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174 results on '"Stéphane Gaudry"'

101. Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury

Author

Michael Darmon, Stuart L. Goldstein, David Gattas, Eric Hoste, Ron Wald, Stéphane Gaudry, Marlies Ostermann, Fredric O. Finkelstein, Sean M. Bagshaw, Ashita Tolwani, and Shigehiko Uchino

Subjects
medicine.medical_specialty, Critical Care, medicine.medical_treatment, Critical Illness, 030232 urology & nephrology, urologic and male genital diseases, Critical Care and Intensive Care Medicine, law.invention, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Anesthesiology, medicine, Humans, Renal replacement therapy, Medical prescription, Intensive care medicine, business.industry, Acute kidney injury, Reproducibility of Results, 030208 emergency & critical care medicine, Acute Kidney Injury, medicine.disease, Intensive care unit, female genital diseases and pregnancy complications, Renal Replacement Therapy, Practice Guidelines as Topic, business, Kidney disease
Abstract

Acute kidney injury (AKI) is associated with incremental risk for death and chronic kidney disease and represents a mounting clinical challenge for healthcare professionals. Renal replacement therapy (RRT) use in ICU settings is rising, likely in response to similar trends in AKI, taken together with an ageing population burdened by high prevalence of multi-morbidity and high illness acuity. Numerous features of RRT prescription and delivery are not standardized, nor are they supported from high-quality evidence derived from randomized trials. Despite the publication of rigorous clinical practice guidelines focused on RRT for AKI that are intended to optimize the quality and reliability of RRT in ICU settings, practice patterns and outcomes continue to show significant variability. In this concise review, we aim to summarize new knowledge and recent advances for the provision of RRT for critically ill patients with AKI.

Published
2017

102. Some remaining important questions after LUNG SAFE: Discussion of 'Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study'

Author

Stéphane Gaudry, Fabiana Madotto, John G. Laffey, Didier Dreyfuss, Dreyfuss, D, Gaudry, S, Madotto, F, and Laffey, J

Subjects
medicine.medical_specialty, Lung, business.industry, Pain medicine, Acute Lung Injury, MEDLINE, Respiratory Distress Syndrome, Adult, Acute respiratory distress, Critical Care and Intensive Care Medicine, Respiration, Artificial, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Anesthesiology, medicine, RESPIRATORY DISTRESS SYNDROME ADULT, 030212 general & internal medicine, Intensive care medicine, business, Human
Published
2017

103. Use of Desmopressin Acetate in Severe Hyponatremia in the Intensive Care Unit

Author

Romain Miguel-Montanes, Cédric Rafat, Frédérique Schortgen, Jean-Damien Ricard, David Hajage, Didier Dreyfuss, Fabrice Bertrand, Vincent Labbé, and Stéphane Gaudry

Subjects
Adult, Male, Paris, medicine.medical_specialty, Time Factors, Epidemiology, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, Interquartile range, law, Intensive care, Severity of illness, medicine, Humans, Desmopressin Acetate, Deamino Arginine Vasopressin, Aged, Retrospective Studies, Aged, 80 and over, Transplantation, business.industry, Sodium, Original Articles, Middle Aged, medicine.disease, Intensive care unit, Surgery, Intensive Care Units, Treatment Outcome, Nephrology, Anesthesia, Urine osmolality, Central pontine myelinolysis, Female, Hyponatremia, business, Biomarkers
Abstract

Excessive correction of chronic and profound hyponatremia may result in central pontine myelinolysis and cause permanent brain damage. In the case of foreseeable or established hyponatremia overcorrection, slowing down the correction rate of sodium plasma levels (PNa) or reinducing mild hyponatremia may prevent this neurologic complication.This retrospective and observational study was performed with 20 consecutive patients admitted to two intensive care units for severe hyponatremia, defined by PNa120 mmol/L and/or neurologic complications ascribable to hyponatremia and subsequently treated by desmopressin acetate (DDAVP) during correction of hyponatremia when the rate of correction was overtly or predictably excessive. The primary endpoint was the effectiveness of DDAVP on PNa control.DDAVP dramatically decreased the rate of PNa correction (median 0.81 mmol/L per hour [interquartile range, 0.46, 1.48] versus -0.02 mmol/L per hour [-0.16, 0.22] before and after DDAVP, respectively; P0.001) along with a concurrent decrease in urine output (650 ml/h [214, 1200] versus 93.5 ml/h [43, 143]; P=0.003), and a rise in urine osmolarity (86 mmol/L [66, 180] versus 209 mmol/L [149, 318]; P=0.002). The maximal magnitude of PNa variations was also markedly reduced after DDAVP administration (11.5 mmol/L [8.25, 14.5] versus 5 mmol/L [4, 6.75]; P0.001). No patient developed seizures after DDAVP or after subsequent relowering of PNa that occurred in 11 patients.Desmopressin acetate is effective in curbing the rise of PNa in patients admitted in the intensive care unit for severe hyponatremia, when the initial rate of correction is excessive.

Published
2014

104. Reply: 'Procedural Considerations on the Use of Polyurethane and/or Conical Cuffs'; 'Estimating the Risk of Ventilator-associated Pneumonia as a Function of Time'; 'Is Tracheobronchial Colonization a Good Marker for Microaspiration in Intubated Critically Ill Patients?'; and 'Translating In Vitro Research: Improving Endotracheal Tube Bench Test Methodology'

Author

Laurent Quinquis, Benoit Misset, François Philippart, Stéphane Gaudry, Sophie Grabar, Jean-Damien Ricard, Islem Ouanes, and Xavier Forceville

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Critically ill, Ventilator-associated pneumonia, Critical Care and Intensive Care Medicine, medicine.disease, Bench test, Intubation, Intratracheal, Pneumonia, Bacterial, medicine, Humans, Female, Intensive care medicine, business, Endotracheal tube
Published
2015

105. Severe Measles Infection

Author

Sonia Machado, Jean-Louis Teboul, Stéphane Gaudry, Olivier Guisset, Antoine Roch, Matthieu Schmidt, Kada Klouche, Romain Sonneville, Didier Dreyfuss, Claude Guérin, Michael Darmon, Jonathan Messika, Cédric Rafat, Frank Chemouni, Natacha Mrozek, Emmanuelle Mercier, Jean-Damien Ricard, and Wilfried Pujol

Subjects
ARDS, medicine.medical_specialty, Pediatrics, business.industry, General Medicine, medicine.disease, medicine.disease_cause, Intensive care unit, Measles, law.invention, Vaccination, Pneumonia, law, SAPS II, Superinfection, medicine, Original Study, Intensive care medicine, business, Pneumonitis
Abstract

France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases of measles were confirmed by serologic testing and/or reverse transcription polymerase chain reaction. The cohort consisted of 21 male and 15 female patients, with a median age of 29.2 years (25th–75th interquartile range [IQR], 27.2–34.2 yr) and a median Simplified Acute Physiology Score (SAPS II) of 13 (IQR, 9–18). Among the 26 patients whose measles vaccination status was documented, none had received 2 injections. One patient had developed measles during childhood. Underlying comorbid conditions included chronic respiratory disease in 9 patients, immunosuppression in 7 patients, and obesity in 3 patients, while measles affected 5 pregnant women. Respiratory complications induced by measles infection led to ICU admission in 32 cases, and measles-related neurologic complications led to ICU admission in 2 cases. Two patients were admitted due to concurrent respiratory and neurologic complications. Bacterial superinfection of measles-related airway infection was suspected in 28 patients and was documented in 8. Four cases of community-acquired pneumonia, 6 cases of ventilator-associated pneumonia, 1 case of tracheobronchitis, and 2 cases of sinusitis were microbiologically substantiated. Of 11 patients who required mechanical ventilation, 9 developed acute respiratory distress syndrome (ARDS). Among the patients with ARDS, extraalveolar air leak complications occurred in 4 cases. Five patients died, all of whom were severely immunocompromised. On follow-up, 1 patient had severe chronic respiratory failure related to lung fibrosis, and 2 patients had mild lower limb paraparesis along with bladder dysfunction, both of which were ascribable to measles-induced encephalitis and myelitis. Among the 5 pregnant patients, the course of measles infection was uneventful, albeit 1 patient underwent emergent cesarean delivery because of fetal growth restriction. Measles is a disease with protean and potentially deceptive clinical manifestations, especially in the immunocompromised patient. Measles-associated pneumonitis and its complications, and less commonly postinfectious encephalomyelitis, are the main source of morbidity and mortality. In contrast with the usually benign course of the disease in immunocompetent patients, measles occurring in immunocompromised patients gives rise to lethal complications including ARDS, with or without bacterial superinfection. Other patients potentially at high risk for severe measles are young adults and pregnant women. Measles pneumonitis may predispose to air leak disease in patients using mechanical ventilation. To date, vaccination remains the most potent tool to control measles infection.

Published
2013

106. Clinical Features and Outcomes in Patients With Disseminated Toxoplasmosis Admitted to Intensive Care: A Multicenter Study

Author

Romain Sonneville, Keyvan Razazi, Alexandre Demoule, Rebecca Hamidfar, Naïke Bigé, Stéphane Gaudry, Antoine Marty, François Vincent, Vincent Castelain, Nicolas Mongardon, Charles Edouard Luyt, Matthieu Schmidt, Martin Dres, David Schnell, Vincent Das, Julien Mayaux, and Jean-Baptiste Micol

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Kaplan-Meier Estimate, law.invention, Immunocompromised Host, Interquartile range, law, Intensive care, Internal medicine, medicine, Risk of mortality, Humans, Intensive care medicine, Retrospective Studies, business.industry, Mortality rate, Hazard ratio, Retrospective cohort study, Length of Stay, Middle Aged, Prognosis, medicine.disease, Intensive care unit, Toxoplasmosis, Intensive Care Units, Treatment Outcome, Infectious Diseases, Female, France, Respiratory Insufficiency, business
Abstract

BACKGROUND Characteristics and outcomes of adult patients with disseminated toxoplasmosis admitted to the intensive care unit (ICU) have rarely been described. METHODS We performed a retrospective study on consecutive adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICUs of 14 university-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting >1 organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on admission and risk factors for 60-day mortality were collected. RESULTS Thirty-eight patients were identified during the study period. Twenty-two (58%) had received an allogeneic hematopoietic stem cell transplant (median, 61 [interquartile range {IQR}, 43-175] days before ICU admission), 4 (10%) were solid organ transplant recipients, and 10 (27%) were infected with human immunodeficiency virus (median CD4 cell count, 14 [IQR, 6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). The 60-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplant (hazard ratio [HR] = 2.28; 95% confidence interval [CI], 1.05-5.35; P = .04) and systolic cardiac dysfunction (HR = 3.54; 95% CI, 1.60-8.10; P < .01) within 48 hours of ICU admission were associated with mortality. CONCLUSIONS Severe disseminated toxoplasmosis leading to ICU admission has a poor prognosis. Recipients of allogeneic hematopoietic stem cell transplant appear to have the highest risk of mortality. We identified systolic cardiac dysfunction as a major determinant of outcome. Strategies aimed at preventing this fatal opportunistic infection may improve outcomes.

Published
2013

107. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study

Author

Odile Fremin-Batteux, Juliette Clarissou-Philippe, Benoît Jauhlac, Severine Guyetand, Jacques Gasnault, Corinne Haioun, Liamine Aissaoui, Marie-Christine Pages, Marie-Pierre Fos, Christian Rose, Didier Hubert, Marie-Rose Rothe, N. Bouziges, Benoît Huc, François Devianne, Sabine Bidart, Anne Forest, Kevin Bertrand, Mohamed Eldeghedy, Annick Verhaeghe, Caroline Malderet, Anne Bertrou, Bernard Guerquin, Catherine Duche, Muriel Archambaud, Rabea Cotteret, Olivier Toullalan, Yves Devaux, Smail Bergheul, Valérie Sivadon-Tardy, Pierre-Gilles Merville, Geneviève Blanchard-Marche, Didier Raoult, Bernard Hory, Florence Richardin, Evelyne Belle, Mohamed Menouar, K Guitteaud, Mohamad Mohty, Ambroise Montcriol, Max Laurin, Aurélia Picard, Jean-Paul Mira, Marie-Charlotte Chopin, Richard Bonnet, Michel Wolff, Sébastien Maillez, Jeanne Maugein, Véronique Leblond, Nicola Walid, Bernard Gauche, Mathieu Evillard, Hassen Jeddi, Anne Bourlet, Isabelle Grawey, Thierry Jault, Sandrine Hiret, Valerie Gaborieau, Véronique Boin-Gay, An Kim, Thierry Constans, Jean-François Gaide, Martine Giraud, Eric Meaudre Desgouttes, Alain Fur, Abdallah Maakaroun, Olivier Matray, Bertrand Maubert, Frédérique Péchinot, Aurelie Garbi, Claire Delbrouck, Benoît Grandclerc, Vincent Cadiergue, Hervé Lécuyer, Bernadette Grignon, Thierry Bensaid, Nicole Constantin, Yannick Chevalier, Hassène Rahmani, Thierry Levent, Joelle Desliers, Florence Van de Velde, Xavier Adhoute, Clara Andriau, Christophe Charasse, Rémi Vatan, Benoît Martha, Alain Lecis, Didier Albert, Romain Jacobs, Hélène Lefranc, Christian Martin, Nasseur Rezgui, Bertrand Pigeon, Catherine Le Henaff, Dominique Cassignard, Françoise Cotes, Eric Pujade Lauraine, Jean-François Gattault, Nicole Ferreira-Maident, Noémie Jourde-Chiche, Hélène Garrec, Olivier Darchen, Carole Schwebel, Marie-Christine Bezian, Patrick Daoud, Tsouria Becaid, Simone Laluque, David Broche, Christine Boisselier, Pascale Martres, Sarah Hammami, Brigitte Olivier, Jean-Marie Nkunzimana, Eric Monlun, Isabelle Marterl-Lafay, Marion Carboni, Marie-Françoise Mattei, Sandrine Castelin, Isabelle Barillot, Marie-Noelle Cufi, Thomas Kaiser, Catherine Herry, Pascal Hutin, Jean-Pierre Bronowicki, Bernard Branger, Pierre Thomas, Elie Zagdoun, Anne Goquelin, Ziad Assaf, Ingrid Croquet, Bruno Pozzetto, Thomas Similowski, Anne-Isabelle Briere, Marie-Thérèse Albertini, Mariam Blaka, Christelle Tassot, Anne Gaschet, Jean-Philippe Lavigne, Antoine Pujol, Philippe Colombat, Edouard Devaud, Hana Talabani-Boizot, François Barière, Anne-Marie Cordier, Philippe Gueudet, Georges Simon, Anne-Sophie Lipovac, Françoise Bandaly, Anne Beauplet-Lepage, Sylvie Prince, Charlotte Jouzel, Jean-Luc Deboutin, Patrick Zavadil, Louis Puybasset, Marie-Cécile Petit, Loïc Guillevin, Kamel Touati, Christophe Ntalu Nkato, Sylvie Carette, Jacques Vaucel, Chantal Delasalle, Marine Gross Goupil, Laurent Gutmann, Christiane Payen, Annick Barboteau, Firouzé Bani-Sadr, Christophe Legendre, Philippe Roulier, Elie Azria, Ibrahim Farah, Isabelle Rouquette-Vincent, Anne-Sophie Erena-Penet, Philippe Labadie, Eric Josien, Aicha Derragui, Mathieu Legrand, Odile Beyne-Rauzy, Jean-Marc Nabholtz, Marie-Joelle Demarcq, Olivier Garosi, Michel Deiber, Fabrice Chaix, Bertrand Souweine, Anne Collignon, Gisèle Renard, Mickael Jego, Gilles Bernardin, Anne Allart, Jocelyn Barrier, Marc Vasse, Philippe Ménager, Marc Wurmser, Abderkader Ouazir, Olivier Gontieron, Yvon Berland, Sébastien Trouiller, David Leysenne, Christophe Ozanon, Fanny Autret, Tahar Saghi, Loïc Dopeux, Sophie Benoit-Coustou, T. Fraisse, Christine Maillard, Karine Nikodijevic, Georges Kaltenbach, Angéline Jamet, Philippe Aucher, Julie Bottero, Marie-Claude Piffaut, Marianne Besnard, Florence Courillon, Marie Bonfils, Christine Ghevaert, Marie Destors, Eliette Jeanmaire, Franck Zerbib, Manuel-Luis Gameiro, T Prazuck, Laurent Mandin, Olivier Guisset, Marguerite Fines, Toufik Feddal, Agnès Jouffret, Louis Mesnard, Thomas Bourrée, Hasinrina Razafimahefa, Sylvestre Tigaud, Vincent Estève, Philippe Malherbe, Jean-Michel Salord, Pascal Adam, Bertrand Rozec, Michel Fuillet, Olivier Lemenand, Denis Quinsat, Ana Danalaché, Véronique Vialette, François Brosset, Patrick Messner Pellenc, Nicolas Heisel, Edouard Girard, Régine Martin, Olivier Garesslin, Catherine Mille, Alexandre Gascon, Marc Nicolino, Laurence Mouly, Claire Fabre, Bénédicte Ponceau, Marie-Etiennette Emeriau, Pascal Cathebras, Bérangère Bernardaud, Michèle Pérouse de Montclos, O. Arsene, Karine Grenet, Yazdan Yazdanpanah, Sten De Witte, Anne Scemla, Laurence Bouillet, Christophe Burucoa, Vincent Loffeier, Séverine Visentin, Luc Desfrere, Miloud Arabi, Frédérique Costa, Sylvie Lechat, Ali Chekroun, Raymond Ruimy, Marie, Jérôme Bizet, Xavier Nassif, Baihas Dib, Patrick Bert-Marcaz, Laurent Martin Lefèvre, Nicholas Sedillot, Blandine Cattier, Emilie Boidin, Daniel Sondag, Aude Bourrouillou, Alain Noirot, Franck Desemerie, Fréderic Heluwaert, Catherine Tamalet, Marc G. Berger, Jean-Daniel Lelièvre, Dominique Perotin, Abdelkader Bemrah, Alain Lozniewski, Bernard Borstein, Hanna Eid, Diana Suatean, Virginie Mignaut, Jean-Claude N'guyen, Valérie Le Goff, Laurent Teillet, Christophe Rolland, Gwenaël Alfonsi, Florence Lachenal, Philippe Bossi, Yves Botreau, Florence Doucet Populaire, Henry Jardel, Nicolas Gallo, Elias Jabre-Sikias, Michel Dupon, Hélène Brihier, Isabelle Patry, Alexandre Leclercq, Bernadette Tourrand, Christophe Roussel, Jean-Emmanuel Kurtz, Bénédicte Paindaveine, Simon Elhadad, Richard Sanchez, Eric Sgro, Pierre Berger, Valérie Murbach, Anne Holstein, Florence Martin, Taoufik Merabet, Amélie Benbara, Milagros Ferreyra, Laure Esposito, Pierre Delobel, Antoine Andremont, Marc Bourlière, Carole-Anne Boudy, Jean-Baptiste Gaulthier, Laurent Tacchini, Olivier Marpeau, Sonia Tesseydre, Marie-Pierre Coulhon, Nathalie Hodee, Marie-Chrsitine Conroy, Pierre Weinbreck, Roland Leclercq, Laurent Souply, Christian Bidault, Annie Elbez, Marie-Annick Lebreton, Patrick Brisou, Agnès Ferroni, Jean-Louis Pourriat, Nadia Anguel, Christian Noel, Philippe Jouvencel, Eric Pichard, Xavier Martin, Mathieu Coste, Pierre Zuber, Catherine Neuwirth, Jean-Pierre Hacot, Paul Aye, Jérôme Guinard, Yves Pean, Jean-Christophe Dengo, Fabrice Petassou, Didier Viole, Thierry Messiaen, Jean Beytout, Philippe Petitjean, Ferdinand Savare, Patrice Cuvillier, Sophie Coignard, Hélène Anglaret, Nassim Kamar, Elisabeth Chachaty, Karine Guimard, Louis Braem, Hacene Fezoui, Pierre Martin, Jean-Paul Viard, Claire Larroche, Nicolai Claudiu-Plesa, Thierry Benoit-Cattin, Olivier Moquet, Thierry Pasdeloup, David Rosay, Rodolphe Jean, Jean-Bernard Mariette, Marc Debouverie, Hervé Peltier, Mustapha Terki, Jacques Daleas, Valérie Dattin-Dorrière, Michel Vergnaud, Emmanuel Grimprel, Sylvène Rosselli, Jean-Marc Didier, Pierre Faurie, Luc Frimat, Aziza Mandjee, Sabine Etchemendy, Pierre Tissières, Jean Nakhleh, Sylvie Mariette, Christian Perronne, Bruno Carbonne, Nathalie Houssiaux-Maisonneuve, Tristan Ferry, S Beague, Anthony Sebban, Marie-Thérèse Hili, Jean-Michel De Kermadec, Lucien Brasme, Gilles Blaison, Caroline Garandeau, Jean-Pierre Sollet, Laurent Tronchon, Thierry Samson, Julien Gesquière, Nicolas Ettahar, Alain Créange, Etienne Laurens, Véronique Equy, Fréderic Bart, Bernard Bouffandeau, Christine Vaillant, Valerie Pesque, Jean-Marc Lalot, Marc Levy, Michel Kaidomar, Mihaela Saplacan, Sterenn Yvenou, Marie-Isabelle Steibach, Emmanuelle Cambau, Agnès Riche, François Fourrier, François Raffi, Mélissa Lalu, Henri Bérard, Danielle Clave, Jean-Claude Mouries, Martine Porcheron, Jean Cabalion, Richard Lamarca, Nathalie Canu, Jean-Baptiste Roseau, Annabelle Stoclin, Luca Luminitan Elena Lupean, Rémi Gebeile, Celia Salanoubat, Carole Marmouset, Pierre Bigot, Anne-Laure Breton, Pierre Kalfon, Colette Vincent, Sophie Marty, Olivier Tandonnet, Alexis Redor, Xavier Valette, Ourida Aoudia, Jacques-Arnaud Seyrig, Bertrand Beaune, Hugues Aumaitre, Georges Pinon, Yann Leveneur, Sylvie Charachon, Raoul Herbrecht, Henriette de Valk, Gary David, Julien Pouyanne, Marc Dommergues, Majed Al Chaar, Véronique Blanc-Amrane, Pascale Guillarmé Grossmann, Bruno Abraham, Yves Morel, Philippe Suel, Denis Sautereau, Olivier Guilloy, Tu Anh Tran, Frédéric Laurent, Zahir Amoura, Jacques-Olivier Bay, Zoubida Elharie-Heraux, Joyce Sibony-Prat, Bernard Guillois, Dominique Rohmer-Heitz, Audrey Barrelet, Jérémie Courouble, Jean-Paul Herry, Daniel Vittecoq, Annie Vermesch-Langlin, Jean Auroux, Claude Aubert, Thierry Harvey, Ghislaine Lamoine-Gimet, J. Riahi, Florence Soraudeau, Bachar Al-Jalaby, Caroline Périsson, Khélifa Ayouz, Florence Cardot, François Maillet, Alain Goux, Théophile Magna, Bertille de Barbeyrac, Adrien May, Dominique Andreotti, Olivier Jonquet, Hélène Dumouchel, Didier Thibaud, Philippe Morlat, Pascal Chevalet, Pascal Ancelin, Guy Chambreuil, Cécile Le Boterff, Anne Ceriez, Olivier Detante, B Pangon, Claude C.A. Bernard, Vincent Cailleaux Pierre-Etienne Cailleux, Jordi Miatello, Pierre-Yves le Berruyer, Sylvain Kouaho, Michel Briaud, Hélène Delaby, Patrick Herbecq, Christine Segonds, Véronique Jault, Pascale Brunel, Christine Dussopt, Jean Thore, Jean-Marc Thouret, Jean-Marc Kerleau, François Le Baron, Slavius Matica, Sophie Leautez-Nainville, Matthieu Pecquet, Laurent Bret, Yacine Sedjelmaci, Pierre Metton, Habiboulaye Diallo, Jany Rey Zermati, Arnaud Delahaye, Hélène Chaussade, Laurent Mandelbrot, Emilie Bessede, Olivier Casanovas, Paul Pierrot, Annick Legras, Dominique Lauque, Hélène Gatti, Jean Catineau, Ebutu Likose, Gilles Capellier, Eric Kibbrecht, Freddy Thibaut, Patrick Valadier, Chantal Lemble, Joël Gaudelus, Joelle Mellier, Joëlle Brochen, Emmanuel Gascou, Stéphane Bonacorsi, Stéphanie Bannier, Bruno Fantin, Didier Raffenot, Valérie Revel, Hakim Amroun, Huguette Negrery, Anne-Laure Fauchais, Paul Mercury, Michel Chuzeville, Christian Zumbo, Nicolas Després, Pascal Roblot, Jérôme Pasche, Jean Claude Boufetteau, Jocelyne Caillon, Julien Boileau, V. Rabier, Benjamin Manéglier, Emilie Jourdes, Franck Ceppa, Christine Recule, Nicolas Degand, Benoît Henry, Thierry Baranger, Dominique Pateron, Agnès Pélaquier, Gérard Bouchet, Hélène Fiette, Ozel Guiden, Dana Ranta, Etienne Ruppé, Nabil Chiouk, Jacques Breuil, Dominique Leduc, Véronique Loustaud, Hervé Métenier, Michel Durand, Isabelle Mahé, Leila Karaoui, Marie-José Collus, Mehran Monchi, Olivier Belmonte, Romain Blondet, Jacques Thierry, Karine Humbert, Gilles Salama, Marie-Noelle Heurtaux, Cécile Goujard, Bruno Sivery, Martial Boisseau, Redouane Dahoumane, Pierre Delour, Christian Niels Meyer, Anne Faudon-Gibelin, Gérard Poulain, Roger-Charles Luciani, J.-C. Souquet, Olivier Grossi, François Vandenesch, Sylvain Mermont, Jacques Bronner, Sonia Dahan, Paul Marzouk, Pascal Pouedras, Noureddine Djafari, François-Xavier Caroli-Bosc, Jean-François Dessin, Brigitte Gruffat, Armelle Morin-Fatome, Sylvie Thoinet, Bano Konate, Jean-Winoc Decousser, Claire Poyart, Patrick Plessis, Olivier Millet, Vincent Cattoir, Françoise Geffroy, Manica Vasseur, Pierre Carli, Isabelle Citony, Christian Richard, Nicolas Sigur, Patrick Marthelet, Luwawu Mbimba, Pierre Feugier, Philippe Sauder, Hama Djerad, Evelyne Bourgerette, Hanen Chahtour, Adrien Lemaignen, Dominique Bechade, Patrick Ochocki, Antoine Vieillard Baron, Dominique Astruc, Marie-Pierre Moiton, Nicolas Dubois, Sylvie Ledru, Corinne Seknazi, Hélène Poupet, Jean-Philippe Brieux, Gérard Barthélémy, Aihem Yehia, Louis-Jean Couderc, Ahmed, Françoise Rigaux, Yohann N'guyen, Philippe Bethery, Damien Corberand, Etienne Auvray, Paul-Louis Woerther, Christian Combe, Sophie Delesalle, Jean-Marie Piala, Faraj Al Freijat, Philippe Juvin, Malcolm Lemyze, Hyacine Rey, Claire Larible, Noel Milpied, Lémia Zgarni, Julia Gaillard, Agnès Juven, Paola Otean, Adrien Melis, André Pechinot, Olivier Bouchaud, Olivier Chassin, Pierre Hausfater, Asma Trabelsi-Jnifen, Vincent Grobost, Didier Lemery, Pierre Soury, Françoise Brevet, Jacques Tankovic, Dominique Sansot, Jean Louis Salomon, Charlotte Cordonnier, Brigitte Lamy, Antoine Maisonneuve, Dominique Pressac, Claude Rémy, Rodolphe Sobesky, Stéphanie Cognet, Pierre Cougoul, Didier Jan, Dominique Perrotin, Cécile Hombrouk-Alet, Thierry André, Gilbert Pochmalicki, Serge Girard, Vincent Zerr, Guillaume Cadiot, Claudine Lasbasses, Michel Slama, Abderrazak El Yamani, Sophie Brovedani, Jean Armengaud, Romain Hernu, Géraldine Mascade, Aurélien Lorléa'ch, Ali Akkari, Mathieu Tourdjman, Christopher Payan, Eric Jullian, Nathalie Fonsale, Frédéric Riehl, Paul Strock, Geneviève Grise, Philippe Mottaz, Christian Floriot, Marie-Noëlle Ungeheuer, Denis Caillot, Arnaud Chalvon-Demersay, Catherine Branger, Stanislas Bruley des Varannes, Marc Paccalin, Marie-Pierre Danjean, Alexandre Mebazaa, Xavier Brunet, Roland De Varax, Laurence Delhoustal, Sophie Haro, Bruno Chabanon-Pouget, Isabelle Goidin, Dominique Chudersky, Corinne Costes, Delphine Chatellier, Maud Gelez, Damien Dassant, Pascal Joly, Jean-Michel Arnal, Zakaria Hamitou, Philippe Rondepierre, Carole Pignon, Valérie Crombe, Amanda Lopes, Chrystelle Kemenar, Olivia Raulin, Anne-Cécile Hochart, Sandrine Gérart Pons, Valérie Zeller, Guillermo Reyes Ortega, Mathilde Guérin, Audrey Migraine Bouvagnet, Florence Eboue, Isabelle Loury-Lariviere, Sophie Leotard, Suzanne Lima, Marie Kassis, Jean-Luc Donay, Jean-Pierre Audié, Guillaume Cartron, Arnaud Ribier, Fanny Buron, Mirela Tuca, Marius Semenescu, Arnaud Serre, Vincent Quentin, Denise Bouyssou-Destriau, Violaine Bresson, Christine Chandesris Joséphine Chapalain-Cagnon, Eric Cua, Henri Courtade, François Bénézit, Sébastien Lamache, Philippe Bonnefoy, Francis Schneider, Richard Monarchi, Adeline Schendel, Paramasiven Mootien, Ghislaine Gardes, Pierre-François Westeel, Jean-François Magny, François Caron, Jocelyn Michon, Didier Eyer, Isabelle Ronda, Pierre-Yves Robillard, Frédéric Renou, Anna Faucher, Jean-Robert Harlé, Anne Debernardi, Grégory Akerman, Benoît Fontenel, Pierre Hourdebaigt-Larrusse, Marie-Noëlle Adam, Aude Lessene, Abdelkader Hrichi, François Blot, Athéna Le Pierres, Romain Lemarie, Françoise Granier, Véronique Tardy, Marc Gatfosse, Pierre-Marie Roger, François Goupil, Saïd Aberrane, Franck Bernardi, Isabelle Plantier, Nathalie Funakoshi, Jean-Gilles Delecalle, Patricia Barbut, Jacques Reynes, Christophe Roy, Sophie Perreve, Michel Garre, David Ribes, Cyrille Ede, Jean-Claude Dausset, Francis Duchene, Jean Caussin, Michelle Becker-Schneider, Gilles Berthelot, Damien Dupont, Jean-Michel Gillot, Aurélie Messager, Jean-Marie Pannecouck, Jean-Christian Roussel, Alain Reynaud, Sylvie Cariou, Anne Dao, François Guillemot, Martin Martinot, Patrick Casali, Anne-Sophie Poirier, Aissa Kerchache, Necera Sakek, Eric Porthault, Christophe Decoene, Chantal Ache-Papillon, Brigitte Bicais, Jean-Claude Feugier, Thierry Masseron, Charles Marty-Ane, Daniele Goldgran Toledano, Jean-Christophe Dubus, Damien du Cheyron, Dominique Decré, Jean-Loup Pennaforte, Ahmed Tigaizin, Bernard Vache, Eric Oswald, Claire Moulinoux, Anne-Christine Jaouen, Caroline Charlier, Anne-Laure Virlouvet, Ali Kara, Jean-Luc Sicsic, Sylvie Goffart, Mathieu Zuber, Claudine Fèbre, Olivier Lortholary, Mathieu Dupont, Annie Vessieres, Thierry Helvadjian, Thomas Signouret, Cedric Daupin, Sandrine Essouri, Jean-Louis Jacob, Pascal Boileau, Caroline Blazejewski, Quentin Lepiller, Juan-Pablo Maureira, Eddy Lebas, Christophe Deschamps, Amévi Ananivi, Clovis Foguem, Daniel Adoue, Abdourahim Chamouine, Alain Michault, Bruno Guérin, Olivier Baud, Clara Vinci, Thierry Weitten, Jean-Marc Eychene, Marie Froidure, Julien Obiols, Patricia Roussellier, Marc Lecuit, André Cabié, Saskia Foucart, Karim Belhadj, Michel Cingotti, Bruno Dumoulard, Jean Puyhardy, Etienne Danquechin Dorval, Lucile Mendes-Martin, Enrique Casalino, Luc Jarrige, Fabien Lambiotte, Philippe Masson, Mohammed Mansouria, Pierre Thouvenot, Katy Jeannot, Martine Nyunga, Valérie Macci, Florent Masia, Claire Briere de la Hosseraye, Wassila Anteur, André Sommabère, Marie-Claude Germain, Isabelle Arnault, Bernard Carbonelle, Philippe Devos, Daniel Protar, Tiphaine Gaillart, Ludovic Lassel, Laurence Hamou-Plotkine, David Trystram, Thierry Bureau, Olivier Collard, Fanny Vuotto, Sophie Malhiere, Frederique Canis, Gillles Plainfosse, Catherine Lechiche, Bertrand Lassere, Martine Chouraqui, Jean Baptiste Michot, Fethi Radhouane-Khanjari, Carole Barbier, Pascal Bonitchi, Abdelaziz Benkhelil, Odile Salmon, Laurent Damaj Gandhi, Bertrand Minguet, Michel Wagner, Odile Falguières, Zahr-Eddine Ali Chaouche, Eric Zaoui, Isabelle Guichard, Bernard Huttin, Apollinaire Karirisi, Gaël Cinquetti, Christophe Plane, Lionel Rostaing, Yanne Henry-Andrieu, Daniel Re, Virginie Verrier, Pascal Bolot, Michel De Biasi, Laurence Vrigneaud, Mathilde Turpin, Marie-Claude Demachy, Etienne Roussel, Michèle Blancs, Olivier Join-Lambert, Yves Ville, Thierry Granger, Gilles Hilbert, Virginie Medeau, Daniel Villers, Benoit Pilmis, François Gouraud, Emmanuel Ardiet, Catherine Heyraud-Blanchet, Alain Devidas, Hélène Dieye, Julie Cremniter, Jean-François Bergmann, Rozenn Le Berre, Virginie Leguen, Daniel Royer, Gilles Le Maout, Christian Harou, Sylvie Gabriel-Soléan, Yves Regouby, Martine Pestel-Caron, Patrick Brunet, David Boutoille, Emmanuelle Bonnin, Patrice Coulon, Marc Sullice, Marianne Barbieux, Gilles Cambonie, Joëlle Tricoire, Marie-Nadège Bachelier, Delphine Briend, Céline Ramanantsoa, Nathalie Bednarek, Didier Lebreton, Julien Lagrandeur, Damien M'Bey, Philippe Audeguy, Elie Saliba, Lena Damaj, Hassan Fallouh, Pascal Couturier, Fabrice Prévost, Yves Domart, Marie-Odile Lafforgue, Anne Le Du, C. Beuscart, Pierre Guillet, Fabrice Larrazet, Marie-Hélène Hausermann, Henri Robert, Nicolas Fanjaud, François Goehringer, Thomas Bachelot Philippe Badia, Jean-Michel Coulaud, Cristel Fissore Magdelein, Renaud Defebvre, Anne-Sohie Moreau, Johan Courjon, Gilles Salles, Michel Mialon, Silvia Iacobelli, Emmanuelle Bille, Marie-Christine Barbier, Yves Aubard, Patrice Badila, Jean-Philippe Rasigade, Alban Deroux, Evelyne Lecaillon-Thibon, Michel Godin, Abdelmajid Djeffal, Viorica Badurescu, Meriem Canitrot, Pierre Blanchard, Antoine Legros, Laurence Got, Françoise Duluc, Mylène M. Maury, Gilles Dassieu, Nordine Khodeir, Jean-Marie Duez, Mathieu Morincomme, Jérôme Lacroix, Mathieu Revest, Koffi Blewoussi, Isabelle Barazer, Françoise Poitevin, Camille Seignovert, Stéphanie Honore Bouakline, Anne Heidt, Brigitte Malbruny, Julien Desblache, Christian Cattoen, Eric Jaunait, Bruno Chaminade, Claude Bazin, Jonathan Chelly, Anne Pottier, Alain Schmitt, Alain Tissot, Karim Dadoun, P. Rebattu, Claudine Contamin, Arnaud Guerard, Nathalie Ravet, Sandrine Khalifa-Thellier, Marlène Chatron, Gaëlle Dörr, Hélène Biessy, Emmanuel Forestier, Bruno Devaux, Jean-Jacques Grelaud, Xavier Tchenio, Marie-Cécile Ploy, Jérémie Violette, Michèle Burdin, Lionel Falchero, Dominique Jacomy, Jean-Christophe Rozé, Damien Labarriere, Stéphane Leroux, Corinne Meregnani, Assia Ferhat Carre, Paul Orode, Jean-Gabriel Paul, Catherine Godon, Agnès Vinay, Régine Barraduc, Dominique Dallay, Alexandre Ampère, Anne-Gaelle Kervegant, Guillaume Louart, Dominique Beal Ardisson, Francoise Leonetti, Jean-Yves Baril, Stéphanie Haiat, Bincy Darre, Jérôme Bay, Yvan Gauthier, Sylvie Radenne, Pierre-Yves Gueugniaud, Philippe Ravaud, Luc Landraud, Guillaume Ranchon, Loïc Chimot, Véronique Duval, Ilhem Agha-Mir, Sabine Camiade, Estelle Wafo, Jean-Patrick Laporte, Mariam Roncato-Saberane, Camille Bron, Patrice Laudat, Samir Kennouche, Nawel Afroukh, Dominique Neri, Hakim Kherouf, Yoar Hichri, Pierre-Edouard Bollaert, Gwenaelle Vary, Denis Castaing, Christine Lefort, Sébastien Rouget, René Robert, Christelle Guillet-Caruba, Catherine Simonin, Alain Vighetto, Severine Cabasson, Alain Brusset, Alexandra Doloy, Christel Cherlet, Ahmed Rouidi, Marina Salvucci, Réginald Pordes, René-Gilles Patrigeon, Emmanuelle Dupre-Narlet, Jacques Minet, Fethi Taleb, Anne-Marie Colingorski, Tahar Hadou, Sylvain Diamantis, Isabelle Glorieux, Thierry May, Jean-Claude Colombani, Anne Berth-Farges, Nicole Desplaces, Renaud de Tayrac, Elisabeth Walter, Fabienne Lorge, Pascal Reboul, Nathalie Dournon, Laurence Estépa, Marie-Lina Toubia, Mathilde Flahault, Thierry Delacour, Dominique Hurel, Hélinoro Andriamaneo, Cécile Bébéar, Denis Grasset, Miloud Serier, Oléna Orléva, Nadine Dubroca, Hervé Gentilhomme, Jean-Luc Baudel, Isabelle Lavenu, Salim Smati, Carlo Saroufim, Eric Placidi, Albert Sotto, Benoît Libeau, Hélène Leroy, François Golfier, Christophe Dollon, Laurence Desnoulez, Eric Barre, Daniel Cohen, Pascal Priollet, Thierry Marsepoil, Benoît Lionnet, Jacques Tebib, Pascale Penn, Antoine Bouissou, Christian Roth, Olivier Martinet, Anna Schmitt, Nathalie Fruleux, Fouzia Radaoui, Jean-Marc Lessinger, Virginie Morando, Jean-Jacques Maillet, Christophe Fruchart, François Boué, François Goffinet, Franck Lellouche, Martin Demarchi, Alain Geissler, Jean-Charles Picaud, David Assouline, Patricia Brazille, Philippe Guimier, Marie-Françoise Dabysing, Bruno Delpeuch, Vanessa Tran, Guy Gengembre, Delphine Deligne, Dominique Vodovar, Yvan Touze, Sabrina Parent, Anne Decoster, Camille Dewitte, Emmanuel Weiss, Thierry Lambert, Thomas Guimard, Vincent Caille, Claude Guérin, Françoise Evreux, Geneviève Barjon, Basile Ondze, Damien Fournier, Olivia Bandin, Sophie Mignart, Henri Demontclos, Didier Perez, Jacques Croize, Nicole Desbois-Nogard, Guenièvre Imbert, Clarisse Dupin, Khalid Ridah, Marie-Christine Varin, Guillaume Arlet, Edith De Clareuil, Marie-Line Eustache, Patricia Le Pimpec, Louise Fortin, Eugène Ngami, Fabrice Mihout, Cecilia Esnault, Vincent Bouden, Véronique Annaix, Yves Poinsignon, Aurélien Lorchleac'h, Jean-Marc Degreff, Marie Garofano, Renaud Mesnage, Anne-Marie Roque-Afonso, Alain Chevailler, Stéphane Hominal, Thierry Charbonnier, Adrianna Bildea, Fabien Fily, Benjamin Davido, Emmanuel Rassiat, Assi Assi, Stéphanie Brunet, Hervé Jacquier, Catherine Claise, Annie Durand, Yannick Monceau, Pierre Blanc, Jean-Marie Sire, Yves Sucin, Jean-Pierre Zarski, Nathalie Bronet, Ingrid Lafon, Philippe Rey, Jacques Markarian, Eric Sennevile, Olivier Wink, Guilène Barnaud, Anne-Sophie Peultier, Sabine Taylor, Rim Savatier, Patrick Valayer, Claude Negrier, Selim Jennane, Edouard Begon, Laura Hyerle, Delphine Bridoux, Claire Daurel, Benoît Dalle, Mathilde Lescat, Philippe Stolidi, Elodie Perrodeau, Xavier Heches, Pierre Castelnau, Philippe Bray, Jean-Claude Texier, Serge Rossignol, Maud Brung-Lefebvre, Jean-François Subra, Jean-Marie Delarbre, Morgane Schneerson, Guyro Jang, Mona Mehri, Nathalie Landgraf, Pierre-Marie Girard, Armand Goll, Zaineb Bekguesmia, Christophe Clement, Michel Collet, Vincent Maze, Amine Benjelloul, Solène Durliat-Ellie, Vincent Letouzey, François Schmitt, Valérie Martinez, Sarah Watson, Abderrezak Bouasria, François Barbier, Raphael Lauretta, Mirana Razafimahery, Cristina Sirbu, Patrick Malherbe, Anne Wuillai, Ludovic Lesecq, Philippe Gaudard, Serge Houssaye, Jacques Monsegu, Gilles Rival, Chantal Chaplain, Jean-Didier Grangé, Oana Zamfiri, Florence Nguyen-Khac, Marc Portneuf, Jean-Michel Pawlotsky, Delphine Bonnet, Laurent Traissac, Sophie Hamon-Charles, Didier Dreyfuss, Louis Bernard, Laurence Detourmignies, Olivier Martineau, François Pettinelli, Marc Zandecki, Michel Dreyfus, Alain Chapelle, Sébastien Sabbat, Anne-Sophie Labussiere, Jean-Louis Gaillard, Chloé Plouzeau-Jayle, Patrick Zoveda, Véronique Leflon, Marie Levy, Aurélie Labé, Bruno Soulie, Raoul Jacques Bensaude, Hecham Moussa, Sylviane Catteu, Nathalie Biron, Loïc Masson, Georges Mourad, Nejla Aissa, Dragos Ciocan, Hubert De Boysson, Jean-Luc Bouyer, Patrick Yeni, Thierry-Pascal Zame, Caroline Thomas, François Cavalié, Laurence Koulmann, Christophe Rioux, Olivier Barraud, François Bricaire, Marguerite Le Poulain, Marie-Noelle Noulard, René Thomas, Guy Semet, Laurent Mosser, Olivier Marret, Brigitte Rivière, Vincent Jarlier, Jean-Philippe Coindre, Marc Villemain, Martin Pierre, Yacine Benkaci, Philippe Chiron, Hoang Vu-Thien, Jérôme Gournay, Andrea Labaune-Kiss, Brigitte Lauzanne, Fanny Lemercier, Souad Silhadi, Imad Kansau, Christophe Poncelet, Olivier Baldesi, Francis Thuet, Olivier Leroy, Aurore Lamberet, Camille Petit Hoang, Sophie Micheli, Ayman Abokasem, Hakima Nesrine, Pierre Lureau, Christian Chidiac, Vincent Piriou, Fabien Zoulim, Dieudonné Nicobaharaye, Anne Tixier, Isabelle Matheron, Soumeth Abasse, Victoria Cacheux, Serge Herson, Christine Fuhrmann, Olivier Proost, Bernard Bedock, Olivier Rogeaux, Mostapha Hajjar, Anne Reverseau, René Courcol, Françoise Carmagnol, Yves Guénard, Céline Ménard, Bouchra Lamia, Bruno Lemmens, Damien Bouhour, L. Lequen, Gaëlle Baty, Cédric Bouet, Dominique Guerrot, Stéphane Blanc, Catherine Chirouze, Anne-Hélène Reboux, A. Vachée, Gregory Taurin, Myriam Mein-Bottini, Jean-Pierre Belot, Alain Lafeuillade, Patricia Gabez-Therou, Philippe Labrousse, Bernard Jarrousse, Philippe Noto, Vincent Brunot, Philippe Condominas, Marion Challier, Béatrice Berçot, Delphine Anuset, Mélanie Daval Cote, François Bernasconi, Y. Costa, Chandrah Goburdhun, Bernard Gressier, Alban Michaud-herbst, Franck Charlier, Moussa Hecham, Luc Boulain, Hélène Corneloup, Alix Greder Belan, Nicolas Boussekey, Claire-Antoinette Dupuy, Yannick Rouquet, Benoit Renard, Benifla Jl, Etienne Javouhey, Michèle Granier, Marie-Christine Jaffarbandjee, Emilie Piet, Benoît Bergues, Claire Malbrunot, Catherine Tiry, Philippe Mérigot, Mouna Ben Soltana, Chantal Roure Sobas, Florian Radenac, Yves Thomas, Agathe Blaise, Sylvie De Martino, Laurence Legout, Gabriel Choukroun, Jean-François Muir, Peggy Dupretz, Patrick Dupont, François Guichart, Julie Jean, Jean-Michel Descamps, Bernard Kittschke, Anne Gruson, Gerard Viquesnel, Marie Keller, Pascal Chavanet, Françis Vallet, Yvan Vaschalde, Jean-Luc Hanouz, Gerard Lina, Françoise Loison, Simon Vincent, Jean-Paul Thellier, Moncef Afi, Dominique Zagozda, Hélène Sokeng-Affoule, Marc Le Bideau, Jean-François Loriferne, Alain Gravet, Sophie Deprecq, Tarik Naceur, Severine Mielczarek, René-Jean Bensadoun, Bernard Karkous, Yves Bléher, Jocelyne Poulain, Véronique Goulet, Laurence Nicolet, Sophie Arista, Antônio Lúcio Teixeira, Jean-François Schved, Laurent Nicolet, Claire Lecomte, Faiza Benddif-Fin, Michel Aumersier, Laurence Burc-Struxiano, Maxime Thouvenin, Samia Harbi, Mathieu Detave, Catherine Rebeyrotte, Jean-Paul Kisterman, Bruno Berdin, Pascal Vincent, Laurent Argaud, Elisabeth Parisi-Duchene, Geneviève Julienne, Fernanda Farto-Bensasson, Georges-Fabrice Blum, Sad Gaizi, Tali-Anne Szwebel, Raphaël Lepeule, Marie-Thérèse Climas, Anne-Françoise Dillies, Amar Boudhane, Umberto Simeoni, Pierre-François Dequin, Gérard Oliviero, Alain Gourlaouen, Caroline Piau, Marie-France Lutz-Murphy, Benoît Claude, Jean-Paul Aubry, Nadine Dubosc-Marchenay, Kamilla Chraibi, Emmanuelle Heusse, Sylvain Le Chevallier, Nathalie Brieu, Farid Sifaoui, Lorraine Letranchant, Hélène Durox, Jean-Pierre Lagasse, Adel Ghedira, Xavier Roubert, Fatma Magdoud, Hélène Jean-Pierre, Etienne Carbonelle, Olivier Dereeper, Lionel Carbillon, Christophe Billy, Mélanie Roblin, Marie-José Kodzin, Philippe Niel, Solène Makdessi, Matteo Vassallo, Maryse Archambaud, Fabian Haccourt, Didier Blaise, Stéphane Bourgeois, Elena Marcu, Charles Kubiak, Brisse Castel, François Guinet, Marie Pouzoullic, Frédérique Nathan-Bonnet, Vincent Gendrin, Céline Becherrawy, Aline Secher, Pierre Abgueguen, Clarence Eloy, Jean-Marc Tourani, Frédéric Klapczynski, Bernard Montmasson, Philippe Real, Joanna Pofelski, Yves Welker, Karim Krechiem, Eric Caumes, Martine Elena-Daumas, Christophe Saigne, Gilles Hittinger, Chantal Delesalle, Jonathan Messika, Fabrice Lesage, Daniela Pop, Daniel Coetmeur, Renato Colamarino, Chetaou Mahaza, Patrick Plésiat, Isabelle Fredenucci, Mylène Baret, Guy Mager, Pascale Chavel, Isabelle Labourdette, Anne-Claude Menguy, Nicolas Fortineau, Ludovic Le Sec, Valérie Gauduchon, Francis Barraud, Nicolas Letellier, Didier Vincent, Janine Frey, Philippe Riegel, Michel Pavic, Jean-Luc Fabre, Jean-Pierre Fauchart, Alain Goudeau, Stéphanie Husson-Wetzel, Philippe Eymerit, Mohamed Camara, Nathalie Seta, Elisabeth Carole Ngo Bell, Philippe Repellin, Laurent Alric, Vincent Leroy, Françoise Delisle Mizon, Jean-Philippe Emond, Marie-Françoise Borie, Lise Crémet, Wladimir Chelle, Elisabeth Brottier-Mancini, Bernard Garrigues, Claire Letellier, Loïc Geffray, Frédéric Méchaï, Julien Bador, Benoit Guery, Alain-Charles Fouilhoux, Corinne Dagada, Pierre Duhaut, Julien Goustille, Arnaud Sément, Francis Carcenac, Isabelle Girard-Buttaz, Claire Chapuzet, Fabienne Jouatte, Bruno Riou, Fabrice Hayoun, Chloé Di Meglio, Youssef Ali, Michel Leneveu, Nathalie Montagne, Yves Garcera, Audrey Moustache, Pierre-Eric Danin, Geneviève Le Lay, Dominique Courouge-Dorcier, Isabelle Worcel, Emmanuel Morelon, Vincent Pestre, Jean-Pierre Vilque, Jean-Christophe Paquet, Lucien Bodson, Anne-Marie Forest, Fabrice Pierre, Christian Pommier, Fabien Dutasta, Pierre Fournel, Stéphanie Courtois, Elodie Dubois, Serge Vanden Einjden, Patrick Honderlick, Pascal Richette, Fabienne Tamion, Véronique Chassy, Richard Megbemado, Anne-Marie Le Reste, Bernard Simian, Henri Osman, Anthony Texier, Badih Ayach, François Simon, Jean-Michel Filloux, Béatrice Dubourdieu, Jean-Claude Semet, Sarah Kubab, Tawfiq Henni, Patrick Dudeffant, Delphine Hequet, Olivier Mimoz, Marc Auburtin, Amélie Chabrol, Mickael Bonnan, Caroline Léonnet, Claire Wintenberger, Serge Ilunga, Patrice Lanba, Sophie Rosello, Alexandre Damage, Flore Bouche, Michel Thibault, Frederic Faibis, Chantal Dhennain, Jean-Philippe Talarmin, Armelle Lamour, Remi Boussier, Fabien Garnier, Marie-Laure Brival, Nourredine Hedjem, Philippe Vande-perre, Raphaël Coint, Jean-Claude Reveil, Eva Weinbronn, Emmanuelle Lavalard, Alexandra Fille, Françoise Le Turdu, Lionel Leroux, Jean-Yves Lefrant, Jean Berthet, Radia Bouaziz, Alain Ravaud, Sylvaine Rousseau, Yacine Merrouche, Alain Le Coustumier, Bertrand Guider, Gisèle Dewulf, Jean-Marc Faucheux, Jacques Piquet, Franck Leibinger, Charles Cerf, Robin Stephan, Jean-Philippe Redonnet, Jean-Paul Stahl, Ella Dzeing, Simona Pavel, Guy Vernet, Ghada Hatem, Samer Kayal, Jacques Deschamps, Dominique Descamps, Marion Levast, Marc Bouiller, Sylvie Dargere, Claire Dingremont, Stéphane Gaudry, François Maillot, Sylvie Odent, Nathalie Cervantes, Hélène Zanaldi, Laurence Gachassin, Olivier Ruyer, David Patin, Benoît Cazenave, Pascal Jacquier, Michelle Boyer, Béatrice Berteaux, Virginie Zarrouk, Jacques Bor, Isabelle Legoff, Hélène Albinet, Florence Rousseau, Gilles Pialoux, Guenaelle Salaun-Beretta, Alexandra Moura, Véronique Vernet Garnier, Didier Lepelletier, Pierre-Alexandre Hauss, Joëlle Belaisch-Amart, Didier Lepeletier, Jacob Xavier, Aline Nare, Annie Motard-Picheloup, Alain Améri, Bertrand Lioger, Jean-Valère Malfuson, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Listeria - National Reference Center Listeria (CNRL), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria (CC-OMS / WHO-CC), Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Département de Médecine interne [Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Biologie des Infections - Biology of Infection, Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources (ICAReB), Institut Pasteur [Paris] (IP), Infectious Disease Department [Saint Maurice], Agence Nationale de la Santé Publique [Saint-Maurice] (ANSP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, MONALISA study group, Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency., ROZIER, marie-Claire, CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections (CNRL), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria - Biologie des Infections (CCOMS), CHU Pitié-Salpêtrière [APHP], Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections ( CNRL ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre collaborateur de l'OMS (CCOMS) des Listeria ( CCOMS ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Biologie des Infections, Institut Pasteur [Paris]-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources ( ICAReB ), Agence Nationale de la Santé Publique [Saint-Maurice] ( ANSP ), Assistance Publique - Hôpitaux de Paris, Assistance publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Paris 5 ( UPD5 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris]-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)

Subjects
Bacteremia/epidemiology/mortality, 0301 basic medicine, Male, Pediatrics, bacteraemia, Infectious Disease Transmission, [SDV]Life Sciences [q-bio], Bacteremia, France/epidemiology, Infant, Newborn, Diseases, Foodborne Diseases, Meningoencephalitis, Pregnancy, Risk Factors, Vertical, Medicine, Listeriosis, Prospective Studies, Pregnancy Complications, Infectious, Prospective cohort study, ddc:618, diabetes, alcoholism, Hazard ratio, Foodborne Diseases/microbiology, immuno suppressive therapies, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Hospitalization, Infectious Diseases, isolates, Population Surveillance, Female, France, Listeria monocytogenes/classification/isolation & purification, Cohort study, Adult, medicine.medical_specialty, 030106 microbiology, Notifiable disease, Listeriosis/diagnosis/epidemiology/microbiology, Context (language use), macromolecular substances, 03 medical and health sciences, Humans, study, Aged, [ SDV ] Life Sciences [q-bio], business.industry, Public health, cirrhosis, Infant, Newborn, Infant, Diseases/epidemiology/microbiology, HIV, Mandatory Reporting, Newborn, medicine.disease, Listeria monocytogenes, infection, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious/epidemiology/microbiology, Meningoencephalitis/epidemiology/microbiology/mortality, Observational study, business, prognostic, mellitus
Abstract

International audience; Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (

Published
2016

108. Use of extracorporeal carbon dioxide removal (ECCO2R) in 239 intensive care units: results from a French national survey

Author

Didier Dreyfuss, Jean-Damien Ricard, Jonathan Messika, Stéphane Gaudry, and Benjamin Deniau

Subjects
medicine.medical_specialty, Extracorporeal Circulation, business.industry, Pain medicine, Extracorporeal circulation, MEDLINE, 030208 emergency & critical care medicine, Carbon Dioxide, Critical Care and Intensive Care Medicine, Extracorporeal carbon dioxide removal, 03 medical and health sciences, Intensive Care Units, 0302 clinical medicine, 030228 respiratory system, Multicenter study, Anesthesiology, Intensive care, Health Care Surveys, medicine, Humans, France, Intensive care medicine, business
Published
2016

109. Pathophysiology of Escherichia coli ventilator-associated pneumonia: implication of highly virulent extraintestinal pathogenic strains

Author

Didier Dreyfuss, Dimitri Margetis, Catherine Branger, Damien Roux, Jean-Damien Ricard, Olivier Clermont, Erick Denamur, Stéphane Gaudry, Jonathan Messika, and Fatma Magdoud

Subjects
Adult, Male, Virulence Factors, Virulence, Drug resistance, Critical Care and Intensive Care Medicine, medicine.disease_cause, law.invention, Microbiology, Mice, Antibiotic resistance, law, Drug Resistance, Bacterial, Genotype, Escherichia coli, Animals, Humans, Medicine, Prospective Studies, Escherichia coli Infections, Aged, Mice, Inbred BALB C, business.industry, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Middle Aged, bacterial infections and mycoses, medicine.disease, Intensive care unit, Virology, respiratory tract diseases, Molecular Typing, Pneumonia, Carrier State, Female, France, business
Abstract

To characterize Escherichia coli ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients by determining antibioresistance and genotypic characteristics of E. coli isolates responsible for VAP or lung colonization, by comparing them with their oropharyngeal and rectal counterparts and by assessing representative isolates' virulence in a pneumonia mouse model.Patients under mechanical ventilation for more than 72 h were screened for simultaneous presence of E. coli in rectal, oropharyngeal, and respiratory samples (colonization or VAP). If present, E. coli isolates were characterized by antimicrobial susceptibility, phylogenetic grouping, and virulence factor (VF) gene content determination. BALB/c mice were challenged intranasally with 3.6 × 10(8) colony-forming units (CFU) of patients' E. coli isolates.Multisite E. coli colonization was observed in 19 % of patients (25 patients, 12 with E. coli VAP). One hundred fifteen distinct E. coli isolates were analyzed. B2 phylogenetic group was predominant, with high VF gene content and low antimicrobial resistance. Antimicrobial resistance diversity was observed in four patients with VAP. E. coli isolates from VAP patients were more frequently B2 isolates, with significantly greater VF gene content than lung colonization isolates. Among screened VF genes, iroN and sfa appeared important for lung infection. A very strong correlation (R (2) = 0.99) was found between VF gene content and mortality in the mouse model.This is the first study establishing antibioresistance and genotypic characteristics of E. coli isolates responsible for VAP in adult ICU patients. These isolates are highly virulent specific extraintestinal pathogenic E. coli strains expressing virulence factors, representing potential targets for new therapies.

Published
2012

110. Renal replacement therapy after cardiac surgery: do not ask 'When', ask 'Why'

Author

David Hajage, Stéphane Gaudry, and Didier Dreyfuss

Subjects
medicine.medical_specialty, Letter, business.industry, medicine.medical_treatment, Acute kidney injury, MEDLINE, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Critical Care and Intensive Care Medicine, medicine.disease, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Ask price, Emergency medicine, medicine, 030212 general & internal medicine, Renal replacement therapy, Intensive care medicine, business
Published
2017

111. Optimal timing of renal replacement therapy in patients with acute kidney injury in the context of sepsis

Author

Anders Perner, Michael Joannidis, David Hajage, Didier Dreyfuss, and Stéphane Gaudry

Subjects
Nephrology, medicine.medical_specialty, Pain medicine, medicine.medical_treatment, 030232 urology & nephrology, Context (language use), Critical Care and Intensive Care Medicine, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Anesthesiology, medicine, Humans, In patient, 030212 general & internal medicine, Renal replacement therapy, Intensive care medicine, business.industry, Research, Acute kidney injury, Acute Kidney Injury, medicine.disease, Renal Replacement Therapy, business
Published
2017

112. Progress in the management of IPF-related acute exacerbations: a goal for patients, respirologists and intensivists

Author

Hilario Nunes, Stéphane Gaudry, and François Vincent

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Idiopathic Pulmonary Fibrosis, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Acute Disease, Humans, Medicine, 030212 general & internal medicine, business, Intensive care medicine, Goals
Published
2018

113. Hyponatremia in the intensive care unit: How to avoid a Zugzwang situation?

Author

Didier Dreyfuss, Martin Flamant, Stéphane Gaudry, Jean-Damien Ricard, Cédric Rafat, and Emmanuelle Vidal-Petiot

Subjects
Hyponatremic encephalopathy, medicine.medical_specialty, Cirrhosis, Review, Critical Care and Intensive Care Medicine, law.invention, law, Anesthesiology, Medicine, Desmopressin Acetate, Intensive care medicine, Extracellular fluid volume, business.industry, nutritional and metabolic diseases, medicine.disease, Intensive care unit, 3. Good health, Hypertonic saline, Heart failure, Central pontine myelinolysis, Arginine vasopressin, business, Hyponatremia, Osmotic demyelination
Abstract

Hyponatremia is a common electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (

Published
2015

114. The authors reply

Author

Jean-Damien Ricard, Romain Miguel Montanes, Stéphane Gaudry, David Hajage, Didier Dreyfuss, and Jonathan Messika

Subjects
Male, Intensive Care Units, Intubation, Intratracheal, Humans, Female, Critical Care and Intensive Care Medicine, Hypoxia, Respiration, Artificial
Published
2015

115. Etiologies, clinical features and outcome of cardiac arrest in HIV-infected patients

Author

Romain Sonneville, Marina Thirion, Nicolas Deye, Charles-Edouard Luyt, Alain Cariou, Guillaume Geri, Nicolas Mongardon, Antoine Kimmoun, Armelle Mathonnet, Nicolas Lerolle, Virginie Lemiale, Stéphane Legriel, Laurent Argaud, David Luis, Frédéric Pène, Laurent Bodson, Florence Boissier, Jean-Paul Mira, Stéphane Gaudry, Julien Mayaux, Laurent Camous, Sébastien Perbet, Bertrand Guidet, 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), 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), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)

Subjects
Adult, CD4-Positive T-Lymphocytes, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], HIV Infections, 030204 cardiovascular system & hematology, Sudden death, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Internal medicine, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, Viral Load, medicine.disease, 3. Good health, Surgery, Heart Arrest, Intensive Care Units, Cohort, Etiology, Female, Cardiology and Cardiovascular Medicine, business, Viral load, Cohort study
Abstract

International audience; BACKGROUND: Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS: Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012). Characteristics and outcome of HIV-infected patients were compared to those of a large cohort of HIV-uninfected patients admitted after CA in the Cochin Hospital ICU during the same period. RESULTS: 99 patients were included (median CD4 lymphocyte count 233/mm(3), viral load 43 copies/ml). When compared with the control cohort of 1701 patients, HIV-infected patients were younger, with a predominance of male, a majority of in-hospital CA (52%), and non-shockable initial rhythm (80.8%). CA was mostly related to respiratory cause (n=36, including 23 pneumonia), cardiac cause (n=33, including 16 acute myocardial infarction), neurologic cause (n=8) and toxic cause (n=5). CA was deemed directly related to HIV infection in 18 cases. Seventy-one patients died in the ICU, mostly for care withdrawal after post-anoxic encephalopathy. After propensity score matching, ICU mortality was not significantly affected by HIV infection. Similarly, HIV disease characteristics had no impact on ICU outcome. CONCLUSIONS: Etiologies of CA in HIV-infected patients are miscellaneous and mostly not related to HIV infection. Outcome remains bleak but is similar to outcome of HIV-negative patients.

Published
2015

116. Functional outcome of prolonged refractory status epilepticus

Author

Pierre-Edouard Bollaert, Sébastien Gibot, Nicolas Lerolle, Guillaume Louis, Julien Jabot, David Luis, Francis Schneider, François Fourrier, Nicolas Barbarot, Laurent Argaud, Antoine Roch, Alexandre Lai, Rémi Coudroy, Tarek Sharshar, Stéphane Gaudry, Bruno Mégarbane, Hervé Outin, Anne Renault, Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHI Poissy-Saint-Germain, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Louis Mourier - AP-HP [Colombes], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Hôpital de Hautepierre [Strasbourg], Hôpital de St Brieuc, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Raymond Poincaré [AP-HP], Hôpital Roger Salengro [Lille], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and HAL UPMC, Gestionnaire

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Population, Status epilepticus, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Status Epilepticus, 0302 clinical medicine, Modified Rankin Scale, Intensive care, Internal medicine, medicine, Humans, 030212 general & internal medicine, Mortality, Intensive care medicine, education, Stroke, Aged, Retrospective Studies, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Research, Sudden cardiac arrest, Retrospective cohort study, Recovery of Function, Middle Aged, medicine.disease, 3. Good health, Hospitalization, Treatment Outcome, Etiology, Female, medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

Introduction To characterize etiology, clinical course and outcomes of patients in prolonged refractory status epilepticus (PRSE) and looking for prognostic factors. Methods Retrospective study conducted in patients hospitalized from January 1, 2001 to December 31, 2011 in 19 polyvalent intensive care units in French university and general hospitals. Patients were adults with a generalized convulsive refractory status epilepticus that lasted more than seven days, despite treatment including an anesthetic drug and mechanical ventilation. Patients with anoxic encephalopathy were excluded. Follow-up phone call was used to determine functional outcome using modified Rankin Scale (mRS) with mRS 0–3 defining good and mRS 4–6 poor outcome. Results 78 patients (35 female) were included. Median age was 57 years. Causes of status epilepticus were various, mainly including prior epilepsy (14.1%), CNS infection (12.8%), and stroke (12.8%). No etiology was found in 27 (34.6%) patients. PRSE was considered controlled in only 53 (67.9%) patients after a median duration of 17 (IQR 12–26) days. The median length of ICU stay was 28 (19–48) days. Forty-one (52.5%) patients died in the ICU, 26 from multiple organ failure, 8 from care withdrawal, 2 from sudden cardiac arrest, 1 from brain death and 4 from unknown causes. PRSE was previously resolved in 20 patients who died in the ICU. At one-year follow-up, there were 12 patients with good outcome and 58 with poor outcome and 8 lost of follow-up. On multivariate analysis, only vasopressor use was a predictor of poor outcome (OR 6.54; 95%CI 1.09-39.29; p = 0.04). Conclusion Poor outcome was observed in about 80% of this population of PRSE. Most patients died from systemic complications linked to their ICU stay. Some patients can recover satisfactorily over time though we did not identify any robust factor of good outcome.

Published
2015

117. Five-year trends for ventilator-associated pneumonia: Correlation between microbiological findings and antimicrobial drug consumption

Author

Catherine Branger, Didier Dreyfuss, Guilène Barnaud, Véronique Tournier, Vincent Fihman, Typhaine Billard-Pomares, David Hajage, Jean-Damien Ricard, Fatma Magdoud, Jonathan Messika, and Stéphane Gaudry

Subjects
Microbiology (medical), Adult, Male, Staphylococcus aureus, Adolescent, medicine.drug_class, Cefepime, Antibiotics, Ceftazidime, Biology, medicine.disease_cause, Microbiology, Cohort Studies, Young Adult, Antibiotic resistance, Enterobacteriaceae, Clavulanic acid, Drug Resistance, Bacterial, medicine, Humans, Pharmacology (medical), Aged, Retrospective Studies, Aged, 80 and over, Pseudomonas aeruginosa, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, General Medicine, Bacterial Infections, Amoxicillin, Middle Aged, medicine.disease, Drug Utilization, Anti-Bacterial Agents, Intensive Care Units, Infectious Diseases, Female, medicine.drug
Abstract

The epidemiology of multidrug-resistant bacteria (MDRB) has changed significantly in European healthcare settings, with a decrease in frequency of meticillin-resistant Staphylococcus aureus and an increase in extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Little is known about the effects of these changes on ventilator-associated pneumonia (VAP). A retrospective 5-year trend analysis of ICU antibiotic consumption and resistance in bacteria causing VAP was undertaken. Poisson regression analysis between complete microbiological data and antibiotic consumption was performed. In total, 252 episodes of VAP in 184 patients were identified between 2007 and 2011, from which 364 causal bacteria were isolated. Enterobacteriaceae isolation rates increased significantly over this period [from 6.64 to 10.52 isolates/1000 patient-days; P=0.006], mostly due to an increase in AmpC-producing Enterobacteriaceae (APE) (2.85-4.51 isolates/1000 patient-days; P=0.013), whereas the number of episodes due to S. aureus and Pseudomonas aeruginosa remained stable. A positive association was found between the increase in APE infections and an increase in past-year antibiotic consumption: amoxicillin/clavulanic acid (P=0.003), ceftazidime and cefepime (P=0.007), carbapenems (P=0.002), fluoroquinolones (P=0.012), macrolides (P=0.002) and imidazoles (P=0.004). No such association was found for the emergence of resistance in P. aeruginosa. These results indicate a change in the epidemiology of VAP, with Enterobacteriaceae exceeding P. aeruginosa and S. aureus. Moreover, a positive correlation was observed between antibiotic consumption and the incidence of potentially MDRB such as APE. No such correlation was found for ESBL-producing Escherichia coli and antibiotic-resistant P. aeruginosa.

Published
2015

118. Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (akiki)

Author

Laurent Martin-Lefevre, Isabelle Hoffmann, Saad Nseir, Guillaume Chevrel, Guillemette Thomas, Nicolas de Prost, Naïke Bigé, Stéphane Gaudry, Alexandre Boyer, Eric Boulet, Marina Thirion, Anne Bretagnol, Clarisse Blayau, Alexandre Lautrette, Florence Tubach, Bertrand Pons, Philippe Markowicz, Nicolas Lerolle, Julien Maizel, Michael Darmon, Didier Dreyfuss, Bruno Mégarbane, Jean Dellamonica, Frédérique Schortgen, Jean-Damien Ricard, Benjamin Zuber, David Hajage, Hodane Yonis, Dorothée Carpentier, Yann Loubières, Julien Mayaux, Jack Richecoeur, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Intercommunal de Créteil (CHIC), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), AP-HP - Hôpital Bichat - Claude Bernard [Paris], CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier René Dubos [Pontoise], Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Rouen, Normandie Université (NU), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Régional d'Orléans (CHRO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Nord [CHU - APHM], Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), 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), Université Paris Diderot, Sorbonne Paris Cité, Paris, France, Université Paris Diderot - Paris 7 (UPD7), CHI Poissy-Saint-Germain, CHU Tenon [AP-HP], CHU Amiens-Picardie, Centre Hospitalier de Versailles André Mignot (CHV), Lille Inflammation Research International Center - U 995 (LIRIC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Saint-Antoine [AP-HP], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), CHU Lille, Inserm, Université de Lille, Lille Inflammation Research International Center (LIRIC) - U995, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables [ECEVE (U1123 / UMR_S_1123)], Centre Hospitalier Intercommunal de Créteil [CHIC], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon [CHD Vendée], Centre Hospitalier Universitaire d'Angers [CHU Angers], Centre Hospitalier Régional d'Orléans [CHRO], Centre Hospitalier Universitaire de Nice [CHU Nice], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] [CHU ST-E], Centre Hospitalier de Versailles André Mignot [CHV], Lille Inflammation Research International Center - U 995 [LIRIC], and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)

Subjects
medicine.medical_treatment, Mesh:Time Factors, Mesh:Acute Kidney Injury/diagnosis, urologic and male genital diseases, law.invention, Mesh:Biomarkers/blood, Study Protocol, 0302 clinical medicine, Clinical Protocols, Mesh:Risk Factors, Pharmacology (medical), Mesh:Clinical Protocols, Prospective Studies, Treatment outcome, Mesh:Treatment Outcome, Acute kidney injury, female genital diseases and pregnancy complications, 3. Good health, Mesh:Intensive Care Units, Mesh:Risk Assessment, Mesh:Renal Replacement Therapy/adverse effects, medicine.medical_specialty, Critical Illness, Risk Assessment, Decision Support Techniques, Renal replacement therapy, Critical care, 03 medical and health sciences, Humans, Intensive care medicine, Mesh:France, Patient Selection, Mesh:Acute Kidney Injury/blood, medicine.disease, Clinical trial, Biomarkers, Time Factors, Mesh:Decision Support Techniques, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Medicine (miscellaneous), Mesh:Prospective Studies, Injury Severity Score, Randomized controlled trial, Mesh:Patient Selection, law, Risk Factors, 030212 general & internal medicine, Mesh:Critical Illness, Intensive care unit, Intensive Care Units, Mesh:Renal Replacement Therapy/methods, Research Design, France, medicine.symptom, Mesh:Acute Kidney Injury/therapy, Randomization, Mesh:Research Design, Mesh:Acute Kidney Injury/physiopathology, Time-to-Treatment, Predictive Value of Tests, Mesh:Predictive Value of Tests, medicine, Mesh:Injury Severity Score, Mesh:Renal Replacement Therapy/mortality, Mesh:Time-to-Treatment, Mechanical ventilation, business.industry, Mesh:Acute Kidney Injury/mortality, Mesh:Humans, Emergency medicine, Anuria, business
Abstract

International audience; BACKGROUND: There is currently no validated strategy for the timing of renal replacement therapy (RRT) for acute kidney injury (AKI) in the intensive care unit (ICU) when short-term life-threatening metabolic abnormalities are absent. No adequately powered prospective randomized study has addressed this issue to date. As a result, significant practice heterogeneity exists and may expose patients to either unnecessary hazardous procedures or undue delay in RRT.METHODS: This is a multicenter, prospective, randomized, open-label parallel-group clinical trial that compares the effect of two RRT initiation strategies on overall survival of critically ill patients receiving intravenous catecholamines or invasive mechanical ventilation and presenting with AKI classification stage 3 (KDIGO 2012). In the 'early' strategy, RRT is initiated immediately. In the 'delayed' strategy, clinical and metabolic conditions are closely monitored and RRT is initiated only when one or more events (severity criteria) occur, including: oliguria or anuria for more than 72 hours after randomization, serum urea concentration >40 mmol/l, serum potassium concentration >6 mmol/l, serum potassium concentration >5.5 mmol/l persisting despite medical treatment, arterial blood pH 5 l/min to maintain SpO2 > 95% or FiO2 > 50% under invasive or noninvasive mechanical ventilation. The primary outcome measure is overall survival, measured from randomization (D0) until death, regardless of the cause. The minimum follow-up duration for each patient will be 60 days. Two interim analyses are planned, blinded to group allocation. It is expected that there will be 620 subjects in all.CONCLUSIONS: The AKIKI study will be one of the very few large randomized controlled trials evaluating mortality according to the timing of RRT in critically ill patients with AKI classification stage 3 (KDIGO 2012). Results should help clinicians decide when to initiate RRT.BACKGROUND: ClinicalTrials.gov NCT01932190.

Published
2015

119. Effects of Proanthocyanidins on Adhesion, Growth, and Virulence of Highly Virulent Extraintestinal Pathogenic Escherichia coli Argue for Its Use to Treat Oropharyngeal Colonization and Prevent Ventilator-Associated Pneumonia

Author

Catherine Branger, Padmapriya Ponnuswamy, Odile Bouvet, Erick Denamur, Hafid Ait Oufella, Dimitri Margetis, Damien Roux, Didier Dreyfuss, Jean-Damien Ricard, Stéphane Gaudry, and Jonathan Messika

Subjects
Male, Critical Illness, Virulence, Context (language use), Biology, Critical Care and Intensive Care Medicine, medicine.disease_cause, Microbiology, Mice, In vivo, medicine, Escherichia coli, Animals, Proanthocyanidins, Escherichia coli Infections, Extraintestinal Pathogenic Escherichia coli, Bacteriological Techniques, Mice, Inbred BALB C, medicine.diagnostic_test, Dose-Response Relationship, Drug, Plant Extracts, Epithelial Cells, Bronchoalveolar lavage, Vaccinium macrocarpon, Proanthocyanidin, Bronchoalveolar Lavage Fluid, Ex vivo
Abstract

OBJECTIVE In the context of increasing microbial resistance and limited new antimicrobials, we aimed to study the antimicrobial effects of cranberry proanthocyanidin extracts on Escherichia coli growth, adhesion to epithelial cells, and lung infection. DESIGN Experimental in vitro and in vivo investigation. SETTING University research laboratory. SUBJECTS Seventy-eight 6- to 8-week-old male Balb/C mice. INTERVENTIONS In vitro, the effect of increasing concentrations of cranberry proanthocyanidin on bacterial growth of different clinical E. coli isolates was evaluated. Ex vivo, adhesion of E. coli to fresh human buccal epithelial cells was measured in the presence or absence of cranberry proanthocyanidin using microscopy. In vivo, lung bacterial count, pulmonary immune response (neutrophil murine chemokine keratinocyte-derived cytokine measurement and polymorphonuclear recruitment in bronchoalveolar lavage fluid), and lethality were evaluated in a pneumonia mouse model with E. coli precultured with or without cranberry proanthocyanidin. E. coli isolates originated from ventilated ICU patients with respiratory tract colonization or ventilator- associated pneumonia. They differed in number of virulence genes. MEASUREMENTS AND MAIN RESULTS A significant inhibition of bacterial growth was observed with increasing concentration of cranberry proanthocyanidin, affecting both time to maximal growth and maximal growth rate (p

Published
2015

120. Did studies on HFOV fail to improve ARDS survival because they did not decrease VILI? On the potential validity of a physiological concept enounced several decades ago

Author

Didier Dreyfuss, Stéphane Gaudry, and Jean-Damien Ricard

Subjects
Mechanical ventilation, ARDS, medicine.medical_specialty, Respiratory Distress Syndrome, Time Factors, Biotrauma, business.industry, medicine.medical_treatment, Ventilator-Induced Lung Injury, High-frequency ventilation, High-Frequency Ventilation, Reproducibility of Results, Lung injury, Critical Care and Intensive Care Medicine, medicine.disease, Survival Rate, Prone position, medicine, Humans, Intensive care medicine, business, Survival rate, Tidal volume, Physiological Phenomena
Abstract

High frequency oscillatory ventilation (HFOV) has been the subject of extensive physiological research for 30 years and even more so of an intense debate on its potential usefulness in the treatment of acute respiratory distress syndrome (ARDS). This technique has been enthusiastically promoted by some teams until two high-quality randomized clinical trials in adults with ARDS showed that HFOV did not decrease and might have even increased mortality. As a consequence of these results, physiological concepts such as atelectrauma and biotrauma on which ARDS management with HFOV were based should be reexamined. In contrast, the concept of volutrauma, i.e., end-inspiratory overdistension, as the cause for ventilator-induced lung injury might help explain excess mortality during mechanical ventilation of ARDS when inspiratory volumes are too high. This is what might have happened during one of the recent studies on HFOV. Failure of this complex technique must be put in perspective with the dramatic improvement of ARDS prognosis with very simple interventions such as tidal volume reduction, early pharmacological paralysis, and prone positioning which all limited end-inspiratory volume.

Published
2015

122. Why ELAIN and AKIKI Should Not Be Compared: Resolving Discordant Studies

Author

Didier Dreyfuss, David Hajage, and Stéphane Gaudry

Subjects
medicine.medical_specialty, business.industry, Acute kidney injury, MEDLINE, Time to treatment, Acute Kidney Injury, 030204 cardiovascular system & hematology, medicine.disease, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Nephrology, Internal medicine, medicine, Humans, 030212 general & internal medicine, business
Published
2017

123. Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study

Author

Benjamin Sztrymf, Stéphane Gaudry, Didier Dreyfuss, Karim Ben Ahmed, Jonathan Messika, Jean-Damien Ricard, Cédric Rafat, and Romain Miguel-Montanes

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, ARDS, medicine.medical_specialty, Catheters, Time Factors, Respiratory rate, medicine.medical_treatment, Partial Pressure, Hemodynamics, Nose, Critical Care and Intensive Care Medicine, medicine.disease_cause, Severity of Illness Index, Oxygen therapy, medicine, Intubation, Intratracheal, Intubation, Humans, Treatment Failure, Simplified Acute Physiology Score, Aged, Retrospective Studies, Respiratory Distress Syndrome, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, General Medicine, Middle Aged, medicine.disease, Surgery, Oxygen, Intensive Care Units, SAPS II, Anesthesia, Acute Disease, Female, business, Respiratory Insufficiency, Nasal cannula
Abstract

BACKGROUND: Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS. METHODS: This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared. RESULTS: Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (PaO2/FIO2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P = .001), occurrence of additional organ failure (76% vs 26%, P = .002), mainly hemodynamic (50% vs 7%, P = .001) or neurological (22% vs 0, P = .01), and trends toward lower PaO2/FIO2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis. CONCLUSIONS: In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS.

Published
2014

124. The case: a crystal-clear diagnosis: acute kidney injury in a patient with suspected meningoencephalitis. Diagnosis: Amoxicillin-induced crystal nephropathy

Author

Cedric, Rafat, Jean-Philippe, Haymann, Stéphane, Gaudry, Vincent, Labbé, Romain, Miguel-Montanes, Nicolas, Dufour, Michel, Daudon, Didier, Dreyfuss, and Jean-Damien, Ricard

Subjects
Male, Amoxicillin, Acute Kidney Injury, Urinalysis, Anti-Bacterial Agents, Renal Replacement Therapy, Treatment Outcome, Meningoencephalitis, Predictive Value of Tests, Risk Factors, Humans, Microscopy, Phase-Contrast, Microscopy, Polarization, Crystallization, Aged
Published
2014

125. Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units

Author

Frédéric Bellec, Arnaud Chiche, Thierry Boulain, Arnaud Desachy, Séverin Cabasson, Julie Boisramé-Helms, Pierre-François Dequin, Philippe Vignon, Ferhat Meziani, Patricia Courouble, Isabelle Geneau, Stephan Ehrmann, François Réminiac, Sébastien Perbet, Stéphane Gaudry, Noémie Clavieras, Jean-Baptiste Lascarrou, Karim Lakhal, Pablo L. Massanet, Yoan Falquet, and Adrien Bouglé

Subjects
Tachycardia, Adult, Male, Mean arterial pressure, Pediatrics, medicine.medical_specialty, Plasma Substitutes, Hemodynamics, Blood volume, Critical Care and Intensive Care Medicine, Interquartile range, Intensive care, medicine, Humans, Prospective Studies, Simplified Acute Physiology Score, Practice Patterns, Physicians', Aged, Monitoring, Physiologic, business.industry, Shock, Middle Aged, Intensive Care Units, Shock (circulatory), Anesthesia, Female, France, medicine.symptom, business
Abstract

To describe the current practices of volume expansion in French intensive care units (ICU). In 19 ICUs, we prospectively observed the prescription and monitoring practices of volume expansion in consecutive adult patients with shock [sustained hypotension and/or need of vasopressor therapy, associated with at least tachycardia and/or sign (s) of hypoperfusion]. Patients were included at the time of prescription of the first fluid bolus (FB). Thereafter, all the FBs administered during the 96 h following shock onset were surveyed. An FB was defined as an intravenous bolus of at least 100 ml of a blood volume expander intended to rapidly improve the patient’s circulatory condition. We included 777 patients [age: 63 ± 15 years; female gender: 274 (35 %); simplified acute physiology score II: 55.9 ± 20.6; ICU length of stay: 6 days (interquartile range (IQR) 3–13); ICU mortality: 32.8 %] and surveyed 2,694 FBs. At enrolment mean arterial pressure was 63 mmHg (IQR 55–71). The most frequent triggers of FB were hypotension, low urine output, tachycardia, skin mottling and hyperlactataemia. Amount of fluid given at each FB was highly variable between centres. Crystalloids were used in 91 % (2,394/2,635) and synthetic colloids in 3.3 % (87/2,635) of FBs. Overall, clinicians used any kind of haemodynamic assessment (central venous pressure measurement, predictive indices of fluid responsiveness, echocardiography, cardiac output monitoring or a combination of these) in 23.6 % (635/2,694) of all FBs surveyed, with an important between-centre heterogeneity. High between-centre variability characterised all the aspects of FB prescription and monitoring, but overall haemodynamic exploration to help guide and monitor FB was infrequent.

Published
2014

126. Acute kidney injury in critical care: experience of a conservative strategy

Author

Cédric Rafat, Didier Dreyfuss, David Hajage, Lucile Regard, Jonathan Messika, Stéphane Gaudry, Clément Leclaire, Jean-Damien Ricard, and Alexandre Bedet

Subjects
Male, medicine.medical_specialty, Time Factors, Critical Care, Organ Dysfunction Scores, medicine.medical_treatment, Oliguria, urologic and male genital diseases, Critical Care and Intensive Care Medicine, Kidney Function Tests, law.invention, Blood Urea Nitrogen, chemistry.chemical_compound, law, Internal medicine, Severity of illness, medicine, Humans, Renal replacement therapy, Simplified Acute Physiology Score, APACHE, Aged, Retrospective Studies, Creatinine, business.industry, Acute kidney injury, Metabolic acidosis, Acute Kidney Injury, Middle Aged, medicine.disease, Intensive care unit, female genital diseases and pregnancy complications, Surgery, Renal Replacement Therapy, Intensive Care Units, chemistry, Potassium, Arterial blood, Female, business, Acidosis
Abstract

Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate.We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria: serum creatinine concentration greater than 300 μmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH7.2), oliguria (urine output135 mL/8 hours or400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator.Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness: Simplified Acute Physiology Score II (55±17 vs 60±19, respectively; P.05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P=.01). Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P.001). In the marginal structural Cox model, RRT was associated with increased mortality (P.01).A conservative approach of AKI was not associated with increased mortality.

Published
2014

127. Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2)

Author

Didier Thevenin, Hoang-Nam Bui, Jérôme Devaquet, Virginie Maxime, Ahmed El Kalioubie, Erika Parmentier, Frédéric Martino, Véronique Leray, Jean-Paul Mira, Jean Etienne Herbrecht, Emmanuelle Mercier, Mercé Jourdain, Carole Schwebel, L. Brisard, Olivier Gontier, Nathalie Rolin, Daniel da Silva, Anne Bretagnol, Vlad Botoc, Vincent Das, Emilie Greau, Jean-Philippe Rigaud, Bertrand Guidet, Michael Darmon, Frédéric Bellec, Jean Reignier, Karim Asehnoune, Christophe Guitton, Saad Nseir, Nadia Anguel, Amélie Le Gouge, Hervé Dupont, Michel Sirodot, Bruno Giraudeau, Frédérique Ganster, Gaël Piton, Ferhat Meziani, René Robert, Jack Richecoeur, Jean-Baptiste Lascarrou, Emmanuel Canet, Michel Djibré, Ali Ait Hssain, Benoit Misset, Stéphanie Martin, Jean-Pierre Quenot, Stéphane Gaudry, Philippe Letocart, Pierre Asfar, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Centre hospitalier universitaire de Nantes (CHU Nantes), 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), 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), Centre Hospitalier Départemental Les Oudairies, CHU La Roche sur Yon, CHU Amiens-Picardie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier de la Région d'Annecy (Pringy), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Bordeaux [Bordeaux], Hôpitaux de Chartres [Chartres], CHU Clermont-Ferrand, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Hôpital de Dieppe, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Hôpital Raymond Poincaré [AP-HP], Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Lille, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Hospitalier de Melun, Hopital Montauban, Centre Hospitalier Intercommunal André Grégoire [Montreuil] (CHI André Gregoire), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Hôtel-Dieu de Nantes, Centre Hospitalier Régional d'Orléans (CHRO), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Cochin [AP-HP], Hopital Saint-Louis [AP-HP] (AP-HP), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier Saint-Joseph [Paris], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier Rodez, Hôpital de Saint-Denis, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CH de Saint-Malo [Broussais], CHU Strasbourg, Hôpital Foch [Suresnes], Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CH Beauvais, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Université Francois Rabelais [Tours], PRES Centre-Val de Loire Université, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), and Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée)

Subjects
Research design, Parenteral Nutrition, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Medicine (miscellaneous), Enteral administration, law.invention, Study Protocol, Mechanical ventilation, Nosocomial infection, Catecholamines, 0302 clinical medicine, Clinical Protocols, Randomized controlled trial, Risk Factors, law, Vasoconstrictor Agents, Pharmacology (medical), Hospital Mortality, 030212 general & internal medicine, Shock, 3. Good health, Intensive Care Units, Treatment Outcome, Research Design, Shock (circulatory), France, medicine.symptom, medicine.medical_specialty, Critical Care, Critical Illness, Shock, Cardiogenic, Nutritional Status, 03 medical and health sciences, Enteral Nutrition, Intensive care, medicine, Humans, In patient, Mortality, Intensive care medicine, Vasoactive drugs, business.industry, 030208 emergency & critical care medicine, Respiration, Artificial, Parenteral nutrition, Energy Intake, business, Biomarkers
Abstract

International audience; BACKGROUND: Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation (IMV) and the most commonly prescribed treatment in intensive care units (ICUs). International guidelines consistently indicate that enteral nutrition (EN) should be preferred over parenteral nutrition (PN) whenever possible and started as early as possible. However, no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality. The primary goal of this trial is to assess the hypothesis that early first-line EN, as compared to early first-line PN, decreases day 28 all-cause mortality in patients receiving IMV and vasoactive drugs for shock. METHODS/DESIGN: The NUTRIREA-2 study is a multicenter, open-label, parallel-group, randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least 48 hours, combined with vasoactive drugs, for shock. Patients will be allocated at random to first-line PN for at least 72 hours or to first-line EN. In both groups, nutritional support will be started within 24 hours after IMV initiation. Calorie targets will be 20 to 25 kcal/kg/day during the first week, then 25 to 30 kcal/kg/day thereafter. Patients receiving PN may be switched to EN after at least 72 hours in the event of shock resolution (no vasoactive drugs for 24 consecutive hours and arterial lactic acid level below 2 mmol/L). On day 7, all patients receiving PN and having no contraindications to EN will be switched to EN. In both groups, supplemental PN may be added to EN after day 7 in patients with persistent intolerance to EN and inadequate calorie intake. We plan to recruit 2,854 patients at 44 participating ICUs. DISCUSSION: The NUTRIREA-2 study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients. Enrollment started on 22 March 2013 and is expected to end in November 2015. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01802099 (registered 27 February 2013).

Published
2014

129. Reply: continuous infusion of amphotericin B deoxycholate for the treatment of life-threatening Candida infections

Author

Stéphane Gaudry, Didier Dreyfuss, and Jean-Damien Ricard

Subjects
Pulmonary and Respiratory Medicine, Cross Infection, Antifungal Agents, business.industry, Continuous infusion, Candidiasis, Critical Care and Intensive Care Medicine, Candida infections, Microbiology, Amphotericin B deoxycholate, Amphotericin B, Medicine, Humans, business, Deoxycholic Acid
Published
2013

130. An intragastric chest tube insertion

Author

Georges Surugue, Stéphane Gaudry, Damien Roux, and Michel Wolff

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Stomach Volvulus, Lumen (anatomy), Critical Care and Intensive Care Medicine, Stomach surgery, medicine, Humans, Diaphragmatic hernia, Hernia, Hernia, Diaphragmatic, Respiratory Distress Syndrome, medicine.diagnostic_test, business.industry, Stomach, Pneumothorax, medicine.disease, Surgery, Abdominal Pain, Chest tube, medicine.anatomical_structure, Chest Tubes, Abdomen, Radiography, Thoracic, business, Chest radiograph, Tomography, X-Ray Computed
Abstract

A 38-year-old man presented with a 1-week history of respiratory distress and abdominal pain with vomiting. He had undergone left lower lobectomy for localized bronchiectasis 6 months earlier. Physical examination revealed unilateral distension of the left thorax with hyperresonance to percussion and absent breath sounds suggestive of left tension pneumothorax. He rapidly presented cardiopulmonary arrest. Early resuscitation was provided but needle aspiration was unsuccessful. Return to spontaneous cardiac activity was obtained after left chest tube insertion and pleural drainage of 1,000 ml of brown fluid and gas. A chest radiograph (Fig. 1) performed before cardiac arrest showed air and liquid in the left pleural cavity with severe deviation of mediastinal structures and right lung compression. A CT-scan (Fig. 2) of the chest revealed herniation of the stomach into the left chest cavity and insertion of the chest tube into the lumen of the intrathoracic stomach. An urgent surgical procedure established the diagnosis of acquired diaphragmatic hernia with intrathoracic gastric volvulus. Perioperative findings confirmed gastric placement of the tube with its trans-diaphragmatic route until the duodenal lumen. Surgery consisted of replacing the stomach back into the abdomen, suturing the iatrogenic gastric perforation, and repairing the diaphragm.

Published
2013

131. Airway fungal colonization compromises the immune system allowing bacterial pneumonia to prevail

Author

Didier Dreyfuss, Jean-Damien Ricard, Meryem Aloulou, Renato C. Monteiro, Damien Roux, Linda Khoy-Ear, Erick Denamur, David Skurnik, Mathilde Phillips-Houlbracq, Stéphane Gaudry, and Julie Bex

Subjects
Male, Antifungal Agents, Bronchi, Critical Care and Intensive Care Medicine, medicine.disease_cause, Microbiology, Interferon-gamma, Immune system, Phagocytosis, Candida albicans, Macrophages, Alveolar, medicine, Pneumonia, Bacterial, Animals, Colonization, Rats, Wistar, Immunity, Cellular, Lung, biology, Pseudomonas aeruginosa, business.industry, Bacterial pneumonia, biology.organism_classification, medicine.disease, Corpus albicans, respiratory tract diseases, Rats, medicine.anatomical_structure, Immunology, business, Pneumonia (non-human)
Abstract

Objective: To study the correlation between fungal colonization and bacterial pneumonia and to test the effect of antifungal treatments on the development of bacterial pneumonia in colonized rats. Design: Experimental animal investigation. Setting: University research laboratory. Subjects: Pathogen-free male Wistar rats weighing 250–275 g. Interventions: Rats were colonized by intratracheal instillation of Candida albicans. Fungal clearance from the lungs and immune response were measured. Both colonized and noncolonized animals were secondarily instilled with different bacterial species (Pseudomonas aeruginosa, Escherichia coli, or Staphylococcus aureus). Bacterial phagocytosis by alveolar macrophages was evaluated in the presence of interferon-gamma, the main cytokine produced during fungal colonization. The effect of antifungal treatments on fungal colonization and its immune response were assessed. The prevalence of P. aeruginosa pneumonia was compared in antifungal treated and control colonized rats. Measurements and Main Results: C. albicans was slowly cleared and induced a Th1-Th17 immune response with very high interferon-gamma concentrations. Airway fungal colonization favored the development of bacterial pneumonia. Interferon-gamma was able to inhibit the phagocytosis of unopsonized bacteria by alveolar macrophages. Antifungal treatment decreased airway fungal colonization, lung interferon-gamma levels and, consequently, the prevalence of subsequent bacterial pneumonia. Conclusions: C. albicans airway colonization elicited a Th1-Th17 immune response that favored the development of bacterial pneumonia via the inhibition of bacterial phagocytosis by alveolar macrophages. Antifungal treatment decreased the risk of bacterial pneumonia in colonized rats.

Published
2013

132. [Acute respiratory distress syndrome]

Author

Stéphane, Gaudry, Jean-Damien, Ricard, and Didier, Dreyfuss

Subjects
Respiratory Distress Syndrome, Humans
Abstract

Acute respiratory distress syndrome (ARDS) is a permeability pulmonary edema due to lung injury from various causes. In 2012, a new definition, taking into account the degree of hypoxemia and the level of positive end-expiratory pressure (PEEP), was published. In addition to progress in the support of organ failures in intensive care, mortality in patients suffering from ARDS has decreased significantly. This improved prognosis is also due to the advent of protective mechanical ventilation that has limited ventilator-induced lung injury (VILI). The treatment of ARDS consists on causative treatment and a strategy of protective ventilation associated with a PEEP level between 10 and 15 cm H20 and the use of prone position or inhaled nitric oxide in the severest cases. The role of extracorporeal membrane oxygenation as adjuvant therapy in ARDS remains unclear.

Published
2013

133. Critères de jugement importants pour les patients (patient-important outcomes) dans les essais contrôlés randomisés en réanimation

Author

B.E. Pasquet, Jean-Damien Ricard, Jonathan Messika, E. Dubief, S Guillo, Didier Dreyfuss, F. Tubac, and Stéphane Gaudry

Subjects
Epidemiology, Public Health, Environmental and Occupational Health
Abstract

Introduction Les decisions therapeutiques en reanimation sont motivees par deux objectifs : limiter la mortalite des patients et ameliorer le pronostic a moyen et long terme des patients ayant survecu (habituellement appele : patient-important outcomes ). L’objectif de ce travail etait de decrire comment les essais controles randomises en reanimation exploraient ces patient-important outcomes . Methodes Il s’agissait d’une revue systematique des essais controles randomises incluant des patients hospitalises en reanimation. Nous avons realise une recherche bibliographique a l’aide de Medline (Pubmed ® ) sur 12 mois (annee 2013). Les donnees ont ete extraites grâce a une double lecture independante par deux reanimateurs seniors. Les caracteristiques generales et methodologiques des essais ont ete recueillies. Tous les criteres de jugement (principaux et secondaires) ont ete recueillis puis classes en six categories dont la categorie des patient-important outcomes . Cette categorie etait englobait : la mortalite a tout moment et les criteres de jugement centres sur les patients evalues apres l’hospitalisation en reanimation. Resultats Parmi les 716 articles evalues apres la recherche bibliographique, 152 presentaient les criteres d’inclusion dans l’etude. Ces 152 articles totalisaient 142 252 patients (âge 61 [54–66] ans). Les trois domaines les plus frequents etaient : la ventilation mecanique (31 %), le sepsis (20 %) et la nutrition (14 %). Les interventions etaient le plus souvent des strategies therapeutiques (40 %), des medicaments (31 %) ou des dispositifs (15 %). Cent-deux essais (68 %) evaluaient le critere de jugement principal apres une periode fixe de 7 [2–28] jours (apres la randomisation) dont seulement 15 (10 %) au-dela de 30 jours. Les autres essais evaluaient le critere de jugement principal a la sortie de reanimation ( n = 33, 22 %) ou de l’hopital ( n = 10, 7 %). Cinq essais ne precisaient pas le moment de cette evaluation. Parmi les 152 criteres de jugement principaux, 31 (20 %) etaient des patient-important outcomes (mortalite = 25 ; statut fonctionnel = 4 ; qualite de vie = 2). Parmi les 801 criteres de jugement secondaires, 169 (21 %) patient-important outcomes (mortalite = 117 ; qualite de vie = 22 ; statut fonctionnel = 19 ; performance cognitive = 7 ; handicap = 2 ; stress post-traumatique = 1 ; satisfaction du patient = 1). Quatre-vingt-seize essais (63 %) rapportaient au moins un patient-important outcome mais seulement 17 (11 %) rapportaient au moins un critere de jugement centre sur le patient apres l’hospitalisation en reanimation. En analyse multivariee, les essais ayant comme domaine le sepsis (OR : 7,6 ; IC95 % : 2,2–25,5) et ayant une bonne qualite methodologique (OR : 4,8 ; IC95 % : 2,1–10,7) etaient plus souvent associes a l’evaluation d’un patient-important outcome . Discussion et conclusion Les patient-important outcomes representent seulement 21 % des criteres de jugement principaux et secondaires des essais controles randomises en reanimation publies en 2013. La grande majorite de ces criteres de jugement sont lies a la mortalite. Par ailleurs, le suivi apres randomisation est souvent court (seulement 10 % des essais ont un critere de jugement principal evalue apres 30 jours) limitant ainsi l’evaluation de criteres centres sur le patient au-dela de l’hospitalisation en reanimation. Les essais randomises a venir devraient inclure l’evaluation de patient-important outcomes afin de mieux guider les choix therapeutiques des medecins reanimateurs.

Published
2016

134. Quels déterminants du succès primaire de l’exsufflation de pneumothorax spontané ?

Author

Didier Dreyfuss, Stéphane Gaudry, B. La Combe, Jean-Damien Ricard, Jonathan Messika, and C. Vuillard

Subjects
Pulmonary and Respiratory Medicine, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, 030212 general & internal medicine
Abstract

Introduction Le pneumothorax spontane idiopathique (PSI) est une pathologie frequente dont le traitement par l’exsufflation a l’aiguille figure dans les recommandations internationales [1] , et est utilisee en premiere ligne dans notre service [2] . Les facteurs associes a son succes sont peu connus. L’objectif principal est de les determiner. Methodes Etude prospective (01/2012–08/2015), observationnelle, monocentrique. Inclusion de tous les patients admis pour un PSI en reanimation/surveillance continue. Le critere de jugement principal est le succes immediat de l’exsufflation (absence de drainage dans les 24 heures). Resultats Parmi les 70 patients inclus, 62 (89 %) ont ete exsuffles a l’aiguille, avec un succes immediat chez 22 (36 % des exsufflations). Sept ont recidive dans le mois suivant. Le taux de succes definitif etait de 29 %. La duree d’evolution du PSI (delai premiers symptomes – exsufflation) etait significativement plus longue lorsque l’exsufflation etait un succes (18 vs 10 h ; p = 0,012). L’exsufflation apres 24 h d’evolution du PSI avait un taux de succes plus important qu’avant 24 h (65 % vs 24 % ; p = 0,006). Un IMC plus bas (20 vs 21 ; p = 0,045) et un score de Light plus faible (11 vs 36, p = 0,007) etaient associes au succes. Le succes de l’exsufflation permettait un gain significatif de duree d’hospitalisation de 5 jours (1 vs 6 j ; p Conclusion Dans la prise en charge du PSI par exsufflation, un delai plus long entre la survenue du pneumothorax et la realisation de l’exsufflation, et un moindre decollement semblent associe a un succes de celle-ci.

Published
2016

135. Epicardial adipose tissue and severe Coronavirus Disease 19

Author

Hélène Bihan, Richard Heidar, Aude Beloeuvre, Lucie Allard, Elise Ouedraogo, Sopio Tatulashvili, Yacine Tandjaoui, Stephane Gaudry, Pierre-Yves Brillet, and Emmanuel Cosson

Subjects
Epicardial fat volume, Epicardial adipose tissue (EAT), Inflammation, COVID-19, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Both visceral adipose tissue and epicardial adipose tissue (EAT) have pro-inflammatory properties. The former is associated with Coronavirus Disease 19 (COVID-19) severity. We aimed to investigate whether an association also exists for EAT. Material and methods We retrospectively measured EAT volume using computed tomography (CT) scans (semi-automatic software) of inpatients with COVID-19 and analyzed the correlation between EAT volume and anthropometric characteristics and comorbidities. We then analyzed the clinicobiological and radiological parameters associated with severe COVID-19 (O2 $$\ge$$ ≥ 6 l/min), intensive care unit (ICU) admission or death, and 25% or more CT lung involvement, which are three key indicators of COVID-19 severity. Results We included 100 consecutive patients; 63% were men, mean age was 61.8 ± 16.2 years, 47% were obese, 54% had hypertension, 42% diabetes, and 17.2% a cardiovascular event history. Severe COVID-19 (n = 35, 35%) was associated with EAT volume (132 ± 62 vs 104 ± 40 cm3, p = 0.02), age, ferritinemia, and 25% or more CT lung involvement. ICU admission or death (n = 14, 14%) was associated with EAT volume (153 ± 67 vs 108 ± 45 cm3, p = 0.015), hypertension and 25% or more CT lung involvement. The association between EAT volume and severe COVID-19 remained after adjustment for sex, BMI, ferritinemia and lung involvement, but not after adjustment for age. Instead, the association between EAT volume and ICU admission or death remained after adjustment for all five of these parameters. Conclusions Our results suggest that measuring EAT volume on chest CT scans at hospital admission in patients diagnosed with COVID-19 might help to assess the risk of disease aggravation.

Published
2021
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136. [New therapeutic strategies in ARDS]

Author

Didier Dreyfuss, Stéphane Gaudry, and Jean-Damien Ricard

Subjects
medicine.medical_specialty, ARDS, Unité de soins intensifs, medicine.medical_treatment, Syndrome de détresse respiratoire aiguë, entilation mécanique, Emergency Nursing, law.invention, Cell therapy, Pharmacotherapy, Mechanical ventilation, law, medicine, Extracorporeal membrane oxygenation, Enseignement Supérieur en Réanimation, Intensive care unit, Intensive care medicine, Acute respiratory distress syndrome, business.industry, Neuromuscular Blocking Agents, medicine.disease, Clinical trial, Emergency Medicine, Traitement pharmacologique, Drug therapy, business
Abstract

Résumé Le traitement du syndrome de détresse respiratoire aiguë (SDRA) fait l’objet, depuis longtemps, de nombreux travaux de recherche, sources d’intenses controverses. L’actualité dans ce domaine est riche et très variée. Les effets sur le pronostic du SDRA de traitements couramment utilisés ont pu récemment être précisés. Par exemple, il a été démontré que le décubitus ventral, qui n’avait montré jusqu’ici qu’une amélioration de l’hématose sans effet sur la mortalité, pouvait améliorer la survie des patients les plus sévèrement hypoxémiques. L’utilisation de curares à la phase aiguë du SDRA a également montré un effet bénéfique sur la survie. La place de l’oxygénation par membrane extracorporelle (ECMO) dans la prise en charge du SDRA reste à définir, malgré des données laissant supposer une possible efficacité. Par ailleurs, une voie de recherche s’est ouverte avec l’avènement des thérapies cellulaires. En effet, les cellules souches mésenchymateuses semblent pouvoir à la fois favoriser la réparation de l’épithélium alvéolaire et prévenir des risques infectieux. Leur efficacité dans les modèles animaux de SDRA demande à être confirmée par des études chez l’homme. Enfin, certaines thérapeutiques prometteuses ont montré leurs limites. C’est le cas notamment des agonistes béta-adrénergiques et des acides gras oméga-3 qui ont montré leur inefficacité dans plusieurs grandes études cliniques sur le SDRA.

Published
2012

137. Reply to the Editor

Author

Stéphane Gaudry, Antoine Rabbat, Yves Cohen, and Hervé Mal

Subjects
Male, Pulmonary and Respiratory Medicine, business.industry, Respiration, Artificial, Idiopathic Pulmonary Fibrosis, cardiovascular system, Humans, Medicine, Female, Surgery, Idiopathic Interstitial Pneumonias, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, business, Classics
Published
2014

139. Delayed reopening of a hemodynamically significant patent foramen ovale after left lung transplantation: emergency management

Author

Stéphane Gaudry, A.-C. Metivier, Michel Fournier, Gabriel Thabut, Eric Brochet, Jean Michel Juliard, Pierre Aubry, Olivier Brugière, Florence Arnoult, Michel Wolff, Giuseppina Biondi, Gaëlle Dauriat, and Hervé Mal

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, medicine.medical_treatment, Pulmonary Fibrosis, Foramen Ovale, Patent, Inferior vena cava, Hypoxemia, stomatognathic system, Pulmonary fibrosis, medicine, Lung transplantation, Humans, Hypoxia, Transplantation, business.industry, Middle Aged, medicine.disease, Surgery, Shunting, medicine.vein, Patent foramen ovale, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Complication, Lung Transplantation
Abstract

We report the case of a man who underwent a left-lung transplantation for pulmonary fibrosis and who developed deterioration of his respiratory condition at Day 16 post-operatively, with marked hypoxemia not explained by the usual early respiratory complications of lung transplantation. Contrast-enhanced transthoracic echocardiography identified a patent foramen ovale with massive spontaneous right-to-left shunting. As for the pathogenesis of this right-to-left shunting, we found no evidence supporting an elevation of right-side pressures, with the redirection of the inferior vena cava flow toward the patent foramen ovale being the suspected mechanism. We conclude that delayed reopening of the patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplantation.

Published
2009

142. Candida albicans impairs macrophage function and facilitates Pseudomonas aeruginosa pneumonia in rat

Author

Georges Saumon, Didier Dreyfuss, Erick Denamur, Jean-Damien Ricard, Nicolas de Prost, Stéphane Gaudry, Jamel El-Benna, and Damien Roux

Subjects
Male, Critical Care and Intensive Care Medicine, medicine.disease_cause, Microbiology, Intensive care, Candida albicans, medicine, Pneumonia, Bacterial, Animals, Rats, Wistar, biology, Pseudomonas aeruginosa, business.industry, Macrophages, Respiratory disease, Bacterial pneumonia, biology.organism_classification, medicine.disease, Rats, Pneumonia, Immunology, Pseudomonadales, business, Pseudomonadaceae
Abstract

To determine whether Candida albicans airway colonization influences Pseudomonas aeruginosa pneumonia prevalence in rats and by which mechanism.Prospective, randomized, controlled animal study.Research laboratory of a university.Male adult Wistar rats weighing 275-300 g.In vivo: P. aeruginosa pneumonia was induced by bronchial instillation of P. aeruginosa in rats previously instilled or not with live or ethanol-killed C. albicans. In vitro: Alveolar macrophages were incubated with or without live or ethanol-killed C. albicans.Quantitative cultures of lung were done. Lung tumor necrosis factor alpha, interferon gamma, and interleukin-6 levels were measured along with reactive oxygen species (ROS) production by alveolar macrophages. P. aeruginosa pneumonia prevalence was higher in rats given live but not ethanol-killed C. albicans. Instilling live C. albicans alone increased lung tumor necrosis factor-alpha and interferon-gamma but not interleukin-6, and was not associated with clinical or histologic signs of infection. These three cytokines were more abundant in lungs instilled with live C. albicans and P. aeruginosa than in those instilled with P. aeruginosa alone or with ethanol-killed C. albicans and P. aeruginosa. Alveolar macrophages incubated with live C. albicans had decreased ROS production.C. albicans impedes alveolar macrophage ROS production and is correlated with an increase of P. aeruginosa pneumonia prevalence in rats. These results highlight the previously overlooked impact of airway fungal colonization on lung bacterial infection, and indicate the need for studies on the potential for antifungal therapy to prevent the onset of ventilator-associated pneumonia caused by P. aeruginosa.

Published
2009

143. Décubitus ventral dans le contexte de chirurgie abdominale récente

Author

Samuel Tuffet, Anne-Claire Lukaszewicz, Didier Payen, Christian Laplace, Stéphane Gaudry, David Hajage, Didier Dreyfuss, Bruno Costaglioli, Noémie Zucman, Jean-Damien Ricard, Marc Pocard, Simon Msika, and Jacques Duranteau

Subjects
Anesthesiology and Pain Medicine
Abstract

Introduction Le decubitus ventral (DV), utilise comme strategie de recrutement alveolaire au cours du SDRA permet une amelioration de l’oxygenation et de la survie. Les urgences chirurgicales abdominales figurent parmi les etiologies extrapulmonaires du SDRA. En cas d’hypoxemie severe en postoperatoire, les reanimateurs sont confrontes a la decision de mettre ou non ces patients en DV. Nous avons cherche a connaitre les complications liees a la mise precoce en DV dans les suites d’une chirurgie abdominale. Patients et methodes Etude retrospective sur 5 ans, approuvee par le comite d’ethique de la SRLF (no 14–31), realisee dans 3 reanimations dont l’objectif etait de comparer la prevalence des complications chirurgicales potentiellement favorisees par le DV entre les patients ayant eu au moins une seance de DV et les patients n’ayant eu aucune seance de DV dans le contexte de SDRA dans les suites d’une chirurgie abdominale. Nous avons inclus des patients adultes ayant presente un SDRA dans un contexte de chirurgie abdominale recente ( Le critere de jugement principal etait le nombre de patients ayant eu au moins une complication chirurgicale potentiellement liee au DV. Cette liste a ete definie a priori : desunion de cicatrice, syndrome du compartiment abdominal, desinsertion de stomie, necrose de stomie, necrose de la cicatrice, abces de paroi, arrachage d’un systeme de drainage (drain peritoneal, drain biliaire), arrachage d’une gastrostomie ou d’une jejunostomie d’alimentation, fistule digestive, eventration. Resultats Parmi les 98 patients inclus (âge 64[± 18] ans, IGS2 53[± 17]), 79 (81 %) avaient ete operes dans un contexte d’urgence dont 41 peritonites. Trente-six patients (37 %) ont eu au moins une seance de DV (nombre de seances : 1 [1–2]) et 62 (63 %) aucune. Les patients mis en DV avaient un rapport PaO2/FiO2 minimal plus faible que ceux du groupe temoin (74[±24] vs 101[± 43] mmHg, p = 0,0005). La premiere seance de DV (duree moyenne 19 [± 10] heures) a permis une augmentation du rapport PaO2/FiO2 moyen de 95 (± 47) a 189 (± 92) mmHg (p = 0,001). Dans le groupe DV, 14 patients (39 %) ont presente au moins une complication chirurgicale contre 27 (44 %) dans le groupe temoin (p = 0,65). Apres application d’un score de propension, l’absence de difference persistait (OR 0,72 [0,26–2,02], p = 0,54). Ces complications ont eu pour consequence une reprise chirurgicale chez 2 (6 %) patients du groupe DV et 4 (6 %) du groupe temoin (p = 0,89). La mortalite en reanimation etait de 42 % dans le groupe DV et de 45 % dans le groupe temoin (p = 0,43). Discussion Ces resultats confirment l’efficacite du DV en terme d’amelioration de l’oxygenation chez des patients ayant eu une chirurgie abdominale recente sans augmentation significative du nombre de complications chirurgicales. Chez les patients presentant un SDRA dans le contexte d’une pathologie abdominale chirurgicale, la mise en DV en postoperatoire ne devrait pas etre limitee.

Published
2015

144. ECCO2R : évaluation de son utilisation dans les réanimations françaises

Author

Benjamin Deniau, Didier Dreyfuss, Stéphane Gaudry, Jonathan Messika, and Jean-Damien Ricard

Subjects
Anesthesiology and Pain Medicine
Abstract

Introduction L’ extracorporeal dioxyde carbon removal (ECCO 2 R) est une technique d’epuration du dioxyde de carbone (CO 2 ) par circulation extra-corporelle, decrite par en 1978 [1] . Des etudes physiologiques ont montre qu’elle permet d’eliminer 50 % du CO 2 produit [2] . Elle est utilisee pour la ventilation ultra-protectrice du syndrome de detresse respiratoire aigu (SDRA) [3] ou comme alternative a la ventilation mecanique au cours de la decompensation hypercapnique de BPCO. En raison du manque de preuve scientifique de son efficacite, elle n’est pas disponible aux Etats-Unis. Neanmoins, en Europe, des projets d’evaluation sont en cours. L’objectif de cette etude est d’evaluer son utilisation en reanimation en France. Materiel et methodes Enquete retrospective, observationnelle, sur l’utilisation de l’ ECCO 2 R au cours des 5 dernieres annees dans les reanimations francaises. L’accord d’un comite d’ethique n’etait pas requis. Afin d’assurer une bonne representativite geographique et la meilleure exhaustivite possible, plusieurs sources ont ete utilisees pour etablir la liste des services de reanimation a contacter (societes savantes, annuaires des hopitaux generaux et universitaires, etablissements prives). Les informations suivantes etaient recueillies par telephone : utilisation et indication de l’ECCO 2 R, choix de la technique, nombre de patients traites, complications, degre de satisfaction (echelle de 0 a 10 ; efficacite en terme de decarboxylation, tolerance et globale), et utilisation de l’ECMO. Resultats Deux cent vingt-deux reanimations ont ete contactees (52 medicales, 20 chirurgicales, 132 polyvalentes, 3 specialisees en chirurgie cardio-thoracique, 6 pediatriques, et 2 specialisees en neurochirurgie). Seules 3 ont refuse de repondre. Trente-trois (15 %) reanimations ont utilise l’ECCO 2 R au cours des 5 dernieres annees (292 patients traites (mediane par centre : 3 [1–7])). Il s’agissait majoritairement de reanimations polyvalentes (48 %) et medicales (33 %). L’iLA ® (Novalung) et l’Hemolung ® (Alung) etaient les techniques les plus utilisees (63 % et 36 %). L’indication majoritaire etait la ventilation ultra-protectrice du SDRA (54 %). Les autres indications etaient : echec de la ventilation non invasive du BPCO (30 %), sevrage de la ventilation invasive du BPCO (12 %) et autres (fistule broncho-pleurale, insuffisance ventriculaire droite, pneumothorax, exacerbation de fibrose pulmonaire) (4 %). Parmi les centres utilisant l’ECCO 2 R, 22 (67 %) rapportaient au moins une complication. Les complications les plus frequentes etaient le saignement (45 %) et la thrombose de filtre (18 %). Les taux de satisfaction etaient : efficacite en termes de decarboxylation 7,9 ± 2,4 ; tolerance 6,9 ± 2,6 ; globale 6,8 ± 2,2. Vingt et un (63 %) centres utilisant l’ECCO 2 R, utilisaient l’ECMO. Les principaux motifs de la non-utilisation de l’ECCO 2 R etaient l’absence d’equipe formee, l’absence de materiel sur place, et l’absence de donnee scientifique suffisante (56,5 %, 38 % et 19,5 % des cas). Discussion Ces resultats preliminaires montrent que l’ECCO 2 R est peu utilisee dans les reanimations francaises. Les donnees scientifiques sont insuffisantes pour en connaitre les indications precises. De nouvelles etudes sont en cours afin de repondre a cette question.

Published
2015

145. Prone positioning in acute respiratory distress syndrome after abdominal surgery

Author

Noémie Zucman, Didier Dreyfuss, S Msika, Jean-Damien Ricard, S Tuffet, M Pocard, Didier Payen, AC Anne-Claire, and Stéphane Gaudry

Subjects
medicine.medical_specialty, ARDS, business.industry, Acute respiratory distress, medicine.disease, Critical Care and Intensive Care Medicine, Prone position, Severe hypoxemia, mental disorders, Emergency medicine, Poster Presentation, medicine, Etiology, Intensive care medicine, business, Abdominal surgery
Abstract

Prone positioning has been used for many years as an alveolar recruitment strategy in acute respiratory distress syndrome (ARDS). Prone positioning in ARDS improves oxygenation and demonstrated recently its effectiveness on prognosis. Extrapulmonary etiologies of ARDS include abdominal emergencies. In cases of severe hypoxemia in the early postoperative period, intensivists discuss prone positioning based on the risk/benefit ratio.

Published
2015

146. Loxapine to control agitation during weaning from mechanical ventilation: a randomized controlled trial

Author

Romain Sonneville, Christophe Clec’h, Jean-Damien Ricard, Didier Dreyfuss, Stéphane Gaudry, David Hajage, Benjamin Sztrymf, and B Megarbanne

Subjects
Mechanical ventilation, medicine.medical_specialty, Spontaneous ventilation, business.industry, medicine.medical_treatment, Loxapine, Critical Care and Intensive Care Medicine, law.invention, Randomized controlled trial, law, Poster Presentation, Emergency medicine, Medicine, Weaning, Observational study, business, medicine.drug
Abstract

Weaning from prolonged mechanical ventilation (MV) in the ICU may be impeded by the occurrence of agitation. Loxapine had the ability to control agitation without affecting the efficacy of spontaneous ventilation in an observational study, justifying the implementation of a randomized controlled trial.

Published
2015

147. Static compliance of the respiratory system in COVID-19 related ARDS: an international multicenter study

Author

Benoit Vandenbunder, Stephan Ehrmann, Michael Piagnerelli, Bertrand Sauneuf, Nicolas Serck, Thibaud Soumagne, Julien Textoris, Christophe Vinsonneau, Nadia Aissaoui, Gauthier Blonz, Giuseppe Carbutti, Romain Courcelle, Alain D’hondt, Stephane Gaudry, Julien Higny, Geoffroy Horlait, Sami Hraiech, Laurent Lefebvre, Francois Lejeune, Andre Ly, Jean-Baptiste Lascarrou, David Grimaldi, and for the COVADIS study group

Subjects
SARS-COV-2, Plateau pressure, Respiratory mechanics, Mechanical ventilation, PEEP, Mortality, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Controversies exist on the nature of COVID-19 related acute respiratory distress syndrome (ARDS) in particular on the static compliance of the respiratory system (Crs). We aimed to analyze the association of Crs with outcome in COVID-19-associated ARDS, to ascertain its determinants and to describe its evolution at day-14. Methods In this observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, Crs was measured at day-1 and day-14. Association between Crs or Crs/ideal body weight (IBW) and breathing without assistance at day-28 was analyzed with multivariable logistic regression. Determinants were ascertained by multivariable linear regression. Day-14 Crs was compared to day-1 Crs with paired t-test in patients still under controlled mechanical ventilation. Results The mean Crs in 372 patients was 37.6 ± 13 mL/cmH2O, similar to as in ARDS of other causes. Multivariate linear regression identified chronic hypertension, low PaO2/FiO2 ratio, low PEEP, and low tidal volume as associated with lower Crs/IBW. After adjustment on confounders, nor Crs [OR 1.0 (CI 95% 0.98–1.02)] neither Crs/IBW [OR 0.63 (CI 95% 0.13–3.1)] were associated with the chance of breathing without assistance at day-28 whereas plateau pressure was [OR 0.93 (CI 95% 0.88–0.99)]. In a subset of 108 patients, day-14 Crs decreased compared to day-1 Crs (31.2 ± 14.4 mL/cmH2O vs 37.8 ± 11.4 mL/cmH2O, p

Published
2021
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148. Monitoring circulating dipeptidyl peptidase 3 (DPP3) predicts improvement of organ failure and survival in sepsis: a prospective observational multinational study

Author

Alice Blet, Benjamin Deniau, Karine Santos, Dirk P. T. van Lier, Feriel Azibani, Xavier Wittebole, Benjamin G. Chousterman, Etienne Gayat, Oliver Hartmann, Joachim Struck, Andreas Bergmann, Massimo Antonelli, Albertus Beishuizen, Jean-Michel Constantin, Charles Damoisel, Nicolas Deye, Salvatore Di Somma, Thierry Dugernier, Bruno François, Stephane Gaudry, Vincent Huberlant, Jean-Baptiste Lascarrou, Gernot Marx, Emmanuelle Mercier, Haikel Oueslati, Peter Pickkers, Romain Sonneville, Matthieu Legrand, Pierre-François Laterre, Alexandre Mebazaa, and AdrenOSS-1 Study Investigators

Subjects
DPP3, Biomarker, Outcome, Sepsis, Septic shock, Organ dysfunction, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Dipeptidyl peptidase 3 (DPP3) is a cytosolic enzyme involved in the degradation of various cardiovascular and endorphin mediators. High levels of circulating DPP3 (cDPP3) indicate a high risk of organ dysfunction and mortality in cardiogenic shock patients. Methods The aim was to assess relationships between cDPP3 during the initial intensive care unit (ICU) stay and short-term outcome in the AdrenOSS-1, a prospective observational multinational study in twenty-four ICU centers in five countries. AdrenOSS-1 included 585 patients admitted to the ICU with severe sepsis or septic shock. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by the Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use and need for renal replacement therapy. cDPP3 levels were measured upon admission and 24 h later. Results Median [IQR] cDPP3 concentration upon admission was 26.5 [16.2–40.4] ng/mL. Initial SOFA score was 7 [5–10], and 28-day mortality was 22%. We found marked associations between cDPP3 upon ICU admission and 28-day mortality (unadjusted standardized HR 1.8 [CI 1.6–2.1]; adjusted HR 1.5 [CI 1.3–1.8]) and between cDPP3 levels and change in renal and liver SOFA score (p = 0.0077 and 0.0009, respectively). The higher the initial cDPP3 was, the greater the need for organ support and vasopressors upon admission; the longer the need for vasopressor(s), mechanical ventilation or RRT and the higher the need for fluid load (all p 40.4 ng/mL upon admission, a decrease in cDPP3 below 40.4 ng/mL after 24 h was associated with an improvement of organ function at 48 h and better 28-day outcome. By contrast, persistently elevated cDPP3 at 24 h was associated with worsening organ function and high 28-day mortality. Conclusions Admission levels and rapid changes in cDPP3 predict outcome during sepsis. Trial Registration ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015.

Published
2021
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149. Syphilitic aortic aneurysm revealed by pericardial tamponade and brain infarction

Author

K. Ben Ahmed, S. Alkhoder, Stéphane Gaudry, and S. Provenchere

Subjects
Adult, Brain Infarction, Male, medicine.medical_specialty, Aortic Aneurysm, Thoracic, business.industry, Pain medicine, Critical Care and Intensive Care Medicine, Magnetic Resonance Imaging, Cardiac Tamponade, Diagnosis, Differential, Echocardiography, Brain infarction, Internal medicine, Anesthesiology, Cardiology, Humans, Medicine, Syphilitic aortic aneurysm, Tamponade, business, Syphilis, Cardiovascular
Published
2013

150. Characteristics and outcomes of acute respiratory distress syndrome related to COVID-19 in Belgian and French intensive care units according to antiviral strategies: the COVADIS multicentre observational study

Author

David Grimaldi, Nadia Aissaoui, Gauthier Blonz, Giuseppe Carbutti, Romain Courcelle, Stephane Gaudry, Aurelie Gaultier, Alain D’hondt, Julien Higny, Geoffrey Horlait, Sami Hraiech, Laurent Lefebvre, Francois Lejeune, Andre Ly, Michael Piagnerelli, Bertrand Sauneuf, Nicolas Serck, Thibaud Soumagne, Piotr Szychowiak, Julien Textoris, Benoit Vandenbunder, Christophe Vinsonneau, Jean- Baptiste Lascarrou, and for the COVADIS study group

Subjects
Renal replacement therapy, Remdesivir, Lopinavir, Ritonavir, Acute kidney injury, Hydroxychloroquine, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Limited data are available regarding antiviral therapy efficacy in most severe patients under mechanical ventilation for Covid-19-related acute respiratory distress syndrome (ARDS). Methods Comparison of antiviral strategies (none, hydroxychloroquine (OHQ), lopinavir/ritonavir (L/R), others (combination or remdesivir) in an observational multicentre cohort of patients with moderate-to-severe Covid-19 ARDS. The primary endpoint was the number of day 28 ventilator-free days (VFD). Patients who died before d28 were considered as having 0 VFD. The variable was dichotomized into “patients still ventilated or dead at day 28” versus “patients weaned and alive at day 28”. Results We analyzed 415 patients (85 treated with standard of care (SOC), 57 with L/R, 220 with OHQ, and 53 others). The median number of d28-VFD was 0 (IQR 0–13) and differed between groups (P = 0.03), SOC patients having the highest d28-VFD. After adjustment for age, sex, Charlson Comorbidity Index, PaO2/FiO2 ratio and plateau pressure and accounting for center effect with a generalized linear mixed model, none of the antiviral strategies increased the chance of being alive and weaned from MV at day 28 compared to the SOC strategy (OR 0.48 CI95% (0.18–1.25); OR 0.96 (0.47–2.02) and OR 1.43 (0.53–4.04) for L/R, OHQ and other treatments, respectively). Acute kidney injury during ICU stay was frequent (55%); its incidence was higher in patients receiving lopinavir (66 vs 53%, P = 0.03). After adjustment for age, sex, BMI, chronic hypertension and chronic renal disease, the use of L/R was associated with an increased risk of renal replacement therapy (RRT). (OR 2.52 CI95% 1.16–5.59). Conclusion In this multicentre observational study of moderate-to-severe Covid-19 ARDS patients, we did not observe any benefit among patients treated with OHQ or L/R compared with SOC. The use of L/R treatment was associated with an increased need for RRT. Take home message Neither hydroxychloroquine nor lopinavir/ritonavir as COVID-19 antiviral treatment is associated with higher ventilator-free days at day 28 when compared with standard of care (no antiviral treatment) in ICU patients under invasive mechanical ventilation. Lopinavir/ritonavir is associated with an increased risk of renal replacement therapy requirement. Tweet COVID-19: Insights from ARDS cohort: no signal of efficacy of any antiviral drugs. Lopinavir/ritonavir may be associated with need for RRT

Published
2020
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