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54. PACMAN trial protocol, Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac major surgery: a randomised, multicentre, double-blind, superiority study

Author

Asehnoune, Karim, Futier, Emmanuel, Feuillet, Fanny, Roquilly, Antoine, Lasocki, Sigismond, Huet, Olivier, Bazin, Jean Etienne, Paugam Burtz, Catherine, Le Moal, C, Lebuffe, G., Belliard, Guillaume, Rimmele, Thomas, Piriou, Vincent, Bruder, Nicolas, Marc, Leone, Mokart, D., Jaber, Samir, Chatel-Josse, Nolwen, Rozec, Bertrand, Simonneau, Frederic, Capron, F., Cuvillon, Philippe, Beaussier, Marc, Plaud, Benoit, Mantz, J., Debaenne, Bertrand, Charbit, B., Beloeil, Helene, Dureuil, Bertrand, Molliex, Serge, Pottecher, Julien, Geeraerts, Thomas, Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Clermont-Ferrand, Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Université de Nantes (UN), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier universitaire de Nantes [CHU Nantes], and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)

Subjects
Male, Respiratory Tract Diseases, law.invention, Anaesthesia, surgery, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, Clinical Protocols, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Acute care, Protocol, 030212 general & internal medicine, Infusions, Intravenous, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, General Medicine, Middle Aged, 3. Good health, Surgical Procedures, Operative, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Corticosteroid, Female, Risk Adjustment, medicine.drug, medicine.medical_specialty, Critical Care, post-operative complications, medicine.drug_class, Trial protocol, dexamethasone, Placebo, Perioperative Care, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Humans, pneumonia, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Mortality, Glucocorticoids, Dexamethasone, Inflammation, business.industry, Perioperative, Length of Stay, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Surgery, Pneumonia, glucocorticoid, business, 030217 neurology & neurosurgery
Abstract

IntroductionPostoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival after surgery. An excessive postoperative inflammatory response participates to the development of postoperative infection and mortality. The aim of the Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac surgery (PACMAN) study is to assess the effectiveness of perioperative administration of corticosteroid to reduce postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.Methods and analysisThe PACMAN is a multicentre, randomised, controlled, double-blind, superiority, two-arm trial of 1222 high-risk patients aged 50 years or older undergoing major non-cardiac surgery at 32 acute care hospital in France. Patients are randomly assigned to dexamethasone (0.2 mg/kg at the end of the surgical procedure and at day +1, n=611) or to placebo (n=611). The primary outcome is a composite of predefined 14-day major pulmonary complications and mortality. Secondary outcomes are surgical complications, infections, organ failures, critical care-free days, length of hospital stay and all-cause mortality at 28 days.Ethics and disseminationThe PACMAN trial protocol has been approved by the ethics committee of Sud Mediterranée V, and will be carried out according to the Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The PACMAN trial is a randomised controlled trial powered to investigate whether perioperative administration of corticosteroids in patients undergoing non-cardiac major surgery reduces postoperative complications. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT03218553; Pre-results.

Published
2019
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65. Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest?

Author

Bougouin, Wulfran, primary, Dumas, Florence, additional, Karam, Nicole, additional, Maupain, Carole, additional, Marijon, Eloi, additional, Lamhaut, Lionel, additional, Jost, Daniel, additional, Geri, Guillaume, additional, Beganton, Frankie, additional, Varenne, Olivier, additional, Spaulding, Christian, additional, Jouven, Xavier, additional, Cariou, Alain, additional, Adnet, F., additional, Agostinucci, J.M., additional, Aissaoui-Balanant, N., additional, Albuisson, J., additional, Algalarrondo, V., additional, Alla, F., additional, Annane, D., additional, Antoine, C., additional, Aubry, P., additional, Azoulay, E., additional, Beganton, F., additional, Benhamou, D., additional, Bougouin, W., additional, Bruel, C., additional, Cariou, A., additional, Carli, P., additional, Cerf, C., additional, Chaib, A., additional, Chastre, J., additional, Cohen, Y., additional, Combes, A., additional, Cornaglia, C., additional, Da Silva, D., additional, Das, V., additional, Demoule, A., additional, Deye, N., additional, Dhonneur, G., additional, Diehl, J.L., additional, Dinanian, S., additional, Domanski, L., additional, Dreyfuss, D., additional, Duboc, D., additional, Dubois-Rande, J.L., additional, Dubourg, O., additional, Duchateau, F.X., additional, Dumas, F., additional, Empana, J.P., additional, Extramiana, F., additional, Fagon, J.Y., additional, Fartoukh, M., additional, Fenioux, C., additional, Fieux, F., additional, Fraisse, F., additional, Gabbas, M., additional, Gandjbakhch, E., additional, Guidet, B., additional, Henry, P., additional, Hidden Lucet, F., additional, Jabre, P., additional, Jacob, L., additional, Joseph, L., additional, Jost, D., additional, Journois, D., additional, Jouven, X., additional, Karam, N., additional, Kassim, H., additional, Lahlou-Laforet, K., additional, Lamhaut, L., additional, Lanceleur, A., additional, Langeron, O., additional, Lanoe, V., additional, Lecarpentier, E., additional, Leenhardt, A., additional, Lellouche, N., additional, Lemiale, V., additional, Linval, F., additional, Loeb, T., additional, Ludes, B., additional, Maltret, A., additional, Mansouri, N., additional, Mantz, J., additional, Marijon, E., additional, Marty, J., additional, Maury, E., additional, Maxime, V., additional, Mekontso-Dessaps, A., additional, Mira, J.P., additional, Monnet, X., additional, Perier, M.C., additional, Piot, O., additional, Pirraccchio, R., additional, Plu, I., additional, Raux, M., additional, Revaux, F., additional, Ricard, J.D., additional, Richard, C., additional, Riou, B., additional, Roussin, F., additional, Santoli, F., additional, Schortgen, F., additional, Sharshar, T., additional, Sideris, G., additional, Spaulding, C., additional, Teboul, J.L., additional, Timsit, J.F., additional, Tourtier, J.P., additional, Tuppin, P., additional, Ursat, C., additional, Varenne, O., additional, Vieillard-Baron, A., additional, Voicu, S., additional, and Wahbi, K., additional

Published
2018
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73. Comfort and patient-centred care without excessive sedation: the eCASH concept.

Author

Spies C., Conti G., Funk G.-C., Badenes R., Mantz J., Takala J., Vincent J.-L., Shehabi Y., Walsh T.S., Pandharipande P.P., Ball J.A., Spronk P., Longrois D., Strom T., Spies C., Conti G., Funk G.-C., Badenes R., Mantz J., Takala J., Vincent J.-L., Shehabi Y., Walsh T.S., Pandharipande P.P., Ball J.A., Spronk P., Longrois D., and Strom T.

Abstract

We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified.Copyright © 2016, The Author(s).

Published
2016

80. Prévention de la dépendance liée au vieillissement

Author

Michel, Jean-Pierre, primary, Dreux, Claude, additional, Vacheron, André, additional, Bégué, P., additional, Cabanis, E.A., additional, Charpentier, B., additional, Dreux, C., additional, Dubousset, J., additional, Dubois, G., additional, Duhamel, J.F., additional, Jaffiol, C., additional, Lecomte, D., additional, Mantz, J.-M., additional, Mattéi, J.F., additional, Michel, J.-P., additional, Nicolas, G., additional, Olié, J.-P., additional, Rouëssé, J., additional, Safavian, A., additional, Sallé, B., additional, Spira, A., additional, Touitou, Y., additional, Vacheron, A., additional, Blanchet, F., additional, Chast, F., additional, Gobert, J.-G., additional, Trivin, F., additional, Vigneron, C., additional, Wautier, J.-L., additional, Brugère, H., additional, Girard, M., additional, and Laplace, J.-P., additional

Published
2015
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82. TRANSCRIPTOME ANALYSIS OF VENTILATOR ASSOCIATED PNEUMONIA IN TRAUMA PATIENTS THE SEPSICHIP PROJECT

Author

Textoris, J., Loriod, B., Benayoun, L., Huet, O., Gourraud, P. -A, Antonini, F., Puthier, D., Mantz, J., Martin, C., Nguyen, C., Marc Leone, Spinelli, Lionel, Technologies avancées pour le génôme et la clinique (TAGC), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), ORL et Chirurgie cervico-faciale pédiatrique - [Hôpitaux Timone et Nord - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Aix Marseille Université (AMU)- Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)- Hôpital Nord [CHU - APHM]

Subjects
[SDV] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], ComputingMilieux_MISCELLANEOUS
Abstract

International audience; no abstract

Published
2009

84. Sedation in non-invasive ventilation: do we know what to do (and why)?

Author

Longrois, D, Conti, Giorgio, Mantz, J, Faltlhauser, A, Aantaa, R, Tonner, P., Conti, Giorgio (ORCID:0000-0002-8566-9365), Longrois, D, Conti, Giorgio, Mantz, J, Faltlhauser, A, Aantaa, R, Tonner, P., and Conti, Giorgio (ORCID:0000-0002-8566-9365)

Abstract

This review examines some of the issues encountered in the use of sedation in patients receiving respiratory support from non-invasive ventilation (NIV). This is an area of critical and intensive care medicine where there are limited (if any) robust data to guide the development of best practice and where local custom appears to exert a strong influence on patterns of care. We examine aspects of sedation for NIV where the current lack of structure may be contributing to missed opportunities to improve standards of care and examine the existing sedative armamentarium. No single sedative agent is currently available that fulfils the criteria for an ideal agent but we offer some observations on the relative merits of different agents as they relate to considerations such as effects on respiratory drive and timing, and airways patency. The significance of agitation and delirium and the affective aspect(s) of dyspnoea are also considered. We outline an agenda for placing the use of sedation in NIV on a more systematic footing, including clearly expressed criteria and conditions for terminating NIV and structural and organizational conditions for prospective multicentre trials.

Published
2014

88. La prévention en santé chez les adolescents

Author

Dreux, Claude, primary, Bégué, P., additional, Cabanis, E.-A., additional, Charpentier, B., additional, Dreux, C., additional, Dubois, G., additional, Duhamel, J.-F., additional, Flahault, A., additional, Huguier, M., additional, Jaffiol, C., additional, Lecomte, D., additional, Mantz, J.-M., additional, Mattéi, J.-F., additional, Nicolas, G., additional, Olié, J.-P., additional, Rouëssé, J., additional, Safavian, A., additional, Salle, B., additional, Spira, A., additional, Touitou, Y., additional, Vacheron, A., additional, Blanchet, F., additional, Chast, F., additional, Gobert, J.-G., additional, Trivin, F., additional, Vigneron, C., additional, Wautier, J.-L., additional, Brugère, H., additional, Girard, M., additional, Laplace, J.-P., additional, Maugendre, M.N., additional, and Haidoux, C., additional

Published
2014
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90. Évaluation du Risque CARDiaque de l’Opéré (RICARDO) : enquête nationale auprès des anesthésistes-réanimateurs concernant la prise en charge périopératoire du patient à risque cardiaque

Author

Sens, N., primary, Payan, A., additional, Sztark, F., additional, Piriou, V., additional, Bouaziz, H., additional, Bruder, N., additional, Jaber, S., additional, Jouffroy, L., additional, Lebuffe, G., additional, Mantz, J., additional, Roche, S., additional, and Tauzin-Fin, F., additional

Published
2013
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