14 results on '"Sofia Ortuno"'
Search Results
2. Abstract 13226: Epinephrine versus Norepinephrine in Cardiac Arrest Patients With Postresuscitation Shock
- Author
-
Wulfran Bougouin, Kaci Slimani, Marie Renaudier, Yannick Binois, Marine Paul, Florence Dumas, Lionel Lamhaut, Thomas Loeb, Sofia Ortuno, Nicolas Deye, Sebastian Voicu, Frankie BEGANTON, daniel jost, Armand Mekontso-Dessap, Eloi Marijon, Xavier JOUVEN, Nadia Aissaoui, and Alain Cariou
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Backgound: Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat postresuscitation shock is unclear. Objectives: To compare outcomes of patients with postresuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephrine. Methods: We conducted an observational multicenter study of consecutive patients managed in 2011-2018 for postresuscitation shock. The primary outcome was all-cause hospital mortality, and secondary outcomes were cardiovascular hospital mortality and unfavorable neurological outcome (Cerebral Performance Category 3 to 5). A multivariate regression analysis and a propensity score analysis were performed, as well as several sensitivity analyses. Results: Of the 766 patients included in five hospitals, 285 (37%) received epinephrine and 481 (63%) norepinephrine. All-cause hospital mortality was significantly higher in the epinephrine group (OR 2.6; 95%CI, 1.4-4.7; P =0.002). Cardiovascular hospital mortality was also higher with epinephrine (aOR 5.5; 95%CI 3.0-10.3; P P =0.02). Conclusions: Among patients with postresuscitation shock after out-of-hospital cardiac arrest, use of epinephrine was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine infusion. A randomized controlled trial comparing the two vasopressors in this population is warranted.
- Published
- 2021
3. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis
- Author
-
Kenneth Ekpe, Damien Roux, Olivier Lesieur, Nicolas Pichon, Cédric Bruel, Stéphane Legriel, Olga Cosic, Bertrand Sauneuf, Nathalie Zappella, Laura Crosby, Baptiste Claude, Marc Garnier, Pierrick Cronier, Maxime Mallet, Carole Ruault, Sofia Ortuno, Arnaud Galbois, Julien Labreuche, Antoine Vieillard-Baron, Centre Hospitalier de Versailles André Mignot (CHV), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupe de recherche clinique en anesthésie réanimation médecine périopératoire [CHU Pitié-Salpétrière] (GRC ARPE), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Anesthésie réanimation [CHU Tenon], CHU Tenon [AP-HP], Hôpital Ambroise Paré [AP-HP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Hôpital Saint-Louis de La Rochelle (CH La Rochelle), CHU Limoges, Ramsay Générale de Santé - Hôpital Privé La Louvière, Centre hospitalier Saint-Joseph [Paris], Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Public du Cotentin (CHPC), Hôpital Louis Mourier - AP-HP [Colombes], Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire (GRC 29 - ARPE), Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CH Centre Hospitalier Public du Cotentin (CHPC), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Service de Pneumologie - R3S [CHU Pitié-Salpêtrière] (SPMIR-R3S)
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Multivariate analysis ,Cirrhosis ,Science ,Peritonitis ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Ascitic Fluid ,Humans ,In patient ,030304 developmental biology ,Aged ,Retrospective Studies ,0303 health sciences ,Multidisciplinary ,Critically ill ,business.industry ,Mortality rate ,Retrospective cohort study ,Digestive signs and symptoms ,Bacterial Infections ,Middle Aged ,medicine.disease ,3. Good health ,Mycoses ,Liver ,030211 gastroenterology & hepatology ,Female ,business ,Secondary Peritonitis ,Complication ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38–9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
- Published
- 2021
4. Recommandations pour la mise en place de la phase de consolidation en Médecine Intensive Réanimation
- Author
-
Piotr Szychowiak, Nolwen Flajoliet, Clément Devautour, Adrien Pepin Lehalleur, Alexandre Pierre, Sofia Ortuno, Sacha Sarfati, and Marion Giry
- Subjects
Intensive care ,Political science ,Emergency Medicine ,Graduate medical education ,Library science ,Emergency Nursing - Published
- 2021
5. Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock
- Author
-
Wulfran, Bougouin, Kaci, Slimani, Marie, Renaudier, Yannick, Binois, Marine, Paul, Florence, Dumas, Lionel, Lamhaut, Thomas, Loeb, Sofia, Ortuno, Nicolas, Deye, Sebastian, Voicu, Frankie, Beganton, Daniel, Jost, Armand, Mekontso-Dessap, Eloi, Marijon, Xavier, Jouven, Nadia, Aissaoui, Alain, Cariou, and V, Waldman
- Subjects
Emergency Medical Services ,Norepinephrine ,Treatment Outcome ,Epinephrine ,Humans ,Vasoconstrictor Agents ,Cardiopulmonary Resuscitation ,Out-of-Hospital Cardiac Arrest - Abstract
Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat post-resuscitation shock is unclear. We assessed outcomes of patients with post-resuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephrine.We conducted an observational multicenter study of consecutive patients managed in 2011-2018 for post-resuscitation shock. The primary outcome was all-cause hospital mortality, and secondary outcomes were cardiovascular hospital mortality and unfavorable neurological outcome (Cerebral Performance Category 3-5). A multivariate regression analysis and a propensity score analysis were performed, as well as several sensitivity analyses.Of the 766 patients included in five hospitals, 285 (37%) received epinephrine and 481 (63%) norepinephrine. All-cause hospital mortality was significantly higher in the epinephrine group (OR 2.6; 95%CI 1.4-4.7; P = 0.002). Cardiovascular hospital mortality was also higher with epinephrine (aOR 5.5; 95%CI 3.0-10.3; P 0.001), as was the proportion of patients with CPC of 3-5 at hospital discharge. Sensitivity analyses produced consistent results. The analysis involving adjustment on a propensity score to control for confounders showed similar findings (aOR 2.1; 95%CI 1.1-4.0; P = 0.02).Among patients with post-resuscitation shock after out-of-hospital cardiac arrest, use of epinephrine was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine infusion. Until additional data become available, intensivists may want to choose norepinephrine rather than epinephrine for the treatment of post-resuscitation shock after OHCA.
- Published
- 2021
6. In-hospital cardiac arrests admitted alive in intensive care units: Insights from the CubRéa database
- Author
-
Clotilde, Bailleul, Etienne, Puymirat, Phillipe, Aegerter, Bertrand, Guidet, Emmanuel, Guerot, Jean-Loup, Augy, Nicolas, Brechot, Jean-Luc, Diehl, Jean-Yves, Fagon, Bertrand, Hermann, Ana, Novara, Sofia, Ortuno, Romy, Younan, Nicolas, Danchin, Alain, Cariou, and Nadia, Aissaoui
- Subjects
Intensive Care Units ,Humans ,Infant ,Hospital Mortality ,Critical Care and Intensive Care Medicine ,Hospitals ,Out-of-Hospital Cardiac Arrest ,Retrospective Studies - Abstract
In-hospital cardiac arrest(IHCA) has received little attention compared with out-of-hospital cardiac arrest.To address the paucity of data on IHCA patients, we examined key features, variations in mortality and predictors of death among patients admitted in French intensive care units(ICUs) from 1997 to 2015.Using the database of the Collège des Utilisateurs de Bases de données en Réanimation(CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of IHCA, patients' outcomes, crude and Simplified Acute Physiology Score(SAPS)-II Standardized mortality and predictors of in-ICU mortality.Of the 376,325 ICU admissions, 15,324(4.08%) had IHCA, with incidence increasing from 2.78% to 3.83%(p0.001). Over time, the patient age increased by 0.7 years(p = 0.04) and SAPS-II increased by 2.3%(p0.001). Crude in-ICU mortality decreased from 78% to 62.5% over the past 18 years(p0.001). The SAPS-II-standardized mortality also decreased over time from 78.4% to 68.3%(p0.001) representing a 10.1% relative decrease from 1997 to 2015. In multivariate analysis, admission in a more recent time-period was an independent correlate of decreased mortality(OR 0.40, 95%CI 0.35-0.46).Occurrence of IHCA increased over time but remains an uncommon reason for being admitted to ICU. From 1997 to 2015, we observed a change in patient profile, with older and more critically ill patients, despite which in-ICU mortality has substantially decreased in IHCA patients, likely resulting from a global improvement in the process of care and more widespread implementation of rapid response teams.
- Published
- 2022
7. Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019
- Author
-
Sofia Ortuno, Mathieu Jozwiak, Jean-Paul Mira, and Lee S. Nguyen
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Myocarditis ,Cardiomyopathy ,heart failure ,Case Report ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,COVID−19 ,sepsis ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,Myocardial infarction ,Ejection fraction ,Troponin T ,business.industry ,Septic shock ,acute respiratory distress syndrome ,medicine.disease ,Tako-tsubo cardiomyopathy ,lcsh:RC666-701 ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic.Case summary: A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 μg/kg/min). Troponin T was elevated (637 ng/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal.Conclusion: Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19.
- Published
- 2021
8. Transplant rejections associated with immune checkpoint inhibitors: A pharmacovigilance study and systematic literature review
- Author
-
Lee S. Nguyen, Sofia Ortuno, Douglas B. Johnson, Javid Moslehi, Bénédicte Lebrun-Vignes, Alexandre Hertig, and Joe-Elie Salem
- Subjects
0301 basic medicine ,Graft Rejection ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Ipilimumab ,Pembrolizumab ,03 medical and health sciences ,Pharmacovigilance ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,Immune Checkpoint Inhibitors ,Immunosuppression Therapy ,business.industry ,Cancer ,Immunosuppression ,Organ Transplantation ,medicine.disease ,Prognosis ,Transplant rejection ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Nivolumab ,business ,medicine.drug - Abstract
Background Solid organ transplant recipients are at increased risk of cancer due to long-term immunosuppression. Immune-checkpoint inhibitors (ICI) showed clinical benefits but increased risk of transplant rejection. Our work aims to assess the main features of reported rejection events. Methods A disproportionality analysis of the World Health Organisation pharmacovigilance database, VigiBase, to identify drugs associated with rejection events. The estimate of this analysis is the information component for which the lower end of the 95% credibility interval (IC025) indicates significance when positive. We combined a systematic literature review of case reports to obtain additional information regarding treatment management and histopathological findings. Results A total of 96 reports of transplant rejections following ICI were included, including kidney (n = 65), liver (n = 23), cornea (n = 2) and heart (n = 5). The main indication reported for ICI was malignant melanoma (39/89, 43.8%). The time to onset between first ICI administration and rejection was 21 [interquartile range: 13; 56] days. Kidney transplant rejection was associated with nivolumab (IC025 = 1.32), pembrolizumab (IC025 = 1.17) and ipilimumab (IC025 = 0.33); while liver transplant rejection was mostly over-reported with nivolumab (IC025 = 1.95). Overall, anti-PD-1 and anti-PD-L1 were more involved than anti-CTLA-4 drugs (93.0% versus 7.0%). Subsequent mortality was 36.5% and involved liver-transplant recipients more than other organ recipients (p Conclusion ICI-associated transplant rejections were mostly reported in kidney and liver transplant recipients. Rejections were T-cell mediated with low participation of humoral response.
- Published
- 2020
9. The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation
- Author
-
Nadine Ajzenberg, Héloïse Flament, Sofia Ortuno, Elena Litvinova, Nicolas Gendron, and Dorothée Faille
- Subjects
Immunofixation ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,paraprotein ,medicine.drug_class ,Context (language use) ,Urine ,Monoclonal antibody ,Gastroenterology ,Dabigatran ,idarucizumab ,T&H Images ,Internal medicine ,medicine ,dabigatran ,Heavy-chain antibody ,biology ,business.industry ,immunofixation ,Idarucizumab ,lcsh:RC666-701 ,biology.protein ,reversal ,Antibody ,business ,medicine.drug - Abstract
Idarucizumab is a humanized antigen binding fragment (Fab) of a recombinant anti-dabigatran monoclonal antibody (IgG1-kappa) that allows rapid and sustained reversal of dabigatran-induced anticoagulation in case of bleeding or urgent surgery. Herein, we report a very unusual case of dabigatran reversal by idarucizumab in a 79-year-old woman with acute kidney failure admitted to a hospital in a context of hemoptysis. Three repeated injections were necessary because of massive dabigatran overdose and high rebounds of dabigatran plasma concentration. Idarucizumab was found on urine immunofixation up to 6 days after the last injection where it reacted with anti-kappa light chain antibody, but not with anti-gamma heavy chain antibody. Physicians should be aware of the increased half-life of idarucizumab in this context of acute kidney impairment and of its interference with urine immunofixation because it could lead to false-positive results and misdiagnosis of a paraprotein.
- Published
- 2019
10. Trends in cardiogenic shock complicating acute myocardial infarction
- Author
-
Nadia Aissaoui, Nicolas Danchin, Francois Schiele, Elodie Drouet, Gilles Lesmeles, Vincent Bataille, Eric Durand, Tabassome Simon, Laurent Bonello, E. Bonnefoy-Cudraz, Sofia Ortuno, Etienne Puymirat, Emmanuel Guerot, Clément Delmas, Centre de Ressources Biologiques APHP-SU (PASS-CRB-APHP-SU), Unité Mixte de Service Production et Analyse de données en Sciences de la vie et en Santé (PASS), and Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Myocardial Infarction ,Shock, Cardiogenic ,Cardiovascular care ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Epidemiology ,medicine ,Humans ,In patient ,Myocardial infarction ,Hospital Mortality ,ComputingMilieux_MISCELLANEOUS ,Aged ,Mechanical ventilation ,Aged, 80 and over ,Heart Failure ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,3. Good health ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization). METHODS AND RESULTS Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in 'real-life' practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1-month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P
- Published
- 2019
11. Impact of hyperoxia on patients hospitalized in an intensive care unit for acute heart failure
- Author
-
Sofia Ortuno, Mathilde Ruggiu, Etienne Puymirat, Nicolas Danchin, Nadia Aissaoui, Jean Luc Diehl, Damien Vimpere, Emmanuel Guerot, Clotilde Bailleul, Jean Loup Augy, Julien Nael, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Paris 5 (UPD5), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and CCSD, Accord Elsevier
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Patient Admission ,law ,Risk Factors ,Oxygen therapy ,Clinical endpoint ,Medicine ,030212 general & internal medicine ,Hospital Mortality ,Hyperoxia ,Aged, 80 and over ,General Medicine ,Middle Aged ,Intensive care unit ,3. Good health ,[SDV] Life Sciences [q-bio] ,OAP ,Intensive Care Units ,Treatment Outcome ,Acute Disease ,USIC ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Readmission ,Preliminary Data ,medicine.medical_specialty ,Paris ,Réhospitalisation ,Hyperoxie ,Pulmonary Edema ,Mortalité ,Patient Readmission ,Risk Assessment ,Pulmonary congestion ,03 medical and health sciences ,Humans ,Mortality ,Aged ,Retrospective Studies ,Heart Failure ,business.industry ,Oxygen Inhalation Therapy ,Odds ratio ,Length of Stay ,medicine.disease ,Confidence interval ,Heart failure ,Emergency medicine ,business - Abstract
Summary Background Oxygen therapy remains a cornerstone of treatment for acute heart failure in patients with pulmonary congestion. While avoiding hypoxaemia has long been a goal of critical care practitioners, less attention has been paid to the potential hazard related to excessive hyperoxia. Aim To evaluate the impact of early hyperoxia exposure among critically ill patients hospitalized in an intensive care unit for acute heart failure. Methods In this preliminary study conducted in a Parisian intensive care unit, we assessed patients with acute heart failure admitted with pulmonary congestion and treated with oxygen therapy from 1 January 2015 to 31 December 2016. The hyperoxia group was defined by having at least one partial pressure of oxygen measurement > 100 mmHg on the first day following admission to the intensive care unit. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were 30-day unplanned hospital admissions, occurrence of infections and intensive care unit and hospital lengths of stay. Results Seventy-five patients were included. Forty-three patients (57.3%) presented hyperoxia, whereas 32 patients (42.7%) did not (control group). The baseline clinical characteristics did not differ between the two groups. The primary endpoint was not statistically different between the two groups (14.0% in the hyperoxia group vs 18.8% in the control group; P = 0.85). The secondary endpoints were also not significantly different between the two groups. In the multivariable analysis, hyperoxia was not associated with increased 30-day mortality (odds ratio 0.77, 95% confidence interval 0.24–2.41). Conclusion In patients referred to an intensive care unit for acute heart failure, we did not find any difference in outcomes according to the presence of hyperoxia.
- Published
- 2019
12. Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?
- Author
-
Mahassen Naili, Romain Pirracchio, Aymeric Lancelot, Nadia Aissaoui, Clément Delmas, Jean-Luc Diehl, Sofia Ortuno, Bernard Cholley, and Clotilde Bailleul
- Subjects
medicine.medical_treatment ,Bioengineering ,030204 cardiovascular system & hematology ,Mechanical assistance ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Hospital discharge ,Extracorporeal membrane oxygenation ,Medicine ,Weaning ,echocardiography ,Assistive Technology ,business.industry ,Mortality rate ,Cardiogenic shock ,weaning ,030208 emergency & critical care medicine ,Oxygenation ,medicine.disease ,surgical procedures, operative ,Anesthesia ,Perspective ,Veno-arterial extracorporeal membrane oxygenation ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Refractory cardiogenic shock patients may be rescued by veno-arterial extracorporeal membrane oxygenation (VA ECMO). After a few days of mechanical assistance, the device can sometimes be successfully removed if the patient has partially or fully recovered from the condition that required the use of ECMO. The percentage of patients with refractory cardiogenic shock who are successfully weaned from ECMO varies from 31% to 76%. Weaning does not mean survival, because 20% to 65% of patients weaned from VA ECMO support do not survive to hospital discharge. The high death rate after successful weaning shows that many questions remain unresolved in this field. In this review, we will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature. Based on this information, we will propose a strategy to optimize the weaning process.
- Published
- 2019
13. Understanding left ventricular assist devices
- Author
-
Amer Hamdan, Melissa Gourjault, Nadia Aissaoui, Jérôme Jouan, Romain Pirracchio, Michiel Morshuis, Christian Latremouille, Benoit Diebold, and Sofia Ortuno
- Subjects
medicine.medical_specialty ,Time Factors ,Critical Care ,medicine.medical_treatment ,Population ,Hemorrhage ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Life Expectancy ,0302 clinical medicine ,law ,Artificial heart ,medicine ,Animals ,Humans ,ddc:610 ,education ,Intensive care medicine ,Adverse effect ,Heart Failure ,education.field_of_study ,business.industry ,Arrhythmias, Cardiac ,Thrombosis ,030208 emergency & critical care medicine ,Hematology ,General Medicine ,equipment and supplies ,medicine.disease ,Regimen ,Nephrology ,Heart failure ,Ventricular assist device ,Equipment Failure ,Heart-Assist Devices ,business ,Medical literature - Abstract
Background/Aims: Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. Regarding this growing number of patients with LVAD, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. Methods: We performed a narrative review of relevant medical literature regarding the physiology of patients with LVAD and management of common complications relevant to the critical care physicians. Results: The most frequent complications occurring in the LVAD patients after the post-operative period are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias. Bleeding is the most frequent adverse event in LVAD due to a combination of anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump. Their management includes antiplatelet therapy arrest, reduction of the anticoagulation regimen and specific therapy if feasible. Infection is the second most common cause of death after cardiac failure in LVAD patients. All infections must be aggressively treated to avoid seeding the device. Device thrombosis can develop even when patients are adequately anticoagulated and taking antiplatelet therapy because the LVAD is responsible for a chronic hypercoagulable state. Conclusion: Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.
- Published
- 2018
14. Hyperoxia effects on intensive care unit mortality: a retrospective pragmatic cohort study
- Author
-
Emmanuel Guerot, Nadia Aissaoui, Clotilde Bailleul, Jean Loup Augy, Caroline Haw-Berlemont, Mathilde Ruggiu, Sofia Ortuno, Damien Vimpere, Bertrand Herrmann, Julien Nael, and Jean Luc Diehl
- Subjects
Adult ,Male ,medicine.medical_specialty ,MEDLINE ,030204 cardiovascular system & hematology ,Hyperoxia ,Critical Care and Intensive Care Medicine ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,law ,Medicine ,Humans ,Hospital Mortality ,Simplified Acute Physiology Score ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Retrospective cohort study ,lcsh:RC86-88.9 ,Middle Aged ,Intensive care unit ,Survival Analysis ,Intensive Care Units ,030228 respiratory system ,Emergency medicine ,Observational study ,Female ,France ,medicine.symptom ,business ,Cohort study - Published
- 2018
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.