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16 results on '"Jacques Durand-Gasselin"'

1. Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

Author

Jacques Durand-Gasselin, Olivier Guisset, Isabelle Vinatier, Céline Dedrie, Maité Garrouste-Orgeas, Marc Leone, Eddy Lebas, Christophe Cracco, Stéphane Legriel, Nathalie Rolin, Jean-Philippe Rigaud, Jean-Yves Lefrant, Renaud Chouquer, Marina Thirion, Danielle Reuter, Laurent Argaud, Pierre-Edouard Bollaert, Anne Renault, Lucien Lecuyer, Valérie Seegers, Amélie Seguin, Elie Azoulay, Samir Jaber, Thomas Rimmelé, Laurent Papazian, Bénédicte Philippon-Jouve, Alain Cariou, Gérald Viquesnel, Nancy Kentish-Barnes, Hugues Georges, Béatrice Eon, Armelle Mathonnet, Ludivine Chalumeau-Lemoine, Florence Boissier, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Unité de Soins Intensifs [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), COIITSS Study Investigators, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), 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), CHU Bordeaux [Bordeaux], Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Centre Hospitalier de Toulon-La Seyne, Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Victor Dupouy, De la Préhistoire à l'Actuel : Culture, Environnement et Anthropologie (PACEA), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Nord [CHU - APHM], Service de Réanimation polyvalente et des Maladies infectieuses, Centre Hospitalier Gustave Dron, Faculté de Médecine [Nancy], Université de Lorraine (UL), Service de biostatistiques et information médicale [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de la Recherche Scientifique (CNRS)-Université de Bordeaux (UB), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), MORNET, Dominique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Cochin [AP-HP], Institut de Physique de Rennes (IPR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional d'Orléans (CHR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and PHRC 10 104, Ministère des Affaires Sociales, de la Santé et des Droits des Femmes

Subjects
Adult, Male, medicine.medical_specialty, Attitude to Death, Psychometrics, Attitude of Health Personnel, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Nurses, Critical Care and Intensive Care Medicine, law.invention, Life Change Events, 03 medical and health sciences, 0302 clinical medicine, Pain control, law, Physicians, Surveys and Questionnaires, medicine, Humans, Intensive care unit, Prospective Studies, End-of-life experience, Cardiopulmonary resuscitation, Decision control, ComputingMilieux_MISCELLANEOUS, Job strain, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Reproducibility of Results, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, 3. Good health, Death, [SDV] Life Sciences [q-bio], Intensive Care Units, Caregivers, Multicenter study, Family medicine, Cohort, Female, business
Abstract

Background As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. Conclusion We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.

Published
2020
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2. Questions to improve family–staff communication in the ICU: a randomized controlled trial

Author

Myriam Moussa, Carole Schwebel, Marc Leone, Laurent Papazian, Sybille Merceron, Romain Truillet, Samir Jaber, Alain Cariou, Hughes Georges, Jacques Durand-Gasselin, Elisabeth Jouve, Sami Hraiech, Anne Renault, Isabelle Vinatier, Jean-Marie Forel, Elie Azoulay, Sandrine Valade, Laurent Argaud, J. Randall Curtis, Nancy Kentish-Barnes, Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Saint-Louis, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, CHRU Brest - service de rééducation fonctionnelle (CHU - BREST ), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier de Toulon-La Seyne, Hôpital de Toulon, Service de Réanimation Médicale [Grenoble], Hôpital Michallon-CHU Grenoble, CHU Grenoble, Hôpital de Tourcoing, Service de soins intensifs, Centre Hospitalier de Versailles André Mignot (CHV), Hôpital de Versaille, Unité de Soins Intensifs [CHU Cochin], Hôpital Cochin [AP-HP], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Nutrition humaine et lipides : Biodisponibilité, métabolisme et régulation, Université de la Méditerranée - Aix-Marseille 2-Institut National de la Recherche Agronomique (INRA)-Université de Provence - Aix-Marseille 1-IFR125-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Shcool of medicine, University of Washington [Seattle], University of Washington, Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital Sainte-Marguerite, CHU Marseille, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), CHU Grenoble-Hôpital Michallon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier de Versailles (CHV), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], CHU Saint Louis [APHP], and MORNET, Dominique

Subjects
Adult, Male, medicine.medical_specialty, Randomization, Critical Care, [SDV]Life Sciences [q-bio], Emotions, Burden, Anxiety, Critical Care and Intensive Care Medicine, Hospital Anxiety and Depression Scale, Stress, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Professional-Family Relations, law, Surveys and Questionnaires, Clinical endpoint, Humans, Medicine, Family, Intensive care unit, 030212 general & internal medicine, Depression (differential diagnoses), ComputingMilieux_MISCELLANEOUS, Aged, business.industry, Depression, Communication, Middle Aged, Respiration, Artificial, 3. Good health, [SDV] Life Sciences [q-bio], Comprehension, 030228 respiratory system, Physical therapy, Female, medicine.symptom, business, Stress, Psychological
Abstract

International audience; Purpose : Relatives of intensive care unit (ICU) patients suffer emotional distress that impairs their ability to acquire the information they need from the staff. We sought to evaluate whether providing relatives with a list of important questions was associated with better comprehension on day 5.Methods : Randomized, parallel-group trial. Relatives of mechanically ventilated patients were included from 14 hospitals belonging to the FAMIREA study group in France. A validated list of 21 questions was handed to the relatives immediately after randomization. The primary endpoint was comprehension on day 5. Secondary endpoints were satisfaction (Critical Care Family Needs Inventory, CCFNI) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale, HADS).Results : Of 394 randomized relatives, 302 underwent the day-5 assessment of all outcomes. Day-5 family comprehension was adequate in 68 (44.2%) and 75 (50.7%) intervention and control group relatives (P = 0.30), respectively. Over the first five ICU days, median number of family–staff meetings/patient was 6 [3–9], median total meeting time was 72.5 [35–110] min, and relatives asked a median of 20 [8–33] questions including 11 [6–13] from the list, with no between-group difference. Satisfaction and anxiety/depression symptoms were not significantly different between groups. The only variable significantly associated with better day-5 comprehension by multivariable analysis was a higher total number of questions asked before day 5.Conclusions : Providing relatives with a list of questions did not improve day-5 comprehension, secondary endpoints, or information time. Further research is needed to help families obtain the information they need.

Published
2018
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3. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial

Author

Samir Jaber, Catherine Paugam, Emmanuel Futier, Jean-Yves Lefrant, Sigismond Lasocki, Thomas Lescot, Julien Pottecher, Alexandre Demoule, Martine Ferrandière, Karim Asehnoune, Jean Dellamonica, Lionel Velly, Paër-Sélim Abback, Audrey de Jong, Vincent Brunot, Fouad Belafia, Antoine Roquilly, Gérald Chanques, Laurent Muller, Jean-Michel Constantin, Helena Bertet, Kada Klouche, Nicolas Molinari, Boris Jung, Marion Monnin, Jean-Marc Delay, Moussa Cissé, Marie Geniez, Matthieu Conseil, Bruno Souche, Jean Michel Constantin, Eric Noll, Elise Morawiec, Alexandre Robert, Thibaut Triglia, Malika Mechati, Jean-Michel Arnal, Jacques Durand-Gasselin, Didier Demoly, Sami Hraiech, Laurent Papazian, Vincent Gilles, Thomas Rimmelé, Béatrice Riu, Pierre Cougot, Olivier Fourcade, Philippe Seguin, Jonathan Charbit, Xavier Capdevila, Marc Leone, Laurent Zieleskiewicz, Carole Ichai, Jean Christophe Orban, Michael Darmon, Elie Azoulay, Virginie Lemiale, Lara Zafrani, Karim Debbat, Oliver Mimoz, Claude Guérin, Eric Kipnis, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génétique, Reproduction et Développement (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'anesthésie et réanimation chirurgicale, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Institut du Cerveau = Paris Brain Institute (ICM), 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], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), 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), Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Clermont-Ferrand, Génétique, Reproduction et Développement - Clermont Auvergne (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Avenue Cheikh Anta Diop, Dakar, Senegal., Anesthesiology, Robert Debré Hospital, PRES Université Nantes Angers Le Mans (UNAM), Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], 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), Conservation des espèces, restauration et suivi des populations (CERSP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), sans affiliation, Centre Hospitalier de Toulon-La Seyne, Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Agressions vasculaires et réponses tissulaires, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service de cardiologie [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Pontchaillou [Rennes], Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Département Imagerie et Simulation pour le Contrôle (DISC), Laboratoire d'Intégration des Systèmes et des Technologies (LIST), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France, Laboratoire de Géologie de Lyon - Terre, Planètes, Environnement [Lyon] (LGL-TPE), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Lille 2 - Faculté de Médecine, 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
Bicarbonate, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Metabolic alkalosis, law.invention, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, law, Intensive care, Medicine, Humans, 030212 general & internal medicine, Renal replacement therapy, education, Infusions, Intravenous, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Sodium bicarbonate, business.industry, 030208 emergency & critical care medicine, General Medicine, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Hydrogen-Ion Concentration, medicine.disease, Intensive care unit, Survival Analysis, 3. Good health, Renal Replacement Therapy, Intensive Care Units, Intravenous sodium bicarbonate, Sodium Bicarbonate, chemistry, Anesthesia, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Acidosis
Abstract

Summary Background Acute acidaemia is frequently observed during critical illness. Sodium bicarbonate infusion for the treatment of severe metabolic acidaemia is a possible treatment option but remains controversial, as no studies to date have examined its effect on clinical outcomes. Therefore, we aimed to evaluate whether sodium bicarbonate infusion would improve these outcomes in critically ill patients. Methods We did a multicentre, open-label, randomised controlled, phase 3 trial. Local investigators screened eligible patients from 26 intensive care units (ICUs) in France. We included adult patients (aged ≥18 years) who were admitted within 48 h to the ICU with severe acidaemia (pH ≤7·20, PaCO2 ≤45 mm Hg, and sodium bicarbonate concentration ≤20 mmol/L) and with a total Sequential Organ Failure Assessment score of 4 or more or an arterial lactate concentration of 2 mmol/L or more. We randomly assigned patients (1:1), by stratified randomisation with minimisation via a restricted web platform, to receive either no sodium bicarbonate (control group) or 4·2% of intravenous sodium bicarbonate infusion (bicarbonate group) to maintain the arterial pH above 7·30. Our protocol recommended that the volume of each infusion should be within the range of 125–250 mL in 30 min, with a maximum of 1000 mL within 24 h after inclusion. Randomisation criteria were stratified among three prespecified strata: age, sepsis status, and the Acute Kidney Injury Network (AKIN) score. The primary outcome was a composite of death from any cause by day 28 and the presence of at least one organ failure at day 7. All analyses were done on data from the intention-to-treat population, which included all patients who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02476253. Findings Between May 5, 2015, and May 7, 2017, we enrolled 389 patients into the intention-to-treat analysis in the overall population (194 in the control group and 195 in the bicarbonate group). The primary outcome occurred in 138 (71%) of 194 patients in the control group and 128 (66%) of 195 in the bicarbonate group (absolute difference estimate −5·5%, 95% CI −15·2 to 4·2; p=0·24). The Kaplan-Meier method estimate of the probability of survival at day 28 between the control group and bicarbonate group was not significant (46% [95% CI 40–54] vs 55% [49–63]; p=0·09. In the prespecified AKIN stratum of patients with a score of 2 or 3, the Kaplan-Meier method estimate of survival by day 28 between the control group and bicarbonate group was significant (37% [95% CI 28–48] vs 54% [45–65]; p=0·0283). Metabolic alkalosis, hypernatraemia, and hypocalcaemia were observed more frequently in the bicarbonate group than in the control group, with no life-threatening complications reported. Interpretation In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined stratum of patients with acute kidney injury. Funding French Ministry of Health and the Societe Francaise d'Anesthesie Reanimation.

Published
2018
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4. Closed loop ventilation mode in Intensive Care Unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes

Author

Thomas Laubscher, Stephane-Yannis Donati, Gaëlle Corno, Didier Demory, Jean-Michel Arnal, Laurent Ducros, Jacques Durand-Gasselin, Dominik Novotni, Aude Garnero, and Gabrielle Quintana

Subjects
Male, medicine.medical_specialty, Sedation, medicine.medical_treatment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, Aged, Mechanical ventilation, business.industry, 030208 emergency & critical care medicine, Workload, Middle Aged, Respiration, Artificial, Intensive care unit, Clinical trial, Intensive Care Units, Anesthesiology and Pain Medicine, 030228 respiratory system, Emergency medicine, Ventilation (architecture), Arterial blood, Female, Blood Gas Analysis, medicine.symptom, business
Abstract

BACKGROUND There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. METHODS This randomized controlled trial compared the number of manual ventilator setting changes between a full closed loop ventilation and oxygenation mode (INTELLiVENT-ASV®) and conventional ventilation modes (volume assist control and pressure support) in Intensive Care Unit (ICU) patients. The secondary endpoints were to compare the number of arterial blood gas analysis, the sedation dose and the user acceptance. Sixty subjects with an expected duration of mechanical ventilation of at least 48 hours were randomized to be ventilated using INTELLiVENT-ASV® or conventional modes with a protocolized weaning. All manual ventilator setting changes were recorded continuously from inclusion to successful extubation or death. Arterial blood gases were performed upon decision of the clinician in charge. User acceptance score was assessed for nurses and physicians once daily using a Likert Scale. RESULTS The number of manual ventilator setting changes per 24 h-period per subject was lower in INTELLiVENT-ASV® as compared to conventional ventilation group (5 [4-7] versus 10 [7-17]) manuals settings per subject per day [P

Published
2018
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5. Acute respiratory failure after drowning: a retrospective multicenter survey

Author

Fabrice Tiger, Carole Ichai, Sami Hraiech, Pierre Michelet, Samir Jaber, Jacques Durand-Gasselin, Jean Dellamonica, Fouad Bouzana, Olivia Charmensat, Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Antibes - Juan-les-Pins, Centre Hospitalier de Toulon-La Seyne, Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nice (CHU Nice), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hôpital de la Timone [CHU - APHM] ( TIMONE ), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] ( DRIS ), Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital Nord [CHU - APHM], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), and CHU Nice

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, MEDLINE, Poison control, 030204 cardiovascular system & hematology, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Injury prevention, medicine, Humans, Intensive care medicine, Retrospective Studies, Mechanical ventilation, Drowning, Noninvasive Ventilation, business.industry, Medical record, Glasgow Coma Scale, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, Respiration, Artificial, Treatment Outcome, Emergency Medicine, Female, France, business, Respiratory Insufficiency, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; OBJECTIVES:Despite the extensive literature on drowning, clinical data are still lacking on the best medical strategy to use. Acute respiratory failure (ARF) is the main component of drowning pathophysiology. The objectives of this multicenter study were to analyze the clinical course of drowning-related ARF patients and to describe the efficacy of the ventilatory strategies used.METHODS:Medical records of drowned adult patients admitted in seven ICUs after prehospital emergency medical care during three consecutive summer periods were retrospectively analyzed.RESULTS:Among the 126 patients (58±21 years) admitted, 38 patients with cardiac arrest at the scene were not analyzed, 26 received mechanical ventilation (MV), and 48 patients received noninvasive ventilation (NIV). Compared with patients placed under MV, the NIV patients presented a better initial neurological (Glasgow Coma Scale of 7±4 vs. 12±3, P

Published
2017
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6. Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study

Author

Jean-Christophe, Orban, Yannick, Walrave, Nicolas, Mongardon, Bernard, Allaouchiche, Laurent, Argaud, Frédéric, Aubrun, Geneviève, Barjon, Jean-Michel, Constantin, Gilles, Dhonneur, Jacques, Durand-Gasselin, Hervé, Dupont, Michèle, Genestal, Chloé, Goguey, Philippe, Goutorbe, Bertrand, Guidet, Hervé, Hyvernat, Samir, Jaber, Jean-Yves, Lefrant, Yannick, Mallédant, Jerôme, Morel, Alexandre, Ouattara, Nicolas, Pichon, Anne-Marie, Guérin Robardey, Michel, Sirodot, Alexandre, Theissen, Sandrine, Wiramus, Laurent, Zieleskiewicz, Marc, Leone, Carole, Ichai, Fabien, Lambiotte, Centre Hospitalier Universitaire de Nice (CHU Nice), Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hôpital de la Croix-Rousse [CHU - HCL], Centre Hospitalier Compiègne-Noyon (CHCN), Centre Hospitalier Compiègne-Noyon, CHU Clermont-Ferrand, CHU Amiens-Picardie, Département d'Anesthésie-Réanimation [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Hôpital d'Instruction des Armées Sainte Anne, Service de Santé des Armées, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Service d'anesthésie et de réanimation B, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), CHU Pontchaillou [Rennes], CHU Saint-Etienne, Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Service de Réanimation Polyvalente [CHU Limoges], CHU Limoges, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Hôpital Princesse Grace [Monaco], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), 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), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), 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), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Herrada, Anthony, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), 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 Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Critical Illness, Multiple Organ Failure, Middle Aged, Cohort Studies, Intensive Care Units, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Cause of Death, Humans, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Hospital Mortality, Prospective Studies, ComputingMilieux_MISCELLANEOUS, Aged
Abstract

International audience; Background: Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.Methods: An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest).Results: A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths.Conclusions: In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.

Published
2017
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7. CAESAR: a new tool to assess relatives' experience of dying and death in the ICU

Author

Maité Garrouste-Orgeas, Danielle Reuter, Alain Cariou, Bénédicte Philippon-Jouve, Jean Yves Lefrant, Pierre-Edouard Bollaert, Olivier Guisset, Marina Thirion, Nancy Kentish-Barnes, Sylvie Chevret, Fabienne Tamion, Ludivine Chalumeau-Lemoine, Jacques Durand-Gasselin, Hugues Georges, Armelle Mathonnet, Nathalie Rolin, Bruno Falissard, Isabelle Vinatier, Lucien Lecuyer, Christophe Cracco, Zoé Cohen-Solal, Amélie Seguin, Renaud Chouquer, Eddy Lebas, Mélanie Adda, Laurent Argaud, Elie Azoulay, Marc Leone, Jean-Philippe Rigaud, Stéphane Legriel, Anne Renault, Céline Dedrie, Béatrice Eon, Samir Jaber, Laurent Papazian, Gérald Viquesnel, Bernard Floccard, Valérie Seegers, Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service de Réanimation Médicale (BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre de recherche en éducation de Nantes (CREN), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital St-André, Réanimation, CHU Bordeaux [Bordeaux], Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Service de Soins Intensifs [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier de Dieppe, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente et des Maladies infectieuses, Centre Hospitalier Gustave Dron, Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de biostatistiques et information médicale [Saint-Louis], Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université Paris-Sud - Paris 11 (UP11), Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) - Université de Montpellier (UM) - Centre National de la Recherche Scientifique (CNRS), Pôle d'anesthésie-réanimation-urgences, CHU de Nimes - Hôpital Carémeau, Université de Nantes (UN), Centre Hospitalier Régional d'Orléans (CHR), Centre Hospitalier d'Angoulême, Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Henri Mondor, Service des soins intensives, CHU Caen, Hôpital Edouard Herriot, Hospices Civils de Lyon - Hôpital Edouard Herriot, Centre National de la Recherche Scientifique (CNRS) - IFR48 - Institut National de la Santé et de la Recherche Médicale (INSERM) - Aix Marseille Université (AMU) - Institut de Recherche pour le Développement (IRD), Service de Réanimation médicale, CHU Nancy, France, Assistance publique - Hôpitaux de Paris (AP-HP) - Groupe Hospitalier Saint-Louis-Lariboisière- Fernand-Widal - Université Paris Diderot - Paris 7 (UPD7), Université Joseph Fourier - Grenoble 1 (UJF) - Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale, Hôpital Charles Nicolle - CHU Rouen, Institut de Recherche et d'Innovation Biomédicale (IRIB), Université de Rouen Normandie, Normandie Université (NU) - Normandie Université (NU), 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) - Hôpital Paul Brousse - Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7) - Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Institut National de la Recherche Agronomique (INRA) - Université Paris Diderot - Paris 7 (UPD7) - Université Paris Descartes - Paris 5 (UPD5) - Université Paris 13 - Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint Louis Paris, CHU, Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4) - Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Montpellier (UM)-Université Montpellier 1 (UM1), Service de réanimation médicale [Rouen], and CHU Saint Louis [APHP]

Subjects
Male, medicine.medical_specialty, Attitude to Death, Time Factors, media_common.quotation_subject, Decision Making, Anxiety, Critical Care and Intensive Care Medicine, Hospital Anxiety and Depression Scale, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Surveys and Questionnaires, Medicine, Humans, Family, 030212 general & internal medicine, Prospective Studies, Intensive care medicine, Prospective cohort study, Depression (differential diagnoses), Qualitative Research, ComputingMilieux_MISCELLANEOUS, media_common, business.industry, Depression, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, Intensive care unit, Complicated grief, Intensive Care Units, Cohort, Commentary, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Grief, Female, medicine.symptom, business
Abstract

International audience; Purpose: To develop an instrument designed specifically to assess the experience of relatives of patients who die in the intensive care unit (ICU). Methods: The instrument was developed using a mixed methodology and validated in a prospective multicentre study. Relatives of patients who died in 41 ICUs completed the questionnaire by telephone 21 days after the death, then completed the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Inventory of Complicated Grief after 3, 6, and 12 months. Results: A total of 600 relatives were included, 475 in the main cohort and 125 in the reliability cohort. The 15-item questionnaire, named CAESAR, covered the patient's preferences and values, interactions with/around the patient and family satisfaction. We defined three groups based on CAESAR score tertiles: lowest (= 69, n = 121, 29.3 %). Factorial analysis showed a single dimension. Cronbach's alpha in the main and reliability cohorts was 0.88 (0.85-0.90) and 0.85 (0.79-0.89), respectively. Compared to a high CAESAR score, a low CAESAR score was associated with greater risks of anxiety and depression at 3 months [1.29 (1.13-1.46), p = 0.001], post-traumatic stress-related symptoms at 3 [1.34 (1.17-1.53), p < 0.001], 6 [OR = 1.24 (1.06-1.44), p = 0.008] and 12 [OR = 1.26 (1.06-1.50), p = 0.01] months and complicated grief at 6 [OR = 1.40 (1.20-1.63), p < 0.001] and 12 months [OR = 1.27 (1.06-1.52), p = 0.01]. Conclusions: The CAESAR score 21 days after death in the ICU is strongly associated with post-ICU burden in the bereaved relatives. The CAESAR score should prove a useful primary endpoint in trials of interventions to improve relatives' well-being.

Published
2016
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8. Complicated grief after death of a relative in the intensive care unit

Author

Elie Azoulay, Marina Thirion, Armelle Mathonnet, Marine Chaize, Isabelle Vinatier, Christophe Cracco, Lucien Lecuyer, Zoé Cohen-Solal, Amélie Seguin, Bénédicte Philippon-Jouve, Sylvie Chevret, Jacques Durand-Gasselin, Bernard Floccard, Jean-Philippe Rigaud, Céline Dedrie, Hugues Georges, Olivier Guisset, Pierre-Edouard Bollaert, Bruno Falissard, Valérie Seegers, Anne Renault, Alain Cariou, Nancy Kentish-Barnes, Béatrice Eon, Maité Garrouste, Danielle Reuter, Laurent Argaud, Eddy Lebas, Ludivine Chalumeau-Lemoine, Benoît Schlemmer, Nathalie Rolin, Jean-Yves Lefrant, Renaud Chouquer, Mélanie Adda, Samir Jaber, Gérard Viquesnel, Marc Leone, Stéphane Legriel, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4)-Centre National de la Recherche Scientifique (CNRS), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service de réanimation chirurgicale, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital St-André, Réanimation, CHU Bordeaux [Bordeaux], Hopital Saint-Louis [AP-HP] (AP-HP), Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Assistance Publique - Hôpitaux de Marseille (APHM), Centre hospitalier de Dieppe, Groupement Hospitalier - Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon (HCL), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente et des Maladies infectieuses, Centre Hospitalier Gustave Dron, Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de biostatistiques et information médicale [Saint-Louis], Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), 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 Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Intensivist, Anxiety, Hospital Anxiety and Depression Scale, Severity of Illness Index, law.invention, Stress Disorders, Post-Traumatic, Treatment Refusal, 03 medical and health sciences, 0302 clinical medicine, law, Severity of illness, medicine, Humans, Family, Prospective Studies, 030212 general & internal medicine, Psychiatry, ComputingMilieux_MISCELLANEOUS, media_common, Principal Component Analysis, Depression, business.industry, Communication, 030208 emergency & critical care medicine, Loneliness, medicine.disease, Intensive care unit, humanities, Complicated grief, 3. Good health, Death, Intensive Care Units, Female, Grief, medicine.symptom, Intubation, business
Abstract

An increased proportion of deaths occur in the intensive care unit (ICU). We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements. End-of-life care and communication in the ICU are associated with the prevalence of complicated grief

Published
2015
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9. Efficiency and safety of a noninvasive therapeutic hypothermia protocol in cardiac arrest

Author

Pierre Michelet, Didier Demory, Sophie de Bourmont, Gaëlle Corno, Jacques Durand-Gasselin, Jean-Michel Arnal, and Stéphane Donati

Subjects
Male, medicine.medical_treatment, Hemodynamics, Clinical Protocols, Hypothermia, Induced, medicine, Humans, In patient, Adverse effect, Saline, Surface cooling, Aged, Retrospective Studies, business.industry, Hypothermia, Middle Aged, medicine.disease, Hypokalemia, Heart Arrest, Treatment Outcome, Median time, Anesthesia, Emergency Medicine, Female, Medical emergency, medicine.symptom, business
Abstract

OBJECTIVES Therapeutic hypothermia (TH) is part of the treatment strategy for comatose survivors of cardiac arrest (CA). The aim of our study was to evaluate the efficiency and the safety of a noninvasive and affordable cooling procedure applied to all types of CA in an ICU. STUDY DESIGN This was a retrospective, observational, monocenter study. PATIENTS AND METHODS In all patients remaining unconscious after CA, irrespective of their initial cardiac rhythm, TH was induced with a rapid intravenous infusion of 30 ml/kg ice-cold (4°C) saline fluid associated with external surface cooling involving ice packs and wet sheets. The body temperature was maintained between 32 and 34°C during 24 h using external surface cooling only. The patients were then passively rewarmed. RESULTS Of 200 eligible patients, 145 were treated by TH; 104 patients completed the 24-h TH treatment. The primary cause of noninclusion or secondary exclusion was severe hemodynamic impairment. From induction, the median time to reach the target temperature was 167 min (47-300 min). During the protocol, 24 patients did not remain within the targeted temperature range. Adverse events included hypokalemia (44%), severe arrhythmia (13.8%), bleeding (4.8%), and seizure (1.4%). All patients presented hyperglycemia. The oxygen partial pressure to oxygen fractional concentration (PaO2/FiO2) ratio remained constant after initiation and throughout the procedure, even in patients with poor systolic function. CONCLUSION This noninvasive TH procedure seems efficient and safe in all patients remaining comatose after CA. Thanks to its simplicity, it could allow prehospital cooling to reach the target temperature more rapidly.

Published
2014

10. Safety and efficacy of a fully closed-loop control ventilation (IntelliVent-ASV®) in sedated ICU patients with acute respiratory failure: a prospective randomized crossover study

Author

Jacques Durand-Gasselin, Dominik Novotni, Didier Demory, Marc Wysocki, Gaëlle Corno, Ricardo Lopez, Jean-Michel Arnal, Isabelle Granier, and Stéphane Donati

Subjects
Male, ARDS, Safety Management, animal structures, Respiratory rate, medicine.medical_treatment, Respiratory physiology, Critical Care and Intensive Care Medicine, Plateau pressure, Outcome Assessment, Health Care, Medicine, Humans, Prospective Studies, Tidal volume, Aged, Monitoring, Physiologic, Mechanical ventilation, Aged, 80 and over, Respiratory Distress Syndrome, Cross-Over Studies, business.industry, Middle Aged, medicine.disease, Respiration, Artificial, Intensive Care Units, Anesthesia, embryonic structures, Breathing, Female, France, Deep Sedation, business, Respiratory minute volume
Abstract

IntelliVent-ASV® is a development of adaptive support ventilation (ASV) that automatically adjusts ventilation and oxygenation parameters. This study assessed the safety and efficacy of IntelliVent-ASV® in sedated intensive care unit (ICU) patients with acute respiratory failure. This prospective randomized crossover comparative study was conducted in a 12-bed ICU in a general hospital. Two periods of 2 h of ventilation in randomly applied ASV or IntelliVent-ASV® were compared in 50 sedated, passively ventilated patients. Tidal volume (V T), respiratory rate (RR), inspiratory pressure (P INSP), SpO2 and ETCO2 were continuously monitored and recorded breath by breath. Mean values over the 2-h period were calculated. Respiratory mechanics, plateau pressure (P PLAT) and blood gas exchanges were measured at the end of each period. There was no safety issue requiring premature interruption of IntelliVent-ASV®. Minute ventilation (MV) and V T decreased from 7.6 (6.5–9.5) to 6.8 (6.0–8.0) L/min (p

Published
2011

11. Postpartum cerebral angiopathy associated with the administration of sumatriptan and dihydroergotamine - a case report

Author

E. Garcia, A Geissler, M. D. Boespflug, Isabelle Granier, and Jacques Durand-Gasselin

Subjects
Adult, Cerebral arteries, Critical Care and Intensive Care Medicine, Dihydroergotamine, Angiopathy, Pregnancy, Oxytocics, medicine, Humans, Vasoconstrictor Agents, Ergonovine, medicine.diagnostic_test, Sumatriptan, business.industry, Vasospasm, Puerperal Disorders, medicine.disease, Cerebral Angiography, Obstetric Labor Complications, Cerebrovascular Disorders, Anesthesia, Angiography, Female, Headaches, medicine.symptom, Tomography, X-Ray Computed, business, Postpartum period, medicine.drug
Abstract

Cerebral angiopathy of the postpartum period is a rare entity, sometimes promoted by vasoconstrictives drug prescription. Its clinical presentation includes headaches, seizures and focal neurological deficits, which develop shortly after a normal pregnancy. The diagnosis is based on clinical findings and angiography, showing multiple narrowing of the intracranial cerebral arteries. This neurological feature is reversible and the clinical outcome is good. We report a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period, occurring after administration of sumatriptan and ergot derivates.

Published
1999
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12. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients

Author

Isabelle Granier, Didier Demory, Marc Wysocki, Jean-Michel Arnal, Jacques Durand-Gasselin, Stéphane Donati, and Gaëlle Corno

Subjects
Pressure-volume curves, Male, medicine.medical_specialty, ARDS, Critical Care, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Positive-Pressure Respiration, Internal medicine, Intensive care, medicine, Pressure, Tidal Volume, Humans, Lung volumes, Prospective Studies, Positive end-expiratory pressure, Tidal volume, Aged, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Middle Aged, medicine.disease, Treatment Outcome, Volume (thermodynamics), Anesthesia, Cardiology, Linear Models, Respiratory Mechanics, Female, Blood Gas Analysis, business
Abstract

To assess the hysteresis of the pressure–volume curve (PV curve) as to estimate, easily and at the bedside, the recruitability of the lung in ARDS patients. Prospective study. Twelve medico-surgical ICU beds of a general hospital. Twenty-six patients within the first 24 h from meeting ARDS criteria. A Quasi-static inflation and deflation PV curve from 0 to 40 cmH2O and a 40 cmH2O recruitment maneuver (RM) maintained for 10 s were successively done with an interval of 30 min in between. Hysteresis of the PV curve (H PV) was calculated as the ratio of the area enclosed by the pressure volume loop divided by the predicted body weight (PBW). The volume increase during the RM (V RM) was measured by integration of the flow required to maintain the pressure at 40 cmH2O and divided by PBW, as an estimation of the volume recruited during the RM. A positive linear correlation was found between H PV and V RM (r = 0.81, P

Published
2007

13. Automatic selection of breathing pattern using adaptive support ventilation

Author

Jean-Michel Arnal, Stéphane Donati, Gaëlle Corno, Isabelle Granier, Jacques Durand-Gasselin, Cyril Nafati, and Marc Wysocki

Subjects
Male, ARDS, Critical Care, medicine.medical_treatment, Respiratory physiology, Critical Care and Intensive Care Medicine, Pulmonary Disease, Chronic Obstructive, Intensive care, medicine, Tidal Volume, Humans, Prospective Studies, Tidal volume, Aged, Monitoring, Physiologic, Mechanical ventilation, COPD, Respiratory Distress Syndrome, Respiratory distress, business.industry, Middle Aged, medicine.disease, Respiration, Artificial, respiratory tract diseases, Anesthesia, Breathing, Respiratory Mechanics, Female, France, business
Abstract

In a cohort of mechanically ventilated patients to compare the automatic tidal volume (V T)–respiratory rate (RR) combination generated by adaptive support ventilation (ASV) for various lung conditions. Prospective observational cohort study in the 11-bed medicosurgical ICU of a general hospital. 243 patients receiving 1327 days of invasive ventilation on ASV. Daily collection of ventilator settings, breathing pattern, arterial blood gases, and underlying clinical respiratory conditions categorized as: normal lungs, ALI/ARDS, COPD, chest wall stiffness, or acute respiratory failure. Overall the respiratory mechanics differed significantly with the underlying conditions. In passive patients ASV delivered different V T–RR combinations based on the underlying condition, providing higher V T and lower RR in COPD than in ALI/ARDS: 9.3 ml/kg (8.2–10.8) predicted body weight (PBW) and 13 breaths/min (11–16) vs. 7.6 ml/kg (6.7–8.8) PBW and 18 breaths/min (16–22). In patients actively triggering the ventilator the V T–RR combinations did not differ between COPD, ALI/ARDS, and normal lungs. ASV selects different V T–RR combinations based on respiratory mechanics in passive, mechanically ventilated patients.

Published
2006

14. Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs

Author

Alain Geissler, Patrick Gerbeaux, Isabelle Granier, Karine Facon, Jacques Durand-Gasselin, and Philippe Blanc

Subjects
medicine.medical_specialty, medicine.drug_class, Antibiotics, Drug resistance, Critical Care and Intensive Care Medicine, medicine.disease_cause, law.invention, Microbial resistance, law, Anesthesiology, Drug Resistance, Bacterial, medicine, Humans, Intensive care medicine, Cross Infection, business.industry, Incidence (epidemiology), Incidence, Bacterial Infections, Health Care Costs, Middle Aged, Antimicrobial, Intensive care unit, Organizational Policy, Anti-Bacterial Agents, Intensive Care Units, Staphylococcus aureus, Emergency medicine, France, business, Algorithms
Abstract

Objective. To evaluate the impact of an intensive care unit (ICU) antibiotic-use policy on the microbial resistance in nosocomial infections and costs. Design. Comparative study before and after policy implementation. Settings. An eleven-bed ICU in a general hospital. Patients. All patients admitted for at least 48 h during a 5year period (1994–1998). Interventions. In 1995, implementation of an antibiotic-use policy. Measurements and main results. Patients' general characteristics, incidence of nosocomial infections, antibiotic-selective pressure (the number of days of antibiotic treatment for 1,000 days of presence in the ICU), presence and types of multi-resistant micro-organisms and costs linked to antibiotic use were recorded before (1994) and after implementation of the policy (1995–1998). For each year, patients' general characteristics and the incidence of nosocomial infections were the same. Costs linked to antibiotics use showed a progressive reduction (100% for 1994, 81% for 1995, 65% for 1998). Antibiotic-selective pressure diminished (from 940 days of antibiotic use per 1,000 days (1994) to 610 (1998), p

Published
2002

15. Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients

Author

Jacques Durand-Gasselin, Aude Garnero, Gaëlle Corno, Jean-Michel Arnal, Carol L. Hodgson, and David V. Tuxen

Subjects
Male, Spirometry, ARDS, Time Factors, Critical Care and Intensive Care Medicine, Positive-Pressure Respiration, medicine, Humans, Lung volumes, Prospective Studies, Respiratory system, Prospective cohort study, Lung, Positive end-expiratory pressure, Aged, Respiratory Distress Syndrome, medicine.diagnostic_test, business.industry, Research, respiratory system, medicine.disease, respiratory tract diseases, Compliance (physiology), medicine.anatomical_structure, Anesthesia, Female, Lung Volume Measurements, business, circulatory and respiratory physiology
Abstract

Introduction Lung recruitment maneuvers followed by an individually titrated positive end-expiratory pressure (PEEP) are the key components of the open lung ventilation strategy in acute respiratory distress syndrome (ARDS). The staircase recruitment maneuver is a step-by-step increase in PEEP followed by a decremental PEEP trial. The duration of each step is usually 2 minutes without physiologic rationale. Methods In this prospective study, we measured the dynamic end-expiratory lung volume changes (ΔEELV) during an increase and decrease in PEEP to determine the optimal duration for each step. PEEP was progressively increased from 5 to 40 cmH2O and then decreased from 40 to 5 cmH2O in steps of 5 cmH2O every 2.5 minutes. The dynamic of ΔEELV was measured by direct spirometry as the difference between inspiratory and expiratory tidal volumes over 2.5 minutes following each increase and decrease in PEEP. ΔEELV was separated between the expected increased volume, calculated as the product of the respiratory system compliance by the change in PEEP, and the additional volume. Results Twenty-six early onset moderate or severe ARDS patients were included. Data are expressed as median [25th-75th quartiles]. During the increase in PEEP, the expected increased volume was achieved within 2[2-2] breaths. During the decrease in PEEP, the expected decreased volume was achieved within 1 [1–1] breath, and 95 % of the additional decreased volume was achieved within 8 [2–15] breaths. Completion of volume changes in 99 % of both increase and decrease in PEEP events required 29 breaths. Conclusions In early ARDS, most of the ΔEELV occurs within the first minute, and change is completed within 2 minutes, following an increase or decrease in PEEP.

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16. Feasibility study on full closed-loop control ventilation (IntelliVent-ASV™) in ICU patients with acute respiratory failure: a prospective observational comparative study

Author

Aude Garnero, Laurent Ducros, Didier Demory, Stéphane Donati, Dominik Novonti, Samir Jaber, Jean-Michel Arnal, Gaëlle Corno, Jacques Durand-Gasselin, and Audrey Berric

Subjects
Male, medicine.medical_specialty, ARDS, Respiratory physiology, Critical Care and Intensive Care Medicine, Intermittent Positive-Pressure Ventilation, Tidal Volume, medicine, Humans, Prospective Studies, Intensive care medicine, Prospective cohort study, Tidal volume, Aged, COPD, Lung, business.industry, Research, Oxygenation, Middle Aged, medicine.disease, Intensive Care Units, medicine.anatomical_structure, Anesthesia, Acute Disease, Breathing, Feasibility Studies, Female, Respiratory Insufficiency, business
Abstract

Introduction IntelliVent-ASV™ is a full closed-loop ventilation mode that automatically adjusts ventilation and oxygenation parameters in both passive and active patients. This feasibility study compared oxygenation and ventilation settings automatically selected by IntelliVent-ASV™ among three predefined lung conditions (normal lung, acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD)) in active and passive patients. The feasibility of IntelliVent-ASV™ use was assessed based on the number of safety events, the need to switch to conventional mode for any medical reason, and sensor failure. Method This prospective observational comparative study included 100 consecutive patients who were invasively ventilated for less than 24 hours at the time of inclusion with an expected duration of ventilation of more than 12 hours. Patients were ventilated using IntelliVent-ASV™ from inclusion to extubation. Settings, automatically selected by the ventilator, delivered ventilation, respiratory mechanics, and gas exchanges were recorded once a day. Results Regarding feasibility, all patients were ventilated using IntelliVent-ASV™ (392 days in total). No safety issues occurred and there was never a need to switch to an alternative ventilation mode. The fully automated ventilation was used for 95% of the total ventilation time. IntelliVent-ASV™ selected different settings according to lung condition in passive and active patients. In passive patients, tidal volume (VT), predicted body weight (PBW) was significantly different between normal lung (n = 45), ARDS (n = 16) and COPD patients (n = 19) (8.1 (7.3 to 8.9) mL/kg; 7.5 (6.9 to 7.9) mL/kg; 9.9 (8.3 to 11.1) mL/kg, respectively; P 0.05). In passive ARDS patients, FiO2 and positive end-expiratory pressure (PEEP) were statistically higher than passive normal lung (35 (33 to 47)% versus 30 (30 to 31)% and 11 (8 to 13) cmH2O versus 5 (5 to 6) cmH2O, respectively; P< 0.05). Conclusions IntelliVent-ASV™ was safely used in unselected ventilated ICU patients with different lung conditions. Automatically selected oxygenation and ventilation settings were different according to the lung condition, especially in passive patients. Trial Registration ClinicalTrials.gov: NCT01489085

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