 hours. Hemoglobin and platelets decreased at 6 hours, after which the procedure became difficult to maintain. Regarding inflammation, active tissue-factor, cleaved PAR-2 and MCP-1 increased by 4-6 hours, but not TNF-α and iNOS. Compared to No-NRP, NRP kidneys showed lower resistance during hypothermic machine perfusion (HMP), likely associated with pe-NRP eNOS activation. Kidneys transplanted after 4 and 6 hours of NRP showed better function and outcome, compared to No-NRP. In conclusion, our results confirm the mechanistic benefits of NRP and highlight 4 hours as its optimal duration, after which injury markers appear.
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Affiliation(s)
- Thomas Kerforne
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Anesthesia and Intensive Care Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Geraldine Allain
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,CardioVascular Surgery Division, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Sebastien Giraud
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Delphine Bon
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Virginie Ameteau
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Pierre Couturier
- INSERM U1082, (IRTOMIT), Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France
| | - William Hebrard
- Unité expérimentale Génétique, Expérimentations et systèmes innovants (GENESI), INRA, Domaine Expérimental du Magneraud, Surgères, France
| | - Jerome Danion
- INSERM U1082, (IRTOMIT), Poitiers, France.,Visceral Surgery Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Jean-Michel Goujon
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Pathology Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Raphael Thuillier
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France
| | - Thierry Hauet
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,Biochemistry Department, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France.,FHU SUPORT 'SUrvival oPtimization in ORgan Transplantation', Poitiers, France
| | - Benoit Barrou
- INSERM U1082, (IRTOMIT), Poitiers, France.,Service d'Urologie et de transplantation rénale, AP-HP, GH Pitié-Salpêtrière, Paris, France.,Pierre and Marie Curie Paris VI University, Paris, France
| | - Christophe Jayle
- INSERM U1082, (IRTOMIT), Poitiers, France.,Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.,CardioVascular Surgery Division, Poitiers Regional and Academic Teaching Hospital Center, Poitiers, France.,IBiSA 'plate-forme MOdélisation Préclinique - Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, Surgères, France
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Garcia R, Inal S, Favreau F, Jayle C, Hauet T, Bruneval P, Kerforne T, Hajj-Chahine J, Degand B. Subcutaneous cardioverter defibrillator has longer time to therapy but is less cardiotoxic than transvenous cardioverter defibrillator. Study carried out in a preclinical porcine model. Europace 2019; 20:873-879. [PMID: 28460030 DOI: 10.1093/europace/eux074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/21/2017] [Indexed: 01/04/2023] Open
Abstract
Aims Totally subcutaneous implantable cardioverter defibrillator (S-ICD) delivers higher shock energy and can have longer time to therapy compared to transvenous implantable cardioverter defibrillator (T-ICD). Aim of the study was to compare time to therapy and to investigate cardiac, cerebral and systemic injuries of S-ICD and T-ICD shocks delivered after ventricular fibrillation (VF) induction. Methods and results Fourteen pigs were randomly implanted with a S-ICD (n = 7) or a T-ICD (n = 7). Five VF episodes were induced in each pig. For each VF episode, up to two shocks could be delivered by the T-ICD or the S-ICD to terminate the arrhythmia. Cardiac, systemic, and cerebral toxicity were monitored. Mean time to therapy was longer in the S-ICD group compared to the T-ICD group (19[18; 23] s vs. 9 [7; 10] s; P = 0.001, respectively). High-sensitivity troponin T levels were significantly higher in the T-ICD group from 1 to 24 h after the procedure (P ≤ 0.02). Creatine phosphokinase activity levels were significantly higher in the S-ICD group, at 3, 6, and 24 h after the procedure (P ≤ 0.05). Lactate levels were not significantly different between groups. S100 protein level was similar in both groups at 1 h after the procedure and then decreased in the T-ICD group compared to the S-ICD group (P = 0.04). Conclusions Time to therapy in S-ICD was twice as long as for T-ICD, but didn't induce relevant brain injury. Conversely, S-ICD shocks were less cardiotoxic than T-ICD shocks.
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Affiliation(s)
- Rodrigue Garcia
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, Poitiers 86021, France.,Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France
| | - Sofiane Inal
- Inserm U1082, Poitiers, 86000, France.,CHU de Poitiers, Service de Biochimie, Poitiers 86000, France
| | - Frederic Favreau
- Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France.,Inserm U1082, Poitiers, 86000, France.,CHU de Poitiers, Service de Biochimie, Poitiers 86000, France
| | - Christophe Jayle
- Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France.,Inserm U1082, Poitiers, 86000, France.,MOPICT Plateform 'Experimental Surgery and Transplantation', INRA, Domaine Expérimental du Magneraud, Surgères 17700 France.,CHU de Poitiers, Service de chirurgie cardio-thoracique, 2 rue de la Milétrie, Poitiers 86021, France
| | - Thierry Hauet
- Univ Poitiers, Faculté de Médecine et de Pharmacie, Poitiers 86000, France.,Inserm U1082, Poitiers, 86000, France.,CHU de Poitiers, Service de Biochimie, Poitiers 86000, France.,MOPICT Plateform 'Experimental Surgery and Transplantation', INRA, Domaine Expérimental du Magneraud, Surgères 17700 France
| | - Patrick Bruneval
- HEGP, APHP, Service d'anatomie-pathologie, 20 Rue Leblanc, Paris 75015, France
| | - Thomas Kerforne
- CHU de Poitiers, Service d'Anesthésie et Réanimation, 2 rue de la Milétrie, Poitiers 86021, France
| | - Jamil Hajj-Chahine
- CHU de Poitiers, Service de chirurgie cardio-thoracique, 2 rue de la Milétrie, Poitiers 86021, France
| | - Bruno Degand
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, Poitiers 86021, France
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26
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L’her E, Jaber S, Verzilli D, Jacob C, Huiban B, Futier E, Kerforne T, Pateau V, Bouchard PA, Gouillou M, Nowak E, Lellouche F. Automated oxygen administration versus conventional oxygen therapy after major abdominal or thoracic surgery: study protocol for an international multicentre randomised controlled study. BMJ Open 2019; 9:e023833. [PMID: 30782716 PMCID: PMC6340445 DOI: 10.1136/bmjopen-2018-023833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/20/2023] Open
Abstract
INTRODUCTION Hypoxemia and hyperoxia may occur after surgery with potential related complications. The FreeO2 PostOp trial is a prospective, multicentre, randomised controlled trial that evaluates the clinical impact of automated O2 administration versus conventional O2 therapy after major abdominal or thoracic surgeries. The study is powered to demonstrate benefits of automated oxygen titration and weaning in term of oxygenation, which is an important surrogate for complications after such interventions. METHODS AND ANALYSIS After extubation, patients are randomly assigned to the Standard (manual O2 administration) or FreeO2 group (automated closed-loop O2 administration). Stratification is performed for the study centre and a medical history of chronic obstructive pulmonary disease (COPD). Primary outcome is the percentage of time spent in the target zone of oxygen saturation, during a 3-day time frame. In both groups, patients will benefit from continuous oximetry recordings. The target zone of oxygen saturation is SpO2=88%-92% for patients with COPD and 92%-96% for patients without COPD. Secondary outcomes are the nursing workload assessed by the number of manual O2 flow adjustments, the time spent with severe desaturation (SpO2 <85%) and hyperoxia area (SpO2 >98%), the time spent in a hyperoxia area (SpO2 >98%), the VO2, the duration of oxygen administration during hospitalisation, the frequency of use of mechanical ventilation (invasive or non-invasive), the duration of the postrecovery room stay, the hospitalisation length of stay and the survival rate. ETHICS AND DISSEMINATION The FreeO2 PostOp study is conducted in accordance with the declaration of Helsinki and was registered on 11 September 2015 (http://www.clinicaltrials.gov). First patient inclusion was performed on 14 January 2016. The results of the study will be presented at academic conferences and submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02546830.
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Affiliation(s)
- Erwan L’her
- Medical Intensive Care, CHRU de Brest—La Cavale Blanche, Brest, France
- LATIM INSERM UMR 1101, FHU Techsan, Université de Bretagne Occidentale, Brest, France
| | - Samir Jaber
- Intensive Care Unit, Department of Anesthesiology B, DAR B CHU de Montpellier, Hôpital Saint Eloi, Université Montpellier 1, Montpellier, France
| | - Daniel Verzilli
- Intensive Care Unit, Department of Anesthesiology B, DAR B CHU de Montpellier, Hôpital Saint Eloi, Université Montpellier 1, Montpellier, France
| | - Christophe Jacob
- Anesthesiology Department, CHRU de Brest—La Cavale Blanche, Brest, France
| | - Brigitte Huiban
- Anesthesiology Department, CHRU de Brest—La Cavale Blanche, Brest, France
| | - Emmanuel Futier
- Anesthesiology Department, Hôpital Estaing, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Kerforne
- Anesthesiology Department, CHU de Poitiers, Poitiers Cedex, France
| | - Victoire Pateau
- LATIM INSERM UMR 1101, FHU Techsan, Université de Bretagne Occidentale, Brest, France
- R&D, Oxynov Inc., Technopôle Brest Iroise, Plouzané, France
| | - Pierre-Alexandre Bouchard
- Research laboratory, Centre de recherche de l’Institut de Cardiologie et de Pneumologie de Québec, Québec, France
| | - Maellen Gouillou
- Centre d’Investigation Clinique CIC INSERM 1412, CHRU de Brest—La Cavale Blanche, Brest, France
| | - Emmanuel Nowak
- Centre d’Investigation Clinique CIC INSERM 1412, CHRU de Brest—La Cavale Blanche, Brest, France
| | - François Lellouche
- Research laboratory, Centre de recherche de l’Institut de Cardiologie et de Pneumologie de Québec, Québec, France
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Kerforne T, Favreau F, Khalifeh T, Maiga S, Allain G, Thierry A, Dierick M, Baulier E, Steichen C, Hauet T. Hypercholesterolemia-induced increase in plasma oxidized LDL abrogated pro angiogenic response in kidney grafts. J Transl Med 2019; 17:26. [PMID: 30642356 PMCID: PMC6332834 DOI: 10.1186/s12967-018-1764-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/31/2018] [Indexed: 01/06/2023] Open
Abstract
Background Renal transplantation is increasingly associated with the presence of comorbidity factors such as dyslipidemia which could influence the graft outcome. We hypothesized that hypercholesterolemia could affect vascular repair processes and promote post-transplant renal vascular remodeling through the over-expression of the anti-angiogenic thrombospondin-1 interacting with vascular endothelial growth factor-A levels. Methods We tested this hypothesis in vitro, in vivo and in a human cohort using (1) endothelial cells; (2) kidney auto-transplanted pig subjected (n = 5) or not (n = 6) to a diet enriched in cholesterol and (3) a renal transplanted patient cohort (16 patients). Results Cells exposed to oxidized LDL showed reduced proliferation and an increased expression of thrombospondin-1. In pigs, 3 months after transplantation of kidney grafts, we observed a deregulation of the hypoxia inducible factor 1a—vascular endothelial growth factor-A axis induced in cholesterol-enriched diet animals concomitant with an overexpression of thrombospondin-1 and a decrease in cortical microvessel density promoting vascular remodeling. In patients, hypercholesterolemia was associated with decreased vascular endothelial growth factor-A plasma levels during early follow up after renal transplantation and increased chronic graft dysfunction. Conclusions These results support a potential mechanism through which a high fat-diet impedes vascular repair in kidney graft and suggest the value of controlling cholesterolemia in recipient even at the early stage of renal transplantation. Electronic supplementary material The online version of this article (10.1186/s12967-018-1764-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Kerforne
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Service d'Anesthésie-Réanimation, CHU de Poitiers, 86000, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000, Poitiers, France
| | - Frédéric Favreau
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Faculté de Médecine, EA 6309 "Maintenance Myélinique et Neuropathies Périphériques», Université de Limoges, 87000, Limoges, France.,Laboratoire de Biochimie et Génétique Moléculaire, CHU de Limoges, 87000, Limoges, France
| | - Tackwa Khalifeh
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Service Medico-Chirurgical de Pediatrie, CHU de Poitiers, 86000, Poitiers, France
| | - Souleymane Maiga
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France
| | - Geraldine Allain
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000, Poitiers, France.,Service de Chirurgie Cardio-Thoracique, CHU de Poitiers, 86000, Poitiers, France
| | - Antoine Thierry
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000, Poitiers, France.,Service de Néphrologie et Transplantation, CHU de Poitiers, 86000, Poitiers, France
| | - Manuel Dierick
- UGCT-Department of Physics and Astronomy, Faculty of Sciences, Ghent University, Proeftuinstraat 86, 9000, Ghent, Belgium
| | - Edouard Baulier
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000, Poitiers, France.,Service de Biochimie, CHU de Poitiers, Poitiers, 86000, France
| | - Clara Steichen
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000, Poitiers, France
| | - Thierry Hauet
- INSERM U1082 IRTOMIT, 2 rue de la Milétrie, CS90577, 86000, Poitiers, France. .,Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000, Poitiers, France. .,Service de Biochimie, CHU de Poitiers, Poitiers, 86000, France. .,IBiSA 'Plate-Forme MOdélisation Préclinique-Innovations Chirurgicale et Technologique (MOPICT)', Domaine Expérimental du Magneraud, 17700, Surgères, France. .,FHU SUPORT 'SUrvival oPtimization in ORgan Transplantation', 86000, Poitiers, France.
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Schaerer F, Kerforne T, Lacroix C, Chauvet S, Rayed-Pelardy F, Biedermann C, Lequeux B, Corbi P, Christiaens L, Rehman M, Larrieu-Ardilouze E. Predictors for myocardial recovery of patients implanted with an ECMO device following myocardial infarction. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rousseau L, Kerforne T, Boisson M, Mimoz O, Dahyot-Fizelier C. Perioperative management of asplenic patients in France: A national survey among anaesthetists. Anaesth Crit Care Pain Med 2017; 36:359-363. [PMID: 28870849 DOI: 10.1016/j.accpm.2017.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 04/23/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Ludivine Rousseau
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
| | - Thomas Kerforne
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1082, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Matthieu Boisson
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Olivier Mimoz
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Department of Adult Emergency - University Hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, University of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Gamet A, Raud-Raynier P, Kerforne T, Velasco S, Christiaens L. Acquired Systemic-to-pulmonary Venous Shunt or Persistent Left Superior Vena Cava? A Rare Right-to-left Shunt Case-based Discussion. J Cardiovasc Echogr 2017; 27:104-106. [PMID: 28758063 PMCID: PMC5516440 DOI: 10.4103/jcecho.jcecho_42_16] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction. After medico-surgical discussion, a first-line conservative treatment with oxygen therapy was chosen, due to the stability of symptoms and high predicted risk of perioperative mortality. The particularities of this case are that we cannot determine if the origin of this shunt is a latent persistent left SVC becoming symptomatic after the SVC obstruction or an abnormal collateral pathway due to the thrombosis and the unusual indirect communication through a pulmonary vein.
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Affiliation(s)
- Alexandre Gamet
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | | | - Thomas Kerforne
- Cardiothoracic Intensive Care Unit, University Hospital of Poitiers, Poitiers, France
| | - Stéphane Velasco
- Department of Radiology, University Hospital of Poitiers, Poitiers, France
| | - Luc Christiaens
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
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Asehnoune K, Mrozek S, Perrigault PF, Seguin P, Dahyot-Fizelier C, Lasocki S, Pujol A, Martin M, Chabanne R, Muller L, Hanouz JL, Hammad E, Rozec B, Kerforne T, Ichai C, Cinotti R, Geeraerts T, Elaroussi D, Pelosi P, Jaber S, Dalichampt M, Feuillet F, Sebille V, Roquilly A. A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project. Intensive Care Med 2017; 43:957-970. [PMID: 28315940 DOI: 10.1007/s00134-017-4764-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 12/26/2016] [Accepted: 03/07/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. METHODS Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French intensive care units (ICUs) were included. The management of invasive ventilation in brain-injured patients admitted between 1 July 2013 and 31 October 2013 (4 months) was monitored and analysed. After the baseline period (1 November 2013-31 December 2013), ventilator settings and decision to extubate were selected as targets to hasten weaning from invasive ventilation. During the intervention period, low tidal volume (≤7 ml/kg), moderate positive end-expiratory pressure (PEEP, 6-8 cm H2O) and an early extubation protocol were recommended. The primary endpoint was the number of days free of invasive ventilation at day 90. Comparisons were performed between the two periods and between the compliant and non-compliant groups. RESULTS A total of 744 patients from 20 ICUs were included (391 pre-intervention; 353 intervention). No difference in the number of invasive ventilation-free days at day 90 was observed between the two periods [71 (0-80) vs. 67 (0-80) days; P = 0.746]. Compliance with the complete set of recommendations increased from 8 (2%) to 52 (15%) patients after the intervention (P < 0.001). At day 90, the number of invasive ventilation-free days was higher in the 60 (8%) patients whose care complied with recommendations than in the 684 (92%) patients whose care deviated from recommendations [77 (66-82) and 71 (0-80) days, respectively; P = 0.03]. The mortality rate was 10% in the compliant group and 26% in the non-compliant group (P = 0.023). Both multivariate analysis [hazard ratio (HR) 1.78, 95% confidence interval (95% CI) 1.41-2.26; P < 0.001] and propensity score-adjusted analysis (HR 2.25, 95% CI 1.56-3.26, P < 0.001) revealed that compliance was an independent factor associated with the reduction in the duration of mechanical ventilation. CONCLUSIONS Adherence to recommendations for low tidal volume, moderate PEEP and early extubation seemed to increase the number of ventilator-free days in brain-injured patients, but inconsistent adoption limited their impact. Trail registration number: NCT01885507.
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Affiliation(s)
- Karim Asehnoune
- Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME-University Hospital of Nantes , Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France.
- Service d'Anesthésie Réanimation, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - Ségolène Mrozek
- Department of Anesthesiology and Critical Care Department, University Hospital of Toulouse, Toulouse, France
| | - Pierre François Perrigault
- Intensive Care Unit, Anesthesia and Critical Care Department, Gui Chauliac University Hospital of Montpellier, Montpellier, France
| | - Philippe Seguin
- Intensive Care Unit, Anesthesia and Critical Care Department, Pontchaillou-University Hospital of Rennes, Rennes, France
| | - Claire Dahyot-Fizelier
- Neuro-Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Poitiers, Poitiers, France
| | - Sigismond Lasocki
- Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Angers, Angers, France
| | - Anne Pujol
- Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Tours, Tours, France
| | - Mathieu Martin
- Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Créteil-CHU Henri Mondor, Assistance publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Russel Chabanne
- Department of Anesthesiology and Intensive Care, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - Laurent Muller
- Department of Anesthesiology and Intensive Care, University Hospital of Nimes, Nimes, France
| | - Jean Luc Hanouz
- Department of Anesthesiology and Intensive Care, University Hospital of Caen, Caen, France
| | - Emmanuelle Hammad
- Department of Anesthesiology and Intensive Care, University Hospital of Marseille, Marseille, France
| | - Bertrand Rozec
- Intensive Care Unit, Anesthesia and Critical Care Department, Laennec-University Hospital of Nantes, Nantes, France
| | - Thomas Kerforne
- Surgical Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Poitiers, Poitiers, France
| | - Carole Ichai
- Intensive Care Unit , Pasteur 2-University Hospital of Nice, Nice, France
| | - Raphael Cinotti
- Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME-University Hospital of Nantes , Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care Department, University Hospital of Toulouse, Toulouse, France
| | - Djillali Elaroussi
- Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Tours, Tours, France
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST National Cancer Research Institute, University of Genoa, Genoa, Italy
| | - Samir Jaber
- Intensive Care Unit, Anesthesia and Critical Care Department, Saint Eloi University Hospital of Montpellier, Montpellier, France
| | - Marie Dalichampt
- Plateforme de Biométrie, Département Promotion de la Recherche Clinique, University Hospital of Nantes, Nantes, France
| | - Fanny Feuillet
- EA 4275, MethodS for Patients-centered Outcomes and HEalth REsearch (SPHERE), UFR des Sciences Pharmaceutiques, Nantes University, Nantes, France
| | - Véronique Sebille
- Plateforme de Biométrie, Département Promotion de la Recherche Clinique, University Hospital of Nantes, Nantes, France
- EA 4275, MethodS for Patients-centered Outcomes and HEalth REsearch (SPHERE), UFR des Sciences Pharmaceutiques, Nantes University, Nantes, France
| | - Antoine Roquilly
- Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME-University Hospital of Nantes , Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
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Tillet S, Giraud S, Kerforne T, Saint-Yves T, Joffrion S, Goujon JM, Cau J, Mauco G, Petitou M, Hauet T. Inhibition of coagulation proteases Xa and IIa decreases ischemia-reperfusion injuries in a preclinical renal transplantation model. Transl Res 2016; 178:95-106.e1. [PMID: 27513209 DOI: 10.1016/j.trsl.2016.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 11/30/2022]
Abstract
Coagulation is an important pathway in the pathophysiology of ischemia-reperfusion injuries. In particular, deceased after circulatory death (DCD) donors undergo a no-flow period, a strong activator of coagulation. Hence, therapies influencing the coagulation cascade must be developed. We evaluated the effect of a new highly specific and effective anti-Xa/IIa molecule, with an integrated innovative antidote site (EP217609), in a porcine preclinical model mimicking injuries observed in DCD donor kidney transplantation. Kidneys were clamped for 60 minutes (warm ischemia), then flushed and preserved for 24 hours at 4°C in University of Wisconsin (UW) solution (supplemented or not). EP217609-supplemented UW solution (UW-EP), compared with unfractionated heparin-supplemented UW solution (UW-UFH) or UW alone (UW). A mechanistic investigation was conducted in vitro: addition of EP217609 to endothelial cells during hypoxia at 4°C in the UW solution inhibited thrombin generation during reoxygenation at 37°C in human plasma and reduced tumor necrosis factor alpha, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 messenger RNA cell expressions. In vivo, function recovery was markedly improved in the UW-EP group. Interestingly, levels of thrombin-antithrombin complexes (reflecting thrombin generation) were reduced 60 minutes after reperfusion in the UW-EP group. In addition, 3 months after transplantation, lower fibrosis, epithelial-mesenchymal transition, inflammation, and leukocyte infiltration were observed. Using this new dual anticoagulant, anti-Xa/IIa activity during kidney flush and preservation is protected by reducing thrombin generation at revascularization, improving early function recovery, and decreasing chronic lesions. Such an easy-to-deploy clinical strategy could improve marginal graft outcome.
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Affiliation(s)
- Solenne Tillet
- Inserm U1082 IRTOMIT, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France
| | - Sébastien Giraud
- Inserm U1082 IRTOMIT, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU Poitiers, Service de Biochimie, Poitiers, France
| | - Thomas Kerforne
- Inserm U1082 IRTOMIT, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU Poitiers, Département d'Anesthésie-Réanimation, Poitiers, France
| | - Thibaut Saint-Yves
- Inserm U1082 IRTOMIT, Poitiers, France; CH d'Angoulème, Service de Chirurgie Urologie, Angoulème, France; CHU de Poitiers, Service d'Urologie, Pôle DUNE, Poitiers, France
| | - Sandrine Joffrion
- Inserm U1082 IRTOMIT, Poitiers, France; CHU Poitiers, Service de Biochimie, Poitiers, France
| | - Jean-Michel Goujon
- Inserm U1082 IRTOMIT, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU de Poitiers, Service d'Anapathomopathologie, Poitiers, France
| | | | - Gérard Mauco
- Inserm U1082 IRTOMIT, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU Poitiers, Service de Biochimie, Poitiers, France
| | | | - Thierry Hauet
- Inserm U1082 IRTOMIT, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU Poitiers, Service de Biochimie, Poitiers, France; IBiSA Plateforme 'plate-forme MOdélisation Préclinique-Innovation Chirurgicale et Technologique (MOPICT), INRA Domaine Expérimental du Magneraud, Surgères, France; FHU SUPORT 'SUrvival oPtimization in ORgan Transplantation', Poitiers, France.
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Kerforne T, Favreau F, Thuillier R, Hauet T, Pinsard M. [Toward a customized preservation for each kidney graft?]. Nephrol Ther 2016; 12:437-442. [PMID: 27720135 DOI: 10.1016/j.nephro.2016.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 01/24/2023]
Abstract
The increased number of patients in waiting list for renal transplantation requires the establishment of recommendations regarding graft preservation techniques. The preservation method impacts graft function and survival particularly in case of extended criteria donors. Based on our experience, the aim of this review is to establish a decisional diagram to draw graft management to 5years in relation to donor type and graft quality. Novel biomarkers are necessary to evaluate graft quality. Nuclear magnetic resonance or transcriptomic analyses are promising. Thus, good quality organs will be preserved in static condition associated to hypothermia; while grafts from extended criteria donors need to be assessed early during dynamic perfusion through an evaluation of perfusion solution to discriminate: good organs, with acceptable risks without perfusion conditions modifications; tolerable risk grafts for which it will be recommended to use a supplementation of perfusion solution with oxygen or pharmacologic additives such as mitochondrion protectors or oxygen carriers; and elevated risks graft which will not be used. This diagram based on experimental data needs to be assessed in clinical trials but highlights the crucial role of kidney graft quality assessment for its management and placed dynamic perfusion preservation as the protocol of choice for extended criteria donors.
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Affiliation(s)
- Thomas Kerforne
- Inserm, U1082, IRTOMIT, ischémie-reperfusion en transplantation d'organe, mécanismes et innovations thérapeutiques, faculté de médecine et de pharmacie de Poitiers, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France; Service de réanimation chirurgicale, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France
| | - Frédéric Favreau
- Inserm, U1082, IRTOMIT, ischémie-reperfusion en transplantation d'organe, mécanismes et innovations thérapeutiques, faculté de médecine et de pharmacie de Poitiers, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France; Laboratoire de biochimie, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France
| | - Raphaël Thuillier
- Inserm, U1082, IRTOMIT, ischémie-reperfusion en transplantation d'organe, mécanismes et innovations thérapeutiques, faculté de médecine et de pharmacie de Poitiers, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France; Laboratoire de biochimie, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France
| | - Thierry Hauet
- Inserm, U1082, IRTOMIT, ischémie-reperfusion en transplantation d'organe, mécanismes et innovations thérapeutiques, faculté de médecine et de pharmacie de Poitiers, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France; Laboratoire de biochimie, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France; Inra, UE1372 GenESI, plateforme labellisée IBiSA MOPICT, BP 52, Saint-Pierre d'Amilly, 17700 Surgères, France; Fédération hospitalo-universitaire suport, CS90577, 86021 Poitiers, France.
| | - Michel Pinsard
- Inserm, U1082, IRTOMIT, ischémie-reperfusion en transplantation d'organe, mécanismes et innovations thérapeutiques, faculté de médecine et de pharmacie de Poitiers, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France; Service de réanimation chirurgicale, CHU de Poitiers, 2, rue de la Milétrie, CS90577, 86021 Poitiers, France
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Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, Mercat A, Bouadma L, Lasocki S, Alfandari S, Friggeri A, Wallet F, Allou N, Ruckly S, Balayn D, Lepape A, Timsit JF. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 2015; 386:2069-2077. [PMID: 26388532 DOI: 10.1016/s0140-6736(15)00244-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [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: 11/25/2022]
Abstract
BACKGROUND Intravascular-catheter-related infections are frequent life-threatening events in health care, but incidence can be decreased by improvements in the quality of care. Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections. We hypothesised that chlorhexidine-alcohol would be more effective than povidone iodine-alcohol as a skin antiseptic to prevent intravascular-catheter-related infections. METHODS In this open-label, randomised controlled trial with a two-by-two factorial design, we enrolled consecutive adults (age ≥18 years) admitted to one of 11 French intensive-care units and requiring at least one of central-venous, haemodialysis, or arterial catheters. Before catheter insertion, we randomly assigned (1:1:1:1) patients via a secure web-based random-number generator (permuted blocks of eight, stratified by centre) to have all intravascular catheters prepared with 2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) or 5% povidone iodine-69% ethanol (povidone iodine-alcohol), with or without scrubbing of the skin with detergent before antiseptic application. Physicians and nurses were not masked to group assignment but microbiologists and outcome assessors were. The primary outcome was the incidence of catheter-related infections with chlorhexidine-alcohol versus povidone iodine-alcohol in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01629550 and is closed to new participants. FINDINGS Between Oct 26, 2012, and Feb 12, 2014, 2546 patients were eligible to participate in the study. We randomly assigned 1181 patients (2547 catheters) to chlorhexidine-alcohol (594 patients with scrubbing, 587 without) and 1168 (2612 catheters) to povidone iodine-alcohol (580 patients with scrubbing, 588 without). Chlorhexidine-alcohol was associated with lower incidence of catheter-related infections (0·28 vs 1·77 per 1000 catheter-days with povidone iodine-alcohol; hazard ratio 0·15, 95% CI 0·05-0·41; p=0·0002). Scrubbing was not associated with a significant difference in catheter colonisation (p=0·3877). No systemic adverse events were reported, but severe skin reactions occurred more frequently in those assigned to chlorhexidine-alcohol (27 [3%] patients vs seven [1%] with povidone iodine-alcohol; p=0·0017) and led to chlorhexidine discontinuation in two patients. INTERPRETATION For skin antisepsis, chlorhexidine-alcohol provides greater protection against short-term catheter-related infections than does povidone iodine-alcohol and should be included in all bundles for prevention of intravascular catheter-related infections. FUNDING University Hospital of Poitiers, CareFusion.
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Affiliation(s)
- Olivier Mimoz
- Service d'Anesthésie et de Réanimation, CHU de Poitiers, Poitiers, France; Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents antiInfectieux, Poitiers, France.
| | - Jean-Christophe Lucet
- AP-HP, Bichat University Hospital, Infection Control Unit, Paris, France; INSERM, UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Thomas Kerforne
- Service d'Anesthésie et de Réanimation, CHU de Poitiers, Poitiers, France
| | - Julien Pascal
- Service de Réanimation Adultes et Unité de Surveillance Continue, CHU Clermont Ferrand, Clermont Ferrand, France
| | - Bertrand Souweine
- Service de Réanimation médicale, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Véronique Goudet
- Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - Alain Mercat
- Département de Réanimation Médicale et Médecine Hyperbare, CHU d'Angers, Angers, France
| | - Lila Bouadma
- INSERM, UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Serge Alfandari
- Service de Réanimation et Maladies infectieuses, CH de Tourcoing, Tourcoing, France
| | - Arnaud Friggeri
- Service d'Anesthésie et de Réanimation Médicale et Chirurgicale, CHU Lyon-Sud, Lyon, France
| | - Florent Wallet
- Service d'Anesthésie et de Réanimation Médicale et Chirurgicale, CHU Lyon-Sud, Lyon, France
| | - Nicolas Allou
- Service de Réanimation Chirurgicale, Hôpital Bichat-Claude-Bernard, Paris, France
| | | | - Dorothée Balayn
- Service d'Anesthésie et de Réanimation, CHU de Poitiers, Poitiers, France
| | - Alain Lepape
- Service d'Anesthésie et de Réanimation Médicale et Chirurgicale, CHU Lyon-Sud, Lyon, France
| | - Jean-François Timsit
- INSERM, UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Codas-Duarte R, Baulier E, Kerforne T, Delpech P, Saintyves T, Barrou B, Tillement J, Hauet T, Badet L. Rôle de la modulation mitochondriale au cours de la conservation rénale: évaluation dans un modèle préclinique de donneur décédé par arrêt cardiaque. Prog Urol 2014; 24:802-3. [DOI: 10.1016/j.purol.2014.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Allain G, Kerforne T, Thuret R, Delpech PO, Saint-Yves T, Pinsard M, Hauet T, Giraud S, Jayle C, Barrou B. Development of a preclinical model of donation after circulatory determination of death for translational application. Transplant Res 2014; 3:13. [PMID: 24999383 PMCID: PMC4082279 DOI: 10.1186/2047-1440-3-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/04/2014] [Indexed: 11/23/2022] Open
Abstract
Background Extracorporeal membranous oxygenation is proposed for abdominal organ procurement from donation after circulatory determination of death (DCD). In France, the national Agency of Biomedicine supervises the procurement of kidneys from DCD, specifying the durations of tolerated warm and cold ischemia. However, no study has determined the optimal conditions of this technique. The aim of this work was to develop a preclinical model of DCD using abdominal normothermic oxygenated recirculation (ANOR). In short, our objectives are to characterize the mechanisms involved during ANOR and its impact on abdominal organs. Methods We used Large White pigs weighing between 45 and 55 kg. After 30 minutes of potassium-induced cardiac arrest, the descending thoracic aorta was clamped and ANOR set up between the inferior vena cava and the abdominal aorta for 4 hours. Hemodynamic, respiratory and biochemical parameters were collected. Blood gasometry and biochemistry analysis were performed during the ANOR procedure. Results Six ANOR procedures were performed. The surgical procedure is described and intraoperative parameters and biological data are presented. Pump flow rates were between 2.5 and 3 l/min. Hemodynamic, respiratory, and biochemical objectives were achieved under reproducible conditions. Interestingly, animals remained hemodynamically stable following the targeted protocol. Arterial pH was controlled, and natremia and renal function remained stable 4 hours after the procedure was started. Decreased hemoglobin and serum proteins levels, concomitant with increased lactate dehydrogenase activity, were observed as a consequence of the surgery. The serum potassium level was increased, owing to the extracorporeal circulation circuit. Conclusions Our ANOR model is the closest to clinical conditions reported in the literature and will allow the study of the systemic and abdominal organ impact of this technique. The translational relevance of the pig will permit the determination of new biomarkers and protocols to improve DCD donor management.
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Affiliation(s)
- Géraldine Allain
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Chirurgie cardio-thoracique, Poitiers F-86000, France
| | - Thomas Kerforne
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Réanimation chirurgicale, Poitiers F-86000, France
| | - Rodolphe Thuret
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Montpellier, Service d'Urologie et de transplantation rénale, Montpellier F-34295, France
| | - Pierre-Olivier Delpech
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service d'Urologie, Poitiers F-86000, France
| | - Thibaut Saint-Yves
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service d'Urologie, Poitiers F-86000, France
| | - Michel Pinsard
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Réanimation chirurgicale, Poitiers F-86000, France ; CHU de Montpellier, Service d'Urologie et de transplantation rénale, Montpellier F-34295, France
| | - Thierry Hauet
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers F-86000, France ; CHU Poitiers, Service de Biochimie, Poitiers F-86000, France ; IBISA Platform 'Experimental Surgery and Transplantation', INRA, Domaine expérimental du Magneraud, Surgères F-17700, France
| | - Sébastien Giraud
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU Poitiers, Service de Biochimie, Poitiers F-86000, France
| | - Christophe Jayle
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; CHU de Poitiers, Service de Chirurgie cardio-thoracique, Poitiers F-86000, France ; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers F-86000, France ; IBISA Platform 'Experimental Surgery and Transplantation', INRA, Domaine expérimental du Magneraud, Surgères F-17700, France
| | - Benoît Barrou
- INSERM U1082, CHU de Poitiers, rue de la Milétrie, B.P. 577, F-86021 Cedex Poitiers, France ; GH Pitié-Salpêtrière, AP-HP, Service d'Urologie et de transplantation rénale, Paris F-75013, France ; UPMC Université Paris VI, Paris F-75013, France
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Kerforne T, Chaillan M, Geraud L, Mimoz O. Ultrasound diagnosis of nasogastric tube misplacement into the trachea during bypass surgery. Br J Anaesth 2014; 111:1032-3. [PMID: 24233318 DOI: 10.1093/bja/aet399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kerforne T, Petitpas F, Scepi M, Loupec T, Dufour J, Nanadoumgar H, Richer J, Cornu-Skurnik A, Bendahou M, Riou B, Debaene B, Mimoz O. Accurate and easy to learn ultrasound sign to confirm correct tracheal intubation in cadaver model. Br J Anaesth 2013; 111:510-1. [DOI: 10.1093/bja/aet270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kerforne T, Petitpas F, Frasca D, Goudet V, Robert R, Mimoz O. Ultrasound-Guided Peripheral Venous Access in Severely Ill Patients With Suspected Difficult Vascular Puncture. Chest 2012; 141:279-280. [DOI: 10.1378/chest.11-2054] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Chaillan M, Badin J, Kerforne T, Voultoury J, Pinsard M. [Severe acute asthma: isoflurane administration via AnaConDa™, is it safe?]. ACTA ACUST UNITED AC 2010; 30:70-2. [PMID: 21146349 DOI: 10.1016/j.annfar.2010.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
Abstract
Standard treatments against severe acute asthma can be insufficient and need salvation treatments, such as isoflurane delivery. These treatments have not been much assessed and could lead to unrecognized side-effects. We report the case of a young man who suffered from intracranial hypertension associated with severe hypercapnia during the delivery of isoflurane via the system AnaConDa™ or Anaesthetic Conserving Device™ (ACD) (Sedama Medical). The rising of PaCO(2) appears to be linked to an ACD-dependent increase in the dead space.
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Affiliation(s)
- M Chaillan
- Service de réanimation médicale, CHU la Milétrie, 2, rue de la Milétrie 86000 Poitiers, France.
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