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1. Human metapneumovirus infection is associated with a substantial morbidity and mortality burden in adult inpatients

Author

Quentin Philippot, Blandine Rammaert, Gaëlle Dauriat, Cédric Daubin, Frédéric Schlemmer, Adrien Costantini, Yacine Tandjaoui-Lambiotte, Mathilde Neuville, Emmanuelle Desrochettes, Alexis Ferré, Laetitia Bodet Contentin, François-Xavier Lescure, Bruno Megarbane, Antoine Belle, Jean Dellamonica, Sylvain Jaffuel, Jean-Luc Meynard, Jonathan Messika, Nicolas Lau, Nicolas Terzi, Isabelle Runge, Olivier Sanchez, Benjamin Zuber, Emmanuel Guerot, Anahita Rouze, Patricia Pavese, François Bénézit, Jean-Pierre Quenot, Xavier Souloy, Anne Lyse Fanton, David Boutoille, Vincent Bunel, Astrid Vabret, Jacques Gaillat, Anne Bergeron, Nathanaël Lapidus, Muriel Fartoukh, and Guillaume Voiriot

Subjects
Human metapneumovirus, Pneumonia, Viral pneumonia, Respiratory viruses, Science (General), Q1-390, Social sciences (General), H1-99
Abstract

Background: Human metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients. Methods: Consecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used. Results: Between March 2018 and May 2019, 208 patients were included. The median age was 74 [62–84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2–7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course. Conclusion: hMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.

Published
2024
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2. Severe infections requiring intensive care unit admission in patients receiving ibrutinib for hematological malignancies: a groupe de recherche respiratoire en réanimation onco-hématologique (GRRR-OH) study

Author

Louise Baucher, Virginie Lemiale, Adrien Joseph, Florent Wallet, Marc Pineton de Chambrun, Alexis Ferré, Romain Lombardi, Laura Platon, Adrien Contejean, Charline Fuseau, Laure Calvet, Frédéric Pène, Achille Kouatchet, Djamel Mokart, Elie Azoulay, and Antoine Lafarge

Subjects
Ibrutinib, Opportunistic infections, Intensive care, Lymphoproliferative disease, Targeted drugs, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background In the last decade, Ibrutinib has become the standard of care in the treatment of several lymphoproliferative diseases such as chronic lymphocytic leukemia (CLL) and several non-Hodgkin lymphoma. Beyond Bruton tyrosine kinase inhibition, Ibrutinib shows broad immunomodulatory effects that may promote the occurrence of infectious complications, including opportunistic infections. The infectious burden has been shown to vary by disease status, neutropenia, and prior therapy but data focusing on severe infections requiring intensive care unit (ICU) admission remain scarce. We sought to investigate features and outcomes of severe infections in a multicenter cohort of 69 patients receiving ibrutinib admitted to 10 French intensive care units (ICU) from 1 January 2015 to 31 December 2020. Results Median time from ibrutinib initiation was 6.6 [3–18] months. Invasive fungal infections (IFI) accounted for 19% (n = 13/69) of severe infections, including 9 (69%; n = 9/13) invasive aspergillosis, 3 (23%; n = 3/13) Pneumocystis pneumonia, and 1 (8%; n = 1/13) cryptococcosis. Most common organ injury was acute respiratory failure (ARF) (71%; n = 49/69) and 41% (n = 28/69) of patients required mechanical ventilation. Twenty (29%; n = 20/69) patients died in the ICU while day-90 mortality reached 55% (n = 35/64). In comparison with survivors, decedents displayed more severe organ dysfunctions (SOFA 7 [5–11] vs. 4 [3–7], p = 0.004) and were more likely to undergo mechanical ventilation (68% vs. 31%, p = 0.010). Sixty-three ibrutinib-treated patients were matched based on age and underlying malignancy with 63 controls receiving conventional chemotherapy from an historic cohort. Despite a higher median number of prior chemotherapy lines (2 [1–2] vs. 0 [0–2]; p

Published
2023
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3. Association between the Cardiac Arrest Hospital Prognosis (CAHP) score and reason for death after successfully resuscitated cardiac arrest

Author

Marine Paul, Stéphane Legriel, Sarah Benghanem, Sofia Abbad, Alexis Ferré, Guillaume Lacave, Olivier Richard, Florence Dumas, and Alain Cariou

Subjects
Medicine, Science
Abstract

Abstract Individualize treatment after cardiac arrest could potentiate future clinical trials selecting patients most likely to benefit from interventions. We assessed the Cardiac Arrest Hospital Prognosis (CAHP) score for predicting reason for death to improve patient selection. Consecutive patients in two cardiac arrest databases were studied between 2007 and 2017. Reasons for death were categorised as refractory post-resuscitation shock (RPRS), hypoxic-ischaemic brain injury (HIBI) and other. We computed the CAHP score, which relies on age, location at OHCA, initial cardiac rhythm, no-flow and low-flow times, arterial pH, and epinephrine dose. We performed survival analyses using the Kaplan–Meier failure function and competing-risks regression. Of 1543 included patients, 987 (64%) died in the ICU, 447 (45%) from HIBI, 291 (30%) from RPRS, and 247 (25%) from other reasons. The proportion of deaths from RPRS increased with CAHP score deciles; the sub-hazard ratio for the tenth decile was 30.8 (9.8–96.5; p

Published
2023
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4. Impact of corticosteroids on the duration of ventilatory support during severe acute exacerbations of chronic obstructive pulmonary disease in patients in the intensive care unit: a study protocol for a multicentre, randomized, placebo-controlled, double-blind trial

Author

Alexis Ferré, Arnaud W. Thille, Armand Mekontso-Dessap, Thomas Similowski, Stéphane Legriel, Philippe Aegerter, Alexandre Demoule, and The Réseau Européen de Recherche en Ventilation Artificielle (REVA) research network

Subjects
Corticosteroids, Exacerbation, COPD, Mechanical ventilation, Mortality, Medicine (General), R5-920
Abstract

Abstract Background Patients who are admitted to the intensive care unit (ICU) for severe acute exacerbations of chronic obstructive pulmonary disease (COPD) have poor outcomes. Although international clinical practice guidelines cautiously recommend the routine use of systemic corticosteroids for COPD exacerbations, data are scarce and inconclusive regarding their benefit for most severe patients who require mechanical ventilation in the ICU. Furthermore, corticosteroids may be associated with an increased risk of infection, ICU-acquired limb weakness, and metabolic disorders. Methods and analysis This study is an investigator-initiated, multicentre, randomized, placebo-controlled, double-blind trial comparing systemic corticosteroids to placebo during severe acute exacerbations of COPD in patients who require mechanical ventilation in French ICUs. A total of 440 patients will be randomized 1:1 to methylprednisolone (1 mg/kg) or placebo for 5 days, and stratified according to initial mechanical ventilation (non-invasive or invasive), pneumonia as triggering factor, and recent use of systemic corticosteroids (

Published
2023
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5. Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Author

Simon Bourcier, Maxime Coutrot, Alexis Ferré, Nicolas Van Grunderbeeck, Julien Charpentier, Sami Hraiech, Elie Azoulay, Saad Nseir, Nadia Aissaoui, Jonathan Messika, Pierre Fillatre, Romain Persichini, Serge Carreira, Alexandre Lautrette, Clément Delmas, Nicolas Terzi, Bruno Mégarbane, Jean-Baptiste Lascarrou, Keyvan Razazi, Xavier Repessé, Claire Pichereau, Damien Contou, Aurélien Frérou, François Barbier, Stephan Ehrmann, Etienne de Montmollin, Benjamin Sztrymf, Elise Morawiec, Naïke Bigé, Danielle Reuter, David Schnell, Olivier Ellrodt, Jean Dellamonica, Alain Combes, and Matthieu Schmidt

Subjects
Hypothyroidism, Myxedema, Coma, Cardiogenic shock, Critical care, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients. Methods We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure. Results Eighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75–24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47–84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27–18.6)] as being independently associated with in-ICU mortality. Conclusions SH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.

Published
2023
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6. Natraemia variations induced by acute dialysis in critically ill patients: a database study

Author

Gilles Troché, Virginie Laurent, Alexis Ferré, Gwenaelle Jacq, Marine Paul, Sybille Merceron, and Stephane Legriel

Subjects
Medicine, Science
Abstract

Abstract Natraemia is often abnormal in critically ill patients and may change rapidly during renal replacement therapy (RRT). This database study in a single intensive care unit (ICU) evaluated natraemia before and after the first RRT session for acute kidney injury. Of 252 patients who required RRT in 2018–2020, 215 were included. Prevalences were 53.9% for hyponatraemia (≤ 135 mmol/L) and 3.7% for hypernatraemia (> 145 mmol/L). Dialysate sodium was ≥ 145 mmol/L in 83% of patients. Median dialysis sodium gradient was 12 mmol/L, with a value above 16 mmol/L in 25% of patients. Median natraemia increased from 135 before to 140 mmol/L after RRT, the median hourly increase being faster than recommended, at 1.0 mmol/L [0.2–1.7]. By multivariate analysis, the only variable significantly associated with the RRT-induced natraemia change was the dialysis sodium gradient [odds ratio, 1.66; 95% confidence interval 1.39–2.10]. Pearson’s correlation coefficient between the gradient and the natraemia change was 0.57. When performing RRT in ICU patients, in addition to the haemodynamic considerations put forward in recommendations, the dialysis sodium gradient deserves careful attention in order to control natraemia variations. Studies to devise a formula for predicting natraemia variations might prove helpful to confirm our results.

Published
2022
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7. Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Author

Alexis Ferré, Fabien Marquion, Marc Delord, Antoine Gros, Guillaume Lacave, Virginie Laurent, Sybille Merceron, Marine Paul, Christelle Simon, Gilles Troché, Clément Charbonnel, Stéphanie Marque-Juillet, Fabrice Bruneel, Stéphane Legriel, and the RESPI-COVID19 Study Group

Subjects
COVID-19, ICU, Ventilator, Mortality, Outcomes, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. Results We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P

Published
2022
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8. Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort.

Author

Louis Marie Galerneau, Sébastien Bailly, Nicolas Terzi, Stéphane Ruckly, Maïté Garrouste-Orgeas, Yves Cohen, Vivien Hong Tuan Ha, Marc Gainnier, Shidasp Siami, Claire Dupuis, Michael Darmon, Elie Azoulay, Jean-Marie Forel, Florian Sigaud, Christophe Adrie, Dany Goldgran-Toledano, Alexis Ferré, Etienne de Montmollin, Laurent Argaud, Jean Reignier, Jean-Louis Pepin, Jean-François Timsit, and OUTCOMEREA network

Subjects
Medicine, Science
Abstract

IntroductionAcute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission.MethodsIn the OutcomeReaTM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting.ResultsBetween January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders.ConclusionUsing systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.

Published
2023
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9. Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Author

Nicolas Massart, Virginie Maxime, Pierre Fillatre, Keyvan Razazi, Alexis Ferré, Pierre Moine, Francois Legay, Guillaume Voiriot, Marlene Amara, Francesca Santi, Saad Nseir, Stephanie Marque-Juillet, Rania Bounab, Nicolas Barbarot, Fabrice Bruneel, Charles-Edouard Luyt, and the COVID ICU Bacteremia Study Group on behalf of the COVID-ICU Investigators

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients. Patients and methods We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching. Results Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05–1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population. Conclusion COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.

Published
2021
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10. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study

Author

Nicolas Massart, Virginie Maxime, Pierre Fillatre, Keyvan Razazi, Alexis Ferré, Pierre Moine, Francois Legay, Guillaume Voiriot, Marlene Amara, Francesca Santi, Saad Nseir, Stephanie Marque-Juillet, Rania Bounab, Nicolas Barbarot, Fabrice Bruneel, Charles-Edouard Luyt, and the COVID ICU Bacteremia Study Group on behalf of the COVID-ICU Investigators

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published
2022
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11. Postextubation Stridor in Severe COVID-19

Author

Georges Abi, Abdallah, Alexis, Ferré, Antoine, Gros, Christelle, Simon, Fabrice, Bruneel, Stéphanie, Marque-Juillet, Stéphane, Legriel, and Marine, Paul

Subjects
Male, Pulmonary and Respiratory Medicine, SARS-CoV-2, COVID-19, General Medicine, Critical Care and Intensive Care Medicine, Respiration, Artificial, Severity of Illness Index, Risk Factors, Intubation, Intratracheal, Humans, Female, Respiratory Sounds, Retrospective Studies
Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, 60-80% of patients admitted to ICU require mechanical ventilation for respiratory distress. We aimed to compare the frequency of postextubation stridor (PES) and to explore risk factors in COVID-19 subjects compared to those without COVID-19.We performed an observational retrospective study on subjects admitted for severe COVID-19 requiring mechanical ventilation48 h during the first and second waves in 2020 and compared these subjects to historical controls without COVID-19 who received mechanical ventilation48 h between 2016-2019. The primary outcome was the frequency of PES, defined as audible stridor within 2 h following extubation.Of the 134 subjects admitted with severe COVID-19 requiring mechanical ventilation, 96 were extubated and included and compared to 211 controls. The frequency of PES was 22.9% in the COVID-19 subjects and 3.8% in the controlsPES affected nearly one-quarter of subjects with COVID-19, a proportion significantly higher than that seen in controls. Independent risk factors for PES were COVID-19, female sex, and tube mobilization or re-intubation or prone positioning. PES was associated with persistent viral shedding at the time of extubation.

Published
2022

12. Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: multicenter observational study across 149 European intensive care units

Author

Marc Garnier, Jean-Michel Constantin, Nicholas Heming, Laurent Camous, Alexis Ferré, Keyvan Razazi, and Nathanaël Lapidus

Subjects
Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Abstract

COVID-19 patients requiring mechanical ventilation are particularly at risk of developing ventilator-associated pneumonia (VAP). Risk factors and the prognostic impact of developing VAP during critical COVID-19 have not been fully documented.Patients invasively ventilated for at least 48 h from the prospective multicentre COVID-ICU database were included in the analyses. Cause-specific Cox regression models were used to determine factors associated with the occurrence of VAP. Cox-regression multivariable models were used to determine VAP prognosis. Risk factors and the prognostic impact of early vs. late VAP, and Pseudomonas-related vs. non-Pseudomonas-related VAP were also determined.3388 patients were analysed (63 [55-70] years, 75.8% males). VAP occurred in 1523/3388 (45.5%) patients after 7 [5-9] days of ventilation. Identified bacteria were mainly Enterobacteriaceae followed by Staphylococcus aureus and Pseudomonas aeruginosa. VAP risk factors were male gender (Hazard Ratio (HR) 1.26, 95% Confidence Interval [1.09-1.46]), concomitant bacterial pneumonia at ICU admission (HR 1.36 [1.10-1.67]), PaOVAP affected almost half of mechanically ventilated COVID-19 patients. Several risk factors have been identified, among which modifiable risk factors deserve further investigation. VAP had a specific negative impact on 90-day mortality, particularly when it occurred between the end of the first week and the third week of ventilation.

Published
2022

13. Incidence of deep venous thrombosis in COVID-19 critically ill patients treated with intermediate-dose of heparin for thromboprophylaxis: The COVIDOP-DVT observational study

Author

Aurélien Maurizot, Simon Chabay, Guillaume Roger, Stéphanie Tapiero, Jean-Louis Georges, Claire Flaujac, Marine Paul, Anne Roche, Fabrice Bruneel, and Alexis Ferré

Subjects
Radiology, Nuclear Medicine and imaging, Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Introduction The high prevalence of deep vein thrombosis (DVT) in patients admitted to intensive care unit (ICU) for COVID-19-related acute respiratory distress syndrome (ARDS) would justify systematic screening of these patients or higher therapeutic dose of heparin for thromboprophylaxis. Material and method We performed a systematic echo-Doppler of the lower limb proximal veins during the first 48 h (visit 1) and from 7 to 9 days after visit 1 (visit 2) in consecutive patients admitted to the ICU of a university-affiliated tertiary hospital for severe proven COVID-19 during the second wave. All patients received intermediate-dose heparin (IDH). The primary objective was to determine DVT incidence on venous Doppler ultrasound. Secondary objectives were to determine whether the presence of DVT modifies the anticoagulation regimen, the incidence of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, and the mortality rate of patients with and without DVT. Results We included 48 patients (30 [62.5%] men) with a median age of 63 years [IQR, 54–70]. The prevalence of proximal deep vein thrombosis was 4.2% (2/48). In these two patients, after DVT diagnosis, anticoagulation was changed from intermediate to curative dose. Two patients (4.2%) had a major bleeding complication according to ISTH criteria. Among the 48 patients, 9 (18.8%) died before hospital discharge. No DVT or pulmonary embolism was diagnosed in these deceased patients during their hospital stay. Conclusion In critically ill patients with COVID-19, management with IDH results in a low incidence of DVT. Although our study is not designed to demonstrate any difference in outcome, our results do not suggest any signal of harm when using intermediate-dose heparin (IDH) COVID-19 with a frequency of major bleeding complications less than 5%.

Published
2023

14. Effect of high-flow nasal cannula oxygen versus standard oxygen on mortality in patients with acute hypoxaemic respiratory failure: protocol for a multicentre, randomised controlled trial (SOHO)

Author

Louis-Marie Galerneau, Christophe Guitton, Rémi Coudroy, Jean-Pierre Frat, Stephan Ehrmann, Gwenaël Prat, Damien Contou, Arnaud Gacouin, Jean-Pierre Quenot, Gwenhaël Colin, Stéphanie Ragot, Arnaud W Thille, Antoine Romen, Béatrice Lacombe, Jean Reignier, Agathe Delbove, Nicholas Sedillot, Alexandre Lautrette, Gonzalo Hernández, Alexandre Demoule, François Beloncle, Julio Badie, Jean Philippe Rigaud, Jean-Christophe Richard, Hamid Merdji, Cédric Daubin, Gaël Bourdin, Anne-Florence Dureau, Edouard Soum, Fabien Jarousseau, Guillaume Carteaux, Abdelhamid Fatah, Marie-Catherine Besse, Alexis Ferre, and Emanuele Turbil

Subjects
Medicine
Abstract

Introduction First-line oxygenation strategy in patients with acute hypoxaemic respiratory failure consists in standard oxygen or high-flow nasal oxygen therapy. Clinical practice guidelines suggest the use of high-flow nasal oxygen rather than standard oxygen. However, findings remain contradictory with a low level of certainty. We hypothesise that compared with standard oxygen, high-flow nasal oxygen may reduce mortality in patients with acute hypoxaemic respiratory failure.Method and analysis The Standard Oxygen versus High-flow nasal Oxygen-trial is an investigator-initiated, multicentre, open-label, randomised controlled trial comparing high-flow nasal oxygen versus standard oxygen in patients admitted to an intensive care unit (ICU) for acute respiratory failure with moderate-to-severe hypoxaemia. 1110 patients will be randomly assigned to one of the two groups with a ratio of 1:1. The primary outcome is the number of patients who died 28 days after randomisation. Secondary outcomes include comfort, dyspnoea and oxygenation 1 hour after treatment initiation, the number of patients intubated at day 28, mortality in ICU, in hospital and until day 90, and complications during ICU stay.Ethics and dissemination The study has been approved by the central Ethics Committee ‘Sud Méditerranée III’ (2020-07-05) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration number NCT04468126.

Published
2024
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15. Natraemia variations induced by acute dialysis in critically ill patients: a database study

Author

Gilles Troché, Virginie Laurent, Alexis Ferré, Gwenaelle Jacq, Marine Paul, Sybille Merceron, and Stephane Legriel

Subjects
Renal Replacement Therapy, Intensive Care Units, Multidisciplinary, Renal Dialysis, Critical Illness, Dialysis Solutions, Sodium, Humans, Acute Kidney Injury
Abstract

Natraemia is often abnormal in critically ill patients and may change rapidly during renal replacement therapy (RRT). This database study in a single intensive care unit (ICU) evaluated natraemia before and after the first RRT session for acute kidney injury. Of 252 patients who required RRT in 2018–2020, 215 were included. Prevalences were 53.9% for hyponatraemia (≤ 135 mmol/L) and 3.7% for hypernatraemia (> 145 mmol/L). Dialysate sodium was ≥ 145 mmol/L in 83% of patients. Median dialysis sodium gradient was 12 mmol/L, with a value above 16 mmol/L in 25% of patients. Median natraemia increased from 135 before to 140 mmol/L after RRT, the median hourly increase being faster than recommended, at 1.0 mmol/L [0.2–1.7]. By multivariate analysis, the only variable significantly associated with the RRT-induced natraemia change was the dialysis sodium gradient [odds ratio, 1.66; 95% confidence interval 1.39–2.10]. Pearson’s correlation coefficient between the gradient and the natraemia change was 0.57. When performing RRT in ICU patients, in addition to the haemodynamic considerations put forward in recommendations, the dialysis sodium gradient deserves careful attention in order to control natraemia variations. Studies to devise a formula for predicting natraemia variations might prove helpful to confirm our results.

Published
2021

16. Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Author

Alexis, Ferré, Fabien, Marquion, Marc, Delord, Antoine, Gros, Guillaume, Lacave, Virginie, Laurent, Sybille, Merceron, Marine, Paul, Christelle, Simon, Gilles, Troché, Clément, Charbonnel, Stéphanie, Marque-Juillet, Fabrice, Bruneel, Stéphane, Legriel, and Alexandre, Wormser

Subjects
RC86-88.9, ICU, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Outcomes, Mortality, Critical Care and Intensive Care Medicine, Ventilator
Abstract

Background To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. Results We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44). Conclusions In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.

Published
2021

17. Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema

Author

Max Guillot, Gilbert A. Mezière, Xavier Monnet, Daniel Lichtenstein, Alexis Ferré, Christian Richard, and Jean-Louis Teboul

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Pulmonary Edema, Critical Care and Intensive Care Medicine, Statistics, Nonparametric, Pulmonary oedema, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, medicine, Humans, Weaning, Prospective Studies, Lung, Aged, Ultrasonography, Mechanical ventilation, Receiver operating characteristic, business.industry, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Lung ultrasound, Intensive Care Units, 030228 respiratory system, Heart failure, Breathing, Female, France, Radiology, business, Ventilator Weaning
Abstract

Detecting weaning-induced pulmonary oedema (WIPO) is important because its treatment might prompt extubation. For this purpose, lung ultrasound might be an attractive tool, since it demonstrates pulmonary oedema through the appearance of B-lines. To test the ideal profile (increase in the number of B-lines) for diagnosing WIPO. Before and at the end of 62 spontaneous breathing trials (SBT) performed in 42 patients, we prospectively assessed lung ultrasound on four anterior chest wall points. B-lines were counted before and at the end of SBT. We looked for the threshold of B-line increase (Delta-B-lines) that provided the best diagnostic accuracy, compared to the reference diagnosis of WIPO established by experts blinded to lung ultrasound. SBT failed in 33 cases. WIPO occurred in 17 cases and all failed. The best diagnostic accuracy was reached with a Delta-B-lines ≥ 6. Among WIPO, the number of B-lines increased by ≥ 6 in 15 cases (including 13 cases with an increase of ≥ 8 B-lines). Among the 16 cases with SBT failure but without WIPO, the Delta-B-lines was ≥ 6 in two cases. Among the 33 cases with SBT failure, this profile diagnosed WIPO with a sensitivity of 88% (64–98) and a specificity of 88% (62–98) [area under the receiver operating characteristic curve 0.91 (0.75–0.98)]. Among the 29 cases with SBT success, a Delta-B-lines ≥ 6 occurred in two cases. This study suggests that a Delta-B-lines ≥ 6 on four anterior points allows the diagnosis of WIPO with the best accuracy. This should be confirmed in larger populations.

Published
2019

18. Can Biomarkers Correctly Predict Ventilator-associated Pneumonia in Patients Treated With Targeted Temperature Management After Cardiac Arrest? An Exploratory Study of the Multicenter Randomized Antibiotic (ANTHARTIC) Study

Author

Nicolas Deye, MD, PhD, Amelie Le Gouge, MSc, Bruno François, MD, Camille Chenevier-Gobeaux, MD, PhD, Thomas Daix, MD, Hamid Merdji, MD, PhD, Alain Cariou, MD, PhD, Pierre-François Dequin, MD, PhD, Christophe Guitton, MD, Bruno Mégarbane, MD, PhD, Jacques Callebert, PharmD, PhD, Bruno Giraudeau, PhD, Alexandre Mebazaa, MD, PhD, Nicolas Vodovar, PhD, for the Clinical Research in Intensive Care and Sepsis-TRIal Group for Global Evaluation and Research in SEPsis (TRIGGERSEP) Network and the ANtibiotherapy during Therapeutic HypothermiA to pRevenT Infectious Complications (ANTHARTIC) Study Group, Arnaud Desachy, Christophe Cracco, Laurence Robin, Marie Anne Fally, David Schnell, Olivier Baudin, Charles Lafon, Philippe Petua, Stéphane Rouleau, Cyrille Nowak, Gaétan Plantefeve, Hervé Mentec, Olivier Pajot, Damien Contou, Jo-Anna Tirolien, Constance Vuillard, Cécile Zylberfajn, Nadile Ali, Dieudonne Kilendo, Olivia Chauvel, Elias Karam, Pascal Chevallier, Dorothée Ducoux, Fabrice Raymond, Christophe Gellis, Jean-Pierre Quenot, Thérèse Devaux, Audrey Large, Sébastien Mortreux, Pierre-Emmanuel Charles, Sébastien Prin, Jean-Baptiste Roudaut, Pascal Andreu, Auguste Dargent, Nora Perrot, Audrey Massard, Solenne Villot, Corinne Pernot, Bruno Francois, Thomas Daix, Philippe Vignon, Nicolas Pichon, Celine Gonzalez, Nicolas Rodier, Jean François Mary, Ludmila Baudrillart, Christine Vallejo, Emmanuelle Begot, Claire Mancia, Michelle Nouaille, Cécile Duchiron, Sandrine Naturel, Marie-Anne De Vinzellles, Hélène Beacco, Thierry Boulain, Chantal Brossard, Armelle Mathonnet, Dalila Benzekri-Lefevre, Anne Bretagnol, Isabelle Runge, François Barbier, Grégoire Muller, Mai-Anh Nay, Julie Rossi, Lucie Muller, Sophie Tollec, Alain Cariou, Nathalie Marin, Camille Chenevier-Gobeaux, Michel Arnaout, Omar Ben Hadj Salem, Wulfran Bougouin, Simon Bourcier, Benoit Champigneulle, Matthieu Jamme, Alexis Ferre, Guillaume Geri, Frédéric Pene, Julien Charpentier, Jean-Daniel Chiche, Lucie Guillemet, Jean-Paul Mira, Marine Paul, Nicolas Deye, Bruno Megarbane, Alexandre Mebazaa, Isabelle Malissin, Sebastian Voicu, Nicolas Vodovar, Jacques Callebert, Claire Pernin, Lydia Suarez, Philippe Manivet, Dominique Vodovar, Anthony Checinski, Lamia Kerdjana, Pierre Garcon, Antoine Goury, Catherine Fauvaux, Salamata Agne, Nahima Gueblaoui, Aude Jacob, Loic Chimot, Catherine Huchet, Nadège Lacoste, Pierre-Henri Dessalles, Mélanie Saint-Leger, Yannick Monseau, Marie Heil, Ferhat Meziani, Hamid Merdji, DrKhoury, Samir Chenaf, Christine Kummerlen, Yannick Rabouel, Hayat Allam, Anne Hutt-Clauss, Alexandra Monnier, Pierre-François Dequin, Christine Mabilat, Emmanuelle Rouve, Charlotte Salmon-Gandonnière, Denis Garot, Youen Jouan, Stephan Ehrmann, Antoine Guillon, Laetitia Bodet–Contentin, Emmanuelle Mercier, Julie Mankikian, Stéphane Legriel, MrSébastien Cavelot, Christophe Guitton, Charlotte Garret, Cédric Bretonniere, Laurent Nicolat, Noëlle Brule, and Olivier Zambon

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

IMPORTANCE:. Ventilator-associated pneumonia (VAP) frequently occurs in patients with cardiac arrest. Diagnosis of VAP after cardiac arrest remains challenging, while the use of current biomarkers such as C-reactive protein (CRP) or procalcitonin (PCT) is debated. OBJECTIVES:. To evaluate biomarkers’ impact in helping VAP diagnosis after cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS:. This is a prospective ancillary study of the randomized, multicenter, double-blind placebo-controlled ANtibiotherapy during Therapeutic HypothermiA to pRevenT Infectious Complications (ANTHARTIC) trial evaluating the impact of antibiotic prophylaxis to prevent VAP in out-of-hospital patients with cardiac arrest secondary to shockable rhythm and treated with therapeutic hypothermia. An adjudication committee blindly evaluated VAP according to predefined clinical, radiologic, and microbiological criteria. All patients with available biomarker(s), sample(s), and consent approval were included. MAIN OUTCOMES AND MEASURES:. The main endpoint was to evaluate the ability of biomarkers to correctly diagnose and predict VAP within 48 hours after sampling. The secondary endpoint was to study the combination of two biomarkers in discriminating VAP. Blood samples were collected at baseline on day 3. Routine and exploratory panel of inflammatory biomarkers measurements were blindly performed. Analyses were adjusted on the randomization group. RESULTS:. Among 161 patients of the ANTHARTIC trial with available biological sample(s), patients with VAP (n = 33) had higher body mass index and Acute Physiology and Chronic Health Evaluation II score, more unwitnessed cardiac arrest, more catecholamines, and experienced more prolonged therapeutic hypothermia duration than patients without VAP (n = 121). In univariate analyses, biomarkers significantly associated with VAP and showing an area under the curve (AUC) greater than 0.70 were CRP (AUC = 0.76), interleukin (IL) 17A and 17C (IL17C) (0.74), macrophage colony-stimulating factor 1 (0.73), PCT (0.72), and vascular endothelial growth factor A (VEGF-A) (0.71). Multivariate analysis combining novel biomarkers revealed several pairs with p value of less than 0.001 and odds ratio greater than 1: VEGF-A + IL12 subunit beta (IL12B), Fms-related tyrosine kinase 3 ligands (Flt3L) + C–C chemokine 20 (CCL20), Flt3L + IL17A, Flt3L + IL6, STAM-binding protein (STAMBP) + CCL20, STAMBP + IL6, CCL20 + 4EBP1, CCL20 + caspase-8 (CASP8), IL6 + 4EBP1, and IL6 + CASP8. Best AUCs were observed for CRP + IL6 (0.79), CRP + CCL20 (0.78), CRP + IL17A, and CRP + IL17C. CONCLUSIONS AND RELEVANCE:. Our exploratory study shows that specific biomarkers, especially CRP combined with IL6, could help to better diagnose or predict early VAP occurrence in cardiac arrest patients.

Published
2024
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19. Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study

Author

Damien Contou, Gwenhaël Colin, Brendan Travert, Sébastien Jochmans, Marie Conrad, Jean-Baptiste Lascarrou, Benoit Painvin, Alexis Ferré, David Schnell, Béatrice La Combe, Rémi Coudroy, Stephan Ehrmann, Jérôme Rambaud, Arnaud Wiedemann, Pierre Asfar, Pierre Kalfon, Emmanuel Guérot, Sébastien Préau, Laurent Argaud, Florence Daviet, Jean Dellamonica, Audrey Dupont, Muriel Fartoukh, Toufik Kamel, Gaetan Beduneau, Florence Canouï-Poitrine, Emmanuelle Boutin, Gérard Lina, Armand Mekontso Dessap, Anne Tristan, Nicolas de Prost, French m-TSS Study Group, Centre Hospitalier Victor Dupouy, CH Départemental Vendée, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier de Melun (CHM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pontchaillou [Rennes], Laboratoire Lasers, Plasmas et Procédés photoniques (LP3), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier d'Angoulême (CH Angoulême), Université de Bretagne Sud - Lorient (UBS Lorient), Université de Bretagne Sud (UBS), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical Research in Intensive Care and Sepsis - TRIal Group for Global Evaluation and Research in SEPsis [CHU Limoges] (Réseau CRICS-TRIGGERSEP ), Hôpital Dupuytren [CHU Limoges], Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service de Réanimation polyvalente [Chartres], Hôpital Louis Pasteur [Chartres], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Assistance Publique - Hôpitaux de Marseille (APHM), Unité de Recherche Clinique de la Côte d’Azur (URRIS UR2CA), Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Normandie Université (NU)-Normandie Université (NU), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor [Créteil], Unité de Recherche Clinique de la Côte d’Azur [Nice] (URRIS UR2CA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, CarMeN, laboratoire, Centre Hospitalier de Melun, Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Henri Mondor, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10

Subjects
0301 basic medicine, Microbiology (medical), Adult, Staphylococcus aureus, medicine.medical_specialty, Adolescent, genetic structures, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030106 microbiology, Disease, law.invention, Sepsis, Menstruation, sepsis, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Intensive care, medicine, Humans, 030212 general & internal medicine, Child, menstrual toxic shock syndrome, Retrospective Studies, Superantigens, Critically ill, business.industry, Medical record, Tracheal intubation, Toxic shock syndrome, Retrospective cohort study, Staphylococcal Infections, tampon, bacterial infections and mycoses, Institutional review board, medicine.disease, Shock, Septic, Intensive care unit, 3. Good health, Anti-Bacterial Agents, [SDV] Life Sciences [q-bio], Infectious Diseases, Icu, Female, Observational study, menstruation, business
Abstract

Background Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. Methods This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between 1 January 2005 and 31 December 2020 in 43 French pediatric (n = 7) or adult (n = 36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as to assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, in critically ill patients with m-TSS. Results In total, 102 patients with m-TSS (median age, 18 years; interquartile range, 16–24 years) were admitted to 1 of the participating ICUs. All blood cultures (n = 102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for superantigenic toxin gene sequences was performed for 76 of the 92 vaginal samples positive for S. aureus (83%), and toxic shock syndrome toxin 1 was isolated from 66 strains (87%). At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS, and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with antitoxin antibiotic therapy, and 8 (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors, and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. Conclusions In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.

Published
2021

20. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

Author

Ana Vallejo de la Cueva, Pablo T. Aznar, Laura González Cubillo, Chiara Robba, Oriol Plans Galván, Nerea Aretxabala Cortajarena, Robert C. Hyzy, Imen Ben Saida, Jorge Rubio, María José Sánchez Carretero, Katie M. Vance, Blanca Furquet, Irene Patricia Barón Barrera, Sarah J. Peterson, Sara C. LaHue, Sergio Llorente Damas, Andrew R. Vogel, Nihal Patel, Alejandro Suarez-de-la-Rica, Cristina Álvarez, Ricard Molina Latorre, Günseli Orhun, Karen Shephard, Marta Martín Martínez, Paula Castello-Mora, Guillem Navarra-Ventura, Michelle Woodham, Carmen Andrea Sanchis-Veryser, Annachiara Marra, Kristine Nelson, Carolina Ferrer Gómez, Francisco Javier Morán Gallego, Muhammed Elhadi, Sarah Cohen, María Esther Rodriguez Delgado, Rafael Badenes, Isabel Reyes García, Christopher Berkey, Karla Núñez Vázquez, Beata-Gabriela K Simpson, Amaia Quintano Rodero, María Pilar Vicente-Fernández, María Luisa García Pérez, Vanja C. Douglas, María Elena Martínez Quintana, Silvia García de Castrillón i Ramal, Silvia Beretta, Mandeep Sing, Robert A Balk, Yolanda Poveda Hernández, Spencer Roberson, Martin Siegemund, Jordi Morillas Pérez, Rameela Raman, Giuseppe Servillo, João Manoel Silva, Brenda T. Pun, Aurélien Mazeraud, María Cruz Martín Delgado, Borja Hinojal Olmedillo, Gemma Gomà Fernández, Miguel Valente, Michael T. Kenes, Laura Galarza, Fabio Silvio Taccone, Wencong Chen, Rita Pereia, Álvaro Ortega Guerrero, Morgan H. Tandy, Alejandro Ruiz Perea, Stephanie Wilson-Linville, Meri Martin Cerezuela, Salvatore Lucio Cutuli, Carlos A. Calvo, María de las Nieves Noci Moreno, Ariadna Bellès, Elisa Govea Bogossian, Mario Dalorzo González, Eva Álvarez Torres, David Díaz Muñoz, Carla Margarida Teixeira, Emilio del Campo Molina, Sol Fernandez-Gonzalo, Christine Harb, Berta Monleón, Anna Teresa Mazzeo, Beatriz Del Moral Barbudo, Thomas Godet, Cristina Delgado Palacios, C. Adrian Austin, Hilde Wøien, Anselmo Caricato, Erik Roman-Pognuz, Bruno Gonçalves, Patricia Rodríguez Villamizar, Eloisa Sofia Tanzarella, Daniel A Godoy Torres, Robert E. Hosse, Lisa Smit, María Rosa Sanchis-Martin, Cristina Murcia Gubianas, Emily Sanders, Karen Herrera-Davis, Sara Torrico Sánchez, Isabel Peña Luna, David A Bennett, Irene Torres, Diana Gil-Castillejos, Laura Labrador Romero, Felipe González-Seguel, Carlos Muñoz De Cabo, Ellis Morgan, Itziar Insausti, Mónica García Simón, Patricia Piñeiro Otero, Genís Carrasco Gómez, M. Montero, Jose García Cantos, Ignacio Garutti, César Rodriguez Nuñez, Fernando Higuero, Sameep Sehgal, Catherine M. Kuza, Yago García Blanco-Traba, Juan Romeu Prieto, Ainhoa Serrano, Elena Abril Palomares, Perihan Ergin Özcan, Mathieu van der Jagt, Elena Gallego Curto, Berta Gallego Rodríguez, Rosalía Navarro Casado, Aaron Lerner, Myrto Tzimou, Sheila Moya Gutiérrez, Beatriz García Góngora, Eleonora Stival, Xavier Andorrà Sunyer, Susana Gallardo Sánchez, Anna Baró Serra, Filadelfo Bustos Molina, Rafael Zaragoza, Verónica Rojas, Paolo Pelosi, Aris Pérez Lucendo, Stéphane Legriel, Eduardo Tobar, Laura Lizama, Viviane Hidalgo-Calibin, Chiara Maria Concetta Massaro, Nekane Romero, Pablo García Domelo, Isabel Jesus Pereira, Kelly Drumright, Frank Rasulo, Mattia Marchesi, Jacques Creteur, Estefanía Carvajal Revuelta, Timothy D. Girard, Pablo Carreño-Montenegro, Ana Montero Feijoo, Ignacio Baeza Gómez, Alba Gonzalo Millán, Esteban Morcillo, Alice Santos, Pilar Leal Sanz, Dulce Morales, Gabriel Heras La Calle, Hollis R. O’Neal, Antonio Ramírez-Palma, Inés Pérez Francisco, Alberto Noto, Matilde González Serrano, Paola Valls, María Jesús Mármol Cubillo, Emilio Maseda, Anna Estermann, Andrés Pujol, E. Wesley Ely, Alexis Ferré, Lucia Chowdhury, Guillaume Lacave, Cristina Granja, Isabel de la Calle Gil, Onur M Orun, Mohamed Boussarsar, David Pestaña Lagunas, Denise Battaglini, Nathan E. Brummel, Rosa María Pérez Manrique, Núria Zellweger, Jaume Puig, Kiran Devulapally, Milagros Calizaya Vargas, Jesús Caballero, Theresa Olasveengen, Cristina Fuster, Aarti Sarwal, Pratik P. Pandharipande, Gabriele Pintaudi, Paula Ramirez, Blanca Fernández Tomás, Maria Claudia Giménez Santamarina, Francisco Luis Pérez Caballero, Enver Rodriguez-Martinez, David Martínez-Gascueña, Irene Paredes Borrachero, Ugo Fraisse, Paloma LaTorre Andreu, Ignacio Catalán-Monzón, Elena Gonzalez, Figen Esen, Lorenzo Peluso, Intensive Care, Pun, B. T., Badenes, R., Heras La Calle, G., Orun, O. M., Chen, W., Raman, R., Simpson, B. -G. K., Wilson-Linville, S., Hinojal Olmedillo, B., Vallejo de la Cueva, A., van der Jagt, M., Navarro Casado, R., Leal Sanz, P., Orhun, G., Ferrer Gomez, C., Nunez Vazquez, K., Pineiro Otero, P., Taccone, F. S., Gallego Curto, E., Caricato, A., Woien, H., Lacave, G., O'Neal, H. R., Peterson, S. J., Brummel, N. E., Girard, T. D., Ely, E. W., Pandharipande, P. P., Creteur, J., Bogossian, E. G., Peluso, L., Gonzalez-Seguel, F., Hidalgo-Cabalin, V., Carreno-Montenegro, P., Rojas, V., Tobar, E., Ramirez-Palma, A., Herrera-Davis, K., Ferre, A., Legriel, S., Godet, T., Fraisse, U., Goncalves, B., Mazeraud, A., Tzimou, M., Rasulo, F., Beretta, S., Marchesi, M., Robba, C., Battaglini, D., Pelosi, P., Mazzeo, A. T., Noto, A., Servillo, G., Marra, A., Cutuli, S. L., Pintaudi, G., Stival, E., Tanzarella, E. S., Roman-Pognuz, E., Concetta Massaro, C. M., Elhadi, M., Smit, L., Olasveengen, T., Pereira, I. J., Teixeira, C. M., Santos, A., Valente, M., Granja, C., Pereia, R., Silva, J., Furquet, B., Garcia Simon, M., Godoy Torres, D. A., Monleon, B., Morcillo, E., Romero, N., Serrano, A., Torrico Sanchez, S., Perez Caballero, F. L., Pena Luna, I., Baeza Gomez, I., Calizaya Vargas, M., Morillas Perez, J., Carrasco Gomez, G., Molina Latorre, R., Moya Gutierrez, S., Baron Barrera, I. P., Delgado Palacios, C., Garcia Gongora, B., Labrador Romero, L., Galarza, L., Catalan-Monzon, I., Rodriguez-Martinez, E., Murcia Gubianas, C., Belles, A., Rodriguez Delgado, M. E., Caballero, J., Morales, D., Pujol, A., Rubio, J., Alvarez Torres, E., Carvajal Revuelta, E., de la Calle Gil, I., Fernandez Tomas, B., Gallego Rodriguez, B., Gonzalez Serrano, M., LaTorre Andreu, P., Perez Lucendo, A., Abril Palomares, E., Gonzalez Gonzalez, E., Martin Delgado, M. C., Munoz De Cabo, C., Aznar, P. T., Calvo, C. A., Garutti, I., Higuero, F., Martinez-Gascuena, D., Maseda, E., Insausti, I., Montero Feijoo, A., Suarez-de-la-Rica, A., Del Moral Barbudo, B., Garcia Blanco-Traba, Y., Gimenez Santamarina, M. C., Gonzalo Millan, A., Llorente Damas, S., Pestana Lagunas, D., Reyes Garcia, I., Ruiz Perea, A., Ortega Guerrero, A., Marmol Cubillo, M. J., Diaz Munoz, D., Garcia de Castrillon i Ramal, S., Andorra Sunyer, X., Noci Moreno, M. D. L. N., Perez Manrique, R. M., del Campo Molina, E., Martinez Quintana, M. E., Fernandez-Gonzalo, S., Goma Fernandez, G., Navarra-Ventura, G., Baro Serra, A., Fuster, C., Plans Galvan, O., Gil-Castillejos, D., Dalorzo Gonzalez, M., Moran Gallego, F. J., Paredes Borrachero, I., Rodriguez Villamizar, P., Romeu Prieto, J., Sanchez Carretero, M. J., Gallardo Sanchez, S., Bustos Molina, F., Garcia Perez, M. L., Castello-Mora, P., Puig, J., Sanchis-Martin, M. R., Sanchis-Veryser, C. A., Vicente-Fernandez, M. P., Zaragoza, R., Lizama, L., Torres, I., Alvarez, C., Ramirez, P., Martin Cerezuela, M., Montero, M. J., Garcia Cantos, J., Valls, P., Aretxabala Cortajarena, N., Garcia Domelo, P., Gonzalez Cubillo, L., Martin Martinez, M., Perez Francisco, I., Poveda Hernandez, Y., Quintano Rodero, A., Rodriguez Nunez, C., Siegemund, M., Estermann, A., Zellweger, N., Ben Saida, I., Boussarsar, M., Esen, F., Ergin Ozcan, P., Berkey, C., Harb, C., Tandy, M. H., Morgan, E., Shephard, K., Hyzy, R. C., Kenes, M., Nelson, K., Hosse, R. E., Vance, K. M., Austin, C. A., Lerner, A., Sanders, E., Balk, R. A., Bennett, D. A., Vogel, A. R., Chowdhury, L., Devulapally, K., Woodham, M., Cohen, S., Patel, N., Kuza, C. M., Sing, M., Roberson, S., Drumright, K., Sehgal, S., Lahue, S. C., Douglas, V. C., and Sarwal, A.

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, covid-19, delirium, Outcomes, Lower risk, Critical Ilness, Task-Force, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Intensive-Care-Unit, Intensive care, Settore MED/41 - ANESTESIOLOGIA, medicine, Survivors, 030212 general & internal medicine, Simplified Acute Physiology Score, Mechaniically Ventilated Patients, Epitiomology, Mechanical ventilation, Coma, Intensive-Care-Unit, Mechaniically Ventilated Patients, Clinical practice Guidelines, Critical Ilness, Task-Force, Sedation, ICU, Survivors, Outcomes, Epitiomology, business.industry, covid, Retrospective cohort study, Articles, Clinical practice Guidelines, covid, delirium, 030228 respiratory system, Sedation, ICU, Emergency medicine, Delirium, medicine.symptom, business, Cohort study
Abstract

Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40·0 (30·0 to 53·0). 1397 (66·9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87·5%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64·0%) of 2088 patients were given benzodiazepines for a median of 7·0 days (4·0 to 12·0) and 1481 (70·9%) were given propofol for a median of 7·0 days (4·0 to 11·0). Median Richmond Agitation–Sedation Scale score while on invasive mechanical ventilation was –4 (–5 to –3). 1704 (81·6%) of 2088 patients were comatose for a median of 10·0 days (6·0 to 15·0) and 1147 (54·9%) were delirious for a median of 3·0 days (2·0 to 6·0). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p≤0·04), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p

Published
2021

21. Invasive Aspergillosis associated with Covid-19: A word of caution

Author

Odile Eloy, Jean-Pierre Bedos, Theophile Cocherie, F. Bruneel, Alexis Ferré, Stéphanie Marque-Juillet, Christelle Simon, Stéphane Legriel, Laura Gouzien, Centre Hospitalier de Versailles André Mignot (CHV), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, This work has been supported by: Centre Hospitalier de Versailles André Mignot ., This work has been supported by: Centre Hospitalier de Versailles Andr? Mignot., and HAL UVSQ, Équipe

Subjects
Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pulmonary Aspergillosis/diagnosis, diagnosis, [SDV]Life Sciences [q-bio], Critical Illness, Aspergillosis, Article, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Coronavirus Infections/pathology, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Aged, Retrospective Studies, Invasive Pulmonary Aspergillosis, 0303 health sciences, 030306 microbiology, business.industry, Critically ill, Incidence (epidemiology), Incidence, COVID-19, Retrospective cohort study, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Infectious Diseases, Coinfection, pathology, Female, Pulmonary Aspergillosis, Complication, business, Coronavirus Infections, Cohort study
Abstract

International audience; Introduction: Invasive pulmonary aspergillosis is a well-known complication of acute respiratory distress syndrome, the most serious manifestation of COVID-19. Four recent studies have reported its incidence among ICU COVID-19 patients. However, they do not share the same case definition, and have provided conflicting results. In this paper we have aimed at reported the incidence of invasive pulmonary aspergillosis for COVID-19 patients in our ICU, and at comparing the different definitions in order to assess their respective relevance. Methods: Retrospective cohort study of critically ill patients with severe COVID-19 requiring ICU management between 1st March and 30th April 2020. Results: Our results showed significantly lower incidence of invasive pulmonary aspergillosis (1.8%;1/53), compared to three out of four previous studies, and wide variation in the numbers of cases with regard to the different definitions. Conclusion: Large-scale studies are needed for a better definition and a more accurate estimation of invasive pulmonary aspergillosis coinfection during COVID-19.

Published
2020

22. Tiagabine-related status epilepticus: a case report and systematic literature review

Author

Geoffroy Hariri, Alexis Ferré, Stéphane Legriel, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier de Versailles André Mignot (CHV), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service des Soins Intensifs [CHU Saint-Antoine], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and We thank the Centre Hospitalier de Versailles for editorial assistance.

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Neurology, Tiagabine, medicine.drug_class, medicine.medical_treatment, Status epilepticus, Anxiety, 03 medical and health sciences, 0302 clinical medicine, Case report, medicine, Humans, 030212 general & internal medicine, Coma, Benzodiazepine, business.industry, General Medicine, 3. Good health, Systematic review, Anticonvulsant, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), GABA Uptake Inhibitors, medicine.symptom, Complication, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

International audience; Tiagabine-related status epilepticus (SE) is an uncommon complication of tiagabine use. We aimed to detail the features and outcomes in a patient with tiagabine poisoning and review the relevant literature. We describe a case of tiagabine-related SE and literature review based on a 1995–2019 PubMed search. We report the case of a 30-year-old man with super-refractory SE after tiagabine poisoning. He fully recovered after 72 h of general anesthesia and was discharged from the ICU on day 16. A literature review showed distinct features among patients with tiagabine-related SE. Tiagabine side effects were characterized by non-convulsive SE after a slight increase in tiagabine dose and a rapid favorable evolution after benzodiazepine and early tiagabine withdrawal. Generalized convulsive SE was a complication of voluntary or involuntary tiagabine poisoning and was particularly refractory. Both presentations are characterized by a return to baseline after prompt and adequate management. Tiagabine-related SE electroclinical features vary according to the underlying pathophysiological mechanism and can be life threatening. Recovery is the rule after tiagabine withdrawal and SE management with progressive therapeutic escalation guided by response to prior anticonvulsant treatments.

Published
2020

23. Thyroid Storm in the ICU: A Retrospective Multicenter Study

Author

Pierre Fillatre, Serge Carreira, Romain Sonneville, Nadia Aissaoui, Julien Charpentier, Yoann Zerbib, David Schnell, Claire Pichereau, Xavier Repessé, Yacine Tandjaoui-Lambiotte, Alexandre Lautrette, Aurélien Frérou, Etienne de Montmollin, Sami Hraiech, Romain Persichini, Matthieu Schmidt, Antoine Kimmoun, Alain Combes, Olivier Ellrodt, Maxime Coutrot, Bruno Mégarbane, Nicolas Terzi, Cecile Aubron, Keyvan Razazi, Elie Azoulay, Alexis Ferré, François Barbier, Vincent Peigne, Elise Morawiec, Danielle Reuter, Guillaume Voiriot, Clément Delmas, Saad Nseir, Naïke Bigé, Simon Bourcier, and Jean-Baptiste Lascarrou

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Thyroid storm, Humans, Renal replacement therapy, 10. No inequality, Survival rate, Aged, Retrospective Studies, business.industry, Mortality rate, Cardiogenic shock, Thyroid, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Survival Rate, Intensive Care Units, medicine.anatomical_structure, Emergency medicine, Female, Thyroid Crisis, business
Abstract

Objectives Thyroid storm represents a rare but life-threatening endocrine emergency. Only rare data are available on its management and the outcome of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management and in-ICU and 6-month survival rates of patients with those most severe thyroid storm forms requiring ICU admission. Design Retrospective, multicenter, national study over an 18-year period (2000-2017). Setting Thirty-one French ICUs. Patients The local medical records of patients from each participating ICU were screened using the International Classification of Diseases, 10th Revision. Inclusion criteria were "definite thyroid storm," as defined by the Japanese Thyroid Association criteria, and at least one thyroid storm-related organ failure. Measurements and main results Ninety-two patients were included in the study. Amiodarone-associated thyrotoxicosis and Graves' disease represented the main thyroid storm etiologies (30 [33%] and 24 [26%] patients, respectively), while hyperthyroidism was unknown in 29 patients (32%) before ICU admission. Amiodarone use (24 patients [26%]) and antithyroid-drug discontinuation (13 patients [14%]) were the main thyroid storm-triggering factors. No triggering factor was identified for 30 patients (33%). Thirty-five patients (38%) developed cardiogenic shock within the first 48 hours after ICU admission. In-ICU and 6-month postadmission mortality rates were 17% and 22%, respectively. ICU nonsurvivors more frequently required vasopressors, extracorporeal membrane of oxygenation, renal replacement therapy, mechanical ventilation, and/or therapeutic plasmapheresis. Multivariable analyses retained Sequential Organ Failure Assessment score without cardiovascular component (odds ratio, 1.22; 95% CI, 1.03-1.46; p = 0.025) and cardiogenic shock within 48 hours post-ICU admission (odds ratio, 9.43; 1.77-50.12; p = 0.008) as being independently associated with in-ICU mortality. Conclusions Thyroid storm requiring ICU admission causes high in-ICU mortality. Multiple organ failure and early cardiogenic shock seem to markedly impact the prognosis, suggesting a prompt identification and an aggressive management.

Published
2019

24. Oseltamivir Resistance in Severe Influenza A(H1N1)pdm09 Pneumonia and Acute Respiratory Distress Syndrome: A French Multicenter Observational Cohort Study

Author

Guillaume Voiriot, Sylvie Behillil, Thomas Chicheportiche, Romain Sonneville, Yacine Tandjaoui-Lambiotte, Damien Roux, Armand Mekontso Dessap, Slim Fourati, Nicolas de Prost, Faten May, Julien Mayaux, Sylvie van der Werf, Vincent Enouf, Laurent Guérin, Alexis Ferré, Eric Maury, Charles-Edouard Luyt, Jean-François Georger, Génétique Moléculaire des Virus à ARN - Molecular Genetics of RNA Viruses (GMV-ARN (UMR_3569 / U-Pasteur_2)), Institut Pasteur [Paris]-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Centre National de Référence des virus des infections respiratoires (dont la grippe) - National Reference Center Virus Influenzae [Paris] (CNR), Institut Pasteur [Paris], Université Sorbonne Paris Cité (USPC), Université Paris Diderot - Paris 7 (UPD7), Groupe Henri Mondor-Albert Chenevier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Hôpital Albert Chenevier, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Service de Réanimation Médico-Chirurgicale [Hôpital Louis Mourier], Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges (CHIV), Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], CHU Tenon [AP-HP], Génétique moléculaire des virus à ARN ((U-Pasteur_ 2 / UMR_3569)), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris 13 (UP13)-Hôpital Avicenne [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pasteur [Paris] (IP)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Centre National de Référence des virus des infections respiratoires (dont la grippe) - National Reference Center Virus Influenzae [Paris] (CNR - laboratoire coordonnateur), Institut Pasteur [Paris] (IP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), and CHU Saint-Antoine [AP-HP]

Subjects
Microbiology (medical), Adult, Oseltamivir, medicine.medical_specialty, viruses, [SDV]Life Sciences [q-bio], Neuraminidase, Acute respiratory distress, Severe influenza, medicine.disease_cause, Antiviral Agents, Virus, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Influenza A Virus, H1N1 Subtype, Internal medicine, Drug Resistance, Viral, Influenza, Human, Influenza A virus, medicine, Influenza A Virus, Humans, H1N1 Subtype, 030212 general & internal medicine, Viral, 0303 health sciences, Respiratory Distress Syndrome, biology, 030306 microbiology, business.industry, virus diseases, Pneumonia, medicine.disease, 3. Good health, respiratory tract diseases, Infectious Diseases, chemistry, biology.protein, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study
Abstract

In a multicenter cohort study including 22 oseltamivir-treated patients with influenza A(H1N1)pdm09 acute respiratory distress syndrome, prevalence of the H275Y substitution in the neuraminidase, responsible for highly reduced sensitivity to oseltamivir, was 23%. Patients infected with the H275Y mutant virus had higher day 28 mortality than others (80% vs 12%; P = .011).

Published
2019

25. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

Author

Suzanne Goursaud, Antoine Ausseur, Jérémie Lemarié, Philippe Michel, Gaël Piton, Maximilien Grall, Emmanuelle Mercier, Fabien Lambiotte, Arnaud-Félix Miailhe, Saad Nseir, Nicholas Sedillot, Philippe Guiot, Aurélie Le Thuaut, Maud Jonas, Sébastien Moschietto, Julien Charpentier, Leptorea, Aurelie Gaultier, Jean-Baptiste Lascarrou, Christophe Cracco, Pierre Asfar, Karim Chaoui, Lara Zafrani, Claire Lhommet, Adel Maamar, Nicolas de Prost, Jean Reignier, Marie-Line Eustache, Yoann Zerbib, Michel Sirodot, Laurent Argaud, Jean-Claude Lacherade, Yannick Monseau, Alexis Ferré, Olivier Lesieur, Pascale Bourhy, Vlad Botoc, Jérôme Pillot, Didier Thevenin, Mickael Landais, Adel Ben Salah, David Osman, Elena Gauvin, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service de Réanimation Médicale, CHU d'Angers, France, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Cholet (CHC), Hôpitaux de Chartres [Chartres], Service de réanimation (CH Saint-Malo), Centre hospitalier de Saint-Malo, Centre Hospitalier Cahors, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier d'Angoulême (CH Angoulême), Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Georges Renon [Niort] (CH Georges Renon Niort), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier de Mulhouse, site du Hasenrain (Mulhouse), Centre hospitalier de Saint-Nazaire, Centre hospitalier [Valenciennes, Nord], Centre Hospitalier Le Mans (CH Le Mans), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier de La Rochelle (CHR), CHU de Saint-Brieuc, Centre Hospitalier René Dubos [Pontoise], Hopital de Périgueux (CH Périgueux), Hopital de Périgueux, Centre Hospitalier Henri Duffaut (Avignon), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier de la Côte Basque (CHCB), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Fleyriat [Bourg en Bresse], Centre Hospitalier d'Annecy, Centre hospitalier d'Annecy, Centre Hospitalier de Lens, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), CHU Amiens-Picardie, Biologie des Spirochètes / Biology of Spirochetes, Institut Pasteur [Paris] (IP), Centre hospitalier de Cahors, Le CHCB, Centre Hospitalier de la Côte Basque, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Institut Pasteur [Paris], Centre Hospitalier Départemental Vendée, Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP)

Subjects
Adult, Male, medicine.medical_specialty, Severe leptospirosis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Multiple Organ Failure, Population, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Risk Factors, Anesthesiology, medicine, Humans, Leptospirosis, Renal replacement therapy, Temperate zone, Hospital Mortality, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Intensive care unit, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, 3. Good health, Intensive Care Units, 030228 respiratory system, Emergency medicine, Outcome, SOFA score, Female, France, business, Mortality
Abstract

International audience; Purpose: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.Methods: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes.Results: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations.Conclusions: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.

Published
2019

26. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases

Author

Nadia Aissaoui, Fiona Ecarnot, Francois Schiele, Guy Meyer, Nicolas Meneveau, Lucie Gaide-Chevronnay, Alexis Ferré, Raphaël Favory, Antoine Kimmoun, Gaël Piton, Philippe Girard, Arthur Neuschwander, Gilles Capellier, Olivier Sanchez, Hervé Dupont, Mircea Cristinar, Elie Zogheib, Nicolas de Prost, B. Guillon, Benjamin Planquette, Nicolas Deye, Sebastien Pili-Floury, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), 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 universitaire de Nantes (CHU Nantes), Centre Hospitalier de Versailles André Mignot (CHV), Réanimation Médicale CHRU Besançon, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Réanimation Médicale [CHU Henri Mondor - APHP] (DHU A-TVB), CHU Henri Mondor-Université Paris-Est Créteil, Faculté de Médecine [Créteil] (UPEC-Médecine), Service de soins intensifs, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire de l'intégration, du matériau au système (IMS), Université Sciences et Technologies - Bordeaux 1 (UB)-Institut Polytechnique de Bordeaux-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5), CIC - HEGP (CIC 1418), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pneumologie, soins intensifs (Pneumo - HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), DESSAIVRE, Louise, and Université Sciences et Technologies - Bordeaux 1-Institut Polytechnique de Bordeaux-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Embolectomy, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Extracorporeal Membrane Oxygenation, Fibrinolysis, medicine, Extracorporeal membrane oxygenation, Humans, 030212 general & internal medicine, Retrospective Studies, business.industry, Retrospective cohort study, Thrombolysis, Middle Aged, medicine.disease, Prognosis, Pulmonary embolism, Surgery, Survival Rate, [SDV] Life Sciences [q-bio], surgical procedures, operative, Echocardiography, Adjunctive treatment, Female, France, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Follow-Up Studies
Abstract

International audience; Aims The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy). Primary outcome was all-cause 30-day mortality. Secondary outcome was 90-day major bleeding. One hundred and twenty-eight patients were treated without ECMO; 52 (mean age 47.6 years) underwent ECMO. Overall 30-day mortality was 48.3% [95% confidence interval (CI) 41-56] (87/180); 43% (95% CI 34-52) (55/128) in those treated without ECMO vs. 61.5% (95% CI 52-78) (32/52) in those with ECMO (P = 0.008). In patients undergoing ECMO, 30-day mortality was 76.5% (95% CI 57-97) (13/17) for ECMO+fibrinolysis, 29.4% (95% CI 51-89) (5/17) for ECMO+surgical embolectomy, and 77.7% (95% CI 59-97) (14/18) for ECMO alone (P = 0.004). Among patients with ECMO, 20 (38.5%, 95% CI 25-52) had a major bleeding event in-hospital; without significant difference across groups. Conclusion In patients with high-risk PE, those with ECMO have a more severe presentation and worse prognosis. Extracorporeal membrane oxygenation in patients with failed fibrinolysis and in those with no reperfusion seems to be associated with particularly unfavourable prognosis compared with ECMO performed in addition to surgical embolectomy. Our findings suggest that ECMO does not appear justified as a stand-alone treatment strategy in PE patients, but shows promise as a complement to surgical embolectomy.

Published
2018

27. Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU: a 10-year retrospective study

Author

Benjamin Planquette, Fabrice Bruneel, Julien Péron, Alexis Ferré, Jean Pierre Bedos, Virginie Laurent, Alban Le Monnier, Peter G. Chiles, Ariane Roujansky, Stéphane Legriel, Etienne Dubuisson, Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Time Factors, Exacerbation, [SDV]Life Sciences [q-bio], Antibiotics, medicine.disease_cause, antibiotics, Pulmonary Disease, Chronic Obstructive, exacerbation, Risk Factors, Odds Ratio, Prevalence, Treatment Failure, Respiratory Tract Infections, ComputingMilieux_MISCELLANEOUS, Original Research, Aged, 80 and over, COPD, Cross Infection, Respiratory tract infections, General Medicine, Middle Aged, 3. Good health, Anti-Bacterial Agents, Pseudomonas aeruginosa, Disease Progression, Female, France, medicine.medical_specialty, medicine.drug_class, International Journal of Chronic Obstructive Pulmonary Disease, medicine, Humans, Pseudomonas Infections, Intensive care medicine, Aged, Retrospective Studies, lcsh:RC705-779, Chi-Square Distribution, business.industry, Retrospective cohort study, Odds ratio, lcsh:Diseases of the respiratory system, medicine.disease, respiratory tract diseases, Logistic Models, Pseudomonas aeurginosa, Multivariate Analysis, ICU, Linear Models, business, Chi-squared distribution
Abstract

Benjamin Planquette,1–4 Julien Péron,2 Etienne Dubuisson,1 Ariane Roujansky,1 Virginie Laurent,1 Alban Le Monnier,3 Stephane Legriel,1 Alexis Ferre,4 Fabrice Bruneel,1 Peter G Chiles,5 Jean P Bedos1 1Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France; 2Unité de Biostatistique Médicale, Hôpital Lyon Sud, Lyon, France; 3Service de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France; 4Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, Université Paris René Descartes, Paris, France; 5Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA,USA Summary: Chronic obstructive pulmonary disease (COPD) is a frequent source of hospitalization. Antibiotics are largely prescribed during COPD exacerbation. Our hypothesis is that large broad-spectrum antibiotics are more and more frequently prescribed. Our results confirm this trend and highlight that the increase in large broad-spectrum use in COPD exacerbation is largely unexplained. Background: Acute COPD exacerbation (AECOPD) is frequently due to respiratory tract infection, and the benefit of antipseudomonal antibiotics (APA) is still debated. Health care–associated pneumonia (HCAP) was defined in 2005 and requires broad-spectrum antibiotherapy. The main objectives are to describe the antibiotic use for AECOPD in intensive care unit and to identify factors associated with APA use and AECOPD prognosis. Methods: We conducted a monocentric, retrospective study on all AECOPDs in the intensive care unit treated by antibiotics for respiratory tract infection. Treatment failure (TF) was defined by death, secondary need for mechanical ventilation, or secondary systemic steroid treatment. A multivariate analysis was used to assess factors associated with APA prescription and TF. Results: From January 2000 to December 2011, 111 patients were included. Mean age was 69years (±12), mean forced expiratory volume 38% of theoretic value (±13). Thirty-five (31%) patients were intubated, and 52 (47%) were treated with noninvasive ventilation. From 107patients, 8 (7%) cases of Pseudomonas aeruginosa were documented. APAs were prescribed in 21% of patients before 2006 versus 57% after (P=0.001). TF prevalence was 31%. Risk factors for P. aeruginosa in COPD and HCAP diagnosis did not influence APA, whereas the post-2006 period was independently associated with APA prescription (odds ratio 6.2; 95% confidence interval 1.9–20.3; P=0.0013). APA did not improve TF (odds ratio 1.09; 95% confidence interval 0.37–3.2). Conclusion: HCAP guidelines were followed by an increase in APA use in AECOPD, without an improvement in prognosis. HCAP prevalence cannot account for the increasing APA trend. Time effect reveals a drift in practices. The microbiological effect of such a drift must be evaluated. Keywords: COPD, exacerbation, Pseudomonas aeurginosa, antibiotics, ICU

Published
2015

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