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1. Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Author: Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Piergiorgio Bresil, Marianne Levin, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson, Robba, C, Graziano, F, Guglielmi, A, Rebora, P, Galimberti, S, Taccone, F, Citerio, G, Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, and Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Vera Spatenkova, Piergiorgio Bresil, Marianne Levin, Piergiorgio Bresil, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Karim Asehnoune, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Charikleia Vrettou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Primoz Gradisek, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson
Subjects: Subarachnoid haemorrhage, Traumatic brain injury, Intracranial pressure, Therapy intensity level, Critical Care and Intensive Care Medicine, Intracranial haemorrhage
Abstract: Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with sixmonths mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p
Published: 2023

2. Comparison of the efficacy of high-flow nasal oxygenation and spontaneous breathing with face mask ventilation during panendoscopy

Author: Clément Conti, Olivier Mauvais, Emmanuel Samain, Laurent Tavernier, Sébastien Pili Floury, Guillaume Besch, and David Ferreira
Subjects: Anesthesiology and Pain Medicine
Published: 2023

3. Continuous Transversus Abdominis Plane Infusion via Surgically Inserted Catheter for Postoperative Analgesia After Abdominal Aortic Surgery by Retroperitoneal Approach: TAPCACAO Study

Author: Lucie, Salomon du Mont, Aline, Jazayeri, Guillaume, Besch, Pierre-Grégoire, Guinot, and Eric, Steinmetz
Subjects: Pain, Postoperative, Catheters, Morphine, Analgesia, Patient-Controlled, General Medicine, Analgesics, Opioid, Treatment Outcome, Double-Blind Method, Humans, Ropivacaine, Surgery, Prospective Studies, Anesthetics, Local, Cardiology and Cardiovascular Medicine, Pain Measurement, Abdominal Muscles
Abstract: The purpose of our study was to evaluate the analgesic properties of continuous transversus abdominis plane (TAP) infusion with ropivacaine compared to placebo for postoperative analgesia in elective surgery of the abdominal aorta by retroperitoneal exposure.We conducted a prospective, single-center, randomized, double-blind study comparing a group of patients with a TAP catheter undoing ropivacaine infusion with a placebo group. Patients received a left retroperitoneal pararectal exposure for abdominal aortic surgery. A continuous infusion catheter was placed under visual control by the surgeon before closure and removed after 48 hr. All patients had postoperative patient-controlled analgesia with morphine. The primary endpoint was morphine consumption during the first 24 hr.The analysis included 25 patients in the placebo group and 24 in the ropivacaine group. The average morphine consumption during the first 24 hr was significantly different, with 31 ± 16 mg in the ropivacaine group and 41 ± 17 mg in the placebo group (P = 0.019). At 48 hr, morphine consumption was still lower in the ropivacaine group (42 ± 26 mg) than in the placebo group (64 ± 25 mg) (P = 0.003). The opioid narcotic-related side effects of opioid infusion (postoperative nausea and vomiting, constipation) and length of hospital stay were similar in both populations.Our study showed that continuous TAP block with ropivacaine via surgically inserted catheter significantly decreased morphine consumption at 24 and 48 hr after elective abdominal aortic surgery by retroperitoneal exposure.
Published: 2022

4. β-lactam dosing at the early phase of sepsis: Performance of a pragmatic protocol for target concentration achievement in a prospective cohort study

Author: Hadrien Winiszewski, Marc Puyraveau, Lucie Vettoretti, Guillaume Besch, Anne-Laure Clairet, Cyrielle Despres, Jennifer Lagoutte-Renosi, Claire Chaignat, Gilles Capellier, Damien Montange, Gaël Piton, Guylaine Labro, Sebastien Pili Floury, and Berengère Vivet
Subjects: Piperacillin, business.industry, Critical Illness, Cefepime, Renal function, Meropenem, beta-Lactams, Critical Care and Intensive Care Medicine, medicine.disease, Anti-Bacterial Agents, Sepsis, Anesthesia, polycyclic compounds, medicine, Clinical endpoint, Humans, Prospective Studies, Dosing, business, Prospective cohort study, medicine.drug
Abstract: Purpose We hypothesized that a protocol of standardized fixed dose using prolonged infusion during the early phase of sepsis may avoid insufficient β-lactam concentrations. Methods In this single center prospective study, patients with sepsis and vasopressors were enrolled if they were treated by either piperacillin-tazobactam, meropenem or cefepime. Βeta-lactams were administered at fixed dose by prolonged infusion. Targeted plasma concentrations for piperacillin, meropenem and cefepime were above 80 mg/L, 8 mg/L and 38 mg/L respectively. Three blood samples were collected per patient over the first 48 h of treatment. Primary endpoint was target concentration achievement during the 48 first hours, defined as all plasma concentrations above the targeted threshold. Results Among the 89 patients completing the three samples, target concentrations were achieved for 61 (69%). Target concentrations were achieved in 20 (53%), 32 (89%), and 9 (60%) of the patients treated with piperacillin, meropenem and cefepime, respectively. By multivariate analysis, lower APACHE 2 score, higher baseline MDRD creatinine clearance, and piperacillin use were independently associated with insufficient β-lactam concentrations. Conclusion Despite a fixed dose antibiotic administration protocol with prolonged infusion insufficient β-lactam concentration was frequent at the early phase of sepsis, especially in less severe patients, without renal failure, and treated with piperacillin. In septic patients with vasopressors, piperacillin dosing higher than 16 g may be needed to achieve the recommended target concentration. Trial registration: NCT02820987
Published: 2022

5. Échographie pleuro-pulmonaire en soins intensifs et en réanimation

Author: David Ferreira, Tommy Grelet, and Guillaume Besch
Subjects: Anesthesiology and Pain Medicine, Emergency Medicine, Emergency Nursing
Published: 2022

6. Le Collège National des Enseignants d’Anesthésie et de Réanimation (CNEAR)

Author: Guillaume Besch, Benoit Plaud, Mathieu Raux, Matthieu Jabaudon, Marc-Olivier Fischer, Emmanuel Samain, Thomas Clavier, Bertrand Dureuil, Pierre Bouzat, Gerald Chanques, Adrien Bouglé, Lionel Velly, Julien Pottecher, Alexy Tran-Dinh, Etienne Gayat, Denis Frasca, Gilles Orliaguet, Benoit Veber, Fanny Vardon Bounes, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 020205 medical informatics, [SDV]Life Sciences [q-bio], 0202 electrical engineering, electronic engineering, information engineering, 030212 general & internal medicine, 02 engineering and technology, ComputingMilieux_MISCELLANEOUS, 3. Good health
Abstract: Resume Le College national des enseignants d’anesthesie et de reanimation (CNEAR) reunit les 181 professionnels hospitalo-universitaires de l’anesthesie-reanimation impliques dans l’enseignement et la recherche en anesthesie, reanimation et medecine perioperatoire. Les objectifs du CNEAR pour la discipline anesthesie-reanimation & medecine peri-operatoire sont avant tout pedagogiques, a destination des etudiants du troisieme et du deuxieme cycle des etudes medicales. Le CNEAR intervient ainsi dans l’organisation, l’evaluation et la validation de l’enseignement du troisieme cycle des specialites medicales. Il realise la publication d’un referentiel actualise de connaissances a destination des etudiants du deuxieme cycle des etudes medicales. Grâce a un partenariat fort avec l’universite numerique en sante et sport (UNESS), le CNEAR assure la mise en ligne de contenus pedagogiques sur la plateforme SIDES NG, la mise en place du livret electronique de l’interne et le suivi regulier du curriculum des internes. Les membres du CNEAR participent egalement a la representation de la discipline aupres des pouvoirs publics et des tutelles au sein du Conseil national professionnel d’anesthesie-reanimation et medecine peri-operatoire (CNP-ARMPO). Pour atteindre ces objectifs, le CNEAR travaille en etroite collaboration avec la sous-section 48-01 (Anesthesie-reanimation et medecine peri-operatoire) du Conseil national des universites et la Societe francaise d’anesthesie et de reanimation (SFAR). Il est par ailleurs membre de droit du CNP-ARMPO et de la Coordination nationale des colleges d’enseignants en medecine (CNCEM) et etend ses collaborations internationales grâce a un partenariat prometteur avec UNESS-International.
Published: 2022

7. Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Author: Anhum Konan, Gael Piton, Maxime Ronot, Youness Hassoun, Hadrien Winiszewski, Guillaume Besch, Alexandre Doussot, Eric Delabrousse, and Paul Calame
Subjects: Critical Care and Intensive Care Medicine
Abstract: Background Although risk factors of occlusive acute mesenteric ischemia are well known, triggering factors of nonocclusive mesenteric ischemia (NOMI) remain unclear. Alongside to the known risk factors for NOMI, the role of atherosclerosis is not fully elucidated. The purpose of our study was to evaluate whether abdominal atherosclerosis is a risk factor for NOMI. Methods From January 2018 to December 2021, all consecutive patients admitted to the intensive care unit who underwent contrast-enhanced CT for suspicion of NOMI were evaluated for inclusion. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. The cohorts were matched by a 1:1 propensity score based on the patient clinical, biological data, and abdominal CT features associated with NOMI. Noncontrast CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA), and common iliac artery according to the Agatston method. Analyses were performed before and after propensity score matching. Results Among the 165 critically ill patients included, 59 (36%) had NOMI. Before matching analysis, the SMA and total abdominal Agatston calcium scores were not different between patients without and with NOMI (52.00 [IQR = 0, 473] vs. 137.00 [IQR = 0, 259], P = 0.857, respectively, and 7253 [IQR = 1220, 21738] versus 5802 [IQR = 2075, 15,084]; P = 0.723). The results were similar after matching 38 patients with NOMI and 38 without: 153 [IQR = 0, 665] versus 85 [IQR = 0, 240] (P = 0.312) for the SMA calcium score, and 7915 [IQR = 1812, 21561] versus 4139 [IQR = 1440, 9858] (P = 0.170) for the total abdominal Agatston calcium score. Conclusion Our results suggest that atherosclerosis is not a risk factor for NOMI in critically ill patients.
Published: 2022

8. Postoperative Neurocognitive Disorders After Closed-Loop Versus Manual Target Controlled-Infusion of Propofol and Remifentanil in Patients Undergoing Elective Major Noncardiac Surgery: The Randomized Controlled Postoperative Cognitive Dysfunction-Electroencephalographic-Guided Anesthetic Administration Trial

Author: Nathalie Boichut, Ngai Liu, Lucie Vettoretti, Grégory Tio, T. Chazot, Melanie Claveau, Nicolas Mahr, Guillaume Besch, Sebastien Pili-Floury, Yannis Bouhake, Emmanuel Samain, and Gilles Chopard
Subjects: Male, Time Factors, Randomization, Intraoperative Neurophysiological Monitoring, Remifentanil, 03 medical and health sciences, 0302 clinical medicine, Postoperative Cognitive Complications, Risk Factors, 030202 anesthesiology, Anesthesia, Closed-Circuit, medicine, Humans, Single-Blind Method, Infusions, Intravenous, Propofol, Aged, business.industry, Electroencephalography, Middle Aged, medicine.disease, Confidence interval, Treatment Outcome, Anesthesiology and Pain Medicine, Elective Surgical Procedures, Anesthesia, Relative risk, Bispectral index, Anesthetic, Anesthesia, Intravenous, Female, France, business, Postoperative cognitive dysfunction, Anesthetics, Intravenous, 030217 neurology & neurosurgery, medicine.drug
Abstract: BACKGROUND The aim of the study was to investigate whether closed-loop compared to manual bispectral index (BIS)-guided target-controlled infusion of propofol and remifentanil could decrease the incidence of postoperative neurocognitive disorders after elective major noncardiac surgery. METHODS Patients aged >50 admitted for elective major noncardiac surgery were included in a single-blind randomized (ratio 2:1) trial. The anesthetic protocol was allocated by randomization into either closed-loop or manual BIS-guided propofol and remifentanil titration. The BIS target range was 40-60. All patients had cognitive assessment the day before surgery and within 72 hours after surgery using a battery of neuropsychological tests. The primary outcome was the rate of postoperative neurocognitive disorders. Postoperative neurocognitive disorders were defined as a decrease >20% from baseline on at least 3 scores. Intergroup comparison of the primary outcome was performed using the χ2 test. RESULTS A total of 143 and 61 patients were included in the closed-loop and manual groups, respectively (age: 66 [8] vs 66 [9] years). The primary outcome was observed in 18 (13%) and 10 (16%) patients of the closed-loop and manual groups, respectively (relative risk [95% confidence interval {CI}], 0.77 [0.38-1.57], P = .47). Intraoperative propofol consumption was lower (4.7 [1.4] vs 5.7 [1.4] mg·kg-1·h-1, mean difference [MD] [95% CI], -0.73 [-0.98 to -0.48], P < .0001) and the proportion of time within the BIS target range higher (84 [77-89] vs 74 [54-81]%, MD [95% CI], 0.94 [0.67-1.21], P < .0001) in the closed-loop group. CONCLUSIONS Closed-loop compared to manual BIS-guided total intravenous anesthesia provided a significant reduction in episodes of an excessive depth of anesthesia while decreasing intraoperative propofol requirement but no evidence for a reduction of the incidence of postoperative neurocognitive disorders after elective major noncardiac surgery was observed.
Published: 2021

9. Optimizing PO2 during peripheral veno-arterial ECMO: a narrative review

Author: Hadrien Winiszewski, Pierre-Grégoire Guinot, Matthieu Schmidt, Guillaume Besch, Gael Piton, Andrea Perrotti, Roberto Lorusso, Antoine Kimmoun, and Gilles Capellier
Subjects: Veno-arterial ECMO, COMPLICATIONS, OUTCOMES, Mixing zone, MULTICENTER, CIRCULATION, HOSPITAL CARDIAC-ARREST, ASSOCIATION, Critical Care and Intensive Care Medicine, Hyperoxemia, THERAPY, Oxygen, EXTRACORPOREAL MEMBRANE-OXYGENATION, HYPEROXIA, CARDIOPULMONARY-RESUSCITATION, Dual circulation
Abstract: During refractory cardiogenic shock and cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to restore a circulatory output. However, it also impacts significantly arterial oxygenation. Recent guidelines of the Extracorporeal Life Support Organization (ELSO) recommend targeting postoxygenator partial pressure of oxygen (PPOSTO2) around 150 mmHg. In this narrative review, we intend to summarize the rationale and evidence for this PPOSTO2 target recommendation. Because this is the most used configuration, we focus on peripheral VA-ECMO. To date, clinicians do not know how to set the sweep gas oxygen fraction (FSO2). Because of the oxygenator’s performance, arterial hyperoxemia is common during VA-ECMO support. Interpretation of oxygenation is complex in this setting because of the dual circulation phenomenon, depending on both the native cardiac output and the VA-ECMO blood flow. Such dual circulation results in dual oxygenation, with heterogeneous oxygen partial pressure (PO2) along the aorta, and heterogeneous oxygenation between organs, depending on the mixing zone location. Data regarding oxygenation during VA-ECMO are scarce, but several observational studies have reported an association between hyperoxemia and mortality, especially after refractory cardiac arrest. While hyperoxemia should be avoided, there are also more and more studies in non-ECMO patients suggesting the harm of a too restrictive oxygenation strategy. Finally, setting FSO2 to target strict normoxemia is challenging because continuous monitoring of postoxygenator oxygen saturation is not widely available. The threshold of PPOSTO2 around 150 mmHg is supported by limited evidence but aims at respecting a safe margin, avoiding both hypoxemia and severe hyperoxemia.
Published: 2022

10. Decision-making process during limitation life-sustaining support meetings in French intensive care units

Author: Terry, Tarcy, Hatem, Kallel, Mathilde, Giffard, Guillaume, Besch, Régis, Aubry, and Hadrien, Winiszewski
Subjects: Life Support Care, Intensive Care Units, Terminal Care, Withholding Treatment, Decision Making, Humans
Published: 2022

11. Optimizing PO

Author: Hadrien, Winiszewski, Pierre-Grégoire, Guinot, Matthieu, Schmidt, Guillaume, Besch, Gael, Piton, Andrea, Perrotti, Roberto, Lorusso, Antoine, Kimmoun, and Gilles, Capellier
Subjects: Oxygen, Extracorporeal Membrane Oxygenation, Shock, Cardiogenic, Humans, Heart Arrest
Abstract: During refractory cardiogenic shock and cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to restore a circulatory output. However, it also impacts significantly arterial oxygenation. Recent guidelines of the Extracorporeal Life Support Organization (ELSO) recommend targeting postoxygenator partial pressure of oxygen (P
Published: 2022

12. Treatment of Hyperlactatemia in Acute Circulatory Failure Based on CO

Author: Vincenza, Caruso, Guillaume, Besch, Maxime, Nguyen, Sebastien, Pili-Floury, Belaid, Bouhemad, Pierre-Grégoire, Guinot, and Laurent, Carteron
Abstract: Hyperlactatemia is a biological marker of tissue hypoperfusion with well-known diagnostic, prognostic, and therapeutic implications in shock states. In daily clinical practice, it is difficult to find out the exact mechanism underlying hyperlactatemia. Central venous to arterial COLACTEL is a randomized, prospective, multicentric, controlled study. It compares the treatment of hyperlactatemia using an algorithm based on the pCOpCOwww.clinicaltrials.gov; identifier: NCT05032521.
Published: 2022

13. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author: Labeau, Sonia O, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Brett, Stephen J, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Deschepper, Mieke, François, Guy, Honore, Patrick M, Jankovic, Radmilo, Khanna, Ashish K, Llaurado-Serra, Mireia, Lin, Frances, Rose, Louise, Rubulotta, Francesca, Saager, Leif, Williams, Ged, Blot, Stijn I, Dritan, Muzha, Antoni Margarit Ribas, Fernando, Lipovesty, Cecilia, Loudet, Fiona, Coyer, Philipp, Eller, Nafseen, Mostafa, Patrick, M Honoré, Vanesa Mercado Telleria, Jasmina, Smajic, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald, Hentchoya, Louise, Rose, Javiera, Soledad, Frances, Lin, Yenny, Cardenas, Amylkar Garay Reyes, Alan, Sustic, Meropi, Mpouzika, Tamas, Vymazal, Hanne Irene Jensen, Hernan, Aguirre-Bermeo, Liivi, Maddison, Maija, Valta, Silvia, Calvino-Gunther, Frank, Bloos, Faustina Excel Adipa, Vasilios, Koulouras, Judy, Enamorado, Zsuzsann, Ágoston, Hrönn, Birgisdóttir, Amit, Gupta, Mohan, Gurjar, Bram, Kilapong, Seyed Mohammadreza Hashemian, Ignacio, Martin-Loeches, Julie, Benbenishty, Andrea, Cortegiani, Kelly, Fletcher, Yoshiro, Hayashi, Wangari, Waweru-Siika, Khalid, Abidi, Sang-Min, Lee, Burhan, Hadri, Mihails, Dolgusevs, Fayez François Abillama, Tomas, Jovaisa, Cyril, Thix, Muhammed, Elhadi, Basri Mat Nor, Shanti, Ratnam, Mohd Zulfakar Mazlan, Sundaresan, Maiyalagan, Luis, Sánchez-Hurtado, Adrian, Belii, Mendsaikhan, Naranpurev, Prabha, Gautam, Dylan De Lange, Rachael, Parke, Rose Ekama Ilesanmi, Mirjana, Shosholcheva, Antonija, Petosic, Ranveig, Lind, Madiha Hashmi Ffarcsi, Javier, Bogarin, Aaron Mark Hernandez, Malgorzata, Mikaszewska-Sokolewicz, Bruno, Sousa, Dana, Tomescu, Dorel, Sandesc, Theogene, Twagirumugabe, Vitaly, Gusarov, Maie, Ebaid, Radmilo, Jankovic, Gari, Slobodianiuk, Andrea, Martonova, Rihard, Knafelj, Mervyn, Mer, Emilio, Maseda, Bernardo, Panka, Joerg, C Schefold, Eva, Joelsson-Alm, Konlawij, Trongtrakul, Lorna, Merritt-Charles, Lamia Ouanes Besbes, Yalım, Dikmen, Lesia, Zgrzheblovska, Mark, Fielding, Francesca, Rubulotta, Ashish, K Khanna, Leif, Saager, Ingrid von der Osten, Alban, Greca, Alma, Cani, Nordian, Xhindi, Genci, Hyska, Antonio Margarit Ribas, Susana, Pinto, Paulo, Alves, Romina, Esposito, Emanuel, Valgolio, John Thomas Sanchez Minope, Antonio, Abdala, Maria, Ayala, Silvina, Bravo, Ana, Bantar, Patricia, Delgado, Gustavo, Badariotti, Fernando, Lipovestky, Ana, Diaz, Pablo, Saul, Mariano, Setten, Alejandra, Aucapina, Ysica, Acosta, Victor, Gonzalez, Luis, Camputaro, Fernando, Baccaro, Robert, Villa, Marcela, Mastantuono, Emiliano, Dean, Oscar Fernández Rostello, Patricia, Brizuela, Julio Ricardo Bartoli, Matias, Guereschi, Cristian, Quiroga, Sofia, Putruele, Paula, Villegas, Veronica, Curilen, Ruben, Fernandez, Mariangeles Gabriela Nocheretti, Rosana Gabriela Escalante, Cecilia Inés Loudet, Silvia, Fernandez, Ana Laura Gonzalez, Gustavo Andres Alvarez, Federico, Iglesias, Silvia, Chaparro, Graciela, Zakalik, Gonzalo, Pagella, Matías, Baini, Pierina Arias Campos, Ignacio, Sabbag, Armando, Schmukler, Imelda Perdomo Fonseca, Gonzalo Martín Alvarez, Mario, Ramirez, Fernando, Tapia, Carlos Alejandro Bascary, Graciela Del Valle Gimenez, Fernando Pablo Bertoletti, Esteban, Milioto, Pablo Julio Maldonaldo Bonsignore, Maria Alejandra Fernandez, Julie, Smith, Tim, Chimunda, Lorraine, Thompson, Teena, Maguire, Wendy, Chaboyer, Stacey, Watts, Marion, Mitchell, Madeleine, Powell, India, Lye, Leanne, Parsons, Nerilee, Baker, Claire, Reynolds, Amy, Thompson, Kristy, Masters, Kellie, Sosnowski, Lynette, Morrison, Gavin, D Leslie, Ramanathan, Lakshmanan, Alexis, Tabah, Wendy, Brown, Sharon, McDowell-Skaines, Andrea, Mclucas, Chris, Smith, Mandy, Tallot, Sarah, Jones, Michelle, Barakat-Johnson, Thomas, Leong, Rand, Butcher, Kerrie, Martin, Philipp, Douschan, Dirk von Lewinski, René, Schmutz, Uta, Kolussi, Fatema, Salman, Zainab, Ateya, Koen De Decker, Niels Van Regenmortel, Anita, Jans, Patricia, Wijnands, Stefano, Coremans, Patrick, M Honore, David De Bels, Tanja, Depuydt, Caroline, Paillet, Luc-Marie, Jacquet, Walter, Swinnen, Francis, Hannes, Matthia, Mergeay, Stijn Van de Velde, Silvie, Allaert, Pieter, Hoste, Christophe, Borin, Sandrine, Balon, Vincent, Fraipont, Patrick, Biston, Nicolas De Schryver, Thierry, Dugernier, Ilse Van Cotthem, Angelica Olivetto de Almeida, Silvia Angelica Jorge, Delmiro, Becker, Raysa Cristina Schmidt, Evellyn, Oliveira, Aline, Ramalho, Eliane, Mazocoli, Audrey, Fioretti, Elaine, Barros, Leticia, Serpa, Suzana, Bianchini, Ticiane, Campanili, Taís, Pantaleao, Paulo Carlos Garcia, Ana Lucia Vitti Ronchini, Rayanne, Santos, Nurulhuda Binti, A Manap, Sean, Bagshaw, Dominic, Carney, Jon, Davidow, Ella, Rokosh, Andréa Maria Laizner, Samantha, Smith, Megan, Mcquirter, Betty Star Kampayana, René, Favre, Martin, Sills, Julie, Dallaire, Cathy, Becker, Sherissa, Microys, Bonnie, Bowes, Jennifer, Lajeunesse, Rishi, Ghosh, Jacqueline, Baptiste-Savoie, Rose, 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Gama, Juan Sebastian Hernandez, Nestor, Caicedo, Jorge, Marin, Maria-Elena, Ochoa, Monica, Gomez, José, Rojas-Suarez, Jeniffer, Gonzalez, Amylkar José Garay Reyes, Edwin, Chapeta, Estefania, Orozco, Ina, Filipović-Grčić, Anita, Vuković, Suzana, Pečenković, Aleksandar, Šuput, Gordana, Zivanovic-Posilovic, Armanda, Bozena, Nikolina, Udiljak, Morena, Milic, Renata Curic Radivojevic, Slobodan, Mihaljevic, Marijana, Matas, Dinko, Tonkovic, Hemena, Čuljak, Ivana, Herceg, Gordana, Pavlisa, Milena, Dobric, Tatjana, Beker, Višnja Nesek Adam, Tanja, Goranovic, Chrysanthos, Markoulias, Mina, Mathaios, Maria, Mylordou, Eleni, Achilleos, Pavlina, Kleanthous, Veronika, Kotanidi, Maria, Foka, Iwy, Charalabous, Anna, Alexandrou, Marios, Georgiou, Artemis, Patsalos, Sofia, Zepoy, Constantina, Constantinou, Petr, Piza, Tomas, Vymazal, Elisabeth, Wiborg, Louise, Bruhn, Karin, Kaasby, Karin Rehnholt Pedersen, Sanne, Mikkelsen, Marie, Collet, Anne, Langvad, Hanne, Andresen, Susanne, Fischer, Inger Ebbesen 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Humberto, Gallegos-Perez, Nancy, Hernandez-Sanchez, Lucia, Hernandez-Ponce, Luis, Gorordo-Delsol, Marcos, Hernandez-Romero, Saira, Gomez, Fernando, Molinar, Silvio, A Ñamendys-Silva, Juan, P Romero-Gonzalez, Daira, Gonzalez, Antonio, Landaverde, Miguel Ángel Sosa, Berenice, Navarro, José Ivan Rodriguez de Molina Serrano, Sergio Reyes Iburrigarro, Alejandro, Ibarra, Joaquin, Aguirre, Mayra, Martinez-Gonzalez, Nayeli Rocio Cañas Padilla, Ana Alícia Velarde Pineda, Missael Vladimir Espinoza Villafuerte, María Ocotlan Gonzalez Herrera, Battsetseg, Baasanjav, Abdelhamid, Hachimi, Mina, Elkhayari, Tarek, Dendane, Nisha Bhandari Subedi, Sabina Dhakal Pathak, Meena, Manandhar, Laura Van Gulik, Mark Van Den Brink, Peter Van Vliet, Benjamin, Gerretsen, Lettie Van Den Berg, Marina De Haan, Binny, Tuinstra, Paul, Kuijpers, Jennifer, Reijntjens, Jan Wytze Vermeijden, Martin, Rinket, Margijske, Vanroest, Auke, Reidinga, Bert, Loef, Willem, Dieperink, Marisa, Onrust, Tom, Dormans, Laura, Bormans, Matty, Koopmans, Rik, T Gerritsen, Arlette Van Den Elst, Mirjam, Evers, Oscar, Oiting, Rob, Wilting, Bart, Ramaker, Mark van der Kuil, Jan-Willem, Fijen, Lenneke, Haas, Jasper, Haringman, Lynette, Newby, Eileen, Gilder, Danielle, Hacking, Rica, Dagooc, Rima, Song, Hansjoerg, Waibel, Frances, Dawn, Jackie, Rapley, Llesley, Chadwick, Carmel, Chapman, Petra, Crone, Jonathan, Albrett, Peter, Marko, Jennifer, Goodson, Troy, Browne, Richard, Whitticase, Cheryl, Davidson, Harriet, Judd, Daniel, Owens, Tonia, Onyeka, Innocent, Ugwu, Rose, Ilesanmi, Prisca Olabisi Adejumo, Afolabi, Owojuyigbe, Anthony, Adenekan, Stella, Uba, Christiana, Chime, Deborah, Jibrin, Babangida John Sankey, Oyebola, Adekola, Simeon, Olanipekun, Mirjana, Shosolcheva, Vanja, Gievski, Andrijan, Kartalov, Filip, Naumovski, Biljana, Kuzmanovska, Angela, Trposak, Zaneta, Bogoevska-Miteva, Rodney, Rosalia, Brita Fosser Olsen, Britt, Sjobo, Karianne Dale Jensen, Drammen, Sykehus, Birgitte Fosser Johansen, Esben, Straede, Edda, Johansen, Inger Johanne Finnstrom, Annette, Toellefsen, Hege, Ostenjo, Hege, Bjorgen, Bjorn, Bratsberg, Elin, Kristoffersen, Elin Mari Skorstad, Siri, Hansen, Sylvi, Vullum, Gro Anne Lunde, Wenche, Arntsen, Mette, Lund, Gro Ringstad Akselsen, Kristina Reinertsen Monstad, Ane, Stenset, Hanne, Haugom, Bjoern, Monsen, Lisa, Høgvall, Siw, Trudvang, Britt, Galaaen, Siv Karin Malmin, Marit Hildegunn Andersen, Rita Foss Hargott, Yvonne, Andersen, Elin, Steffenak, Marit, Nyhus, Barbro, Meland, Madiha, Hashmi, Noelia, Rivas, Elizabeth, Maidana, Alberto de Jesús Ortiz, Dolly Mabel Bordon Cabral, Marcelo, Simi, Cesar, Aponte, Juan Carlos Rivas, Sirley, Gill, Amilcar, Garcia, Gloria, Alvarenga, Laura, Cespedes, Hugo, Perez, Maria Liz Moreira, Fidelina, Canete, Roberto, Gonzalez, Natalia, Monges, Mary, Coman, Marcelo, Pederzani, Natalia, Franco, Ferdinand, Aganon, Regina, Martinez, Debbie, Noblezada-Uy, Chris Gerome Ellazar, Franklin Dean Cerezo, Jose Emmanuel Palo, Cristal April Jane Aperocho, Michael, Isanan, Marta, Tubacka, Przemyslaw, Jasiewicz, Miroslaw, Czuczwar, Michal, Borys, Aleksandra, Gutysz-Wojnicka, Lidia, Glinka, Ryszard, Gawda, Jan, Bilawicz, Paula, Cabrita, João, Vieira, Margarida Ferreira Figueiredo, Cristiana Mota Pinheiro, Nelson, Antunes, Laura, Pedro, Fatima, Ferreira, Isabel, Parente, Maria, Varela, Fatima, Fernandes, Claudia, Martins, Abel, Viveiros, Raquel, Cavaco, Clara Santa Rita, Sofia, Dias, Ana Margarida Feranandes, Pedro, Silva, Catarina, Nunes, João, Cabral, Filpe, Pires, Hilaryano, Ferreira, Jacinta, Santos, Vitor Manuel Vaz Pinto, Bruno Miguel Bispo, Amelia, Ferreira, Elena, Molinos, Estevão, Lafuente, Ricardo, Gregorio, Humberto, Costa, Ângela, Lima, Susana, Ferreira, Vanda, Seromenho, Eulália, Luis, Idália, Valerio, Helena, Cesar, Ana, Tavares, Ahmed Subhy Alsheikhly, Saeed, Mahmood, Catalin Traian Guran, Alida, Moise, Daniela Carmen Filipescu, Mihail, Luchian, Mihai, Popescu, Monica Adriana Scutariu, Cristina, Petrisor, Natalia, Hagau, Ioana, Grigoras, Tatiana, Patrichi, Vitaly, Gusarev, Alexandra, Pivkina, Vladimir, Kulakov, Olga, Ignatenko, Julia, Kovaleva, Trina, Zhivotneva, Marina, Zhedaeva, Nikita, Matiushkov, Olga, Ershova, Natalya, Egorova, Victoria, Khoronenko, Danil, Baskakov, Dmitry, Sergeev, Michael, Piradov, Liudmila, Grishina, Marat, Magomedov, Evgeniy, Zuev, Uri, Gorokhovatsky, Anna, Leonova, Liudmila, Fadeeva, Vladislav, Belskiy, Dmitriy, Galishevskiy, Nadezhda, Zubareva, Maksim, Tribulev, Oksana, Zueva, Alexander, Kiselev, Nikolaj, Kamenshchikov, Ekaterina, Tokareva, Maxim, Petrushin, Irina, Starchenko, Isaac, Nshimyumuremyi, Jerome, Muhizi, Egide, Buregeya, Josue, Nzarora, Amer, Assiri, Maie Salem Ebaid, Ghaleb, Almekhlafi, Yasser, Mandourah, Jelena, Velickovic, Dejan, Veličković, Bojan, Jovanovic, Adi, Hadzibegovic, Branislava, Stefanovic, Vanja, Misic, Vesna, Bumbasirevic, Marija, Rajković, Milena, Stojanovic, Srđan, Gavrilovic, Maja, Stanojević, Aktham, Yaghi, Anton, Turčan, Peter, Firment, Garri, Slobodianiuk, Daria, Rabarova, Danca, Lančaričová, Janko, Vlaovic, Matjaž, Groznik, Milica, Lukic, Janja, Perme, Maja, Sostaric, Nejc, Umek, Tomislav, Mirkovic, Simon, Dolenc, Misa, Fister, Nika, Zorko, Andrej, Markota, Nomhle Princess Yeni, Phumele, Jali, Shelley, Schmollgruber, Muhommed Ridwaan Syed, Nivisha, Parag, Robert, Wise, Maria, Galiana, José Alejandro Navarro, Ana María De Pablo, Patricia, Albert, Pilar, Martinez, Yolanda, Mendiara, Barbara, Garcia, Ana Alabart Llinas, Marilyn, Riveiro, Elisabet, Gallart, Alba, Riera, Miquel, Sanz, Swagotika, Salo, Miguel Angel Gimenez Lajara, Montserrat Venturas Nieto, Rosa, Garcia, José Manuel Garcia Pena, Maria Carmen Gorgolas, Maria Aranzazu Isasi, Rafael, Sierra, Federico, Gordo, Isabel, Conejo, Vicent, Salvà-Costa, Carolina, Garzón-Tovar, Sara, Lospitao, Rafael, Gonzalez, Pedro, Gutierrez, Mercè, Girona, Jordi, Adamuz, Pablo Garcia Olivares, José Peral Gutierrez de Ceballos, Celia, Tirado, Irene De Wit, Ana Belén Curto Polo, Maria Del Mar Diaz Salcedo, Javier, Ripolles-Melchor, Eugenio, Martinez-Hurtado, Jorge Duerto Alvarez, María Luisa Bravo Arcas, Juan Ignacio Torres Gonzalez, Ana Belén Sánchez de la Ventana, Pablo Lopez-Arcas Calleja, Raquel Garcia Alvarez, Purificacion Sanchez Zamora, Alvaro Ortega Guerrero, Rosario, Cosano, Jonathan, Perez-Vacas, Margarita, Campos-Perez, Emma Moreno Barreiro, Losune Cano Sanchez, Monica Garcia Diaz, Raquel, Jimenez, Lorena Del Rio Cabajo, Daniel Sancho Muriel, Helena Fernandez Alonso, Ana Wensell Fernández, Isabel Santín Piñan, Guillermo Muñiz Albaiceta, Maria Cristina Iglesias Fernandez, Francisco Javier Saenz Abos, Pablo, Monedero, Ramon Molina Chueca, Lydia Gallego Aguirre, Silvia Call Manosa, Carmen Partera Luque, Neus, Calpe, Monica Recio Losilla, Meritxell Tapia Fores, Olga, Farre, Oscar, Fernandez, M Del Rosario Villar Redondo, Donaldo, S Arteta Arteta, Maria Angeles Hurtado Sanchez, Cristina Paños Espinosa, Laura Martinez Reyes, Laura Claramunt Domenech, Carmen Velasco Guillén, Josep Trenado Alvarez, Mercedes Del Cotillo, Jesus Emilio Barrueco-Francioni, Belen Burgos Conde, Maria Pilar Sogues Blanco, Maria Luisa Blasco, Ana Isabel Clement, Clara, Hurtado, Luz Coronado Sanz, David, Perez-Torres, Estefanía, Prol-Silva, Jorge, Pereira, Iván Areán González, Anastasio Espejo Cano, Cesar Rodriguez Nuñez, Inmaculada Lorenzo Fernadez, Alejandra Azahara Marguello Fernandez, Rosa Del Bosque Diez, Badiola, Hilario, Begoña, Zalba-Etayo, Ana, Pascual-Bielsa, Preveen, Banwarie, Dick, Nahar, Alisha van Axel, Naraindath, N Boedjawan, Erika Backlund Jansson, Ann-Sofie, Malvemyr, Lotta, Johansson, Ulla, Sandberg, Catarina, Tingsvik, Gunilla, Mattsson, Gun, Löf, Martin, Spångfors, Mona, Ringdal, Sebastian, Geijer, Lotti, Orvelius, Mia, Hylen, Caroline, Lagerhäll, Eva, Åkerman, Viveca Hamback Hellkvist, Ulrica, Mickelsson, Ewa, Wahlbom, Ing-Marie, Larsson, Ewa, Wallin, Filippo, Boroli, Solenne, Ory, Margaret Lynn Jong, Alexander, Dullenkopf, Martin, Lang, Yvan, Fleury, Marianne, Maus, Nawfel, Ben-Hamouda, Anne, Fishman, Mei Yu Hsu, Shu Chuan Chang, Konlawij, Trongtratul, Chaiwut, Sawawiboon, Sunthiti, Morakul, Bodin, Khwannimit, Keevan, Singh, Dale, Ventour, Dianne, Figaro-Barclay, Sasha, Sankar-Maharaj, Mhamed Sami Mebazaa, Salma, Kamoun, Souheil, Elatrous, Lamia, Besbes, Fekri, Abroug, Walid, Naija, Youssef Zied Elhechmi, Walid, Sellami, Zied, Hajjej, Takoua, Merhabene, Imen, Talik, Ozlem Ozkan Kuscu, Ozcengiz, Dilek, Avşar, Zerman, Hayriye Cankar Dal, Sema, Turan, Semih, Aydemir, Hakan, Yilmaz, Duygu Kayar Calili, Seval, İzdes, Melike, Cengiz, Ayça, Gümüş, Banu, Taşdemir, Ali, Kağnıcı, Mustafa, Ay, Serap Avcı Ay, Gulbahar, Caliskan, Turkay, Akbas, Abidin Oner Balbay, Serdar, Efe, Volkan, Inal, Gülseren, Elay, Pınar, Karabacak, Boğaç, Özserezli, Evren, Şentürk, Oktay, Demirkiran, Suha, Bozbay, Elif, Erdogan, Mustafa, Akker, Nebia, Peker, Asu, Ozgultekin, Sibel Ocak Serin, Can, Turan, Gulsah, Karaoren, Senay, Goksu, Sait, Karakurt, Huseyin, Arikan, Fethi, Gül, İsmail, Cinel, Iskender, Kara, Hasan Nabi Undar, Yesim Serife Bayraktar, Jale Bengi Çelik, Murat Emre Tokur, Demet Tok Aydin, İsmail, Yildiz, Beysim, Özcan, Başar, Erdivanli, Ahmet, Eroglu, Devrim, Akdağ, Nurdan, Ünlü, Adonis, Dungca, Ashwaq, Ali, Bindu, Thankamma, Paul Eric Reyes, Sini, John, Ajitha, Rajendran, Fatima Kasem El Ahmad, Kathleen Ann Smiley, Susanna, Hojden, Mia Thorning Miller, Vishnu Das Sasidharan Nair, Maria Gracia San Antonio, Khaled Al Qawasmeh, Sabah Abu Shawish, Hilary, Twiggs, Ines, Rosado, Volodymyr, Babych, Faye, Morren, Charlotte, Young, Nicola, Vaughan-Jones, Stephanie, Harris, Karen, Burns, Carmel, Georgiev, Rosina, Shayamano, Ian, Kerslake, Peter, Creber, Ana, Vochin, Catherine, O'Brien, Paul, Caddell, Samantha, Hagan, Mandy, Hughes, Tomasz, Torlinski, James, Sherwin, Santhana, Kannan, Amber, Markham, Richard, Lebon, Jason, Cupitt, Julius, Cranshaw, Nigel, White, Victoria, Marriott, Wendy, Milner, Casiano Barrera Groba, Joao, Azoia, Petra, Polgarova, Shaly, George, Ritoo, Kapoor, Ceri, Lynch, Nathalie, Fox, Karen, Cranmer, Natalie, Fox, Thomas, Llewellym, Kelly, Matthews, Louise, Maltby, Jowena, Ibao, Karen, Boulton, Rachel, Jarman, Karen, Baxter, Ashok Sundai Raj, Arif, Moghal, Joanne, White, Suzanne, Barrowcliffe, Mark, Pulletz, Vaarisan, Ganeshalingam, Rosaleen, Baruah, Carole, Boulanger, Helen, Baker, Justin, Woods, Poe Poe Ei, Vongayi, Ogbeide, Paul, Hayden, Jennifer, Hughes, Madhu, Balasubramanian, Armorel, Salberg, Rajnish, Saha, Dagmar, Holmquist, Claire, Derbyshire, Neil, Smith, Elizabeth, Stones, Jane, Ademokun, Monica, Popescu, Maria Schofield Legorburo, Samantha, North, Carole, Brett, Helen, Jaundoo, Jayne, Craig, Simon, Whiteley, Clare, Howcroft, Liz, Wilby, Peter, Delve, David, Shaw, Karen, Williams, Ingeborg, D Welters, Jane, Mcmullen, Stephen, Brett, Leah, Flores, Treiza, Trueman-Dawkins, Mae, Templeton, John, Adams, Catherine, Smith, John, Prowle, Heather, Byers, Andrea, Mcdonnell, Bernd Oliver Rose, Rosie, Reece-Anthony, Luis, Mendes, Marcela, Vizcaychipi, Rhian, Bull, Grace, Lacaden, Eleanor, Santiago, Carlos Castro Delgado, Sarah, Farnell-Ward, Elaine, Thorpe, Justine, Somerville, Anne, Williams, Donna, Cummings, Helen, Derrick, Sarah, Brumwell, Claire, Randell, Nicola, Mccann, Emma, Aves, Gillian, Berry, Tamas, Szakmany, Una, Gunter, Paul, Pulak, Nikki, Sarkar, Kerry, Wright, Vitor, Gomes, Jones, Jo, Ruth, Palfrey, Julie, Camsooksai, Abby, Lewis, Antony, Eneas, Ascanio, Tridente, Louise, Barr, Beverley, Thomas, Emma, Parkin, Daniel, Horner, Christian, Frey, Suzanne, Bench, Rachel, Baumber, Phil, Broadhurst, Matthew, Jackson, Lynne, Williams, Michele, Clark, Jonathan, Paddle, Sarah, Bean, Sarah, Buckley, Christopher, Palfreeman, Sophie, Liu, Nicola, Allison, Ben, Attwood, Penny, Parsons, Victoria, Houghton, Sarah Jane Turner, David, Higgins, Egidija, Bielskute, Nicola, Horrigan, Reni, Jacob, Karen, Habgood, Ahmed, Zaki, Amy, Collins, Jenny, Lord, Charalice, Ramiro, Agnieszka, 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European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, Muzha, D., Ribas, A.M., Lipovesty, F., Loudet, C., Coyer, F., Eller, P., Mostafa, N., Honoré, P.M., Telleria, V.M., Smajic, J., Nogueira, P.C., Nafees, KMK, Hentchoya, R., Rose, L., Soledad, J., Lin, F., Cardenas, Y., Reyes, A.G., Sustic, A., Mpouzika, M., Vymazal, T., Jensen, H.I., Aguirre-Bermeo, H., Maddison, L., Valta, M., Calvino-Gunther, S., Bloos, F., Adipa, F.E., Koulouras, V., Enamorado, J., Ágoston, Z., Birgisdóttir, H., Gupta, A., Gurjar, M., Kilapong, B., Hashemian, S.M., Martin-Loeches, I., Benbenishty, J., Cortegiani, A., Fletcher, K., Hayashi, Y., Waweru-Siika, W., Abidi, K., Lee, S.M., Hadri, B., Dolgusevs, M., Abillama, F.F., Jovaisa, T., Thix, C., Elhadi, M., Nor, B.M., Ratnam, S., Mazlan, M.Z., Maiyalagan, S., Sánchez-Hurtado, L., Belii, A., Naranpurev, M., Gautam, P., De Lange, D., Parke, R., Ilesanmi, R.E., Shosholcheva, M., Petosic, A., Lind, R., Ffarcsi, M.H., Bogarin, J., Hernandez, 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A.S., Goller, S., Afonso, E., Larina, E., Labeau, Sonia O. [0000-0003-3863-612X], Afonso, Elsa [0000-0003-0873-0852], Benbenishty, Julie [0000-0002-8488-9649], Blackwood, Bronagh [0000-0002-4583-5381], Boulanger, Carole [0000-0002-1392-6633], Brett, Stephen J. [0000-0003-4545-8413], Calvino-Gunther, Silvia [0000-0003-3586-7205], Chaboyer, Wendy [0000-0001-9528-7814], Coyer, Fiona [0000-0002-8467-0081], Deschepper, Mieke [0000-0001-6797-3147], Honore, Patrick M. [0000-0002-6697-4890], Jankovic, Radmilo [0000-0003-0742-8686], Khanna, Ashish K. [0000-0002-9083-891X], Llaurado-Serra, Mireia [0000-0002-5123-0581], Lin, Frances [0000-0001-8735-5469], Rose, Louise [0000-0003-1700-3972], Rubulotta, Francesca [0000-0001-8644-1728], Saager, Leif [0000-0003-3416-4727], Williams, Ged [0000-0002-7481-2445], Blot, Stijn I. [0000-0003-2145-0345], Apollo - University of Cambridge Repository, Critical Care, Labeau S.O., Afonso E., Benbenishty J., Blackwood B., Boulanger C., Brett S.J., Calvino-Gunther S., Chaboyer W., Coyer F., Deschepper M., Francois G., Honore P.M., Jankovic R., Khanna A.K., Llaurado-Serra M., Lin F., Rose L., Rubulotta F., Saager L., Williams G., Blot S.I., Muzha D., Ribas A.M., Lipovesty F., Loudet C., Eller P., Mostafa N., Telleria V.M., Smajic J., Nogueira P.C., Nafees K.M.K., Hentchoya R., Soledad J., Cardenas Y., Reyes A.G., Sustic A., Mpouzika M., Vymazal T., Jensen H.I., Aguirre-Bermeo H., Maddison L., Valta M., Bloos F., Adipa F.E., Koulouras V., Enamorado J., Agoston Z., Birgisdottir H., Gupta A., Gurjar M., Kilapong B., Hashemian S.M., Martin-Loeches I., Cortegiani A., Fletcher K., Hayashi Y., Waweru-Siika W., Abidi K., Lee S.-M., Hadri B., Dolgusevs M., Abillama F.F., Jovaisa T., Thix C., Elhadi M., Nor B.M., Ratnam S., Mazlan M.Z., Maiyalagan S., Sanchez-Hurtado L., Belii A., 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N.N., Jansson E.B., Malvemyr A.-S., Johansson L., Sandberg U., Tingsvik C., Mattsson G., Lof G., Spangfors M., Ringdal M., Geijer S., Orvelius L., Hylen M., Lagerhall C., Akerman E., Hellkvist V.H., Mickelsson U., Wahlbom E., Larsson I.-M., Wallin E., Boroli F., Ory S., Jong M.L., Dullenkopf A., Lang M., Fleury Y., Maus M., Ben-Hamouda N., Fishman A., Hsu M.Y., Chang S.C., Trongtratul K., Sawawiboon C., Morakul S., Khwannimit B., Singh K., Ventour D., Figaro-Barclay D., Sankar-Maharaj S., Mebazaa M.S., Kamoun S., Elatrous S., Besbes L., Abroug F., Naija W., Elhechmi Y.Z., Sellami W., Hajjej Z., Merhabene T., Talik I., Kuscu O.O., Dilek O., Zerman A., Dal H.C., Turan S., Aydemir S., Yilmaz H., Calili D.K., Izdes S., Cengiz M., Gumus A., Tasdemir B., Kagnici A., Ay M., Ay S.A., Caliskan G., Akbas T., Balbay A.O., Efe S., Inal V., Elay G., Karabacak P., Ozserezli B., Senturk E., Demirkiran O., Bozbay S., Erdogan E., Akker M., Peker N., Ozgultekin A., Serin S.O., Turan C., Karaoren G., Goksu S., Karakurt S., Arikan H., Gul F., Cinel I., Kara I., Undar H.N., Bayraktar Y.S., Celik J.B., Tokur M.E., Aydin D.T., Yildiz I., Ozcan B., Erdivanli B., Eroglu A., Akdag D., Unlu N., Dungca A., Ali A., Thankamma B., Reyes P.E., John S., Rajendran A., Ahmad F.K.E., Smiley K.A., Hojden S., Miller M.T., Das Sasidharan Nair V., Antonio M.G.S., Qawasmeh K.A., Shawish S.A., Twiggs H., Rosado I., Babych V., Morren F., Young C., Vaughan-Jones N., Harris S., Burns K., Georgiev C., Shayamano R., Kerslake I., Creber P., Vochin A., O'Brien C., Caddell P., Hagan S., Hughes M., Torlinski T., Sherwin J., Kannan S., Markham A., Lebon R., Cupitt J., Cranshaw J., White N., Marriott V., Milner W., Groba C.B., Azoia J., Polgarova P., George S., Kapoor R., Lynch C., Fox N., Cranmer K., Llewellym T., Matthews K., Maltby L., Ibao J., Boulton K., Jarman R., Baxter K., Raj A.S., Moghal A., White J., Barrowcliffe S., Pulletz M., Ganeshalingam V., Baruah R., Baker H., Woods J., Ei P.P., Ogbeide V., Hayden P., Hughes J., Balasubramanian M., Salberg A., Saha R., Holmquist D., Derbyshire C., Smith N., Stones E., Ademokun J., Legorburo M.S., North S., Brett C., Jaundoo H., Craig J., Whiteley S., Howcroft C., Wilby L., Delve P., Shaw D., Williams K., Welters I.D., McMullen J., Brett S., Flores L., Trueman-Dawkins T., Templeton M., Adams J., Prowle J., Byers H., McDonnell A., Rose B.O., Reece-Anthony R., Mendes L., Vizcaychipi M., Bull R., Lacaden G., Santiago E., Delgado C.C., Farnell-Ward S., Thorpe E., Somerville J., Williams A., Cummings D., Derrick H., Brumwell S., Randell C., McCann N., Aves E., Berry G., Szakmany T., Gunter U., Pulak P., Sarkar N., Wright K., Gomes V., Jones J., Palfrey R., Camsooksai J., Lewis A., Eneas A., Tridente A., Barr L., Thomas B., Parkin E., Horner D., Frey C., Bench S., Baumber R., Broadhurst P., Jackson M., Williams L., Clark M., Paddle J., Bean S., Buckley S., Palfreeman C., Liu S., Allison N., Attwood B., Parsons P., Houghton V., Turner S.J., Higgins D., Bielskute E., Horrigan N., Jacob R., Habgood K., Zaki A., Collins A., Lord J., Ramiro C., Kubisz-Pudelko A., Kotze M., Williams H., Iovenko I., Tsarev A., Briva A., Mendez G., Napolitano L., Teig M., Rodriguez G.E., Ben-Jacob T., Potestio C., Eng T., Mahanes D., Khanna A., Duggal A., Nananmori M., Lois M., Karamchandani K., Bealer C., Barefield C., Terry D., Fivecoat P., Idowu O., Cata J., Clesi T., Peterson J., Hatton K., Dhaliwal J., Mueller D., Tao J., Eltorai A.S., Pastores S.M., Remor N., Salazar J., Barkas D., Joffe A., Barnes C., Sona C., Schallom M., Short J., Lorenzo J., Von Der Osten I., Borkowska M., Demarre L., Pleitinckx V., Xing C., Debue A.-S., Goller S., Larina E., Labeau, S. O., Blackwood, B., Brett, S. J., Deschepper, M., Francois, G., Honore, P. M., Khanna, A. K., Williams, G., Blot, S. I., Ribas, A. M., Telleria, V. M., Nogueira, P. C., Nafees, K. M. K., Reyes, A. G., Jensen, H. I., Adipa, F. E., Agoston, Z., Hashemian, S. M., Lee, S. -M., Abillama, F. F., Nor, B. M., Mazlan, M. Z., Sanchez-Hurtado, L., De lange, D., Ilesanmi, R. E., Ffarcsi, M. H., Hernandez, A. M., Schefold, J. C., Besbes, L. O., Minope, J. T. S., Rostello, O. F., Bartoli, J. R., Nocheretti, M. G., Escalante, R. G., Loudet, C. I., Gonzalez, A. L., Alvarez, G. A., Campos, P. A., Fonseca, I. P., Alvarez, G. M., Bascary, C. A., del Valle Gimenez, G., Bertoletti, F. P., Bonsignore, P. J. M., Fernandez, M. A., Leslie, G. D., Mclucas, A., Jacquet, L. -M., de Almeida, A. O., Jorge, S. A., Schmidt, R. C., Garcia, P. C., Ronchini, A. L. V., Manap, N. B. A., Laizner, A. M., Mcquirter, M., Kampayana, B. S., Sepulveda, M. I., Zamorano, M. J. F., Zhao, R. H., Hu, L. P., Jiao, Q. F., Wang, H. Y., Xia, C. J., Insu, L., Zhu, J. Y., Zhu, J. F., Huang, R. F., Wang, L. L., Song, J. H., Liu, X. M., Li, Z. S., Li, L. C., Zeng, J. M., Hu, X. C., Wang, R. X., Tak, P. S., Ho, S. W., Jiang, Q. X., Huang, L. P., Liu, X. L., Jiang, J. H., Gong, Y. Y., Lei, D. H., Bi, A. P., Zhao, H. M., Cao, Z. Q., Wu, S. F., Tian, X. F., Feng, Z. X., Liu, X. Z., Jiang, Z. X., Wang, G. X., Hu, R. L., Li, X. Q., Yu, Z. J., Yang, Y. X., Gama, L. M. S., Hernandez, J. S., Ochoa, M. -E., Reyes, A. J. G., Filipovic-Grcic, I., Vukovic, A., Pecenkovic, S., Suput, A., Radivojevic, R. C., Culjak, H., Adam, V. N., Pedersen, K. R., Kjaergard, I. E., Kodal, A. M., Hansen, T. C. B., Pedersen, A. S. B., Thomsen, T. D., Frandsen, T. M., Bliksted, I. A., Tamayo, L. M., Tutillo, D. R. M., Hurtado, C. V., Garcia, M. F., Kutimets, M., Lofqvist, C., Sakki, J. -K., Valta, M. A., Plantefeve, G., Deserts, M. D., Gunther, S. C., Timsit, J. -F., Farkas, J. -C., Bosl, K., Schuppel, S., Stubner, A., Osei, I. P., Kusi-Appiah, A. -C., Yakubu, Y. H., Patsiou, E. -C., Stalika, K. M. M., Enamorado, J. E., Jonasdottir, R. J., Lestari, M. I., Finn, D. O. C. R., Mcpherson, S., Ghioldi, D. M., Bruno, A. V., Maggiore, S. M., Volta, C. A., Taibi, M. R., Tranello, F. P., Giusti, G. D., Martin, M. A., Correia, M. C., Kim, J. H., Kim, K. C., Bae, J. -M., Park, S. Y., Park, T. S., Lee, H. B., Kim, S. C., Chee, H. K., Huh, J. W., Sim, Y. S., Ahn, J. -J., Kang, B. J., Lee, W. -Y., Lee, S. J., Feghaly, M. E., Belkhair, W. A., Tababa, O. W. E., Alkhumsi, S. I. R., Alshrif, A. I., Aboufray, A. A., Triki, A. R., Zahra, H. B., Al-Alawi, M. M. S., Ghula, M. A. A., Bahrin, L. K. K., Deva, S. R., Rahim, A. H. A., Hassan, W. N. W., Ismail, W. N. W., Ali, M. N., Khoo, T. M., Samat, N. M., Tong, J. M. G., Adib, N. A. N., Nor, M. B. M., Sulaiman, S. R., Foong, K. W., Hua, N. P., Zermeno, J. M., Nava, C. L. L., Nandyelly, S. J. R., Sanchez-Hurtado, L. A., Nava, L. P. A., Herrera, J. G., de Anda, G. F. V., Namendys-Silva, S. A., Romero-Gonzalez, J. P., Sosa, M. A., de Molina Serrano, J. I. R., Iburrigarro, S. R., Padilla, N. R. C., Pineda, A. A. V., Villafuerte, M. V. E., Herrera, M. O. G., Subedi, N. B., Pathak, S. D., Vermeijden, J. W., Gerritsen, R. T., Fijen, J. -W., Adejumo, P. O., Sankey, B. J., Olsen, B. F., Jensen, K. D., Johansen, B. F., Finnstrom, I. J., Skorstad, E. M., Lunde, G. A., Akselsen, G. R., Monstad, K. R., Hogvall, L., Malmin, S. K., Andersen, M. H., Hargott, R. F., de Jesus Ortiz, A., Cabral, D. M. B., Rivas, J. C., Moreira, M. L., Ellazar, C. G., Cerezo, F. D., Palo, J. E., Aperocho, C. A. J., Figueiredo, M. F., Pinheiro, C. M., Rita, C. S., Feranandes, A. M., Pinto, V. M. V., Bispo, B. M., Lima, A., Alsheikhly, A. S., Guran, C. T., Filipescu, D. C., Scutariu, M. A., Ebaid, M. S., Velickovic, D., Rajkovic, M., Stanojevic, M., Turcan, A., Lancaricova, D., Yeni, N. P., Syed, M. R., Navarro, J. A., De Pablo, A. M., Llinas, A. A., Lajara, M. A. G., Nieto, M. V., Pena, J. M. G., Gorgolas, M. C., Isasi, M. A., Salva-Costa, V., Garzon-Tovar, C., Olivares, P. G., de Ceballos, J. P. G., Polo, A. B. C., del Mar Diaz Salcedo, M., Alvarez, J. D., Arcas, M. L. B., Gonzalez, J. I. T., de la Ventana, A. B. S., Calleja, P. L. -A., Alvarez, R. G., Zamora, P. S., Guerrero, A. O., Barreiro, E. M., Sanchez, L. C., Diaz, M. G., Muriel, D. S., Alonso, H. F., Fernandez, A. W., Pinan, I. S., Albaiceta, G. M., Fernandez, M. C. I., Abos, F. J. S., Chueca, R. M., Aguirre, L. G., Manosa, S. C., Luque, C. P., Losilla, M. R., Fores, M. T., del Rosario Villar Redondo, M., Arteta Arteta, D. S., Sanchez, M. A. H., Espinosa, C. P., Reyes, L. M., Domenech, L. C., Guillen, C. V., Alvarez, J. T., del Cotillo, M., Barrueco-Francioni, J. E., Conde, B. B., Blanco, M. P. S., Blasco, M. L., Clement, A. I., Sanz, L. C., Gonzalez, I. A., Cano, A. E., Nunez, C. R., Fernadez, I. L., Fernandez, A. A. M., Boedjawan, N. N., Jansson, E. B., Malvemyr, A. -S., Lof, G., Spangfors, M., Lagerhall, C., Akerman, E., Hellkvist, V. H., Larsson, I. -M., Jong, M. L., Hsu, M. Y., Chang, S. C., Mebazaa, M. S., Elhechmi, Y. Z., Kuscu, O. O., Dal, H. C., Calili, D. K., Izdes, S., Gumus, A., Tasdemir, B., Kagnici, A., Ay, S. A., Balbay, A. O., Ozserezli, B., Senturk, E., Serin, S. O., Gul, F., Cinel, I., Undar, H. N., Bayraktar, Y. S., Celik, J. B., Tokur, M. E., Aydin, D. T., Yildiz, I., Ozcan, B., Akdag, D., Unlu, N., Reyes, P. E., Ahmad, F. K. E., Smiley, K. A., Miller, M. T., Antonio, M. G. S., Qawasmeh, K. A., Shawish, S. A., Groba, C. B., Raj, A. S., Ei, P. P., Legorburo, M. S., Welters, I. D., Mcmullen, J., Mcdonnell, A., Rose, B. O., Delgado, C. C., Mccann, N., Turner, S. J., Rodriguez, G. E., Eltorai, A. S., Pastores, S. M., Demarre, L., and Debue, A. -S.
Subjects: Male, Original, medicine.medical_treatment, artificial, Critical Care and Intensive Care Medicine, Medical and Health Sciences, Pressure ulcer, law.invention, Decubitus epidemiology, ICU, Morbidity, Mortality, Outcome, Pressure injury, Risk factors, Adult, Aged, Hospital Mortality, Humans, Patient Discharge, Prevalence, Risk Factors, Intensive Care Units, Respiration, Artificial, 0302 clinical medicine, decubitus epidemiology, pressure injury, pressure ulcer, outcome, risk factors, morbidity, mortality, law, Medicine and Health Sciences, adults, Medicine, Simplified Acute Physiology Score, icu, ziekenhuissterfte, Immunodeficiency, intensive care, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, mannen, volwassenen, COST, Intensive care unit, STATE, ULCERS, Underweight, medicine.symptom, Life Sciences & Biomedicine, Human, medicine.medical_specialty, risicofactoren, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, pressure injuries, Intensive Care Unit, prevalentie, NO, 1117 Public Health and Health Services, DecubICUs Study Team, 03 medical and health sciences, Critical Care Medicine, Anesthesiology, General & Internal Medicine, Health Sciences, ouderen, Mechanical ventilation, Science & Technology, business.industry, decubitus, Risk Factor, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Odds ratio, medicine.disease, Emergency & Critical Care Medicine, Confidence interval, 030228 respiratory system, Emergency medicine, kunstmatige ademhaling, RISK-FACTORS, business, respiration
Abstract: Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Published: 2021
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14. Evolution of Practices in Treatment of Abdominal Aortic Aneurysm in France between 2006 and 2015

Author: Simon Rinckenbach, Guillaume Besch, Lucie Salomon du Mont, Eric Steinmetz, Benjamin Kretz, Service de Chirurgie vasculaire - Médecine vasculaire (CHRU Besançon), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service d'anesthésie et réanimation chirurgicale [CHRU de Besançon], Service de chirurgie cardio-vasculaire et thoracique (CHU Dijon), and Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)
Subjects: medicine.medical_specialty, Time Factors, Aortic Rupture, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, cardiovascular diseases, Practice Patterns, Physicians', Surgical treatment, business.industry, Open surgery, Endovascular Procedures, General Medicine, Length of Stay, Surgical procedures, medicine.disease, Abdominal aortic aneurysm, Surgery, Outcome and Process Assessment, Health Care, Treatment Outcome, cardiovascular system, Open repair, France, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract: Background The main objective of this study was to identify the changes that have occurred in the treatment of abdominal aortic aneurysms (AAA) in France over a period of 10 years. Materials and methods Comprehensive data for AAA surgical activity from all French health establishments between 2006 and 2015 were collected from the records of the “Agence Technique de l'Information sur l'Hospitalisation.” Based on the common classification of medical procedures, our research was conducted on surgical procedures involving open and endovascular surgical treatment of AAA. A year-by-year descriptive analysis was completed for the number of procedures, the change in the type of surgery performed in each type of institution, and the mean duration of hospital stays. Results During the study period, the number of AAA treated increased overall by 28.2% (from 6,412 procedures in 2006 to 8,221 in 2015). The proportion of endovascular procedures increased in this period (from 27.0% in 2006 to 68.5% in 2015) like their number from 1,735 to 5,632. The number of fenestrated endovascular aneurysm repair (listed since 2013) increased from 251 to 373 in 3 years. Open repair decreased from 4,677 interventions in 2006 to 2,589 in 2015 with higher proportion of suprarenal clamping in open surgery (from 23% in 2006 to 40% in 2015). The number of ruptured AAA treated in open surgery remained stable over this period (473 in 2006 and 462 in 2015). Conclusions In France, the number of AAA operated between 2006 and 2015 increased by 28.2%. There was a significant increase in endovascular techniques, which became largely predominant in 2015. In open repair, the proportion of complex procedures increased in this period. However, this transformation, which is in line with current recommendations and major publications, needs to be reassessed in the long term.
Published: 2019

15. Minimum effective concentration of ropivacaine for 90% ultrasound-guided axillary brachial plexus block, with or without intravenous dexamethasone

Author: Marc Puyraveau, Mathieu Pascual, Guillaume Besch, Francis Berthier, Loubena Assila, Lucie Vettoretti, Sebastien Pili-Floury, Tommy Grelet, David Ferreira, and Emmanuel Samain
Subjects: business.industry, Ropivacaine, Amides, Brachial Plexus Block, Ultrasound guided, Dexamethasone, Anesthesiology and Pain Medicine, Regional anesthesia, Axillary block, Anesthesia, Axillary brachial plexus block, Medicine, Humans, Anesthetics, Local, business, Ultrasonography, Interventional, medicine.drug, Ultrasonography
Published: 2021

16. Semi-elemental versus polymeric formula for enteral nutrition in brain-injured critically ill patients: a randomized trial

Author: Camille Gilli, Anne Sophie Balon, Emmanuel Samain, Gilles Blasco, Hadrien Winiszewski, Sebastien Pili-Floury, Guillaume Besch, Gilles Capellier, Gaël Piton, and Laurent Carteron
Subjects: Adult, Male, medicine.medical_specialty, Critical Illness, Critical Care and Intensive Care Medicine, Gastroenterology, Enteral administration, Statistics, Nonparametric, law.invention, 03 medical and health sciences, Enteral Nutrition, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Humans, Prospective Studies, 030212 general & internal medicine, Gastroparesis, Brain injury, Critically ill, Aged, Nutrition, Food, Formulated, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Glasgow Coma Scale, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, medicine.disease, Semi-elemental, Intensive care unit, Parenteral nutrition, Brain Injuries, Vomiting, Female, France, medicine.symptom, business
Abstract: Background The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis. The purpose of this study was to compare the efficacy and tolerance of a semi-elemental versus a polymeric formula for enteral nutrition (EN) in brain-injured critically ill patients. Methods Prospective, randomized study including brain-injured adult patients [Glasgow Coma Scale (GCS) ≤ 8] with an expected duration of mechanical ventilation > 48 h. Intervention: an enteral semi-elemental (SE group) or polymeric (P group) formula. EN was started within 36 h after admission to the intensive care unit and was delivered according to a standardized nurse-driven protocol. The primary endpoint was the percentage of patients who received both 60% of the daily energy goal at 3 days and 100% of the daily energy goal at 5 days after inclusion. Tolerance of EN was assessed by the rate of gastroparesis, vomiting and diarrhea. Results Respectively, 100 and 95 patients were analyzed in the SE and P groups: Age (57[44–65] versus 55[40–65] years) and GCS (6[3–7] versus 5[3–7]) did not differ between groups. The percentage of patients achieving the primary endpoint was similar (46% and 48%, respectively; relative risk (RR) [95% confidence interval (CI)] = 1.05 (0.78–1.42); p = 0.73). The mean daily energy intake was, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (p = 0.42). Protein intakes were 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day (p p = 0.21), and 16% versus 8% patients suffered from diarrhea (p = 0.11). No patient presented vomiting in either group. Conclusion Semi-elemental compared to polymeric formula did not improve daily energy intake or gastrointestinal tolerance of enteral nutrition. Trial registration EudraCT/ID-RCB 2012-A00078-35 (registered January 17, 2012).
Published: 2021

17. Quality of life 10 years after cardiac surgery in adults: a long-term follow-up study

Author: Andrea Perrotti, Fiona Ecarnot, Francesco Monaco, Enrica Dorigo, Palmiero Monteleone, Guillaume Besch, and Sidney Chocron
Subjects: Male, Adult, Quality of life, medicine.medical_specialty, Time Factors, Long term follow up, education, lcsh:Computer applications to medicine. Medical informatics, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Coronary artery bypass graft, medicine, Humans, 030212 general & internal medicine, Cardiac Surgical Procedures, Coronary Artery Bypass, Cardiac surgery, Follow up, Intensive care medicine, Letter to the Editor, Aged, Quality of Life Research, business.industry, Research, 030503 health policy & services, Public Health, Environmental and Occupational Health, General Medicine, Middle Aged, humanities, Logistic Models, Multivariate Analysis, lcsh:R858-859.7, Female, France, 0305 other medical science, business, Follow-Up Studies
Abstract: Background Quality of life (QoL) is a multifactorial concept that assesses physical and mental health. We prospectively studied the quality of life of patients undergoing coronary artery bypass graft (CABG) surgery using the Short-Form 36-item questionnaire (SF-36) up to 10 years after surgery. Methods Between January 2000 and December 2002, all patients undergoing elective isolated CABG in the cardiac & thoracic surgery department of a large university hospital in Eastern France underwent initial QoL evaluation with the SF-36. The same questionnaire was mailed to every patient annually (± 2 weeks around the date of surgery) up to 10 years after their operation. We recorded socio-demographic and clinical variables at inclusion. Predictors of impaired QoL at 10 years were identified by logistic regression. Results A total of 272 patients (213 men, 59 women) were enrolled; mean age at inclusion was 65 ± 10 years. At 10 years post-surgery, 81 patients had died (29.7%). The physical component summary (PCS) score was significantly higher at 5 years after surgery than at baseline (p
Published: 2020

18. Lung Recruiting Effect of Prone Positioning in Spontaneously Breathing Patients with COVID-19 Assessed by Electrical Impedance Tomography

Author: Yannick Brunin, Sebastien Pili-Floury, Cyrielle Despres, and Guillaume Besch
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), High-Frequency Ventilation, Critical Care and Intensive Care Medicine, Patient Positioning, Internal medicine, Prone Position, medicine, Humans, Electrical impedance tomography, Aged, Lung, SARS-CoV-2, business.industry, COVID-19, Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences, Lung recruitment, Prone position, Treatment Outcome, medicine.anatomical_structure, Exhalation, Practice Guidelines as Topic, Breathing, Cardiology, business
Published: 2021

19. Clinical effectiveness of ultrasound-guided dual transversus abdominis plane block for postoperative analgesia in open abdominal aortic surgery patients: The randomised, double-blind ETAP trial

Author: Thomas Levy, Guillaume Besch, Julien Chenet, Vivien Salignon, Lucie Salomon du Mont, Emmanuel Samain, Elodie Dupont, Sebastien Pili-Floury, and Marc Puyraveau
Subjects: medicine.medical_specialty, Pain, Postoperative, business.industry, Clinical effectiveness, Aortic surgery, Ultrasound guided, Surgery, Double blind, Analgesia, Epidural, Anesthesiology and Pain Medicine, Text mining, Treatment Outcome, Abdominal muscles, Double-Blind Method, Transversus Abdominis Plane Block, Medicine, Feasibility Studies, Humans, Ultrasonography, business, Ultrasonography, Interventional, Abdominal Muscles
Published: 2020

20. Hypophosphatemia in critically ill adults and children - A systematic review

Author: Carole Ichai, Olivier Joannes-Boyau, Angelique de Man, Sonja Fruhwald, Jan Gunst, Stéphane Dauger, Mette M. Berger, Annika Reintam Blaser, Maria Helena Perez, Kadri Tamme, Carina Benstoem, Michael P Casaer, Jan Wernerman, Stefan J. Schaller, Joel Starkopf, Manu L N G Malbrain, Guillaume Besch, Michael Hiesmayr, ACS - Diabetes & metabolism, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, Supporting clinical sciences, and Intensive Care
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Hypophosphatemia, Critical Illness, MEDLINE, 030209 endocrinology & metabolism, Phosphate, CINAHL, Critical Care and Intensive Care Medicine, law.invention, Refeeding syndrome, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, medicine, Prevalence, Humans, Intensive care medicine, Child, Outcome, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Retrospective cohort study, medicine.disease, Clinical research, outcome, Observational study, business, Critical illness
Abstract: BACKGROUND & AIMS: Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphatemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphatemia, associated morbidity and treatments. METHODS: A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for pediatric critically ill patients, and prevalence of hypophosphatemia was assessed in both groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. RESULTS: For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphatemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care. In both critically ill adults and children, several studies report that hypophosphatemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphatemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphatemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. CONCLUSIONS: Evidence on the definition, outcome and treatment of clinically relevant hypophosphatemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines. ispartof: CLINICAL NUTRITION vol:40 issue:4 pages:1744-1754 ispartof: location:England status: published
Published: 2020

21. Hypophosphataemia in Critically Ill Adults and Children – A Systematic Review

Author: Annika Reintam Blaser, Jan Gunst, Carole Ichai, Michael Casaer, Carina Benstoem, Guillaume Besch, Stephane Dauger, Sonja M Fruhwald, Michael Hiesmayr, Olivier Joannes-Boyau, Manu LNG Malbrain, Maria-Helena Perez, Stefan J Schaller, Angelique de Man, Joel Starkopf, Kadri Tamme, Jan Wernerman, and Mette M Berger
Abstract: Background: Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphataemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphataemia, associated morbidity and treatments. Methods: A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for paediatric critically ill patients, and prevalence of hypophosphataemia was assessed in both of these groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.Results: For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphataemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care.In both critically ill adults and children, several studies report that hypophosphataemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphataemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphataemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. Conclusion: Evidence on the definition, outcome and treatment of clinically relevant hypophosphataemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines.
Published: 2020

22. Pulmonary embolism among critically ill patients with ARDS due to COVID-19

Author: Guillaume Besch, Guillaume Mourey, Franck Grillet, Sebastien Pili-Floury, Basile Mouhat, Gilles Capellier, Hadrien Winiszewski, Nicolas Meneveau, Julien Behr, Gaël Piton, Emmanuel Samain, Nicolas Mahr, Patricia Dockhorn Costa, Thomas Senot, Thibaud Soumagne, and Alexandra Fournel
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, ARDS, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Critical Illness, Comorbidity, Pandemic, medicine, Humans, Intensive care medicine, Letter to the Editor, Pandemics, Aged, Respiratory Distress Syndrome, business.industry, Critically ill, SARS-CoV-2, COVID-19, Middle Aged, medicine.disease, Pulmonary embolism, Acute Disease, Female, business, Pulmonary Embolism
Published: 2020

23. Neck ultrasound to improve risk assessment for difficult tracheal intubation in the operating room: The TUBECHO case-control prospective observational pilot study

Author: Sebastien Pili-Floury, Guillaume Besch, Marc Boinette, Marc Puyraveau, Emmanuel Samain, Jonathan Paillot, and Romain Boinette
Subjects: medicine.medical_specialty, Operating Rooms, business.industry, medicine.medical_treatment, Tracheal intubation, MEDLINE, Pilot Projects, Risk Assessment, Neck ultrasound, Anesthesiology and Pain Medicine, Anesthesia, Emergency medicine, medicine, Intubation, Intratracheal, Humans, Observational study, Prospective Studies, Risk assessment, business
Published: 2020

24. Individual versus collective debriefing after interprofessional training course simulation: The randomised DEBRIEF-SIM trial

Author: Floriane Ciceron, Christophe Avena, Sebastien Pili-Floury, Medhi Benkhadra, Claude Girard, Jeanne-Antide Rouge, Guillaume Besch, Gregory Dupont, Christophe Laithier, and Emmanuel Samain
Subjects: medicine.medical_specialty, business.industry, Training course, Debriefing, education, General Medicine, Critical Care and Intensive Care Medicine, Confidence interval, Session (web analytics), Critical phase, Anesthesiology and Pain Medicine, Primary outcome, Anesthesiology, Physical therapy, Medicine, Humans, Learning, Student nurse, Clinical Competence, Technical skills, business, Simulation Training
Abstract: Introduction Debriefing is a critical phase in simulation-based education that is extremely time-consuming for the instructors. The aim of the study was to assess whether a collective debriefing was non-inferior to an individual debriefing to improve learning outcomes after a simulation session. Methods This randomised controlled multicentre non-inferiority study included pairs comprising one resident and one student nurse in anaesthesia. Each pair underwent two sessions of a simulated life-threatening emergency held at a 6-week interval. Six participant pairs underwent simulation sessions every half-day of training. The debriefing performed after the first session was either individual (1 debriefing by pair; individual group) or collective (1 debriefing by 6 pairs; collective group). The primary outcome was the evolution of a 34-parameter technical skill score (Delta-TSS-34) between the two simulation sessions. The non-inferiority margin was 5. The change in the Anaesthetists’ Non-Technical Skills score (Delta-ANTS), and the debriefing duration per participant pair were secondary endpoint measures. Results Respectively 23 and 21 pairs were included in the collective and individual groups. Delta-TSS-34 was non-inferior in the collective group compared to the individual group (mean intergroup difference [95% confidence interval]: 2.71 [0.44–4.98]). Delta-ANTS did not significantly differ between the two groups (median [interquartile range]: 22 [10–37] versus 25 [17–35], p = 0.57; respectively in the collective and individual groups). The debriefing duration per participant pair was significantly lower in the collective group (10 [10–11] min versus 27 [25–28] min; p Conclusion Collective debriefing was non-inferior to individual debriefing to improve learning outcomes after simulation of medical emergencies and allows a significant reduction in the time dedicated to the debriefing.
Published: 2020

25. Blood glucose control management in critically ill adult patients: Results of a French nationwide practice survey

Author: Lucie Salomon du Mont, Christelle Schneider, Guillaume Besch, Sebastien Pili-Floury, and Emmanuel Samain
Subjects: Blood Glucose, medicine.medical_specialty, Glucose control, Adult patients, business.industry, Critically ill, Critical Illness, General Medicine, Glycemic Control, Critical Care and Intensive Care Medicine, Anesthesiology and Pain Medicine, Surveys and Questionnaires, Emergency medicine, Diabetes Mellitus, Medicine, Humans, Hypoglycemic Agents, France, business
Published: 2020

26. Kinetics of endocan in patients undergoing cardiac surgery with and without cardiopulmonary bypass

Author: Sidney Chocron, Andrea Perrotti, Pierre-Alain Poinsot, Fiona Ecarnot, Guillaume Besch, Benoit Barrucand, and Philippe Lassalle
Subjects: Male, medicine.medical_specialty, Inflammatory response, Immunology, 030204 cardiovascular system & hematology, Biochemistry, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Cardiopulmonary bypass, Retrospective analysis, Humans, Immunology and Allergy, Medicine, In patient, Prospective Studies, Coronary Artery Bypass, Molecular Biology, Aged, Retrospective Studies, Cardiopulmonary Bypass, Lung, business.industry, 030208 emergency & critical care medicine, Hematology, Cabg surgery, Coronary Vessels, Neoplasm Proteins, Cardiac surgery, Kinetics, surgical procedures, operative, medicine.anatomical_structure, Anesthesia, Female, Proteoglycans, business, circulatory and respiratory physiology, Artery
Abstract: Background Endocan plays an important role in the processes of inflammation and infection. The use of cardiopulmonary bypass (CPB) during cardiac surgery can induce an inflammatory response. We aimed to describe the kinetics of endocan in patients undergoing cardiac surgery with and without the use of CPB. Methods Single-centre, observational study with retrospective analysis of prospectively collected data, to compare the kinetics of endocan in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Endocan was measured at induction of general anesthesia (baseline), and at 6, 24, 48 and 72 h after the end of surgery. Patients were classified into two groups, namely those undergoing CPB (CPB group) and those without CPB (off-pump group). Results In total, 91 patients were included in this analysis: 61 patients in the CPB group and 30 in the off-pump group. There were no major significant differences between groups. Patients with CPB had a significantly higher level of endocan at 6 h (9.7 ± 6.7 ng/ml vs 6.9 ± 3.3 ng/ml, p = 0.03), but the difference was no longer statistically significant at subsequent timepoints. Endocan values were not significantly correlated with the duration of CPB (p = 0.53). Conclusion Endocan levels in patients undergoing isolated CABG surgery with CPB are significantly higher at 6 h than in patients with off-pump surgery, and peaks earlier in those with CPB (6 h) than in those undergoing off-pump surgery (24 h).
Published: 2018

27. Impact of Nutritional State on Critical Limb Ischemia Early Outcomes (DENUCRITICC Study)

Author: Simon Rinckenbach, Eric Steinmetz, Marie-Catherine Morgant, Betty Leclerc, Guillaume Besch, Lucie Salomon du Mont, and Aline Laubriet
Subjects: Male, Time Factors, 030204 cardiovascular system & hematology, Severity of Illness Index, 0302 clinical medicine, Ischemia, Risk Factors, Odds Ratio, Prevalence, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, 80 and over, Univariate analysis, education.field_of_study, Endovascular Procedures, General Medicine, Limb Salvage, Treatment Outcome, Female, France, medicine.symptom, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Critical Illness, Population, Nutritional Status, Amputation, Surgical, Peripheral Arterial Disease, 03 medical and health sciences, Internal medicine, Severity of illness, medicine, Humans, Intensive care medicine, education, Geriatric Assessment, Aged, Chi-Square Distribution, business.industry, Malnutrition, Cardiovascular Agents, Critical limb ischemia, Odds ratio, Length of Stay, medicine.disease, body regions, Logistic Models, Nutrition Assessment, Multivariate Analysis, Vascular Grafting, Surgery, business, Chi-squared distribution
Abstract: Despite current progress, the prognosis of critical limb ischemia (CLI) remains poor. The ageing of the population, the increasing prevalence of diabetes mellitus, and the stability of tobacco use will increase the prevalence of CLI. CLI patients have risk factors for malnutrition, and the impact of malnutrition on morbidity and mortality has been demonstrated in the general population. However, we have little information on the consequences of undernutrition in the CLI population. The aim of this study is to assess the impact of malnutrition on the early outcomes in CLI patients.This is a double-center prospective study that included all consecutive hospitalized patients with CLI. All patients were screened for malnutrition and divided into 2 groups: severe malnourished patients (group A) and moderate malnourished and well-nourished (group B). This distribution was based on age-indexed clinical and biological data and the patient's general condition: the Nutritional Risk Index for patients younger than 75 years, the Mini Nutritional Assessment, or the Geriatric Nutritional Risk Index for those older than 75 years. The primary end point was defined as the rate of 30-day death. Outcomes were compared in a univariate analysis. Stepwise logistic regression was used for the multivariate analysis. Variables with a P value0.2 in the univariate analysis were introduced in the multivariate model.We included 106 patients. The prevalence of malnutrition was 75.5%, divided into moderate malnutrition (51.9%) and severe malnutrition (23.6%). Six patients (24%) died in group A compared with 8 in group B (4.9%) (P = 0.01). By univariate analysis, severe malnutrition was the only factor associated with death at 30 days. By stepwise logistic regression, severe malnutrition (odds ratio 6.1, 95% confidence interval 1.6-23.7, P = 0.006) was found to be the significant risk factors for death at 30 days.This study is the first to demonstrate prospectively the major importance of malnutrition in the early prognosis of CLI patients.
Published: 2017

28. Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative Glycemic Control after Coronary Artery Bypass Graft Surgery

Author: Sidney Chocron, Guillaume Besch, Guillaume Flicoteaux, Emmanuel Samain, Frédéric Mauny, Lucie Salomon du Mont, Andrea Perrotti, Marc Puyraveau, Maude Baltres, Benoit Barrucand, and Sebastien Pili-Floury
Subjects: medicine.medical_specialty, business.industry, 030208 emergency & critical care medicine, Perioperative, 030204 cardiovascular system & hematology, law.invention, Surgery, Clinical trial, 03 medical and health sciences, Coronary artery bypass surgery, 0302 clinical medicine, Anesthesiology and Pain Medicine, Glycemic index, medicine.anatomical_structure, Randomized controlled trial, law, Anesthesia, medicine, business, Exenatide, Glycemic, Artery, medicine.drug
Abstract: Background We aimed to assess the clinical effectiveness of intravenous exenatide compared to insulin in perioperative blood glucose control in coronary artery bypass grafting surgery patients. Methods Patients more than 18 yr old admitted for elective coronary artery bypass grafting were included in a phase II/III nonblinded randomized superiority trial. Current insulin use and creatinine clearance of less than 60 ml/min were exclusion criteria. Two groups were compared: the exenatide group, receiving exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min), and the control group, receiving insulin therapy. The blood glucose target range was 100 to 139 mg/dl. The primary outcome was the proportion of patients who spent at least 50% of the study period within the target range. The consumption of insulin (Cinsulin) and the time to start insulin (Tinsulin) were compared between the two groups. Results In total, 53 and 51 patients were included and analyzed in the exenatide and control groups, respectively (age: 70 ± 9 vs. 68 ± 11 yr; diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in the exenatide group and in 41 (80%) patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P < 0.001), and Tinsulin was significantly longer (12 [7 to 16] vs. 7 [5 to 10] h, P = 0.02) in the exenatide group. Conclusions Exenatide alone at the dose used was not enough to achieve adequate blood glucose control in coronary artery bypass grafting patients, but it reduces overall consumption of insulin and increases the time to initiation of insulin.
Published: 2017

29. Stratégie anesthésique : ALR vs AG, halogénés vs anesthésiques intraveineux, analgésie

Author: Francis Berthier, Sebastien Pili-Floury, Emmanuel Samain, and Guillaume Besch
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, business.industry, medicine, 030204 cardiovascular system & hematology, business
Abstract: Points essentiels La periode operatoire est une periode a risque pour le coronarien. La prise en charge anesthesique est basee sur une strategie de prevention et de detection rapide et de traitement des evenements cardiaques. L’optimisation des parametres hemodynamique pour maintenir l’equilibre de la balance energetique du myocarde est un element important de la periode operatoire. L’effet des agents anesthesique et de l’anesthesie perimedullaire sur l’hemodynamique et sur les systemes de regulation cardiovasculaire doivent etre pris en compte dans la gestion de l’anesthesie. Le maintien de la normothermie est recommande chez le coronarien opere en chirurgie non cardiaque. Le benefice de l’anesthesie perimedullaire en termes de reduction du risque cardiovasculaire n’a pas ete clairement montre malgre un nombre important d’etudes et de meta-analyses. Cette technique reste cependant une excellente methode d’analgesie et pourrait reduire les complications respiratoires postoperatoires. La gestion des antiplaquettaires frequemment utilises chez le coronarien a fait l’objet de recommandation specifiques. Le preconditionnement par un agent anesthesique halogene, demontre experimentalement et tres probable en chirurgie cardiaque n’a pas fait la preuve de son efficacite en chirurgie generale. Le choix d’un agent halogene pour l’entretien de l’anesthesie reste guide sur d’autres criteres que la prevention de l’ischemie myocardique ou de l’infarctus du myocarde (IDM) perioperatoires. Le preconditionnement ischemique a distance n’a pas ete montre efficace pour reduire le risque de complications cardiaques perioperatoires. La prevention des complications cardiaques au moyen de nitres ou alpha-2-agonistes administres de maniere prophylactique n’est pas recommandee.
Published: 2017

30. Ultrasound-guided intermediate cervical block versus superficial cervical block for carotid artery endarterectomy: The randomized-controlled CERVECHO trial

Author: P. Petit, Emmanuel Samain, Sebastien Pili-Floury, Arslane Alilet, Corinne Joly, Guillaume Besch, and Benedicte Devaux
Subjects: medicine.medical_specialty, Ropivacaine, business.industry, medicine.medical_treatment, 030208 emergency & critical care medicine, General Medicine, Critical Care and Intensive Care Medicine, Surgery, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Anesthesia, medicine, Nerve block, media_common.cataloged_instance, General anaesthesia, European union, Complication, Prospective cohort study, business, medicine.drug, media_common, Cervical Plexus Block
Abstract: Introduction The value of ultrasound guidance for intermediate cervical blocks in patients undergoing carotid artery endarterectomy is poorly described. This study aimed at comparing the efficacy of ultrasound-guided intermediate cervical block to superficial cervical block for carotid artery endarterectomies. Patients and methods We conducted a single-centre randomized-controlled study in a French University Hospital, from April 2011 to March 2012. The anaesthesia technique was randomly allocated to patients scheduled for carotid artery endarterectomy under regional anaesthesia (ropivacaine 4.75 mg/mL): superficial cervical block in the Control group, and ultrasound-guided intermediate cervical block in the Echo group. The main outcome measure was the percentage of surgery performed without supplemental topical anaesthesia. The secondary outcomes were: rate of conversion to general anaesthesia, amount of supplemental topical lidocaine and block-related complications. P Results Demographic data for the 86 patients included [mean (SD) age 73 (11) years] did not differ between groups. Surgery was performed without supplemental topical lidocaine in 23% and 7% of the patients in the Echo and Control groups, respectively ( P = 0.068). Conversion to general anaesthesia for inadequate analgesia was needed in 0 and 2 patients in the Echo and Control groups, respectively. The mean dose of topical lidocaine was not different between groups. No complication directly related to a cervical block was observed. Conclusions Ultrasound-guided intermediate cervical plexus block and superficial cervical blocks performed for carotid artery surgery seems to provide similar results, but this study was probably underpowered to detect any difference. Trial registration European Union Drug Regulating Authorities Clinical Trials (Eudra-CT) registration number: 2010-A 01490-39.
Published: 2017

31. Prevalence and Impact of Malnutrition in Patients Surgically Treated for Chronic Mesenteric Ischemia

Author: Charlotte Allain, Nicolas Guelle, Lucie Salomon du Mont, Simon Rinckenbach, Guillaume Besch, Service de Chirurgie vasculaire - Médecine vasculaire (CHRU Besançon), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service d'anesthésie et réanimation chirurgicale [CHRU de Besançon], and Clinique Saint Vincent
Subjects: Male, medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], Population, Nutritional Status, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Weight loss, Risk Factors, Internal medicine, Mesenteric Vascular Occlusion, medicine, Prevalence, Humans, Splanchnic Circulation, education, Aged, Retrospective Studies, 2. Zero hunger, Aged, 80 and over, education.field_of_study, business.industry, Malnutrition, Retrospective cohort study, Nutritional status, General Medicine, Middle Aged, medicine.disease, 3. Good health, Chronic mesenteric ischemia, Treatment Outcome, Mesenteric Ischemia, Chronic Disease, Surgery, Observational study, Female, Stents, France, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Body mass index, Vascular Surgical Procedures
Abstract: Background Patients suffering from chronic mesenteric ischemia are at risk of malnutrition due to the fear of food and weight loss. However, the impact of malnutrition on the morbidity and mortality at the time of surgery is not studied extensively, just as its prevalence. The main objective of this study was to evaluate the influence of malnutrition on the survival of the patients operated for chronic mesenteric ischemia. The secondary objectives were to evaluate the prevalence of malnutrition in this population and to evaluate the early complications after surgery according to the nutritional condition of the patients. Methods We conducted a monocentric retrospective observational study including consecutively all the patients operated for chronic mesenteric ischemia between 2005 and 2016. The nutritional status was determined a posteriori according to the criteria of the French High Health Authority using body mass index, the percentage of weight loss, and albumin. We thus divided the patients into 2 groups, “malnourished” and “non-malnourished.” We compared the survival of the patients of the 2 groups with a log-rank test. Results We enrolled 54 patients including 35 men (65%), with a mean age of 68.1 years (±12.3). The prevalence of malnutrition was 70% (38 patients), including 9 severely malnourished patients (23.6%). Twenty-nine patients (53.7%) were treated by endovascular technique, and twenty-five had conventional surgery (46.3%). The type of management was not different between the 2 groups: 20 patients of the malnourished group (52.6%) and 9 patients of the non-malnourished group (56.3%) were treated by endovascular technique (P = 0.8). The 30-day mortality was null in the non-malnourished group, whereas ten patients (26.3%) died in the malnourished group (P = 0.02). The short-term complications were not significantly different between the malnourished and the non-malnourished groups (37% vs. 19%, P = 0.32). The mean duration of follow-up was 639 days (±660). The 3-year survival was not different between the endovascular group and the open surgery group (43% vs. 52%, P = 0.7). The 3-year survival was statistically higher in the non-malnourished group (87%) than in the malnourished group (49.6%) (P = 0.01). Conclusions In our experience, preoperative malnutrition is a factor significantly decreasing the survival of the patients treated with open surgery or with endovascular technique for chronic mesenteric ischemia. A more optimal preoperative management of this malnutrition could improve the results of these procedures.
Published: 2018

32. Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial

Author: Guillaume Besch, Marc Puyraveau, Lucie Vettoretti, David Ferreira, Sebastien Pili-Floury, Tommy Grelet, Emmanuel Samain, Francis Berthier, and Jean-Christophe Clement
Subjects: Adult, Male, medicine.drug_class, medicine.medical_treatment, Analgesic, Placebo, Dexamethasone, law.invention, Forearm, Randomized controlled trial, Double-Blind Method, law, medicine, Humans, Ropivacaine, Prospective Studies, Anesthetics, Local, Saline, Glucocorticoids, Pain, Postoperative, business.industry, Local anesthetic, Drug Synergism, General Medicine, Middle Aged, Brachial Plexus Block, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Treatment Outcome, Anesthesia, Injections, Intravenous, Female, business, medicine.drug, Follow-Up Studies
Abstract: Background and objectivesThe effect of intravenous dexamethasone on the duration of axillary plexus block performed using ropivacaine is not described. The aim of this study is to assess the effect of intravenous dexamethasone on the duration of axillary plexus block analgesia after distal upper arm surgery.MethodsIn this prospective, randomized, placebo-controlled, double-blinded trial, consenting patients scheduled for hand or forearm surgery under ultrasound-guided axillary plexus block performed using 0.5 mL/kg of 0.475% ropivacaine, were randomized to receive an intravenous injection of either 8 mg/2 mL of dexamethasone (Dexa group) or 2 mL of saline (Control). The primary outcome was the time of first analgesic intake after axillary block. Secondary outcomes included motor or sensory block duration, total use of postoperative analgesics, and block-related complications.ResultsAmong the 98 patients included, 6 and 2 patients did not require postoperative analgesic intake in Dexa and Control groups, respectively (p=0.06). The time of first analgesic intake was significantly longer in the Dexa (20.9±9.3 hours) than in the Control group (14.7±6.6 hours, pConclusionsThis study showed that intravenous dexamethasone delayed for 6 hours the time to first analgesic intake after upper arm surgery under axillary plexus block performed with the long-lasting local anesthetic ropivacaine. This suggests that intravenous dexamethasone could be an interesting adjuvant to axillary plexus block.Trial registration numberNCT02862327
Published: 2018

33. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography

Author: Eric Delabrousse, Guillaume Besch, Gaël Piton, Sébastien Bouveresse, Sebastien Pili-Floury, and Nicolas Badet
Subjects: Male, medicine.medical_specialty, Abdominal compartment syndrome, Critical Illness, Abdominal ct, Computed tomography, Compartment Syndromes, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, 0302 clinical medicine, Intravesical pressure, law, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Aged, medicine.diagnostic_test, business.industry, Critically ill, General Medicine, Middle Aged, medicine.disease, Intensive care unit, Intensive Care Units, 030220 oncology & carcinogenesis, Shock (circulatory), Area Under Curve, Female, Radiology, medicine.symptom, Intra-Abdominal Hypertension, business, Tomography, X-Ray Computed
Abstract: The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS.Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP 12 mmHg).Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40-0.49] in patients with IVP 12 mmHg and PAR = 0.52 [0.48-0.53] in patients with IVP ≥ 12 mmHg; p 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis.The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH.• CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome. • Raising the possibility of an IAH on a CT examination is relevant information for the clinician. • The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when 0.8).
Published: 2018

34. Pectoral nerve block and persistent pain following breast cancer surgery: an observational cohort study

Author: Guillaume Besch, Caroline Lagrave-Safranez, Fiona Ecarnot, Valentine De Larminat, Catherine Gay, Francis Berthier, Emmanuel Samain, and Sebastien Pili-Floury
Subjects: medicine.medical_specialty, Thoracic Nerves, business.industry, Persistent pain, medicine.medical_treatment, Pain, Breast Neoplasms, medicine.disease, Surgery, Cohort Studies, Anesthesiology and Pain Medicine, Text mining, Breast cancer, medicine, Nerve block, Humans, business, Mastectomy, Cohort study
Published: 2018

35. Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative Glycemic Control after Coronary Artery Bypass Graft Surgery: A Phase II/III Randomized Trial

Author: Guillaume, Besch, Andrea, Perrotti, Frederic, Mauny, Marc, Puyraveau, Maude, Baltres, Guillaume, Flicoteaux, Lucie, Salomon du Mont, Benoit, Barrucand, Emmanuel, Samain, Sidney, Chocron, and Sebastien, Pili-Floury
Subjects: Blood Glucose, Male, Venoms, Middle Aged, Treatment Outcome, Glycemic Index, Preoperative Care, Exenatide, Humans, Hypoglycemic Agents, Insulin, Female, Coronary Artery Bypass, Infusions, Intravenous, Peptides, Aged
Abstract: We aimed to assess the clinical effectiveness of intravenous exenatide compared to insulin in perioperative blood glucose control in coronary artery bypass grafting surgery patients.Patients more than 18 yr old admitted for elective coronary artery bypass grafting were included in a phase II/III nonblinded randomized superiority trial. Current insulin use and creatinine clearance of less than 60 ml/min were exclusion criteria. Two groups were compared: the exenatide group, receiving exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min), and the control group, receiving insulin therapy. The blood glucose target range was 100 to 139 mg/dl. The primary outcome was the proportion of patients who spent at least 50% of the study period within the target range. The consumption of insulin (Cinsulin) and the time to start insulin (Tinsulin) were compared between the two groups.In total, 53 and 51 patients were included and analyzed in the exenatide and control groups, respectively (age: 70 ± 9 vs. 68 ± 11 yr; diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in the exenatide group and in 41 (80%) patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P0.001), and Tinsulin was significantly longer (12 [7 to 16] vs. 7 [5 to 10] h, P = 0.02) in the exenatide group.Exenatide alone at the dose used was not enough to achieve adequate blood glucose control in coronary artery bypass grafting patients, but it reduces overall consumption of insulin and increases the time to initiation of insulin.
Published: 2017

36. Long-term compliance with a validated intravenous insulin therapy protocol in cardiac surgery patients: a quality improvement project

Author: Sebastien Pili-Floury, Aline Bondy, Lucie Salomon du Mont, Emmanuel Samain, Andrea Perrotti, Guillaume Besch, Sidney Chocron, Raphaelle Tucella, and Guillaume Flicoteaux
Subjects: Male, medicine.medical_specialty, Quality management, medicine.medical_treatment, Protocol Deviation, 030204 cardiovascular system & hematology, Nursing Staff, Hospital, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Clinical Protocols, law, Infusion Procedure, Physicians, medicine, Humans, Insulin, 030212 general & internal medicine, Cardiac Surgical Procedures, Infusions, Intravenous, Aged, Retrospective Studies, Protocol (science), business.industry, Surrogate endpoint, Health Policy, Public Health, Environmental and Occupational Health, General Medicine, Middle Aged, Intensive care unit, Quality Improvement, Cardiac surgery, Intensive Care Units, Hyperglycemia, Emergency medicine, Female, Guideline Adherence, business
Abstract: Quality problem Safe and efficient blood glucose (BG) level control after cardiac surgery relies on an intensive care unit (ICU) team-based approach, including implementation of a dynamic insulin therapy protocol (ITP). Long-term compliance with such a complex protocol is poorly addressed in the literature. The aim of this study was to assess the long-term compliance of nurses with the ITP, 7 years after its implementation in the ICU. Initial assessment A professional practice evaluation, integrated in a process of quality improvement program, was retrospectively conducted on 224 consecutive cardiac surgery patients over a 6-month period (PHASE 1). The timing of BG measurements and the insulin infusion rate adjustments (primary endpoints) were correctly performed according to protocol requirements in 35 and 53% of the cases, respectively. Choice of solution and implementation After systemic analysis of the causes of protocol deviations, four corrective measures aiming at improving both physician and nurse adherence to the protocol were implemented in the ICU. Evaluation Evaluation of 104 patients in PHASE 2 showed a significant improvement in both the timing of BG measurements (83 %, P < 0.001 vs. PHASE 1), and insulin infusion rate adjustments (76%, P < 0.001). Lessons learned Seven years after the implementation of a dynamic insulin infusion protocol, major protocol deviations were observed. Identification of several causes after a professional practice evaluation and the implementation of simple corrective measures restored a high level of nurse compliance.
Published: 2017

37. How to identify patients at risk of abdominal compartment syndrome after surgical repair of ruptured abdominal aortic aneurysms in the operating room: A pilot study

Author: Simon Rinckenbach, Guillaume Besch, Lucie Salomon du Mont, and Betty Leclerc
Subjects: Male, Resuscitation, medicine.medical_specialty, Operating Rooms, Time Factors, Abdominal compartment syndrome, Anemia, Aortic Rupture, Pilot Projects, 030204 cardiovascular system & hematology, 030230 surgery, Risk Assessment, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, medicine, Prevalence, Humans, Radiology, Nuclear Medicine and imaging, Aortic rupture, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Reproducibility of Results, General Medicine, Middle Aged, medicine.disease, Surgery, Blood pressure, Early Diagnosis, Treatment Outcome, ROC Curve, Shock (circulatory), Area Under Curve, Female, France, medicine.symptom, Intra-Abdominal Hypertension, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Aortic Aneurysm, Abdominal
Abstract: Objectives Abdominal compartment syndrome (ACS) is poorly identified in surgery for ruptured abdominal aortic aneurysm and an early management is crucial. The aim of this study was to validate how many risk factors were needed to predict ACS. Secondary objectives were to assess its prevalence and the 30-day mortality. Methods All patients operated for ruptured abdominal aortic aneurysm during 5 years were included. An independent committee performed a retrospective diagnosis of ACS. Eight criteria were selected from the literature, and corresponded to pre- and intraoperative period: anemia (hemoglobin lower than 10 g/dL), prolonged shock (systolic blood pressure 30), massive fluid resuscitation (≥3500 mL per hour for at least 1 h) and transfusions (>10 units packed blood red cell since the beginning of the treatment), severe hypothermia (≤33℃), acidosis (pH Results Eight patients were ACS+ and 28 ACS-, with three criteria for ACS+ and 1.5 for ACS- ( p = 0.002). Three criteria among the eight selected criteria have the best cutoff for sensitivity and specificity (75% and 82%) with a positive predictive value of 54% and a negative predictive value of 92%. The prevalence of ACS was 17%. The 30-day mortality in ACS+ tended to be higher than in ACS- ( p = 0.108). Conclusion The present results suggest that patients with an ACS seemed to have higher mortality and the threshold of three factors among eight specific factors is enough to predict this.
Published: 2017

38. Propofol-remifentanil anesthesia for upper airway endoscopy in spontaneous breathing patients: the ENDOTANIL Randomized Trial

Author: Guillaume, Besch, Angeline, Chopard-Guillemin, Elisabeth, Monnet, Arnaud, Causeret, Amelie, Jurine, Gerald, Baudry, Benjamin, Lasry, Laurent, Tavernier, Emmanuel, Samain, and Sebastien, Pili-Floury
Subjects: Male, Remifentanil, Tertiary Care Centers, Double-Blind Method, Laryngoscopy, Respiration, Bronchoscopy, Humans, Female, Esophagoscopy, Middle Aged, Propofol, Anesthetics, Intravenous
Abstract: The ENDOTANIL Trial aimed at comparing an association of target-controlled infusion (TCI) of remifentanil and propofol to TCI of propofol alone on the clinical conditions during pan endoscopy for assessment of the upper airway (pan endoscopy) performed under tubeless general anesthesia.This double-blind, single center, parallel, randomized, placebo-controlled trial was conducted in a French tertiary level of care, from June 2009 to February 2013. Patients scheduled for elective pan endoscopy were anesthetized using propofol TCI combined to either remifentanil TCI (effect-site concentration=1.5 ng.mL-1; remifentanil group) or placebo (control group). The main outcome measure was the percentage of clinically acceptable conditions for pan endoscopy, using a 5-criteria score (ease of laryngoscopy, position and movements of the vocal cords, cough and movements of the limbs to stimulation). The secondary outcomes were hemodynamic and respiratory safety.In this study 218 patients (mean±SD age 60 [10] yrs) were included. Clinically acceptable conditions were observed in 68% and 64% of the patients included in Remifentanil and Control group, respectively (P=0.39). None of the 5 parameters of the pan endoscopy score was significantly different between the 2 groups. Hemodynamic alterations were significantly lower in the Remifentanil as compared to the control group. Incidence of hypoxemia or need for rescue mechanical ventilation did not significantly differ between the 2 groups.The adjunction of remifentanil to propofol TCI, at a dose that maintain spontaneous breathing, did not improve the conditions for pan endoscopy, but attenuates the hemodynamic response induced by upper airway stimulation.
Published: 2016

39. Preoperative plasma B-type natriuretic peptide (BNP) identifies abnormal transthoracic echocardiography in elderly patients with traumatic hip fracture

Author: A. Boillot, R. Chopard, Guillaume Besch, Sebastien Pili-Floury, Alexandre Mebazaa, L. Saunier, M. Ginet, F. Bartholin, and E. Samain
Subjects: Male, medicine.medical_specialty, medicine.drug_class, Ventricular Dysfunction, Left, Predictive Value of Tests, Reference Values, Interquartile range, Internal medicine, medicine.artery, Natriuretic Peptide, Brain, Preoperative Care, medicine, Natriuretic peptide, Humans, Prospective Studies, Prospective cohort study, Aged, General Environmental Science, Aged, 80 and over, Hip fracture, Hip Fractures, business.industry, Brain natriuretic peptide, medicine.disease, Stenosis, ROC Curve, Echocardiography, Predictive value of tests, Pulmonary artery, Cardiology, General Earth and Planetary Sciences, Female, business, Biomarkers
Abstract: This prospective study was designed to evaluate whether preoperative plasma brain natriuretic peptide (BNP) could identify significant preoperative cardiovascular disease in elderly hip-fractured patients.Preoperative plasma BNP measurement and rest transthoracic echocardiography (TTE) were performed within 24 h after admission in consecutive hip-fractured patients aged ≥65 years. The major echocardiographic abnormality (MEA) group included patients with at least one TTE abnormality, defined as systolic pulmonary artery pressure (PAP(s)) ≥50 mmHg, left ventricular (LV) systolic dysfunction, increased LV filling pressure (LVFP) or severe valvular disease. The control group included the remaining patients.Seventy-five patients (mean±SD (range) age=85±5 (69-97) years) were included during a 6-month period. Twenty-four (32%) patients constituted the MEA group (17 elevated PAP(s), three LV systolic dysfunctions, 10 increased LVFP, one severe aortic stenosis and one severe mitral regurgitation). Median (interquartile) preoperative BNP value was significantly greater in MEA than in the control group (527 (361) vs. 119 (154) pg ml(-1); p0.0001). A preoperative plasma BNP cut-off value at 285 pg ml(-1) predicted well MEA with an area under the receiver operating characteristic (ROC) curve equal to 0.895 (p0.0001) and with a hazard ratio (HR) (confidence interval, CI) of 23.8 (3.7-142.9) (p=0.0008) on multivariate analysis. The presence of MEA or BNP≥285 pg ml(-1) was associated with high mortality.The incidence of echocardiographic signs of elevated PAP(s) or elevated LVFP in elderly hip-fractured patients was high. A preoperative BNP value ≥285 pg ml(-1) can discriminate between elderly hip-fractured patients with or without MEA.
Published: 2012

40. Early post-operative cognitive dysfunction after closed-loop versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elective major non-cardiac surgery

Author: Lucie Vettoretti, Nathalie Boichut, Melanie Claveau, Sebastien Pili-Floury, Emmanuel Samain, Yannis Bouhake, Guillaume Besch, Nicolas Mahr, T. Chazot, and Ngai Liu
Subjects: Male, Research design, education, consciousness monitor, MEDLINE, Remifentanil, Neuropsychological Tests, anesthesia, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Piperidines, Study Protocol Clinical Trial, 030202 anesthesiology, Anesthesia, Closed-Circuit, Humans, Medicine, Cognitive Dysfunction, Single-Blind Method, Propofol, Aged, Aged, 80 and over, business.industry, Incidence (epidemiology), anesthesia, general, Neuropsychology, General Medicine, Middle Aged, anesthesia, intravenous, monitor, bispectral index, Elective Surgical Procedures, Research Design, Bispectral index, Anesthesia, Anesthetic, (MeSH terms) cognitive dysfunction, Female, business, Anesthetics, Intravenous, 030217 neurology & neurosurgery, Research Article, medicine.drug
Abstract: Introduction: Post-operative cognitive dysfunction (POCD) is frequent in patients older than 60 years undergoing major non-cardiac surgery, and increases both morbidity and mortality. Anesthetic drugs may exert neurotoxic effects and contribute to the genesis of POCD. The hypothesis of the POCD-ELA trial was that closed-loop target-controlled infusion of propofol and remifentanil could reduce the occurrence of POCD by decreasing the risk of excessive depth of anesthesia and the dose of anesthetic drugs. Methods and analysis: We designed a single-center, single-blind, randomized, controlled, parallel trial and aim to include 204 patients aged >60 years undergoing elective major non-cardiac surgery. Patients will be randomized to receive closed-loop versus manual target-controlled infusion of propofol and remifentanil guided by bispectral index monitoring. Cognitive assessment will be performed the day before surgery (baseline) and within 72 hours after surgery, using a battery of validated neuropsychological tests. The primary outcome is the incidence of POCD within 72 hours after surgery. POCD is defined as a Z-score value > 1.96 for at least 2 different tests or a Z-score composite value >1.96. The calculation of the Z-score is based on data from an age-matched control population who did not undergo surgery or general anesthesia. Ethics and dissemination: This study was approved by the Ethics Committee (Comité de Protection des Personnes Est-II) and authorized by the French Health Products Agency (Agence Nationale de Sécurité des Médicaments, Saint-Denis, France). The University Hospital of Besancon is the trial sponsor and the holder of all data and publication rights. Results of the study will be submitted for publication in a peer-review international medical journal and for presentation in abstract (oral or poster) in international peer-reviewed congresses. Registration: The trial is registered with ClinicalTrials.gov (Identifier: NCT02841423, principal investigator: Prof Emmanuel Samain, date of registration: July 22, 2016). Last amendment of protocol: version 8.0 April 2018.
Published: 2018

41. Abdominal compartment syndrome and ruptured aortic aneurysm

Author: Lucie Salomon du Mont, Simon Rinckenbach, Anne-Laure Parmentier, Betty Leclerc, and Guillaume Besch
Subjects: medicine.medical_specialty, Abdominal compartment syndrome, business.industry, Decompression, medicine.medical_treatment, Organ dysfunction, General Medicine, Ruptured Aortic Aneurysm, 030204 cardiovascular system & hematology, 030230 surgery, medicine.disease, Surgery, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, Laparotomy, medicine, medicine.symptom, Prospective cohort study, business, Abdominal surgery
Abstract: Background The abdominal compartment syndrome (ACS) has been clearly identified as being one of the main causes of mortality after ruptured abdominal aortic aneurysm (rAAA). The ACS is defined as a sustained intra-abdominal pressure > 20 mm Hg associated with a new organ dysfunction or failure. A pilot study was conducted and found that the threshold of 3 among 8 selected criteria, we would predict an ACS occurrence with a 54% positive predictive value and a 92% negative predictive value. But a multicentric prospective study was clearly needed to confirm these results. The outcome of this new study is to assess the qualities of a predictive test on occurrence of the ACS after rAAA surgery. Methods This is a 30 months prospective cohort study conducted in 12 centers and 165 patients will be included. All patients with a rAAA will be consecutively included, whatever the surgical treatment. At the end of surgery, all patients have an abdominal closure and a monitoring of intrabladder pressure will be established every 3 to 4 hours. Decompressive laparotomy will be indicated when ACS occurs. Follow-up period is 1 month. Eight pre- and per-operative criteria will be studied: anemia, hypotension, cardiac arrest, obesity, massive fluid resuscitation, transfusion, hypothermia, and acidosis. Discussion In the literature, there is no recommendation about prophylactic decompression, but early decompressive laparotomy appears to improve survival. This study should make it possible to establish a predictive test, detect the ACS early, and consider a prophylactic decompression in the operating room. Trial registration ClinicalTrials.gov, NCT02859662, Registered on 4 August 2016.
Published: 2018

42. Ultrasound description of a superior laryngeal nerve space as an anatomical basis for echoguided regional anaesthesia

Author: E. Samain, Sebastien Pili-Floury, Y. Henry, Laurent Tatu, Guillaume Besch, G. Barberet, and Francis Berthier
Subjects: Adult, medicine.medical_specialty, Basis (linear algebra), business.industry, Ultrasound, Laryngeal Nerves, Regional anaesthesia, Middle Aged, Surgery, Superior laryngeal nerve, Anesthesiology and Pain Medicine, Anesthesia, Conduction, medicine, Humans, Ultrasonography, business, Aged
Published: 2012

43. Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia

Author: Gilles Capellier, Sebastien Pili-Floury, Guillaume Besch, Hadrien Winiszewski, and Gaël Piton
Subjects: Chest Pain, medicine.medical_specialty, 030204 cardiovascular system & hematology, Left sided, Preeclampsia, Young Adult, 03 medical and health sciences, Text mining, 0302 clinical medicine, Pre-Eclampsia, 030202 anesthesiology, Pregnancy, medicine, Humans, Ultrasonography, Aortic Aneurysm, Thoracic, business.industry, Type B aortic dissection, General Medicine, medicine.disease, Abdominal Pain, Surgery, Aortic Dissection, Treatment Outcome, Anesthesiology and Pain Medicine, 030228 respiratory system, Female, Radiology, business, 030217 neurology & neurosurgery
Published: 2017

44. Impact du contrôle glycémique sur la mortalité et la morbidité cardiovasculaire après implantation valvulaire aortique percutanée (TAVI)

Author: Sebastien Pili-Floury, Guillaume Besch, Caroline Morel, Guillaume Flicoteaux, Romain Chopard, Emmanuel Samain, and Andrea Perrotti
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction L’implantation valvulaire aortique percutanee (TAVI) est devenue le traitement de choix du retrecissement aortique des patients a haut risque et/ou contre-indiques a la chirurgie conventionnelle. L’hyperglycemie, l’hypoglycemie et la variabilite glycemique postoperatoires augmentent la morbidite et la mortalite apres chirurgie cardiaque. L’objectif de cette etude est d’evaluer pour la premiere fois l’impact de la qualite du controle glycemique perioperatoire sur le pronostic des patients beneficiant d’une TAVI. Materiel et methodes Analyse retrospective des donnees des patients du CHRU de Besancon inclus dans les registres FRANCE1 et FRANCE2 entre 2009 et 2012. FRANCE1 et FRANCE2 sont 2 cohortes prospectives observationnelles multicentriques francaises evaluant la survie des patients beneficiant de TAVI. Les patients ont ete repartis en 2 groupes selon qu’ils presentaient (groupe M) ou non (groupe C) avant le 30 e jour (j30) postoperatoire l’un des evenements suivant : deces, accident vasculaire cerebral (AVC), syndrome coronarien aigu (SCA), insuffisance cardiaque aigue, trouble du rythme ou de la conduction cardiaque grave. L’ensemble des valeurs de glycemie (G) capillaire mesurees au cours des 48 heures suivant le debut de la TAVI ont ete recueillies. Le critere de jugement principal etait le coefficient de variation glycemique (CV GLY ), defini par le rapport de l’ecart-type (ET GLY ) a la moyenne (M GLY ) des G mesurees (CV GLY = ET GLY × 100/M GLY ). Les criteres de jugement secondaires etaient la M GLY , et la frequence des hyperglycemies (G > 1,5 g/L) et des hypoglycemies moderees (G p Resultats Les donnees de 57 patients dans le groupe M et de 107 patients dans le groupe C ont ete analysees. Dans le groupe M, 16 (28) deces, 9 (16) AVC, 6 (10) SCA, 12 (21) insuffisances cardiaques aigues, et 14 (25) troubles du rythme ou de la conduction cardiaque grave ont ete observes a j30. Le nombre moyen de G mesurees etait de 17 ± 5 dans le groupe M et de 15 ± 5 dans le groupe C ( p = 0,01). Le CV GLY etait significativement plus faible dans le groupe M (CV GLY : 14,1 ± 3,0 vs 15,6 ± 4,2 %, p = 0,13 ; respectivement dans les groupes M vs C). La comparaison des donnees sociodemographiques et des criteres de jugement secondaires est presentee dans le Tableau 1 . Discussion Dans une cohorte monocentrique incluant 164 patients beneficiant d’une TAVI, la qualite du controle glycemique postoperatoire ne semble pas modifier la mortalite et la morbidite cardiovasculaire precoces.
Published: 2015

45. Occurrence of and risk factors for electroencephalogram burst suppression during propofol-remifentanil anaesthesia

Author: Mariette Mercier, Nathalie Boichut, E. Samain, C. Pericard, Ngai Liu, Guillaume Besch, S. Pili-Floury, T. Chazot, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)
Subjects: Male, MESH : Retrospective Studies, MESH : Piperidines, MESH : Aged, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, 0302 clinical medicine, Piperidines, MESH: Risk Factors, 030202 anesthesiology, Risk Factors, Odds Ratio, MESH : Female, General anaesthesia, Propofol, MESH: Aged, MESH: Middle Aged, MESH : Hemodynamics, MESH: Anesthesia, General, Age Factors, Electroencephalography, MESH : Adult, Middle Aged, MESH : Risk Factors, Anesthetics, Combined, 3. Good health, Burst suppression, MESH: Piperidines, MESH: Propofol, Anesthesia, Bispectral index, Female, MESH : Anesthetics, Combined, MESH: Anesthetics, Intravenous, Anesthetics, Intravenous, medicine.drug, MESH : Anesthetics, Intravenous, Adult, MESH: Hemodynamics, MESH : Male, MESH : Sex Factors, MESH: Monitoring, Intraoperative, Remifentanil, [SDV.CAN]Life Sciences [q-bio]/Cancer, Anesthesia, General, 03 medical and health sciences, Sex Factors, MESH: Sex Factors, Monitoring, Intraoperative, MESH: Electroencephalography, Post-hoc analysis, medicine, Humans, MESH : Middle Aged, MESH : Propofol, MESH : Electroencephalography, MESH : Anesthesia, General, Aged, Retrospective Studies, MESH: Age Factors, MESH: Humans, business.industry, MESH : Humans, Hemodynamics, MESH: Adult, MESH: Retrospective Studies, Odds ratio, MESH: Male, MESH: Odds Ratio, Confidence interval, Anesthesiology and Pain Medicine, MESH : Monitoring, Intraoperative, MESH : Odds Ratio, MESH : Age Factors, MESH: Anesthetics, Combined, business, MESH: Female, 030217 neurology & neurosurgery
Abstract: International audience; BACKGROUND: Suppression ratio (SR) derived from bispectral index (BIS) monitoring is correlated to EEG burst suppression. It may occur during deep anaesthesia, but also in the case of metabolic or haemodynamic brain injury. The goal of the study was to describe the occurrence of SR and to determine factors associated with SR during propofol-remifentanil general anaesthesia maintenance. METHODS: We conducted a post hoc analysis of BIS recordings in consecutive patients included in two multi-centre trials, undergoing non-cardiac surgery using a dual closed-loop BIS controller allowing automated propofol-remifentanil administration. The percentage of time spent with a BIS value between 40 and 60 (T(BIS 40-60)) was measured. Two groups of patients were defined: the SR group, including patients with at least one episode of SR value >10% lasting more than 1 min, and the control group. Factors associated with SR were analysed using a stepwise multivariate analysis. RESULTS: A total of 1494 patients [age=57 (17) yr; T(BIS 40-60)=76 (17%)] were analysed and 131 (8.7%) patients constituted the SR group. The main independent factors associated with SR were advanced age [odds ratio (95% confidence interval)=4.80 (1.85-12.43) (P=0.027), 10.59 (3.76-29.81) (P80 yr, respectively], history of coronary artery disease (CAD) [2.53 (1.47-4.37) (P=0.001)] and male gender [1.57 (1.03-2.40) (P=0.03)]. CONCLUSIONS: The occurrence of SR during BIS-controlled propofol and remifentanil anaesthesia is mainly observed in elderly male patients or in patients with a history of CAD. The mechanisms underlying SR and the potential consequences for the patient's postoperative outcome remain unsolved.
Published: 2011

46. Évaluation échographique du recrutement induit par l’Optiflow™ versus VNI après chirurgie cardiaque (étude AÉRATION)

Author: Sebastien Pili-Floury, E. Samain, Guillaume Besch, Benoit Barrucand, Y. Barrande, David Ferreira, and F. Stéphan
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Introduction La periode postoperatoire de chirurgie cardio-thoracique est a risque d’insuffisance respiratoire aigue (IRA) notamment par la constitution d’atelectasies. En cas d’IRA, un support ventilatoire par ventilation non invasive (VNI) peut etre instaure afin de permettre un recrutement alveolaire. L’oxygenotherapie nasale a haut debit par Optiflow™ est une alternative proposee. Son impact en termes de recrutement est discute. L’objectif de l’etude AERATION est de comparer l’effet de recrutement de l’Optiflow™ versus la VNI en cas d’IRA apres chirurgie cardio-thoracique. Materiel et methodes Etude prospective, observationnelle, monocentrique, ancillaire de l’essai therapeutique OPTIFLOW ( www.clinicaltrials.gov NCT01458444 ), menee aux soins intensifs de chirurgie cardio-thoracique entre le 1er mai et le 31 juillet 2013 apres accord du CPP II Est. Tous les patients presentant les criteres habituels d’IRA ou 1 facteur de risque d’IRA (IMC > 30 kg/m2, FEVG [1] . Le critere de jugement principal etait la valeur du score de reareation pulmonaire, defini par la moyenne des scores de chaque quadrant [1] . Le critere de jugement secondaire etait le rapport PaO2/FiO2 apres 1 h (P/FH1) de VNI ou d’Optiflow™. Les donnees sont presentees en m±DS et nombre de patients (%) respectivement pour les variables quantitatives et qualitatives. Le seuil de significativite est p Resultats Douze patients dans le groupe O et 8 patients dans le groupe V ont ete inclus de maniere consecutive (âge : 70 ± 11 vs 68 ± 10 ans, sexe masculin : 5 (50) vs 5 (62), IMC : 30 ± 3 vs 33 ± 6 kg/m2, IGS2 : 19 ± 7 vs 23 ± 4, PaO2/FiO2 = 217 ± 74 vs 273 ± 75, 11 ± 1 vs 11 ± 1 quadrants explores, respectivement dans les groupes O et V). Le score de reaeration pulmonaire n’etait pas statistiquement different (3,6 ± 3,2 vs 1,4 ± 3,4, respectivement dans les groupes V et O, p = 0,20). Le P/FH1 etait significativement plus eleve dans le groupe V (P/FH1 = 316 ± 73 vs 201 ± 54, p Fig. 1 represente la frequence du gain d’aeration par quadrant et par groupe. Discussion Sous reserve d’un petit effectif, le gain d’aeration du parenchyme pulmonaire semble plus faible apres 1 h Optiflow™ qu’apres 1 h de VNI.
Published: 2014

47. Propofol-Rémifentanil pour l’anesthésie de la triple endoscopie des voies aériennes supérieures en ventilation spontanée : résultats de l’essai randomisé ENDOTANIL

Author: E. Monnet, L. Tavernier, E. Samain, Sebastien Pili-Floury, Amelie Jurine, A. Chopard-Guillemin, A. Causeret, and Guillaume Besch
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Introduction En l’absence d’intubation tracheale (IT), l’administration intraveineuse a objectif de concentration (AIVOC) de propofol (P) reste le gold standard pour l’anesthesie generale en ventilation spontanee (AG-VS) pour la triple endoscopie des voies aeriennes superieures (TE-VAS). Une interaction synergique entre P et remifentanil (R) ameliorant les conditions de la laryngoscopie pour IT est decrite. L’objectif de l’etude ENDOTANIL est d’evaluer l’impact de l’association de P et de R sur les conditions de realisation de la TE-VAS en AG-VS. Materiel et methodes Essai randomise controle en double insu contre placebo (ClinicalTrials.gov : NCT02093143 ), mene entre juin 2009 et fevrier 2013 apres accord du CPP II Est. Tous les patients admis pour une TE-VAS elective etaient eligibles. Apres consentement eclaire, les patients ont ete repartis en 2 groupes par le tirage au sort : le groupe R beneficiant d’une AG-VS par P + R en AIVOC, et le groupe P d’une AG-VS par P + Placebo. Les conditions de realisation de la TE-VAS etaient evaluees par 5 criteres [1] : facilite de la laryngoscopie, position et mouvements des cordes vocales, mouvements des membres et/ou toux a la stimulation. Le critere de jugement principal etait PPCA la proportion de patients presentant des conditions « cliniquement acceptables », definies par l’absence de critere « mauvais ». Les criteres de jugement secondaires etaient la tolerance hemodynamique (FC maximale et minimale, PAM maximale et minimale) et respiratoire (hypoxie moderee [SpO 2 2 p Resultats 105 patients dans le groupe P et 113 patients dans le groupe R ont ete inclus (âge : 60 ± 10 vs. 60 ± 9 ans ; sexe masculin : 89 (84) vs. 91 (81) patients ; score ASA > 2 : 28 (26) vs. 25 (22) patients, respectivement dans les groupes P et R). La valeur de PPCA ne differait pas significativement entre les groupes P (67 (64) patients) et R (77 (68) patients) ( p = 0,39), quel que soit le critere considere ( Fig. 1 ). La tolerance hemodynamique (FC maximale : 91 ± 19 vs. 90 ± 16 bpm ( p = 0,46) ; FC minimale : 79 ± 15 vs. 76 ± 13 bpm ( p = 0,21) ; PAM maximale : 110 ± 21 vs. 105 ± 21 mmHg ( p = 0,06) ; PAM minimale : 89 ± 17 vs. 82 ± 16 mmHg ( p = 0,003), respectivement dans les groupes P et R) et respiratoire (SpO 2 p = 0,44) ; SpO 2 p = 0,87), respectivement pour les groupes P et R) etait comparable entre les 2 groupes. L’ethylisme chronique (risque relatif [intervalle de confiance 95 %] = 0,47 [0,24–0,92], p = 0,03) et la valeur du BIS lors de la laryngoscopie (1,024 [1,002–1,046], p = 0,03) etaient associes a de mauvaises conditions de realisation de la TE-VAS en analyse multivariee. Discussion L’association de P et R ne permet pas d’ameliorer les conditions de realisation de la TE-VAS sous AG-VS.
Published: 2014

48. Comparaison de 2 méthodes de débriefing après simulation sur le score de compétence technique : étude DEBRIEF-SIM

Author: Guillaume Besch, Sebastien Pili-Floury, M. Benkhadra, E. Samain, Y. Gavand, J.-A. Rouge, and Floriane Ciceron
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Introduction L’utilisation de la simulation, outil pedagogique indispensable en formation medicale ou paramedicale [1] , reste compliquee car tres consommatrice de temps d’enseignant et d’argent, notamment lors du debriefing [2] . Le debriefing d’une seance de simulation est habituellement realise par un instructeur de maniere individuelle pour chaque candidat. Pour economiser du temps, il pourrait etre remplace par un debriefing collectif, dont la qualite pedagogique est mal documentee. Cette etude a pour objectif de comparer un debriefing collectif a un debriefing individuel apres la simulation de la gestion en binome d’une situation d’urgence vitale. Materiel et methodes Apres accord institutionel, cette etude prospective, bicentrique, randomisee, en intention de traiter, a inclus 48 binomes constitues d’un DES d’anesthesie-reanimation (DESAR) et d’un eleve infirmier anesthesiste (EIADE) de 2 CHRU. Chaque binome a ete evalue a 6 semaines d’intervalle, sur la simulation d’un arret cardiaque chez une femme enceinte (SimMom, Laerdal ® ; Noelle, Gomard ® ). Le groupe I beneficiait d’un debriefing individuel apres la premiere seance (visionnage de l’enregistrement video en presence des instructeurs), le groupe C d’un debriefing collectif (presentations multimedia sur les criteres techniques et non techniques en presence simultanee de 6 binomes). Un score de competence technique (ST-34) (34 parametres, 45 points) etait mesure en temps reel et en aveugle, par deux evaluateurs independants. Les participants ont evalue qualitativement chaque type de debriefing (questionnaire). Les resultats sont en m ± DS [IC 95 %]. La non-inferiorite du debriefing collectif (groupe C) par rapport au debriefing individuel (groupe I) etait etablie si la limite inferieure de l’intervalle de confiance de la difference entre la progression entre les 2 groupes etait superieure a –5. Un p Resultats Vingt et un binomes dans le groupe I et 23 dans le groupe C ont ete analyses. Les deux groupes sont comparables en termes de cursus d’etude des DESAR et EIADE. La progression du ST 34 dans les groupes I et C etait respectivement de 2,1 ± 3,8 [0,5–3,7] ( p p Fig. 1 ). La difference entre la progression des 2 groupes etait 2,71 [0,44–4,98], superieur au seuil de significativite retenu. Le debriefing individuel etait considere plus satisfaisant (DESAR : 91 % vs 2 % EIADE : 96 % vs 4 %) et plus stressant (DESAR : 75 % vs 25 %; EIADE : 25 % vs 75 %) que le debriefing collectif. Le temps passe au debriefing pour 6 binomes etait respectivement de 162 ± 24 min pour le debriefing individuel et de 62 ± 3 min pour le debriefing collectif. Discussion L’amelioration des competences techniques par l’intermediaire de la simulation, n’est pas moins efficace avec un debriefing collectif qu’avec un debriefing individuel, mais est beaucoup plus rapide, ce qui pourrait etre une source d’economie de moyen tres important. Ce dernier reste cependant le debriefing prefere des participants bien qu’il soit considere plus stressant.
Published: 2014

49. Bloc pectoral échoguidé et douleur chronique postopératoire après chirurgie carcinologique du sein : analyse ajustée sur un score de propension d’une cohorte observationnelle

Author: Emmanuel Samain, Sebastien Pili-Floury, Caroline Lagrave, Guillaume Besch, Guislaine Poupon, Valentine De Larminat, Pierre-Antoine Doutre, Caroline Meyer, and Claudia Lejuste
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction La chirurgie carcinologique du sein est a risque de douleur chronique postoperatoire (DCPO). L’effet benefique du recours a l’anesthesie loco-regionale reste debattu. Le bloc pectoral PECSII associe l’injection d’un anesthesique local entre le grand et le petit pectoral (bloc interpectoral PECSI), et sous le muscle serratus anterieur. Le PECSII ameliore la qualite de l’analgesie et reduit la consommation de morphine apres mastectomie radicale [1] . L’objectif de cette etude est d’evaluer l’impact du PECSII sur l’incidence de la DCPO apres chirurgie carcinologique du sein. Patientes et methodes Etude retrospective incluant toutes les patientes admises au centre hospitalier de Belfort entre novembre 2013 et novembre 2014 pour une chirurgie carcinologique du sein. Les patientes ont ete reparties en 2 groupes : le groupe P, incluant les patientes ayant beneficie d’un PECSII echoguide avec 3 mg/kg de ropivacaine, et le groupe C. Le critere de jugement principal etait l’incidence de la DCPO a 6 mois, evaluee de maniere prospective en utilisant le Questionnaire Douleur Saint-Antoine lors d’un entretien telephonique. Les donnees des patientes ayant exprime leur refus de repondre n’ont pas ete analysees. Les criteres de jugement secondaires etaient la consommation de morphine postoperatoire et l’incidence des nausees-vomissements postoperatoires (NVPO). Une analyse multivariee par regression logistique ajustee sur un score de propension a ete effectuee pour identifier les facteurs associes a la DCPO. Les resultats sont presentes en moyenne ± ecart-type et en nombre (pourcentage). Le seuil de significativite est p Resultats Les donnees de 66 patientes dans le groupe PECSII et de 107 patientes dans le groupe C ont ete analysees (âge : 62 ± 13 vs 65 ± 4 ans, p = 0,15 ; score ASA > 2 : 7 [15] vs 14 [13], p = 0,81 ; obesite : 21 [32] vs 20 [19], p = 0,04 ; douleur preoperatoire : 2 [3] vs 4 [4], p = 1,00 ; respectivement dans les groupes PECSII vs C). Vingt-sept (41) patientes dans le groupe PECSII et 42 (39) patientes dans le groupe C presentaient une DCPO a 6 mois ( p = 0,83). La dose moyenne postoperatoire de morphine n’etaient pas significativement diminuee dans le groupe PECSII (0,6 ± 0,2 vs 0,7 ± 0,3 mg/kg, p = 0,68 ; respectivement dans les groupes PECSII vs C). Dix (15) patientes dans le groupe PECSII et 6 (6) patientes dans le groupe C ont presente des NVPO ( p = 0,06). En analyse multivariee ajustee sur un score de propension, la realisation du PECSII n’etait pas associee a une reduction de l’incidence de la DCPO. Discussion Dans une cohorte monocentrique incluant 173 patientes, la realisation d’un bloc pectoral PECSII echoguide ne permettait pas de reduire l’incidence de la DCPO a 6 mois d’une chirurgie carcinologique du sein.
Published: 2015

50. Évaluation du stress généré par un exercice de simulation in situ

Author: Valérie Riccardetti de Grivel, Sébastien Pili Floury, Gilles Blasco, Guillaume Besch, Olivier Vincent, Emmanuel Samain, and Yannick Brunin
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction La simulation est recommandee dans le maintien des competences des professionnels de sante [1] . La simulation in situ (SIS) permet d’evaluer le comportement des professionnels dans leur environnement reel (utilisation des procedures et des ressources materielles locales) mais pourrait exposer les apprenants a un stress important qui reste mal evalue. Les objectifs de ce travail etaient d’evaluer le stress ressenti par les professionnels au decours d’une seance de simulation in situ et de rechercher des facteurs predictifs d’un stress important. Materiel et methodes Etude prospective observationnelle monocentrique ancillaire d’un audit clinique visant a evaluer la prise en charge de l’ACR intra-hospitalier dans notre institution, a l’aide de la SIS. Onze services (3 medicaux, 3 chirurgicaux et 5 soins intensifs) ont ete designes par tirage au sort par la commission EPP de l’institution pour participer a l’etude. Le jour de l’evaluation, un mannequin de simulation de haute-fidelite (SimKelly, Laerdal™, Norvege) et un moyen d’enregistrement video etaient disposes dans une chambre du service evalue. Les etapes de l’intervention incluait : recueil de la non opposition du personnel ; presentation des caracteristiques du mannequin ; scenario debute de maniere aleatoire ; debriefing. Le scenario etait le suivant : declenchement de l’appel malade pour douleur thoracique aigue, ACR sur FV a l’arrivee du personnel dans la chambre, fin de la simulation apres 8 minutes ou administration de 2 CEE. A l’issu du debriefing, une echelle validee d’autoevaluation du stress (echelle PDI pour Peri Traumatic Distress) [2] etait renseignee par les participants. Les donnees demographiques et l’experience prealable de la simulation ou de la reanimation d’un ACR etaient recueillies. Les caracteristiques des professionnels presentant un score de stress important (definis par un PDI > 14) ont ete comparees aux caracteristiques de ceux avec un PDI ≤ 14 en analyse univariee (tests non parametriques, p Resultats Durant les 11 seances de SIS, 60 personnels de sante ont participe aux seances de SIS et 46 personnes ont complete les questionnaires. Le PDI moyen ± ecart-type etait de 15 ± 2. Vingt-neuf professionnels ont constitue le groupe stresse et avaient un PDI > 14. Les resultats de l’analyse univariee sont donnees dans le Tableau 1 . Discussion Ce travail suggere qu’un pourcentage important de professionnels de sante soumis a une SIS ressent un stress important independamment de l’experience prealable ou de l’exposition a la simulation. Les consequences a plus long terme meritent d’etre evaluees.
Published: 2015

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