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3. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

Author

Huang, Stephen, Vignon, Philippe, Mekontso-Dessap, Armand, Tran, Ségolène, Prat, Gwenael, Chew, Michelle, Balik, Martin, Sanfilippo, Filippo, Banauch, Gisele, Clau-Terre, Fernando, Morelli, Andrea, De Backer, Daniel, Cholley, Bernard, Slama, Michel, Charron, Cyril, Goudelin, Marine, Bagate, Francois, Bailly, Pierre, Blixt, Patrick-Johansson, Masi, Paul, Evrard, Bruno, Orde, Sam, Mayo, Paul, McLean, Anthony S., and Vieillard-Baron, Antoine

Published
2022
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4. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis

Author

Geri, Guillaume, Vignon, Philippe, Aubry, Alix, Fedou, Anne-Laure, Charron, Cyril, Silva, Stein, and Repessé, Xavier

Subjects
Mortality -- France, Database industry, Septic shock, Database industry, Health care industry
Abstract

Purpose Mechanisms of circulatory failure are complex and frequently intricate in septic shock. Better characterization could help to optimize hemodynamic support. Methods Two published prospective databases from 12 different ICUs including echocardiographic monitoring performed by a transesophageal route at the initial phase of septic shock were merged for post hoc analysis. Hierarchical clustering in a principal components approach was used to define cardiovascular phenotypes using clinical and echocardiographic parameters. Missing data were imputed. Findings A total of 360 patients (median age 64 [55; 74]) were included in the analysis. Five different clusters were defined: patients well resuscitated (cluster 1, n = 61, 16.9%) without left ventricular (LV) systolic dysfunction, right ventricular (RV) failure or fluid responsiveness, patients with LV systolic dysfunction (cluster 2, n = 64, 17.7%), patients with hyperkinetic profile (cluster 3, n = 84, 23.3%), patients with RV failure (cluster 4, n = 81, 22.5%) and patients with persistent hypovolemia (cluster 5, n = 70, 19.4%). Day 7 mortality was 9.8%, 32.8%, 8.3%, 27.2%, and 23.2%, while ICU mortality was 21.3%, 50.0%, 23.8%, 42.0%, and 38.6% in clusters 1, 2, 3, 4, and 5, respectively (p < 0.001 for both). Conclusion Our clustering approach on a large population of septic shock patients, based on clinical and echocardiographic parameters, was able to characterize five different cardiovascular phenotypes. How this could help physicians to optimize hemodynamic support should be evaluated in the future., Author(s): Guillaume Geri [sup.1] [sup.2] [sup.3], Philippe Vignon [sup.4] [sup.5] [sup.6], Alix Aubry [sup.1] [sup.2], Anne-Laure Fedou [sup.4], Cyril Charron [sup.1], Stein Silva [sup.7], Xavier Repessé [sup.1], Antoine Vieillard-Baron [sup.1] [...]

Published
2019
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5. Limited value of end-expiratory inferior vena cava diameter to predict fluid responsiveness impact of intra-abdominal pressure

Author

Vieillard-Baron, Antoine, Evrard, Bruno, Repessé, Xavier, Maizel, Julien, Jacob, Christophe, Goudelin, Marine, and Charron, Cyril

Subjects
Medical research, Medicine, Experimental, Septic shock -- Diagnosis, Health care industry
Abstract

Purpose We sought to determine the diagnostic ability of the end-expiratory inferior vena cava diameter (IVC.sub.EE) to predict fluid responsiveness (FR) and the potential confounding effect of intra-abdominal pressure (IAP). Methods In this multicenter study, 540 consecutive ventilated patients with shock of various origins underwent an echocardiographic assessment by experts. The IVC.sub.EE, velocity time integral (VTI) of the left ventricular outflow tract (LVOT) and intra-abdominal pressure (IAP) were measured. Passive leg raising (PLR) was then systematically used to perform a reversible central blood volume expansion. FR was defined by an increase in LVOT VTI [greater than or equal to] 10% after 1 min of PLR. Results Since IVC.sub.EE was not obtained in 117 patients (22%), 423 were studied (septic shock: 56%), 129 of them (30%) having elevated IAP ([greater than or equal to] 12 mmHg) and 172 of them (41%) exhibiting FR. IVC.sub.EE [less than or equal to] 13 mm predicted FR with a specificity of at least 80% in 62 patients (15%), while IVC.sub.EE [greater than or equal to] 25 mm predicted the absence of FR with a specificity of at least 80% in 61 patients (14%). In the remaining 300 patients (71%), the intermediate value of IVC.sub.EE did not allow predicting FR. An adjusted relationship between IVC.sub.EE and FR was observed while this relationship was less pronounced in patients with IAP [greater than or equal to] 12 mmHg. Conclusions Measurement of IVC.sub.EE in ventilated patients is moderately feasible and poorly predicts FR, with IAP acting as a confounding factor. IVC.sub.EE might add some value to guide fluid therapy but should not be used alone for fluid prediction purposes., Author(s): Antoine Vieillard-Baron [sup.1] [sup.2] [sup.3], Bruno Evrard [sup.4] [sup.5], Xavier Repessé [sup.1], Julien Maizel [sup.6], Christophe Jacob [sup.7], Marine Goudelin [sup.4] [sup.5], Cyril Charron [sup.1], Gwenaël Prat [sup.7], Michel [...]

Published
2018
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6. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact

Author

Mekontso Dessap, Armand, Boissier, Florence, Charron, Cyril, Bégot, Emmanuelle, Repessé, Xavier, Legras, Annick, and Brun-Buisson, Christian

Subjects
Medical research, Medicine, Experimental, Respiratory distress syndrome, Mortality -- France -- United Kingdom, Cor pulmonale, Acute respiratory distress syndrome, Health care industry
Abstract

Rationale Increased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP). Objectives To determine the prevalence and prognosis of ACP and build a clinical risk score for the early detection of ACP. Methods This was a prospective study in which 752 patients with moderate-to-severe ARDS receiving protective ventilation were assessed using transesophageal echocardiography in 11 intensive care units. The study cohort was randomly split in a derivation (n = 502) and a validation (n = 250) cohort. Measurements and main results ACP was defined as septal dyskinesia with a dilated RV [end-diastolic RV/left ventricle (LV) area ratio >0.6 ([greater than or equal to]1 for severe dilatation)]. ACP was found in 164 of the 752 patients (prevalence of 22 %; 95 % confidence interval 19-25 %). In the derivation cohort, the ACP risk score included four variables [pneumonia as a cause of ARDS, driving pressure [greater than or equal to]18 cm H.sub.2O, arterial oxygen partial pressure to fractional inspired oxygen (PaO.sub.2/FiO.sub.2) ratio Conclusions We report a 22 % prevalence of ACP and a poor outcome of severe ACP. We propose a simple clinical risk score for early identification of ACP that could trigger specific therapeutic strategies to reduce RV afterload., Author(s): Armand Mekontso Dessap [sup.1] [sup.2], Florence Boissier [sup.1] [sup.2], Cyril Charron [sup.3], Emmanuelle Bégot [sup.4] [sup.5] [sup.6], Xavier Repessé [sup.3], Annick Legras [sup.7], Christian Brun-Buisson [sup.1] [sup.2], Philippe Vignon [...]

Published
2016
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7. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, Cecconi, Maurizio, Marco, Bezzi, Alicia, Gira, Philipp, Eller, Tarikul, Hamid, Injamam Ull Haque, Wim De Buyser, Antonella, Cudia, Daniel De Backer, Pierre, Foulon, Vincent, Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste, Mesland, Patrick, Biston, Michael, Piagnerelli, Lionel, Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe, Vanhove, Pierre, Bulpa, Viktoria, Ilieva, David, Katz, Alexandra, Binnie, Anna, Geagea, Fernando, Tirapegui, Gustavo, Lago, Jerónimo, Graf, Rodrigo, Perez-Araos, Patricio, Vargas, Felipe, Martinez, Eduardo, Labarca, Daniel Molano Franco, Daniela, Parra-Tanoux, Luis Felipe Reyes, David, Yepes, Filip, Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, Gamal, Abdelnasser, Ahmed, Hammouda, Omar, Elmandouh, Ahmed, Azzam, Aliae Mohamed Hussein, Islam, Galal, Awad, Ahmed K., Azab, Mohammed A., Maged, Abdalla, Hebatallah, Assal, Mostafa, Alfishawy, Sherief, Ghozy, Samar, Tharwat, Abdullah, Eldaly, Anneli, Ellervee, Veronika, Reinhard, Anne, Chrisment, Chrystelle, Poyat, Julio, Badie, Fernando Berdaguer Ferrari, Björn, Weiss, Clara, Schellenberg, Grunow, Julius J., Marco, Lorenz, Schaller, Stefan J., Peter, Spieth, Marc, Bota, Falk, Fichtner, Kristina, Fuest, Tobias, Lahmer, Johannes, Herrmann, Patrick, Meybohm, Nikolaos, Markou, Georgia, Vasileiadou, Evangelia, Chrysanthopoulou, Panagiotis, Papamichalis, Ioanna, Soultati, Sameer, Jog, Kushal, Kalvit, Sheila Nainan Myatra, Ivan, Krupa, Aisa, Tharwat, Alistair, Nichol, Aine, Mccarthy, Ata, Mahmoodpoor, Tommaso, Tonetti, Paolo, Isoni, Savino, Spadaro, Carlo Alberto Volta, Lucia, Mirabella, Alberto, Noto, Gaetano, Florio, Amedeo, Guzzardella, Chiara, Paleari, Federica, Baccanelli, Marzia, Savi, Massimo, Antonelli, Gennaro De Pascale, San, Luca, Barbara, Vaccarini, Giorgia, Montrucchio, Gabriele, Sales, Donadello, Katia, Leonardo, Gottin, Marta, Nizzero, Enrico, Polati, De Rosa, Silvia, Demet, Sulemanji, Abdurraouf, Abusalama, Muhammed, Elhadi, Montelongo De FelipeJesus, Daniel Rodriguez Gonzalez, Victor Hugo Madrigal Robles, Nancy, Canedo, Alejandro Esquivel Chavez, Tarek, Dendane, Bart, Grady, Ben de Jong, Eveline van der Heiden, Patrick, Thoral, Bas van den Bogaard, Spronk, Peter E., Sefanja, Achterberg, Melanie, Groeneveld, Ralph K. L., So, Calvin de Wijs, Harm, Scholten, Albertus, Beishuizen, Cornet, Alexander D., Reidinga, Auke C., Hetty, Kranen, Roos, Mensink, Spaarne, Gasthuis, Sylvia den Boer, Marcel de Groot, Oliver, Beck, Carina, Bethlehem, Bas van Bussel, Tim, Frenzel, Celestine de Jong, Rob, Wilting, Jozef, Kesecioglu, Jannet, Mehagnoul-Schipper, Datonye, Alasia, Ashok, Kumar, Ahad, Qayyum, Muhammad, Rana, Mustafa Abu Jayyab, Rosario Quispe Sierra, Aaron Mark Hernandez, José de Almeida, Lúcia, Taborda, Mónica, Anselmo, Tiago, Ramires, Catarina, Silva, Carolina, Roriz, Rui, Morais, Pedro, Póvoa, Patricia, Patricio, André, Pinto, Maria Lurdes Santos, Vasco, Costa, Pedro, Cunha, Celina, Gonçalves, Sandra, Nunes, João, Camões, Diana, Adrião, Ana, Oliveira, Ali, Omrani, Muna Al Maslamani, Abdurrahmaan Suei elbuzidi, Bara Mahmoud Al qudah, Abdel Rauof Akkari, Mohamed, Alkhatteb, Anas, Baiou, Ahmed, Husain, Mohamed, Alwraidat, Ibrahim Abdulsalam Saif, Dana, Bakdach, Amna, Ahmed, Mohamed, Aleef, Awadh, Bintaher, Cristina, Petrisor, Evgeniy, Popov, Ksenia, Popova, Mariia, Dementienko, Boris, Teplykh, Alexey, Pyregov, Liubov, Davydova, Belskii, Vladislav, Elena, Neporada, Ivan, Zverev, Svetlana, Meshchaninova, Dmitry, Sokolov, Elena, Gavrilova, Irina, Shlyk, Igor, Poliakov, Marina, Vlasova, Ohoud, Aljuhani, Amina, Alkhalaf, Felwa Bin Humaid, Yaseen, Arabi, Ahmed, Kuhail, Omar, Elrabi, Ghannam, Madihah E., Ng Teng Fong, Amit, Kansal, Vui Kian Ho, Jensen, Ng, Raquel Rodrígez García, Xiana Taboada Fraga, Mª del Pilar García-Bonillo, Antonio, Padilla-Serrano, Marta Martin Cuadrado, Carlos, Ferrando, Ignacio, Catalan-Monzon, Laura, Galarza, Fernando, Frutos-Vivar, Jorge, Jimenez, Carmen, Rodríguez-Solis, Enric, Franquesa-Gonzalez, Guillermo Pérez Acosta, Luciano Santana Cabrera, Juan Pablo Aviles Parra, Francisco Muñoyerro Gonzalez, Maria del Carmen Lorente Conesa, Ignacio Yago Martinez Varela, Orville Victoriano Baez Pravia, Maria Cruz Martin Delgado, Carlos Munoz de Cabo, Ana-Maria, Ioan, Cesar, Perez-Calvo, Arnoldo, Santos, Ane, Abad-Motos, Javier, Ripolles-Melchor, Belén Civantos Martin, Santiago Yus Teruel, Juan Higuera Lucas, Aaron Blandino Ortiz, Raúl de Pablo Sánchez, Jesús Emilio Barrueco-Francioni, Lorena Forcelledo Espina, Bonell-Goytisolo, José M., Iñigo, Salaverria, Antonia Socias Mir, Emilio, Rodriguez-Ruiz, Virginia Hidalgo Valverde, Patricia Jimeno Cubero, Francisca Arbol Linde, Nieves Cruza Leganes, Juan Maria Romeu, Pablo, Concha, José Angel Berezo-Garcia, Virginia, Fraile, Cristina, Cuenca-Rubio, David, Pérez-Torres, Ainhoa, Serrano, Clara Martínez Valero, Andrea Ortiz Suner, Leire, Larrañaga, Noemi, Legaristi, Gerardo, Ferrigno, Safa, Khlafalla, Rosita, Bihariesingh-Sanchit, Hallands, Sjukhus, Frank, Zoerner, Jonathan, Grip, Kristina, Kilsand, Johan, Mårtensson, Jonas, Österlind, Akademiska, Sjukhuset, Magnus von Seth, Västerviks, Sjukhus, Johan, Berkius, Samuele, Ceruti, Andrea, Glotta, Seval, Izdes, Işıl Özkoçak Turan, Ahmet, Cosar, Burcin, Halacli, Necla, Dereli, Mehmet, Yilmaz, Türkay, Akbas, Gülseren, Elay, Selin, Eyüpoğlu, Yelíz, Bílír, Kemal Tolga Saraçoğlu, Ebru, Kaya, Ayca Sultan Sahin, Pervin Korkmaz Ekren, Tuğçe, Mengi, Kezban Ozmen Suner, Yakup, Tomak, Ahmet, Eroglu, Asad, Alsabbah, Katie, Hanlon, Kevin, Gervin, Sean, Mcmahon, Samantha, Hagan, Higenbottam, Caroline V., Randeep, Mullhi, Lottie, Poulton, Tomasz, Torlinski, Allen, Gareth, Nick, Truman, Gopal, Vijayakumar, Chris, Hall, Alasdair, Jubb, Lenka, Cagova, Nicola, Jones, Sam, Graham, Nicole, Robin, Amanda, Cowton, Adrian, Donnelly, Natalia, Singatullina, Melanie, Kent, Carole, Boulanger, Zoë, Campbell, Elizabeth, Potter, Natalie, Duric, Tamas, Szakmany, Royal, Brompton, Orinta, Kviatkovske, Nandor, Marczin, Caroline, Ellis, Rajnish, Saha, Chunda, Sri-Chandana, John, Allan, Lana, Mumelj, Harish, Venkatesh, Vera Nina Gotz, Anthony, Cochrane, Barbara, Ficial, Shruthi, Kamble, Nuttha, Lumlertgul, Christopher, Oddy, Susan, Jain, Giulia Beatrice Crapelli, Aikaterini, Vlachou, David, Golden, Sweyn, Garrioch, Jeremy, Henning, Gupta, Loveleena, Miriam, Davey, Lina, Grauslyte, Erika, Salciute-Simene, Martin, Cook, Danny, Barling, Phil, Broadhurst, Sarah, Purvis, Michael, Spivey, Benjamin, Shuker, Irina, Grecu, Daniel, Harding, Dean, James T., Nielsen, Nathan D., Sama, Al-Bayati, Mohammed, Al-Sadawi, Mariane, Charron, Peter, Stubenrauch, Jairo, Santanilla, Catherine, Wentowski, Dorothea, Rosenberger, Polikseni, Eksarko, and Randeep Jawa, Greco, Massimiliano [0000-0003-1003-4637], De Corte, Thomas [0000-0001-5011-6640], Ercole, Ari [0000-0001-8350-8093], Antonelli, Massimo [0000-0003-3007-1670], Azoulay, Elie [0000-0002-8162-1508], Citerio, Giuseppe [0000-0002-5374-3161], Morris, Andy Conway [0000-0002-3211-3216], De Pascale, Gennaro [0000-0002-8255-0676], Duska, Frantisek [0000-0003-1559-4078], Elbers, Paul [0000-0003-0447-6893], Einav, Sharon [0000-0001-8963-9633], Forni, Lui [0000-0002-0617-5309], Galarza, Laura [0000-0002-4658-748X], Girbes, Armand RJ [0000-0002-0711-0494], Grasselli, Giacomo [0000-0002-1735-1400], Gusarov, Vitaly [0000-0002-2900-1459], Jubb, Alasdair [0000-0001-5593-866X], Kesecioglu, Jozef [0000-0002-3007-8445], Lavinio, Andrea [0000-0002-8832-918X], Delgado, Maria Cruz Martin [0000-0002-7468-4594], Mellinghoff, Johannes [0000-0002-5455-8953], Myatra, Sheila Nainan [0000-0001-6761-163X], Ostermann, Marlies [0000-0001-9500-9080], Pellegrini, Mariangela [0000-0001-5668-7399], Povoa, Pedro [0000-0002-7069-7304], Schaller, Stefan J [0000-0002-6683-9584], Teboul, Jean-Louis [0000-0002-5748-7820], Wong, Adrian [0000-0003-4968-7328], De Waele, Jan J [0000-0003-1017-9748], Cecconi, Maurizio [0000-0002-4376-6538], Apollo - University of Cambridge Repository, Intensive care medicine, ACS - Diabetes & metabolism, AII - Infectious diseases, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, UCL - SSS/DDUV/GECE - Génétique cellulaire, UCL - (SLuc) Service de soins intensifs, investigators, ESICM UNITE-COVID, Girbes, Armand R. J. [0000-0002-0711-0494], Schaller, Stefan J. [0000-0002-6683-9584], and De Waele, Jan J. [0000-0003-1017-9748]

Subjects
Adult, Anestesi och intensivvård, Anesthesiology and Intensive Care, Original, SARS-CoV-2, Critical Illness, Other Research Radboud Institute for Health Sciences [Radboudumc 0], ACUTE KIDNEY INJURY, COVID-19, CORONAVIRUS DISEASE 2019, Pneumonia, Acute Kidney Injury, Critical Care and Intensive Care Medicine, Respiration, Artificial, Surge capacity, Critical care, Intensive Care Units, Settore MED/41 - ANESTESIOLOGIA, Medicine and Health Sciences, Humans, CRITICALLY-ILL PATIENTS
Abstract

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality. Correction in: Intensive Care Medicine, vol. 48, issue 8, pages 1130-1131.DOI: 10.1007/s00134-022-06801-2

Published
2022
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8. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

Author

Stephen, Huang, Philippe, Vignon, Armand, Mekontso-Dessap, Ségolène, Tran, Gwenael, Prat, Michelle, Chew, Martin, Balik, Filippo, Sanfilippo, Gisele, Banauch, Fernando, Clau-Terre, Andrea, Morelli, Daniel, De Backer, Bernard, Cholley, Michel, Slama, Cyril, Charron, Marine, Goudelin, Francois, Bagate, Pierre, Bailly, Patrick-Johansson, Blixt, Paul, Masi, Bruno, Evrard, Sam, Orde, Paul, Mayo, Anthony S, McLean, Antoine, Vieillard-Baron, and Thomas, Daix

Subjects
Heart Failure, Male, Intensive Care Units, Ventricular Dysfunction, Left, Echocardiography, Hypertension, Pulmonary, Ventricular Dysfunction, Right, COVID-19, Humans, Female, Pulmonary Embolism, Aged, Retrospective Studies
Abstract

Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR 4), pulmonary embolism (OR 5) and increased PaCOAlmost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.

Published
2022

9. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Author

Flaatten, Hans, De Lange, Dylan W., Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Boumendil, Ariane, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zaferidis, Tilemachos, Guidet, Bertrand, Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemens, Swinnen, Walter, De Buysscher, Pieter, De Neve, Nikolaas, Abraham, Paul, Fleury, Yvan, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioannis, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Prado Mira, Ángela, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesús, Ibarz, Mercedes, Trenado-Alvarez, Josep, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlies, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqas, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Boultoukas, Evangelos, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Furneval, Julie, Ridgway, Stephanie, Saha, Rajnish, Clark, Thomas, Wood, James, Bolger, Clare, Bassford, Christopher, Lewandowski, john, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavros, Tasioudis, Polychronis, Lampiri, Kleri, Zisopoulou, Vasiliki, Ifigenia, Ravani, Eymorfia, Pagaki, Angela, Anttoniou, Katsoulas, Theodoros A., Kyparissi, Aikaterini, Aikaterini, Kounougeri, Marinakis, George, Tsimpoukas, Fotios, Spyropoulou, Anastasia, Zygoulis, Paris, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Rossi, Maurizio, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Brizio, Elisabetta, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, van Dijk, I., van Lelyveld-Haas, L. E. M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H. J., Dieperink, Willem, de Waard, Monique C., Bormans, Laura, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Fehrle, Lutz, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Børresen, Ole Marius, Bjørsvik, Geir, Maini, Sameer, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Zukowski, Maciej, Bernas, Szymon, Serwa, Marta, Stefaniak, Jan, Pawel, Maciejewski, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Castelo Branco, Miguel, Barros, Inês, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Boris, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Hans, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, Yapici, Nihan, University of Bergen (UiB), Haukeland University Hospital, University Medical Center [Utrecht], CIBER de Epidemiología y Salud Pública (CIBERESP), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), St George’s University Hospitals, Aarhus University Hospital, Mater Misericordiae University Hospital (The Mater Hospital), NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Ghent University Hospital, Karolinska University Hospital [Stockholm], Hôpitaux Universitaires de Genève (HUG), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Gestionnaire, Hal Sorbonne Université, Flaatten, H, De Lange, D, Morandi, A, Andersen, F, Artigas, A, Bertolini, G, Boumendil, A, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Schmutz, R, Wimmer, F, Eller, P, Zotter, K, Swinnen, W, De Buysscher, P, De Neve, N, Abraham, P, Fleury, Y, Schefold, J, Biskup, E, Taliadoros, I, Piza, P, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Dey, N, Solling, C, Rasmussen, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Prado Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Homez Guzman, M, Rico-Feijoo, J, Ibarz, M, Trenado-Alvarez, J, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Boultoukas, E, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Furneval, J, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ifigenia, R, Eymorfia, P, Angela, A, Katsoulas, T, Kyparissi, A, Aikaterini, K, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Gupta, M, Gurjar, M, Maji, I, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Rossi, M, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Brizio, E, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Mellea, S, Graziani, E, Barattini, M, van Dijk, I, van Lelyveld-Haas, L, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, Bormans, L, Hahn, M, Kemmerer, N, Strietzel, H, Fehrle, L, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Borresen, O, Bjorsvik, G, Maini, S, Czuczwar, M, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Serwa, M, Stefaniak, J, Pawel, M, Szymkowiak, M, Adamik, B, Catorze, N, Castelo Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Kawati, R, Sivik, J, Nauska, J, Smole, D, Parenmark, F, Lyren, J, Rockstroh, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, Yapici, N, Flaatten, Han, De Lange, Dylan W., Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Boumendil, Ariane, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andrea, Watson, Ximena, Zaferidis, Tilemacho, Guidet, Bertrand, Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemen, Swinnen, Walter, De Buysscher, Pieter, De Neve, Nikolaa, Abraham, Paul, Fleury, Yvan, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioanni, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcu, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobia, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Prado Mira, Ángela, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesú, Ibarz, Mercede, Trenado-Alvarez, Josep, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlie, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqa, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Boultoukas, Evangelo, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Furneval, Julie, Ridgway, Stephanie, Saha, Rajnish, Clark, Thoma, Wood, Jame, Bolger, Clare, Bassford, Christopher, Lewandowski, john, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavro, Tasioudis, Polychroni, Lampiri, Kleri, Zisopoulou, Vasiliki, Ifigenia, Ravani, Eymorfia, Pagaki, Angela, Anttoniou, Katsoulas, Theodoros A., Kyparissi, Aikaterini, Aikaterini, Kounougeri, Marinakis, George, Tsimpoukas, Fotio, Spyropoulou, Anastasia, Zygoulis, Pari, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Rossi, Maurizio, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Brizio, Elisabetta, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, van Dijk, I., van Lelyveld-Haas, L.E.M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H.J., Dieperink, Willem, de Waard, Monique C., Bormans, Laura, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Fehrle, Lutz, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Børresen, Ole Mariu, Bjørsvik, Geir, Maini, Sameer, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Zukowski, Maciej, Bernas, Szymon, Serwa, Marta, Stefaniak, Jan, Pawel, Maciejewski, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Castelo Branco, Miguel, Barros, Inê, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Bori, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Han, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, and Yapici, Nihan

Subjects
Male, Time Factors, Outcome Assessment, Frail Elderly/statistics & numerical data, [SDV]Life Sciences [q-bio], HSJ UCI, Passive, Critical Care and Intensive Care Medicine, Frailty/classification/diagnosis/mortality/therapy, Severity of Illness Index, Severity of illne, Elderly, 0302 clinical medicine, Quality of life, Frailty, ICU, Mortality, Octogenarians, Severity of illness, Aged, 80 and over, Critical Illness, Europe, Euthanasia, Passive, Female, Frail Elderly, Geriatric Assessment, Humans, Intensive Care Units, Length of Stay, Outcome Assessment, Health Care, Proportional Hazards Models, Prospective Studies, Quality of Life, Hospital Mortality, 80 and over, 030212 general & internal medicine, Prospective cohort study, education.field_of_study, ddc:617, Mortality rate, [SDV] Life Sciences [q-bio], Length of Stay/statistics & numerical data, Cohort, Intensive Care Units/statistics & numerical data, Critical Illne, SOFA score, Human, medicine.medical_specialty, Time Factor, Intensive Care Unit, Population, INTENSIVE-CARE, Europe/epidemiology, Outcome Assessment (Health Care), 03 medical and health sciences, Octogenarian, Intensive care, Journal Article, medicine, COHORT, Octogenarinans, Intensive care medicine, education, Aged, OLDER, Euthanasia, business.industry, 030208 emergency & critical care medicine, Health Care, Prospective Studie, Critical Illness/mortality, UNIT, Emergency medicine, Proportional Hazards Model, business
Abstract

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥80years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30days. Results: A total of 5021 patients with a median age of 84years (IQR 81–86years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥80years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807).

Published
2017
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10. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis

Author

Stein Silva, Philippe Vignon, Xavier Repessé, Anne-Laure Fedou, Guillaume Geri, Cyril Charron, Alix Aubry, and Antoine Vieillard-Baron

Subjects
Male, medicine.medical_specialty, Organ Dysfunction Scores, Fluid responsiveness, CIRCULATORY FAILURE, Hemodynamics, Critical Care and Intensive Care Medicine, Statistics, Nonparametric, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Anesthesiology, Hypovolemia, Post-hoc analysis, Research Letter, medicine, Humans, Prospective Studies, Aged, Simplified Acute Physiology Score, Acute respiratory distress syndrome, Septic shock, business.industry, Doppler, COVID-19, Stroke Volume, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Shock, Septic, Influenza, Intensive Care Units, 030228 respiratory system, Echocardiography, Initial phase, Cardiology, Female, medicine.symptom, business, Human
Abstract

Mechanisms of circulatory failure are complex and frequently intricate in septic shock. Better characterization could help to optimize hemodynamic support. Two published prospective databases from 12 different ICUs including echocardiographic monitoring performed by a transesophageal route at the initial phase of septic shock were merged for post hoc analysis. Hierarchical clustering in a principal components approach was used to define cardiovascular phenotypes using clinical and echocardiographic parameters. Missing data were imputed. A total of 360 patients (median age 64 [55; 74]) were included in the analysis. Five different clusters were defined: patients well resuscitated (cluster 1, n = 61, 16.9%) without left ventricular (LV) systolic dysfunction, right ventricular (RV) failure or fluid responsiveness, patients with LV systolic dysfunction (cluster 2, n = 64, 17.7%), patients with hyperkinetic profile (cluster 3, n = 84, 23.3%), patients with RV failure (cluster 4, n = 81, 22.5%) and patients with persistent hypovolemia (cluster 5, n = 70, 19.4%). Day 7 mortality was 9.8%, 32.8%, 8.3%, 27.2%, and 23.2%, while ICU mortality was 21.3%, 50.0%, 23.8%, 42.0%, and 38.6% in clusters 1, 2, 3, 4, and 5, respectively (p

Published
2019
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11. Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography

Author

Charron, Cyril, Vignon, Philippe, Prat, Gwenaël, Tonnelier, Alexandre, Aegerter, Philippe, Boles, Jean-Michel, and Amiel, Jean-Bernard

Subjects
Echocardiography, Health care industry
Abstract

Purpose To determine the minimum number of supervised transesophageal echocardiography (TEE) that intensivists should perform to reach competence in performing and interpreting a comprehensive hemodynamic assessment in ventilated intensive care unit patients. Methods Prospective and multicentric study. Skills of 41 intensivists (trainees) with no (level 0) or little (level 1) experience in echocardiography was evaluated over a 6-month period, using a previously validated skills assessment score (/40 points). Trainees were evaluated at 1 (M1), 3 (M3) and 6 months (M6) by their tutor while performing 2 TEE examinations in ventilated patients. Competence was a priori defined by a skills assessment score >35/40 points. Results No difference in the score was observed between level 0 and level 1, except at M1 (22.2 ± 6.2 vs. 25.9 ± 4.4 points, p = 0.03). After 6 months, trainees performed a mean of 31 ± 9 supervised TEE. The score gradually increased from M1 to M6 (24 ± 6, 32 ± 3, and 35 ± 3 points, p < 0.001), regardless of trainees' initial level. A correlation was found between the number of supervised TEE and the skills assessment score (r.sup.2 = 0.60; p 35/40 points was 25, with a sensitivity of 81 % and a specificity of 93 % (area under the ROC curve: 0.91 ± 0.04). A number of 31 supervised TEE examinations predicted a score >35/40 points with a specificity close to 100 %. Conclusion The performance of at least 31 supervised examinations over 6 months is required to reach competence in TEE driven hemodynamic evaluation of ventilated patient., Author(s): Cyril Charron [sup.1] [sup.2], Philippe Vignon [sup.3] [sup.4] [sup.5], Gwenaël Prat [sup.6], Alexandre Tonnelier [sup.6], Philippe Aegerter [sup.2] [sup.7], Jean-Michel Boles [sup.6], Jean-Bernard Amiel [sup.3] [sup.4] [sup.5], Antoine Vieillard-Baron [...]

Published
2013
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12. A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe

Author

Vieillard-Baron, Antoine, Slama, Michel, Mayo, Paul, Charron, Cyril, Amiel, Jean-Bernard, Esterez, Cédric, and Leleu, François

Subjects
Echocardiography -- Investigations -- Health aspects -- Safety and security measures, Company legal issue, Health care industry
Abstract

Purpose To evaluate the hemodynamic monitoring capability and safety of a single-use miniaturized transesophageal echocardiography (TEE) probe left in place in ventilated critically ill patients. Methods The probe was inserted in 94 patients and designed to be left in place for up to 72 h. Three views were obtained: the superior vena caval transverse, the mid-esophageal four-chamber, and the transgastric mid-papillary short-axis views. Observational data on the feasibility of insertion, complications, image quality, and influence on management were recorded and analyzed. Results No failure of probe insertion was observed. The nasogastric tube had to be removed in 17 % of cases. Image quality was judged as adequate or optimal in 91/94 (97 %) of cases in the superior vena caval view, 89/94 (95 %) of cases in the four-chamber view, and 86/94 (91 %) of cases in the short-axis view. The duration of monitoring was 32 ± 23 h, allowing 2.8 ± 1.6 hemodynamic evaluations per patient that led to a mean of 1.4 ± 1.5 therapeutic changes per patient. Among the 263 hemodynamic assessments, 132 (50 %) had a direct therapeutic impact in 62 patients (66 %). Two patients developed lip ulceration from the probe, and two patients had self-limited gastric bleeding. Conclusion The single-use miniaturized probe could be inserted in all patients. Image quality was acceptable in the majority of cases, and the information derived from the device was useful in making management decisions in patients with hemodynamic failure on ventilatory support. Further studies are needed to confirm the good tolerance and to compare the new device with other hemodynamic monitoring techniques., Author(s): Antoine Vieillard-Baron [sup.1] [sup.2], Michel Slama [sup.3], Paul Mayo [sup.4], Cyril Charron [sup.1] [sup.2], Jean-Bernard Amiel [sup.5] [sup.6] [sup.7], Cédric Esterez [sup.1] [sup.2], François Leleu [sup.3], Xavier Repesse [sup.1] [...]

Published
2013
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25. Limited value of end-expiratory inferior vena cava diameter to predict fluid responsiveness impact of intra-abdominal pressure

Author

Gwenaël Prat, Antoine Vieillard-Baron, Julien Maizel, Guillaume Geri, Michel Slama, Bruno Evrard, Marine Goudelin, Christophe Jacob, Xavier Repessé, Cyril Charron, and Philippe Vignon

Subjects
Male, medicine.medical_specialty, Fluid responsiveness, Blood volume, Vena Cava, Inferior, Critical Care and Intensive Care Medicine, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Internal medicine, medicine, Pressure, Ventricular outflow tract, Humans, Intra abdominal pressure, Septic shock, business.industry, Confounding, Hemodynamics, 030208 emergency & critical care medicine, Shock, medicine.disease, Prognosis, Shock, Septic, 030228 respiratory system, medicine.vein, Shock (circulatory), Cardiology, Fluid Therapy, Female, medicine.symptom, business
Abstract

We sought to determine the diagnostic ability of the end-expiratory inferior vena cava diameter (IVCEE) to predict fluid responsiveness (FR) and the potential confounding effect of intra-abdominal pressure (IAP). In this multicenter study, 540 consecutive ventilated patients with shock of various origins underwent an echocardiographic assessment by experts. The IVCEE, velocity time integral (VTI) of the left ventricular outflow tract (LVOT) and intra-abdominal pressure (IAP) were measured. Passive leg raising (PLR) was then systematically used to perform a reversible central blood volume expansion. FR was defined by an increase in LVOT VTI ≥ 10% after 1 min of PLR. Since IVCEE was not obtained in 117 patients (22%), 423 were studied (septic shock: 56%), 129 of them (30%) having elevated IAP (≥ 12 mmHg) and 172 of them (41%) exhibiting FR. IVCEE ≤ 13 mm predicted FR with a specificity of at least 80% in 62 patients (15%), while IVCEE ≥ 25 mm predicted the absence of FR with a specificity of at least 80% in 61 patients (14%). In the remaining 300 patients (71%), the intermediate value of IVCEE did not allow predicting FR. An adjusted relationship between IVCEE and FR was observed while this relationship was less pronounced in patients with IAP ≥ 12 mmHg. Measurement of IVCEE in ventilated patients is moderately feasible and poorly predicts FR, with IAP acting as a confounding factor. IVCEE might add some value to guide fluid therapy but should not be used alone for fluid prediction purposes.

Published
2017

26. Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography

Author

Cyril Charron, Jean-Michel Boles, Antoine Vieillard-Baron, Jean-Bernard Amiel, Alexandre Tonnelier, Gwenaël Prat, Philippe Aegerter, and Philippe Vignon

Subjects
medicine.medical_specialty, Educational measurement, Inservice Training, Critical Care, business.industry, Hemodynamics, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, Multicenter study, law, Anesthesiology, medicine, Humans, Clinical Competence, Educational Measurement, France, Prospective Studies, Intensive care medicine, business, human activities, Competence (human resources), Echocardiography, Transesophageal
Abstract

To determine the minimum number of supervised transesophageal echocardiography (TEE) that intensivists should perform to reach competence in performing and interpreting a comprehensive hemodynamic assessment in ventilated intensive care unit patients.Prospective and multicentric study. Skills of 41 intensivists (trainees) with no (level 0) or little (level 1) experience in echocardiography was evaluated over a 6-month period, using a previously validated skills assessment score (/40 points). Trainees were evaluated at 1 (M1), 3 (M3) and 6 months (M6) by their tutor while performing 2 TEE examinations in ventilated patients. Competence was a priori defined by a skills assessment score35/40 points.No difference in the score was observed between level 0 and level 1, except at M1 (22.2 ± 6.2 vs. 25.9 ± 4.4 points, p = 0.03). After 6 months, trainees performed a mean of 31 ± 9 supervised TEE. The score gradually increased from M1 to M6 (24 ± 6, 32 ± 3, and 35 ± 3 points, p0.001), regardless of trainees' initial level. A correlation was found between the number of supervised TEE and the skills assessment score (r (2) = 0.60; p0.001). The number of supervised TEE examinations which best predicted a score35/40 points was 25, with a sensitivity of 81 % and a specificity of 93 % (area under the ROC curve: 0.91 ± 0.04). A number of 31 supervised TEE examinations predicted a score35/40 points with a specificity close to 100 %.The performance of at least 31 supervised examinations over 6 months is required to reach competence in TEE driven hemodynamic evaluation of ventilated patient.

Published
2013
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27. Routine prone positioning in patients with severe ARDS: feasibility and impact on prognosis

Author

B. Page, Vincent Caille, Koceila Bouferrache, Antoine Vieillard-Baron, Samuel Castro, Philippe Aegerter, F. Jardin, and Cyril Charron

Subjects
Adult, Male, medicine.medical_specialty, ARDS, medicine.medical_treatment, Lung injury, Critical Care and Intensive Care Medicine, Severity of Illness Index, Intensive care, Anesthesiology, Prone Position, medicine, Humans, Hospital Mortality, Prospective Studies, Intensive care medicine, Prospective cohort study, Aged, Monitoring, Physiologic, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Middle Aged, Prognosis, medicine.disease, Respiration, Artificial, respiratory tract diseases, Intensive Care Units, Prone position, Breathing, Feasibility Studies, Female, France, business
Abstract

Since 1997, we have routinely used prone positioning (PP) in patients who have a PaO(2)/FiO(2) below 100 mmHg after 24-48 h of mechanical ventilation and who are ventilated using a low stretch ventilation strategy. We report here the characteristics and prognosis of this subgroup of patients with severe lung injury to illustrate the feasibility, role, and impact of routine PP in acute respiratory distress syndrome (ARDS).A total of 218 patients were admitted because of ARDS between 1997 and 2009. Of these patients, 57 (26%) were positioned prone because of a PaO(2)/FiO(2) below 100 mmHg after 24-48 h of mechanical ventilation. Age was 51 ± 16 years, PaO(2)/FiO(2) 74 ± 19, and PaCO(2) 54 ± 10 mmHg. The lung injury score was 3.13 ± 0.15. Tidal volume was 7 ± 2 mL/kg, PEEP 5.6 ± 1.2 cmH(2)O, and plateau pressure 27 ± 3 cmH(2)O. Prone sessions lasted 18 h/day and 3.4 ± 1.1 sessions were required to obtain an FiO(2) below 60%. The 60-day mortality was 19% and death occurred after 12 ± 5 days. The ratio between observed and predicted mortality was 0.43. In patients with a PaO(2)/FiO(2) below 60 mmHg, the 60-day mortality was 28%. Logistic regression analysis showed that among the 218 patients, PP appeared to be protective with an odds ratio of 0.35 [0.16-0.79].We demonstrate the clinical feasibility of routine PP in patients with a PaO(2)/FiO(2) below 100 mmHg after 24-48 h and suggest that, when combined with a low stretch ventilation strategy, it is protective with a high survival rate.

Published
2011
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28. Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome

Author

François Jardin, Jérôme Devaquet, Cyril Charron, Antoine Vieillard-Baron, Jerome Aboab, Armand Mekontso Dessap, and Laurent Brochard

Subjects
Male, ARDS, Critical Care, Ventricular Dysfunction, Right, Lung injury, Critical Care and Intensive Care Medicine, Severity of Illness Index, Statistics, Nonparametric, Hypercapnia, Positive-Pressure Respiration, 03 medical and health sciences, Plateau pressure, 0302 clinical medicine, Respiratory Rate, Intensive care, Tidal Volume, medicine, Humans, Prospective Studies, Positive end-expiratory pressure, Tidal volume, Aged, Analysis of Variance, Respiratory Distress Syndrome, business.industry, Respiratory disease, 030208 emergency & critical care medicine, Respiratory Dead Space, Middle Aged, medicine.disease, respiratory tract diseases, 030228 respiratory system, Anesthesia, Acute Disease, Linear Models, Female, Acidosis, Respiratory, medicine.symptom, business, Echocardiography, Transesophageal, circulatory and respiratory physiology
Abstract

To evaluate the effects of acute hypercapnia induced by positive end-expiratory pressure (PEEP) variations at constant plateau pressure (P (plat)) in patients with severe acute respiratory distress syndrome (ARDS) on right ventricular (RV) function.Prospective observational study in two academic intensive care units enrolling 11 adults with severe ARDS (PaO(2)/FiO(2)150 mmHg at PEEP5 cmH(2)O). We compared three ventilatory strategies, each used for 1 h, with P (plat) at 22 (20-25) cmH(2)O: low PEEP (5.4 cmH(2)O) or high PEEP (11.0 cmH(2)O) with compensation of the tidal volume reduction by either a high respiratory rate (high PEEP/high rate) or instrumental dead space decrease (high PEEP/low rate). We assessed RV function (transesophageal echocardiography), alveolar dead space (expired CO(2)), and alveolar recruitment (pressure-volume curves).Compared to low PEEP, PaO(2)/FiO(2) ratio and alveolar recruitment were increased with high PEEP. Alveolar dead space remained unchanged. Both high-PEEP strategies induced higher PaCO(2) levels [71 (60-94) and 75 (53-84), vs. 52 (43-68) mmHg] and lower pH values [7.17 (7.12-7.23) and 7.20 (7.16-7.25) vs. 7.30 (7.24-7.35)], as well as RV dilatation, LV deformation and a significant decrease in cardiac index. The decrease in stroke index tended to be negatively correlated to the increase in alveolar recruitment with high PEEP.Acidosis and hypercapnia induced by tidal volume reduction and increase in PEEP at constant P (plat) were associated with impaired RV function and hemodynamics despite positive effects on oxygenation and alveolar recruitment ( ClinicalTrials.gov #NCT00236262).

Published
2009
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29. Reversal of refractory septic shock with drotrecogin alpha (activated)

Author

Vincent Caille, F. Jardin, Guillaume Belliard, Philippe Aegerter, Antoine Vieillard-Baron, B. Page, and Cyril Charron

Subjects
Male, Resuscitation, medicine.medical_specialty, Multiple Organ Failure, Critical Care and Intensive Care Medicine, Norepinephrine (medication), Sepsis, Anti-Infective Agents, Refractory, Intensive care, medicine, Humans, Prospective Studies, Aged, Dose-Response Relationship, Drug, business.industry, Septic shock, Middle Aged, medicine.disease, Shock, Septic, Survival Analysis, Recombinant Proteins, Surgery, Treatment Outcome, Lactic acidosis, Shock (circulatory), Anesthesia, Acidosis, Lactic, Female, France, medicine.symptom, business, Protein C, medicine.drug
Abstract

We previously reported that early continuous veno-venous hemodiafiltration (CVVHDF) enables rapid identification of a subgroup of patients with “refractory” septic shock and a 100% risk of death. The objective of this study was to investigate whether early administration of drotrecogin alpha (activated) (DrotAA) to this selected subgroup of septic patients at extremely high risk of death would significantly improve prognosis. Prospective observational study in a medical intensive-care unit of a University Hospital. Twenty-three patients with refractory septic shock were included. “Refractory” shock was defined as persistent circulatory failure despite adequate circulatory support, associated with persisting lactic acidosis despite early CVVHDF. Response to CVVDHF was assessed after 6 h of this continuous procedure. Patients selected by this strategy received DrotAA infusion for four days. The 28-day mortality rate of the 23 patients was 39%. No difference was observed at inclusion between survivors and nonsurvivors. In patients who finally survived, 12 h of DrotAA infusion was associated with a significant decrease in lactic acidosis and in norepinephrine dose. DrotAA therapy was associated with unexpectedly high 28-day survival in patients with “refractory” septic shock.

Published
2009
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30. Hemodynamic effects of passive leg raising: an echocardiographic study in patients with shock

Author

Vincent Caille, Antoine Vieillard-Baron, François Jardin, Guillaume Belliard, Cyril Charron, and Julien Jabot

Subjects
Male, Cardiac function curve, medicine.medical_specialty, Vena Cava, Superior, Diastole, Cardiac index, Hemodynamics, Critical Care and Intensive Care Medicine, Severity of Illness Index, Internal medicine, Intensive care, Heart rate, medicine, Humans, Aged, Leg, business.industry, Shock, Respiration, Artificial, Preload, Shock (circulatory), cardiovascular system, Cardiology, Female, medicine.symptom, business, Echocardiography, Transesophageal
Abstract

To determine the effects of passive leg raising (PLR) on hemodynamics and on cardiac function according to the preload dependency defined by the superior vena cava collapsibility index (DeltaSVC).Forty patients with shock, sedated and mechanically ventilated, were included. Transesophageal echocardiography was performed. At baseline (T1), two groups were defined according to DeltaSVC. Eighteen patients presenting a DeltaSVC36%, an indicator of preload dependency, formed group 1, whereas 22 patients (group 2) exhibited a DeltaSVC30% (not preload-dependent). Measurements were then performed during PLR (T2), back to baseline (T3), and after volume expansion (T4) in group 1 only. At T1, DeltaSVC was significantly higher in group 1 than in group 2, 50 +/- 9% and 7 +/- 6%, respectively. In group 1, we found a decrease in DeltaSVC at T2 (24 +/- 9%) and T4 (17 +/- 7%), associated with increased systolic, diastolic and arterial pulse pressures. Cardiac index also increased, from 1.92 +/- 0.74 (T1) to 2.35 +/- 0.92 (T2) and 2.85 +/- 1.2 l/min/m(2) (T4) and left ventricular end-diastolic volume from 51 +/- 41 to 61 +/- 51 and 73 +/- 51 ml/m(2). None of these variations was found in group 2. No change in heart rate was observed.Hemodynamic changes related to PLR were only induced by increased cardiac preload.

Published
2008
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31. Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics

Author

Montaine Lefèvre, Antoine Vieillard-Baron, Vincent Caille, François Jardin, Gwenaël Prat, Jean-Michel Boles, Philippe Aegerter, Guillaume Belliard, and Cyril Charron

Subjects
medicine.medical_specialty, Scoring system, business.industry, Hemodynamics, Monitoring system, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, Transesophageal echocardiographic monitoring, law, Anesthesiology, Intensive care, medicine, Intensive care medicine, business, human activities
Abstract

Objective Transesophageal echocardiography (TEE) is increasingly used in hemodynamic monitoring in the intensive care unit. This paper describes and validates a scoring system for assessing competence in TEE performed by intensivists for this indication.

Published
2007
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32. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact

Author

Cyril Charron, Emmanuelle Begot, Annick Legras, Philippe Vignon, Xavier Repessé, Antoine Vieillard-Baron, Christian Brun-Buisson, Armand Mekontso Dessap, and Florence Boissier

Subjects
Male, medicine.medical_specialty, ARDS, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Pulmonary heart disease, 03 medical and health sciences, 0302 clinical medicine, stomatognathic system, Afterload, Pulmonary Heart Disease, Predictive Value of Tests, Risk Factors, Intensive care, Internal medicine, medicine, Prevalence, Humans, Prospective Studies, Prospective cohort study, Mechanical ventilation, Respiratory Distress Syndrome, Framingham Risk Score, business.industry, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Prognosis, Respiration, Artificial, humanities, Intensive Care Units, Treatment Outcome, 030228 respiratory system, SAPS II, Acute Disease, Cardiology, Female, business, Echocardiography, Transesophageal
Abstract

Increased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP). To determine the prevalence and prognosis of ACP and build a clinical risk score for the early detection of ACP. This was a prospective study in which 752 patients with moderate-to-severe ARDS receiving protective ventilation were assessed using transesophageal echocardiography in 11 intensive care units. The study cohort was randomly split in a derivation (n = 502) and a validation (n = 250) cohort. ACP was defined as septal dyskinesia with a dilated RV [end-diastolic RV/left ventricle (LV) area ratio >0.6 (≥1 for severe dilatation)]. ACP was found in 164 of the 752 patients (prevalence of 22 %; 95 % confidence interval 19–25 %). In the derivation cohort, the ACP risk score included four variables [pneumonia as a cause of ARDS, driving pressure ≥18 cm H2O, arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio

Published
2015

33. Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient?

Author

François Jardin, Karim Chergui, Olivier Peyrouset, Antoine Vieillard-Baron, and Cyril Charron

Subjects
Male, Cardiac function curve, medicine.medical_specialty, Vena Cava, Superior, Systole, Heart Ventricles, Point-of-Care Systems, Fluid responsiveness, Hemodynamics, Vena Cava, Inferior, Routine practice, Critical Care and Intensive Care Medicine, Severity of Illness Index, Sepsis, Diastole, Intensive care, Internal medicine, Anesthesiology, Humans, Medicine, In patient, Prospective Studies, Aged, Analysis of Variance, business.industry, medicine.disease, Shock, Septic, Cardiology, Female, business, human activities, Echocardiography, Transesophageal
Abstract

Transesophageal echocardiography (TEE) has proven its efficiency in assessing hemodynamics in patients by its ability to evaluate cardiac function and fluid responsiveness. Classically, it requires quantitative measurements, whereas in routine practice TEE is used in our unit especially as a qualitative procedure. We assessed the accuracy of this qualitative central hemodynamic evaluation obtained by TEE at the bedside.Prospective study conducted in a medical ICU between September 2004 and April 2005. All TEE examinations performed in consecutive patients hospitalized for septic shock and mechanically ventilated for an associated acute lung injury were eligible for evaluation. Intensivists trained in echocardiography were asked to classify (a) respiratory changes in the superior vena cava (SVC), (b) left ventricular (LV) systolic function, (c) right ventricular (RV) end-diastolic size, and (d) shape and kinetics of the interventricular septum (IVS). A post-hoc quantitative evaluation was then performed by a trained investigator unaware of the patients' status.We evaluated 83 examinations in 30 patients. Qualitative evaluation was easily able to distinguish patients with significant or nonsignificant SVC respiratory changes, normal, moderately or markedly depressed LV systolic function, and nondilated or dilated right ventricle. Acute cor pulmonale was also well recognized.By its ability accurately to evaluate hemodynamic status qualitative TEE could be useful for intensivists in managing circulatory failure in septic shock, rendering the more time-consuming quantitative evaluation useless.

Published
2006
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34. Incidence, causes and prognosis of hypotension related to meprobamate poisoning

Author

Anne Rabiller, François Jardin, Armand Mekontso-Dessap, Antoine Vieillard-Baron, Cyril Charron, and Karim Chergui

Subjects
Adult, Male, Cardiac index, Critical Care and Intensive Care Medicine, Inferior vena cava, Intensive care, medicine, Humans, Meprobamate, Retrospective Studies, Ejection fraction, Gastric emptying, business.industry, Incidence, Cardiogenic shock, Middle Aged, Prognosis, medicine.disease, Respiration, Artificial, Intensive Care Units, Anti-Anxiety Agents, Gastric Emptying, medicine.vein, Charcoal, Anesthesia, Heart failure, Female, Hypotension, business, medicine.drug
Abstract

Meprobamate self-poisoning has been reported as potentially inducing hypotension. We examined the incidence and causes of hypotension induced by this poisoning and its prognosis.Retrospective observational study conducted in a medical ICU between June 1997 and October 2003. Seventy-four patients admitted for meprobamate poisoning and needing mechanical ventilation were included. Demographic, clinical, and laboratory data were compared between patients with and without hypotension. All echocardiograms recorded in patients with hypotension were reviewed, and left ventricular (LV) and right ventricular (RV) functions were assessed.Twenty-nine (40%) patients exhibited hypotension without any significant difference in age, gender, cardiac history, or meprobamate concentration in blood when compared to patients without hypotension. Base excess was significantly lower in patients with hypotension. Echocardiography demonstrated a hypokinetic state, associating decreased LV ejection fraction (45+/-15%) and cardiac index (2+/-0.7 l min(-1) m(-2)), and increased inferior vena cava diameter. Most patients with hypotension received inotropic drugs by infusion, and were ventilated for significantly longer.Meprobamate self-poisoning induces hypotension, notably related to cardiac failure, in about 40% of cases. This has important therapeutic consequences, as frequent inotropic drug infusion. The mechanisms of cardiac toxicity remain largely unknown, and no predictive factor could be isolated.

Published
2005
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35. Intravenous phosphate in the intensive care unit: More aggressive repletion regimens for moderate and severe hypophosphatemia

Author

Nadine Gagnon, Martine Leblanc, Francis Bernard, Yoanna Skrobik, Nathalie Simoneau, and Thierry Charron

Subjects
Male, musculoskeletal diseases, medicine.medical_specialty, Hypophosphatemia, Potassium Compounds, urologic and male genital diseases, Critical Care and Intensive Care Medicine, Phosphates, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, Anesthesiology, medicine, Humans, Prospective Studies, Intensive care medicine, Prospective cohort study, Infusion Pumps, Aged, Intravenous potassium, business.industry, nutritional and metabolic diseases, Middle Aged, medicine.disease, Phosphate, Intensive care unit, female genital diseases and pregnancy complications, Clinical trial, Intensive Care Units, stomatognathic diseases, Treatment Outcome, chemistry, Anesthesia, Female, business
Abstract

To evaluate efficacy and safety of aggressive correction of hypophosphatemia with intravenous potassium phosphate in the ICU.Randomized interventional prospective study in the medical and surgical ICU of a tertiary university hospital.Critically ill patients with hypophosphatemia between June and November 1998.Patients with moderate hypophosphatemia (0.65 and0.40 mmol/l; n=37) were randomized into two groups: group 1 received 30 mmol potassium phosphate intravenously in 50 ml saline over 2 h, and group 2 received 30 mmol potassium phosphate in 100 ml saline over 4 h. Patients with severe hypophosphatemia (0.40 mmol/l; n=10) were also randomized into two groups: group 3 received 45 mmol potassium phosphate intravenously in 100 ml saline over 3 h, and group 4 received 45 mmol potassium phosphate in 100 ml saline over 6 h. Electrolytes, blood gas, renal function were monitored until day 3; urine was collected during and until 6 h after infusions. The overall efficacy of the protocols was 98% by the end of the infusion. There was no statistical difference in phosphate values between groups at the end of infusion or at 24 h. No adverse events were noted; one patient had an increase in serum potassium to 6.1 mmol/l. Phosphaturia in all groups was elevated as evidenced by fractional excretion above 20%.More rapid administration of large potassium phosphate boluses is effective and safe for correcting hypophosphatemia in ICU patients with preserved renal function if baseline serum potassium is below 4 mmol/l.

Published
2003
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36. Validity of applying TRISS analysis to paediatric blunt trauma patients managed in a French paediatric level I trauma centre

Author

Stéphane Blanot, Pierre Carli, Emmanuelle Schmautz, Philippe Meyer, Brigitte Charron, Bruno Riou, and Gilles Orliaguet

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, Standard score, Wounds, Nonpenetrating, Critical Care and Intensive Care Medicine, Injury Severity Score, Trauma Centers, Predictive Value of Tests, Internal medicine, Intensive care, Outcome Assessment, Health Care, medicine, Humans, Child, Retrospective Studies, Trauma Severity Indices, Receiver operating characteristic, business.industry, Major trauma, Age Factors, Infant, Reproducibility of Results, Revised Trauma Score, Hospitals, Pediatric, medicine.disease, Survival Analysis, Confidence interval, Blunt trauma, Child, Preschool, Female, France, business
Abstract

Objective: Using a weighted combination of the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the type of injury (blunt or penetrating) and patient age, the TRISS method is used to calculate the probability of survival (ps) in trauma patients. The goal of this study was to compare the ability of the American Major Trauma Outcome Study (MTOS) norm for adult blunt trauma patients (ADULT) and the specific norm for paediatric patients (PED) to estimate the ps of injured children using TRISS methodology. Design: Retrospective analysis using a paediatric trauma patient database. Setting: a French level 1 paediatric trauma centre. Patients: Four hundred seven consecutive paediatric blunt trauma patients, treated over a 3-year period. Measurements: The observed and expected survivals were compared, using the M, W and Z scores, with both ADULT and PED. The W score is the number of survivors more or less than expected from the MTOS predictions for 100 patients. A Z score, which measures the significance of W, between –1.96 and +1.96, indicates no significant difference between observed and expected survivors. A value of M less than 0.88 indicates a disparity in the severity match between the study group and the MTOS group. We calculated the standardised W score (Ws), which represents the W score that would have been observed if the case mix of severity was identical to that of the MTOS group. Accordingly, a standardised Z score (Zs) was also calculated. In addition, we calculated the area under the receiver operating curve (aROC) using both norms, while calibration was also assessed by calculation of the Hosmer-Lemeshow goodness-of-fit tests. Results: Using PED, the number of actual survivors (n=364) was not significantly different from the MTOS (n=358). The value of M, 0.65, indicated a disparity in the severity match between the study group and the MTOS group, due to a higher proportion of patients with lower ps (TRISS

Published
2001
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37. Kaposi's sarcoma: a reversible cause of ARDS in HIV-infected patient

Author

Xavier Repessé, Antoine Vieillard-Baron, Cyril Charron, and Siu-Ming Au

Subjects
Adult, medicine.medical_specialty, ARDS, medicine.medical_treatment, Biopsy, Critical Care and Intensive Care Medicine, Gastroenterology, Procalcitonin, law.invention, Diagnosis, Differential, law, Stomach Neoplasms, Internal medicine, Gastroscopy, HIV Seropositivity, Medicine, Humans, Kaposi's sarcoma, Sarcoma, Kaposi, Chemotherapy, Respiratory Distress Syndrome, medicine.diagnostic_test, business.industry, medicine.disease, Intensive care unit, Female, Sarcoma, business, Complication, Tomography, X-Ray Computed, Imaging in Intensive Care Medicine
Abstract

A 38-year-old untreated human immunodeficiency virus (HIV)-infected transsexual female was admitted to our intensive care unit (ICU) for acute respiratory distress syndrome (ARDS). She had no fever and no other organ failure at admission. Leukocyte count was 10.2 g/L, C-reactive protein (CRP) was 135 mg/L, serum procalcitonin was 0.11 lg/L, CD4 count was 180/mm, and lactate dehydrogenase (LDH) level was 625 UI/L (N \626 UI/L). Chest X-ray and thoracic computed tomography (Fig. 1a) revealed diffuse alveolo-interstitial pulmonary lesions associated with pseudotumoral nodules visualized at bronchoscopy. Gastrointestinal endoscopy showed typical ‘‘cherry-red’’ lesions (Fig. 1b). Skin lesion biopsies confirmed the diagnosis of Kaposi’s sarcoma (KS). The patient fully recovered after chemotherapy and was discharged from hospital 8 weeks later. KS is known as a lymphoproliferative disorder related to human herpesvirus 8 (HHV8) occurring in HIV-infected patients [1]. KS usually presents as extensive papular–nodular skin lesions [2]. ARDS has become a rare complication of KS thanks to the widespread use of highly active antiretroviral therapy (HAART) [2] and is described to occur without typical skin lesions in 15 % of the pulmonary forms [3]. Low LDH level, negative serum procalcitonin, and CD4 count over 50/mm make other opportunistic infections unlikely [3]. Thoracic computed tomography is characterized by striking flame-shaped opacities and spicular thickening of the bronchovascular bundles [4]. HAART is the cornerstone of treatment [5], but severe clinical presentations can require chemotherapy, such as anthracyclines or paclitaxel [5].

Published
2013

38. A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe

Author

Paul H. Mayo, Antoine Vieillard-Baron, Michel Slama, François Leleu, Cyril Charron, Xavier Repesse, Philippe Vignon, Jean-Bernard Amiel, and Cédric Esterez

Subjects
Male, medicine.medical_specialty, Time Factors, Acute Lung Injury, Pilot Projects, Critical Care and Intensive Care Medicine, medicine, RESPIRATORY DISTRESS SYNDROME ADULT, Humans, Prospective Studies, Disposable Equipment, Monitoring, Physiologic, Respiratory Distress Syndrome, Single use, Miniaturization, Critically ill, business.industry, Hemodynamics, Shock, Middle Aged, Respiration, Artificial, Feasibility Studies, Female, Radiology, France, Patient Safety, business, human activities, Echocardiography, Transesophageal
Abstract

To evaluate the hemodynamic monitoring capability and safety of a single-use miniaturized transesophageal echocardiography (TEE) probe left in place in ventilated critically ill patients.The probe was inserted in 94 patients and designed to be left in place for up to 72 h. Three views were obtained: the superior vena caval transverse, the mid-esophageal four-chamber, and the transgastric mid-papillary short-axis views. Observational data on the feasibility of insertion, complications, image quality, and influence on management were recorded and analyzed.No failure of probe insertion was observed. The nasogastric tube had to be removed in 17 % of cases. Image quality was judged as adequate or optimal in 91/94 (97 %) of cases in the superior vena caval view, 89/94 (95 %) of cases in the four-chamber view, and 86/94 (91 %) of cases in the short-axis view. The duration of monitoring was 32 ± 23 h, allowing 2.8 ± 1.6 hemodynamic evaluations per patient that led to a mean of 1.4 ± 1.5 therapeutic changes per patient. Among the 263 hemodynamic assessments, 132 (50 %) had a direct therapeutic impact in 62 patients (66 %). Two patients developed lip ulceration from the probe, and two patients had self-limited gastric bleeding.The single-use miniaturized probe could be inserted in all patients. Image quality was acceptable in the majority of cases, and the information derived from the device was useful in making management decisions in patients with hemodynamic failure on ventilatory support. Further studies are needed to confirm the good tolerance and to compare the new device with other hemodynamic monitoring techniques.

Published
2012

40. Lung 'recruitment' or lung overinflation maneuvers?

Author

François Jardin, Cyril Charron, and Antoine Vieillard-Baron

Subjects
medicine.medical_specialty, business.industry, Anesthesiology, Pain medicine, Emergency medicine, MEDLINE, medicine, Ventricular pressure, Lung Overinflation, Critical Care and Intensive Care Medicine, business, Lung recruitment
Published
2005
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