Search

Author(s): Christophe Guervilly [sup.1] [sup.2], Eloi Prud'homme [sup.1], Vanessa Pauly [sup.2], Jérémie Bourenne [sup.3], Sami Hraiech [sup.2] [sup.4], Florence Daviet [sup.1], Mélanie Adda [sup.1], Benjamin Coiffard [sup.1] [sup.2], Jean Marie [...]

Purpose To investigate whether neuromuscular blocking agents (NMBA) exert beneficial effects in acute respiratory distress syndrome (ARDS) by reason of their action on respiratory mechanics, particularly transpulmonary pressures (P.sub.L). Methods A prospective randomised controlled study in patients with moderate to severe ARDS within 48 h of the onset of ARDS. All patients were monitored by means of an oesophageal catheter and followed up for 48 h. Moderate ARDS patients were randomised into two groups according to whether they were given a 48-h continuous infusion of cisatracurium besylate or not (control group). Severe ARDS patients did not undergo randomisation and all received cisatracurium besylate per protocol. The changes during the 48-h study period in oxygenation and in respiratory mechanics, including inspiratory and expiratory P.sub.L and driving pressure, were assessed and compared. Delta P.sub.L (âP.sub.L) was defined as inspiratory P.sub.L minus expiratory P.sub.L. Results Thirty patients were included, 24 with moderate ARDS and 6 with severe ARDS. NMBA infusion was associated with an improvement in oxygenation in both moderate and severe ARDS, accompanied by a decrease in both plateau pressure and total positive end-expiratory pressure. The mean inspiratory and expiratory P.sub.L were higher in the moderate ARDS group receiving NMBA than in the control group. In contrast, there was no change in either driving pressure or âP.sub.L related to NMBA administration. Conclusions NMBA could exert beneficial effects in patients with moderate ARDS, at least in part, by limiting expiratory efforts., Author(s): Christophe Guervilly [sup.1], Magali Bisbal [sup.2] [sup.3], Jean Marie Forel [sup.1], Malika Mechati [sup.3], Samuel Lehingue [sup.1], Jeremy Bourenne [sup.3], Gilles Perrin [sup.3], Romain Rambaud [sup.1], Melanie Adda [sup.1], [...]

Purpose Prone position (PP) improves oxygenation and outcome of acute respiratory distress syndrome (ARDS) patients with a PaO.sub.2/FiO.sub.2 ratio Methods We conducted a prospective multicenter study that included adult patients with severe and moderate ARDS. LUS data were collected at four time points: 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. Overdistension was not assessed. Results Fifty-one patients were included. Oxygenation response after PP was not correlated with a specific LUS pattern. The patients with focal and non-focal ARDS showed no difference in global reaeration score. With regard to the entire PP session, the patients with non-focal ARDS had an improved aeration gain in the anterior areas. Oxygenation response was not associated with aeration changes. No difference in PaCO.sub.2 change was found according to oxygenation response or lung morphology. Conclusions In ARDS patients with a PaO.sub.2/FiO.sub.2 ratio [less than or equal to]150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP., Author(s): Malik Haddam [sup.1] , Laurent Zieleskiewicz [sup.1] , Sebastien Perbet [sup.2] , Alice Baldovini [sup.1] , Christophe Guervilly [sup.3] , Charlotte Arbelot [sup.4] , Alexandre Noel [sup.5] , Coralie [...]

Background The relationship between tiredness and the risk of medical errors is now commonly accepted. The main objective of this study was to assess the impact of an intensive care unit (ICU) night shift on the cognitive performance of a group of intensivists. The influence of professional experience and the amount of sleep on cognitive performance was also investigated. Methods A total of 51 intensivists from three ICUs (24 seniors and 27 residents) were included. The study participants were evaluated after a night of rest and after a night shift according to a randomized order. Four cognitive skills were tested according to the Wechsler Adult Intelligence Scale and the Wisconsin Card Sorting Test. Results All cognitive abilities worsened after a night shift: working memory capacity (11.3 ± 0.3 vs. 9.4 ± 0.3; p < 0.001), speed of processing information (13.5 ± 0.4 vs. 10.9 ± 0.3; p < 0.001), perceptual reasoning (10.6 ± 0.3 vs. 9.3 ± 0.3; p < 0.002), and cognitive flexibility (41.2 ± 1.2 vs. 44.2 ± 1.3; p = 0.063). There was no significant difference in terms of level of cognitive impairment between the residents and ICU physicians. Only cognitive flexibility appeared to be restored after 2 h of sleep. The other three cognitive skills were altered, regardless of the amount of sleep during the night shift. Conclusions The cognitive abilities of intensivists were significantly altered following a night shift in the ICU, regardless of either the amount of professional experience or the duration of sleep during the shift. The consequences for patients' safety and physicians' health should be further evaluated., Author(s): François Maltese [sup.1], Mélanie Adda [sup.1], Amandine Bablon [sup.1], Sami Hraeich [sup.1] [sup.2], Christophe Guervilly [sup.1], Samuel Lehingue [sup.1] [sup.2], Sandrine Wiramus [sup.3], Marc Leone [sup.2] [sup.4], Claude Martin [...]

Purpose A specific biomarker of post-ARDS fibroproliferation could be useful in the identification of patients who could benefit from therapies aiming to modulate fibroproliferation such as corticosteroids.The aim of this prospective study was to determine the best threshold of the N-terminal-peptidetype III procollagen (NT-PCP-III) in non-resolving ARDS to validate this threshold according to the outcome. Methods Concerning the best threshold of NT-PCP-III, all consecutive patients with a non-resolving ARDS were included if all the following criteria were fulfilled: moderate to severe ARDS lasting for at least 5 days, lung biopsy performed, serum and alveolar NT-PCP-III obtained within 1 week prior to biopsy, and no documented infection contra-indicating the corticosteroids. In the validation cohort part of the study, patients were included at day 7 if they presented a persistent moderate to severe ARDS. Results Nineteen of 32 patients had fibroproliferatio nonbiopsy. Serum and alveolar NT-PCP-III were higher in patients with fibroproliferation. Using a threshold of 9 [micro]g/L, alveolar NT-PCP-III had the highest accuracy for diagnosing fibroproliferation (sensitivity = 89.5 % and specificity = 92.3 %). Regarding the 51 patients included in the validation cohort, the mortality rate at day 60 was increased in patients presenting an alveolar NT-PCP-III level higher than 9 [micro]g/L (69 vs. 17 %, p < 0.001). The mean alveolar level of NT-PCP-III on day 7 was 8.1-fold higher in nonsurvivors (p = 0.03). Conclusions The determination of NT-PCP-III on BAL done at day 7 in persistent ARDS is able to identify patients with fibroproliferation who could be included in a trial of corticosteroids or any other treatment that might help resolve lung fibroproliferation., Author(s): Jean-Marie Forel [sup.1] [sup.2], Christophe Guervilly [sup.2], Sami Hraiech [sup.1] [sup.2], François Voillet [sup.2], Guillemette Thomas [sup.1] [sup.2], Claude Somma [sup.3], Véronique Secq [sup.1] [sup.4], Catherine Farnarier [sup.5], Marie-Josée [...]

Author(s): Jeremy Bourenne [sup.1] , Christophe Guervilly [sup.2] , Malika Mechati [sup.1] , Sami Hraiech [sup.2] , Megan Fraisse [sup.1] , Magali Bisbal [sup.3] , Antoine Roch [sup.2] , Jean [...]

Byline: Olivier Baldesi (1), Fabrice Michel (2), Christophe Guervilly (2), Nathalie Embriaco (2), Aliocha Granfond (3), Bernard Scola (4), Henri Portugal (5), Laurent Papazian (2) Keywords: Epithelial lining fluid; Pneumonia; Diagnosis; BAL; Urea; Dilution; Accuracy Abstract: Objective This study was designed to determine if bronchoalveolar lavage (BAL) quantitative culture results can be used confidently for the diagnosis of bacterial ventilator-associated pneumonia (VAP) without taking dilution into account. Design Prospective observational cohort study. Setting A 12-bed medical ICU in a teaching hospital. Patients A total of 241 BAL (three 50-mL aliquots) were performed in 127 patients presenting a suspicion of VAP. Interventions All consecutive adults who were ventilated more than 48 h were included if VAP was clinically suspected. A dilution factor, k, was developed according to the formula: dilution factor k = concentration of urea in plasma/concentration of urea in lavage fluid recovered. Using this dilution factor, the quantitative bacterial counts were interpreted accordingly with a corrected positive threshold at 10.sup.5 colony forming unit (CFU) mL.sup.-1. Measurements and results Eighty-nine BAL with at least one micro-organism aY=10.sup.4 CFU mL.sup.-1 were identified (37%). In 176 BAL (73%), k ranged from 10 to 100. Median k was 24.4 (9.7--40.2) in VAP group and 24.6 (13.1--57.8) in patients without pneumonia (NS). Among the 25 BAL with micro-organism counts of 10.sup.4 CFU mL.sup.-1, 3 had a dilution factor lower than 10, resulting in corrected counts below the threshold of 10.sup.5 CFU mL.sup.-1. Two out of 15 patients with micro-organism counts of 10.sup.3 CFU mL.sup.-1 had corrected micro-organism counts of 10.sup.5 CFU mL.sup.-1. Finally, only five BAL (2.1%) were misclassified when the dilution correction factor was applied. Conclusions Using urea as dilution factor, we showed that BAL dilution variations did not alter the interpretation of BAL quantitative bacterial culture when administrating three aliquots of 50 mL of saline. Author Affiliation: (1) Service de Reanimation medico-chirurgicale, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France (2) Reanimation Medicale, Assistance Publique, Hopitaux de Marseille, URMITE CNRS-UMR 6236, Universite de la Mediterranee, Marseille, France (3) Reanimation polyvalente, Hopital Font-Pre, Toulon, France (4) Laboratoire de Bacteriologie, Assistance Publique, Hopitaux de Marseille, URMITE CNRS-UMR 6236, Universite de la Mediterranee, Marseille, France (5) Laboratoire de Biologie, Hopital Sainte-Marguerite, Universite de la Mediterranee, 13009, Marseille, France Article History: Registration Date: 16/01/2009 Received Date: 11/08/2008 Accepted Date: 30/12/2008 Online Date: 03/02/2009 Article note: This study was conducted in the Medical Intensive Care Unit of the Hopital Sainte-Marguerite, 13009 Marseille, France.

Author(s): Pierre Esnault [sup.1], Bertrand Prunet [sup.1], Cédric Nguyen [sup.1], Jean Marie Forel [sup.2], Christophe Guervilly [sup.2], Yongfang Zhou [sup.3], Yan Kang [sup.3] Author Affiliations: (1) Intensive Care Unit, Sainte [...]

Author(s): Maria Bolaki [sup.1], Vassilis Amargianitakis [sup.2], Dimitris Georgopoulos [sup.2], Christophe Guervilly [sup.3] [sup.4], Laurent Papazian [sup.3] [sup.4] Author Affiliations: (1) grid.412481.a, Respiratory Department, University Hospital of Heraklion, , Iraklio, [...]

Author(s): Christophe Guervilly [sup.1] , Stephanie Dizier [sup.1] , Guillemette Thomas [sup.1] , Nicolas Jaussaud [sup.2] , Pierre Morera [sup.2] , Sami Hraiech [sup.1] , Fanny Klazen [sup.1] , Jean-Marie [...]

To the Editor: Members of the genus Haemophilus are commensal bacteria of the upper respiratory tract, and H. influenzae is the main pathogen in this genus that can cause a [...]