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6,636 results on '"Service de Réanimation"'

201. Kidney biopsy in the critically ill patient, results of a multicentre retrospective case series

Author: Philipponnet, C., Guérin, C., Canet, E., Robert, R., Mariat, C., Dijoud, F., Azoulay, E., Souweine, B., Heng, A.-E., Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, Lyon, France, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France, Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France, Service de Néphrologie, Hôpital Nord, CHU Saint Etienne, Saint Etienne, France, Laboratoire d'Anatomie Pathologie, Centre de Pathologie-Est, Hospices Civils de Lyon, Université de Lyon, Lyon, France, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Service de Néphrologie - Hémodialyses [CHU Clermont-Ferrand], Pôle RHEUNNIRS [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], Service de Néphrologie [CHU Saint Etienne], and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)
Subjects: [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND: The impact of a contributive result of kidney biopsy on the management of patients in the intensive care unit (ICU) has not been extensively investigated yet. METHODS: This was a retrospective study conducted between 2000 and 2011 in five French ICUs. The study included 56 patients. They had at least one non-renal organ failure, as defined by a Sequential Organ Failure Assessment (SOFA) score ≥3 on ICU admission, and kidney biopsy was performed during ICU stay. Kidney samples were obtained by percutaneous (N.=55) or transjugular biopsy (N.=1). RESULTS: The mean Simplified Acute Physiology Score II and total SOFA scores on ICU admission were 52±19 years and 10.3±3.6, respectively. ICU mortality was 23%. The median (interquartile range) time between ICU admission and kidney biopsy was 9 days (5-21). Pathologic findings in the 54 analyzable kidney biopsies were acute tubular necrosis (N.=26), glomerulonephritis (N.=14), acute vascular nephritis (N.=11), acute interstitial nephritis (N.=6), and deposit disease (N.=3). Kidney biopsy was contributive to the management of 40 patients. In 23 of these, new treatments were started, in 13 ongoing treatments were stopped, including four life-sustaining therapies, and in 13 it was decided to start chronic renal replacement. Severe bleeding was observed in 7 patients, with fatal outcome in one case. CONCLUSION: Kidney biopsy may have a significant impact on the management of critically ill patients. Further studies should be done to identify the groups of ICU patients likely to benefit from the procedure with minimum risk.
Published: 2013

202. Efficacy of renal replacement therapy in critically ill patients: a propensity analysis

Author: Elie Azoulay, Frank Chemouni, Yves Cohen, Christophe Clec’h, Anne-Sylvie Dumenil, Maité Garrouste-Orgeas, Jean-François Timsit, Dany Goldgran-Toledano, Alexandre Lautrette, Carole Schwebel, Michael Darmon, Anesthésie-Réanimation Réanimation Médicale, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Service de réanimation médicale, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Faculté de Médecine-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Service de Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Service de Réanimation Chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Service de Reanimation Polyvalente, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Saint-Joseph, Service de Réanimation Polyvalente, Centre Hospitalier de Gonesse, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), and BMC, Ed.
Subjects: medicine.medical_specialty, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, media_common.quotation_subject, Critical Care and Intensive Care Medicine, urologic and male genital diseases, 03 medical and health sciences, 0302 clinical medicine, Severity of illness, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Rifle, 030212 general & internal medicine, Renal replacement therapy, Intensive care medicine, Prospective cohort study, media_common, Selection bias, business.industry, Mortality rate, Research, Confounding, 030208 emergency & critical care medicine, female genital diseases and pregnancy complications, 3. Good health, Emergency medicine, Propensity score matching, business
Abstract: International audience; ABSTRACT: INTRODUCTION: Although renal replacement therapy (RRT) is a common procedure in critically ill patients with acute kidney injury (AKI), its efficacy remains uncertain. Patients who receive RRT usually have higher mortality rates than those who do not. However, many differences exist in severity patterns between patients with and those without RRT and available results are further confounded by treatment selection bias since no consensus on indications for RRT has been reached so far. Our aim was to account for these biases to accurately assess RRT efficacy, with special attention to RRT timing. METHODS: We performed a propensity analysis using data of the French longitudinal prospective multicenter Outcomerea database. Two propensity scores for RRT were built to match patients who received RRT to controls who did not despite having a close probability of receiving the procedure. AKI was defined according to RIFLE criteria. The association between RRT and hospital mortality was examined through multivariate conditional logistic regression analyses to control for residual confounding. Sensitivity analyses were conducted to examine the impact of RRT timing. RESULTS: Among the 2846 study patients, 545 (19%) received RRT. Crude mortality rates were higher in patients with than in those without RRT (38% vs 17.5%, P < 0.001). After matching and adjustment, RRT was not associated with a reduced hospital mortality. The two propensity models yielded concordant results. CONCLUSIONS: In our study population, RRT failed to reduce hospital mortality. This result emphasizes the need for randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.
Published: 2012
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203. Randomized Controlled Trial of Chlorhexidine Dressing and Highly Adhesive Dressing for Preventing Catheter-related Infections in Critically Ill Adults

Author: Caroline Tournegros, Xavier Arrault, Bruno Mourvillier, Gaëtan Plantefève, Régis Bronchard, Alain Lepape, Christophe Adrie, Jean-Ralph Zahar, Jean-Christophe Lucet, Rémy Gauzit, Maité Garrouste-Orgeas, Julien Bohé, Marion Antona, Carole Schwebel, Serge Alfandari, Gilles Troché, Stéphane Ruckly, Jean-François Timsit, Olivier Mimoz, Aurélien Vesin, Bertrand Souweine, Emmanuel Canet, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale et infectieuse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Service des maladies infectieuses, CH Argenteuil, Centre Hospitalier de Versailles André Mignot (CHV), Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Service de Médecine Intensive [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Réanimation Médicale Sud, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Laboratoire des pathogènes émergents -- Emerging Pathogens Laboratory (LPE-Fondation Mérieux), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Bichat - Claude Bernard, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, General ICU, Hôpital Delafontaine, Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Centre Hospitalier de Versailles André Mignot, Hôpital André Mignot, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Université Grenoble Alpes (UGA), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Hôpital Hôtel-Dieu [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), and Hôpital Cochin [AP-HP]
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Resuscitation, medicine.drug_class, Critical Illness, [SDV]Life Sciences [q-bio], Occlusive Dressings, Critical Care and Intensive Care Medicine, Dermatitis, Contact, Statistics, Nonparametric, law.invention, 03 medical and health sciences, 0302 clinical medicine, Antiseptic, Randomized controlled trial, law, Intensive care, Adhesives, medicine, Central Venous Catheters, Humans, 030212 general & internal medicine, Aged, Skin, business.industry, Chlorhexidine, 030208 emergency & critical care medicine, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Intensive care unit, 3. Good health, Surgery, Occlusive dressing, Catheter, Intensive Care Units, Catheter-Related Infections, Anti-Infective Agents, Local, Female, France, business, medicine.drug
Abstract: International audience; Most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates.OBJECTIVES: To determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates.METHODS: In a 2:1:1 assessor-masked randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICUs, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings from May 2010 to July 2011. Coprimary endpoints were major CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidine dressings and catheter colonization rate with highly adhesive nonchlorhexidine versus standard nonchlorhexidine dressings. Catheter-colonization, CR-BSIs, and skin reactions were secondary endpoints.MEASUREMENTS AND MAIN RESULTS: A total of 1,879 patients (4,163 catheters and 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7 per 1,000 vs. 2.1 per 1,000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [CI], 0.174-0.619; P = 0.0006) and the CR-BSI rate 60% lower (0.5 per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% CI, 0.186-0.868; P = 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P < 0.0001) and the number of dressings per catheter to two (one to four) versus three (one to five) (P < 0.0001) but increased skin colonization (P < 0.0001) and catheter colonization (HR, 1.650; 95% CI, 1.21-2.26; P = 0.0016) without influencing CRI or CR-BSI rates.CONCLUSIONS: A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased the CRI rate in patients in the ICU with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization. Clinical trial registered with www.clinicaltrials.gov (NCT 01189682).
Published: 2012
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204. Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study

Author: Bianca Bromberger, Christoph Fisser, Darryl Abrams, Matthieu Schmidt, Giovanni Lino, Alain Combes, Matthias Lubnow, Sacha Rozencwajg, Thomas Frapard, Tài Pham, Gennaro Martucci, Popugaev Ka, Sergey S. Petrikov, Thomas Mueller, Antonio Arcadipane, Daniel Brodie, Alexis Serra, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University Hospital Regensburg, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Columbia University [New York], New York Presbyterian Hospital, Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Henri Mondor, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Henri Mondor, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Adult, Male, ARDS, Internationality, medicine.drug_class, Sedation, medicine.medical_treatment, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Tracheotomy, Mechanical ventilation, Tracheostomy, Germany, Extracorporeal membrane oxygenation, Humans, Medicine, 030212 general & internal medicine, Retrospective Studies, Outcome, Respiratory Distress Syndrome, Simplified Acute Physiology Score, Acute respiratory distress syndrome, business.industry, RC86-88.9, Research, Bleeding, Retrospective cohort study, Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, medicine.disease, United States, 3. Good health, Treatment Outcome, surgical procedures, operative, Italy, 030228 respiratory system, SAPS II, Anesthesia, Sedative, Female, France, medicine.symptom, ECMO, business
Abstract: Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p p Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.
Published: 2021
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205. Non–C. difficileClostridioides Bacteremia in Intensive Care Patients, France

Author: Guillaume Morel, Romain Sonneville, Damien Contou, David Rousset, Djamel Mokart, Amélie Seguin, Bruno Mégarbane, Lucie Biard, Moustafa Abdel Nabey, Guillaume Dumas, Guillaume Voiriot, Anne-Sophie Moreau, Laura Platon, Yacine Tandjaoui, Elie Azoulay, Muriel Picard, Achille Kouatchet, Frédéric Pène, Guillaume Mulier, Lara Zafrani, Etienne Ghrenassia, Isabelle Oddou, Hôpital de Hautepierre [Strasbourg], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Avicenne [AP-HP], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Lapeyronie [Montpellier] (CHU), Hôpital Cochin [AP-HP], Hôpital Roger Salengro [Lille], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Victor Dupouy, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], CHU Tenon [AP-HP], CHU Strasbourg, Immunologie humaine, physiopathologie & immunothérapie (HIPI (UMR_S_976 / U976)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Mégarbane, Bruno
Subjects: Microbiology (medical), medicine.medical_specialty, Critical Care, Epidemiology, Infectious and parasitic diseases, RC109-216, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Clostridium, Clostridioides, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Intensive care, medicine, Humans, Non–C. difficile Clostridioides Bacteremia in Intensive Care Patients, France, bacteremia, bacteria, intensive care, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, biology, business.industry, Research, medicine.disease, C difficile, biology.organism_classification, Hemolysis, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Infectious Diseases, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Bacteremia, ICU, Clostridium Infections, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, France, hemolysis, business
Abstract: Article Summary: This multicenter study focusing on critically ill patients showed a strong relationship between hemolysis and mortality., Usually responsible for soft tissue infections, Clostridioides species can also cause bacteremia, life-threatening infections often requiring intensive care unit (ICU) admission. We conducted a multicenter retrospective study to investigate Clostridioides bacteremia in ICUs to describe the clinical and biologic characteristics and outcomes in critically ill patients. We identified 135 patients with Clostridioides bacteremia, which occurred almost exclusively (96%) in patients with underlying conditions. Septic shock and digestive symptoms were the hallmarks of Clostridioides bacteremia in the ICU. We identified 16 different species of Clostridioides, among which C. perfringens accounted for 31% of cases. Despite the high sensitivity of Clostridioides to common antimicrobial drugs, mortality rates were high: 52% for ICU patients and 71% overall at 3 months. In multivariate analysis, the most important factor associated with increased risk for death was the presence of hemolysis. Clostridioides bacteremia often leads to multiple organ failures, which have high mortality rates.
Published: 2021
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206. Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure

Author: Pierre Emmanuel Charles, Carole Schwebel, Jean-Pierre Gangneux, Arnaud Foucrier, Maité Garrouste-Orgeas, Samir Jaber, Michael Darmon, Vincent Jullien, Bertrand Souweine, Kada Klouche, Ferhat Meziani, Bernard Allaouchiche, Michel Wolff, Jean-Christophe Navellou, Stéphane Ruckly, Vincent Das, Laurent Argaud, Adeline Paris, Danièle Maubon, Jean-François Timsit, Elie Azoulay, Joel Cousson, Jean-Louis Trouillet, Muriel Cornet, Fabrice Bruneel, Didier Gruson, Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service de réanimation médicale, Centre Hospitalier Universitaire de Reims (CHU Reims), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Laboratoire de Biophotonique et Pharmacologie - UMR 7213 (LBP), Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS), Département d'Endocrinologie et Nutrition (LOUVAIN - Endocrino), Université Catholique de Louvain = Catholic University of Louvain (UCL), CIC - Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), CSE, Centre européen de sociologie et de science politique (CESSP), Université Paris 1 Panthéon-Sorbonne (UP1)-École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS), Epidémiologie pronostique des cancers et affections graves, Service de Réanimation médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Reanimation Médicale et Infectieuse [Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bichat-Claude Bernard, Service de Réanimation, Hospices Civils de Lyon (HCL)-Hôpital E. Herriot, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de Parasitologie-Mycologie [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Biologie et Pathologie, CHU Grenoble, Epilepsies de l'Enfant et Plasticité Cérébrale (U1129), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Naval Research Laboratory (NRL), Unité de Soins Intensifs et de Maladies Infectieuses, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), TheREx, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Astellas, University of Grenoble 1/Albert Michallon University Hospital, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA)), Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de réanimation médicale , hôpital Pitié salpêtrière, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], réanimation chirurgicale, CH Versailles, Ministère de la santé, Hospices Civils de Lyon ( HCL ), Centre Hospitalier Universitaire de Reims ( CHU Reims ), Laboratoire HIFIH, Université d'Angers ( UA ), Laboratoire de Biophotonique et Pharmacologie - UMR 7213 ( LBP ), Réseau nanophotonique et optique, Université de Strasbourg ( UNISTRA ) -Université de Haute-Alsace (UHA) Mulhouse - Colmar ( Université de Haute-Alsace (UHA) ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Strasbourg ( UNISTRA ) -Université de Haute-Alsace (UHA) Mulhouse - Colmar ( Université de Haute-Alsace (UHA) ) -Centre National de la Recherche Scientifique ( CNRS ) -Centre National de la Recherche Scientifique ( CNRS ), Département d'Endocrinologie et Nutrition ( LOUVAIN - Endocrino ), Université Catholique de Louvain ( UCL ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre européen de sociologie et de science politique ( CESSP ), Centre National de la Recherche Scientifique ( CNRS ) -École des hautes études en sciences sociales ( EHESS ) -Université Panthéon-Sorbonne ( UP1 ) -Centre National de la Recherche Scientifique ( CNRS ) -École des hautes études en sciences sociales ( EHESS ) -Université Panthéon-Sorbonne ( UP1 ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bichat-Claude Bernard, Hospices Civils de Lyon ( HCL ) -Hôpital E. Herriot, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Institut de recherche, santé, environnement et travail ( Irset ), Université d'Angers ( UA ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ) -Université des Antilles ( UA ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Epilepsies de l'Enfant et Plasticité Cérébrale ( U1129 ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Naval Research Laboratory ( NRL ), Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hopital Saint Louis Paris, CHU Saint Louis [APHP], Service de Réanimation Médicale, CHU Grenoble-Hôpital Albert Michallon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble] ( TIMC-IMAG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Laboratoire Microorganismes : Génome et Environnement ( LMGE ), Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Centre National de la Recherche Scientifique ( CNRS ) -Université d'Auvergne - Clermont-Ferrand I ( UdA ), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP], Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Catholique de Louvain (UCL), Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Université Panthéon-Sorbonne (UP1), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bichat-Claude Bernard, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], and Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)
Subjects: Male, 0301 basic medicine, Antifungal Agents, Time Factors, Placebo-controlled study, multicenter, systemic antifungal therapy, law.invention, Echinocandins, placebo-controlled trial, high-risk, law, ComputingMilieux_MISCELLANEOUS, Cross Infection, critically-ill patients, Hazard ratio, Candidiasis, surgical-patients, General Medicine, Middle Aged, Intensive care unit, Anti-Bacterial Agents, 3. Good health, Editorial, Female, SOFA score, double-blind, management, medicine.drug, medicine.medical_specialty, Critical Illness, Multiple Organ Failure, 030106 microbiology, Placebo, Disease-Free Survival, Drug Administration Schedule, [ SDV.EE.SANT ] Life Sciences [q-bio]/Ecology, environment/Health, Lipopeptides, 03 medical and health sciences, Double-Blind Method, Internal medicine, medicine, Humans, Candidiasis, Invasive, intensive-care-unit, Aged, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, Septic shock, business.industry, Micafungin, medicine.disease, Surgery, septic shock, Multiple organ dysfunction syndrome, business
Abstract: International audience; Importance Although frequently used in treating intensive care unit (ICU) patients with sepsis, empirical antifungal therapy, initiated for suspected fungal infection, has not been shown to improve outcome.Objective To determine whether empirical micafungin reduces invasive fungal infection (IFI)–free survival at day 28.Design, Setting, and Participants Multicenter double-blind placebo-controlled study of 260 nonneutropenic, nontransplanted, critically ill patients with ICU-acquired sepsis, multiple Candida colonization, multiple organ failure, exposed to broad-spectrum antibacterial agents, and enrolled between July 2012 and February 2015 in 19 French ICUs.Interventions Empirical treatment with micafungin (100 mg, once daily, for 14 days) (n = 131) vs placebo (n = 129).Main Outcomes and Measures The primary end point was survival without proven IFI 28 days after randomization. Key secondary end points included new proven fungal infections, survival at day 28 and day 90, organ failure, serum (1-3)-β-D-glucan level evolution, and incidence of ventilator-associated bacterial pneumonia.Results Among 260 patients (mean age 63 years; 91 [35%] women), 251 (128, micafungin group; 123, placebo group) were included in the modified intent-to-treat analysis. Median values were 8 for Sequential Organ Failure Assessment (SOFA) score, 3 for number of Candida-colonized sites, and 99 pg/mL for level of (1-3)-β-D-glucan. On day 28, there were 82 (68%) patients in the micafungin group vs 79 (60.2%) in the placebo group who were alive and IFI free (hazard ratio [HR], 1.35 [95% CI, 0.87-2.08]). Results were similar among patients with a (1-3)-β-D-glucan level of greater than 80 pg/mL (n = 175; HR, 1.41 [95% CI, 0.85-2.33]). Day-28 IFI–free survival in patients with a high SOFA score (>8) was not significantly different when compared between the micafungin vs placebo groups (HR, 1.69 [95% CI, 0.96-2.94]). Use of empirical micafungin decreased the rate of new invasive fungal infection in 4 of 128 patients (3%) in the micafungin group vs placebo (15/123 patients [12%]) (P = .008).Conclusions and Relevance Among nonneutropenic critically ill patients with ICU-acquired sepsis, Candida species colonization at multiple sites, and multiple organ failure, empirical treatment with micafungin, compared with placebo, did not increase fungal infection–free survival at day 28.Trial Registration clinicaltrials.gov Idenitfier: NCT01773876
Published: 2016
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207. The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study

Author: Alain Noirot, Jean-Christophe Navellou, Frédérique Ganster, Khaldoun Kuteifan, Arnaud Pavon, Damien Barraud, F Kara, Olivier Martinet, Vincent Castelain, Jean-Pierre Quenot, Guillaume Louis, Joel Cousson, Christine Binquet, Henry Lessire, Chaouki Mezher, Pierre Perez, Julio Badie, Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques ( CIC-EC ), Université de Bourgogne ( UB ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Service de réanimation polyvalente, Centre hospitalier de Haguenau, Service de réanimation Médicale, CHU Strasbourg, Service de réanimation médicale, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Centre Hospitalier Universitaire de Reims ( CHU Reims ), Centre hospitalier régional Metz-Thionville ( CHR Metz-Thionville ), Centre Hospitalier Emile Muller [Mulhouse] ( CH E.Muller Mulhouse ), Groupe Hospitalier de Territoire Haute Alsace ( GHTHA ) -Groupe Hospitalier de Territoire Haute Alsace ( GHTHA ), CH de Vesoul, CH Belfort-Montbéliard, CH Montbéliard, CH Colmar, Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Réanimation médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA)-Groupe Hospitalier de Territoire Haute Alsace (GHTHA), and BMC, Ed.
Subjects: Male, medicine.medical_specialty, Pediatrics, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Critical Care and Intensive Care Medicine, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Severity of illness, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, 030212 general & internal medicine, Prospective Studies, Mortality, 10. No inequality, Prospective cohort study, Aged, Aged, 80 and over, Septic shock, business.industry, [ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Research, Hazard ratio, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Shock, Septic, 3. Good health, Intensive Care Units, Shock (circulatory), Emergency medicine, Cohort, Female, France, medicine.symptom, business, Cohort study, Follow-Up Studies
Abstract: International audience; INTRODUCTION: To provide up-to-date information on the prognostic factors associated with 28-day mortality in a cohort of septic shock patients in intensive care units (ICUs). METHODS: Prospective, multicenter, observational cohort study in ICUs from 14 French general (non-academic) and university teaching hospitals. All consecutive patients with septic shock admitted between November 2009 and March 2011 were eligible for inclusion. We prospectively recorded data regarding patient characteristics, infection, severity of illness, life support therapy and discharge. RESULTS: Among 10,941 patients admitted to participating ICUs between October 2009 and September 2011, 1495 (13.7%) patients presented inclusion criteria for septic shock and were included. Invasive mechanical ventilation was needed in 83.9% (n=1248), inotropes in 27.7% (n=412), continuous renal replacement therapy in 32.5% (n=484) and hemodialysis in 19.6% (n=291). Mortality at 28 days was 42% (n=625). Variables associated with time to mortality, right-censored at day 28: age (for each additional 10 yrs) (hazard ratio, HR=1.29; 95% confidence interval [CI]: 1.20-1.38), immunosuppression (HR=1.63; 95%CI: 1.37-1.96), Knaus class C/D score versus class A/B score (HR=1.36; 95%CI:1.14-1.62) and Sepsis-related Organ Failure Assessment (SOFA) score (HR=1.24 for each additional point; 95%CI: 1.21-1.27). Patients with septic shock and renal/urinary tract infection had a significantly longer time to mortality (HR=0.56; 95%CI: 0.42-0.75). CONCLUSION: Our observational data of consecutive patients from real-life practice confirm that septic shock is common and carries high mortality in general intensive care unit populations. Our results are in contrast with the clinical trial setting, and could be useful for healthcare planning and clinical study design.
Published: 2012
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208. Development and validation of a predictive model for death in acquired severe ADAMTS13 deficiency-associated idiopathic thrombotic thrombocytopenic purpura: the French TMA Reference Center experience

Author: Jean-Bernard Palcoux, Bertrand Guidet, Hanspeter Rottensteiner, Dominique Bordessoule, Didier Gruson, Paul Coppo, Claire Pouteil-Noble, Jacques Pourrat, Jean-Paul Mira, Alain Wynckel, Cécile Vigneau, Agnès Veyradier, Claire Presne, Pierre-Yves Boëlle, Cyrielle Assie, Sandrine Malot, Cédric Daubin, Rana Grillberger, Lionel Galicier, Philippe Vanhille, Marc Buffet, Véronique Le Guern, François Provôt, Gabriel Choukroun, Guy Bonmarchand, Mohamed Hamidou, Christiane Mousson, Ygal Benhamou, Pascale Poullin, Elie Azoulay, Eric Rondeau, Service de Médecine Interne [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'immunologie et hématologies biologiques [Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Baxter Innovations GmbH, Campus Vienna, Service de Néphrologie, Centre Hospitalier Universitaire de Reims (CHU Reims)-Hôpital Maison Blanche, Service de Néphrologie - Médecine Interne, CHU Amiens-Picardie-hôpital Sud, Service d'Hémaphérèse - Médecine Interne, Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Service de néphrologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Réanimation, CHU Bordeaux [Bordeaux]-Hôpital Pellegrin-Tripode, Service de médecine interne [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges], CHU Limoges, Service de Néphrologie - Immunologie Clinique [Toulouse], CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse]-PRES Université de Toulouse, Service de Réanimation polyvalente, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Service de Médecine Interne, Service de néphrologie et transplantation, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Service de médecine interne et néphrologie, CH Valenciennes, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néphrologie pédiatrique, CHU Clermont-Ferrand, Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de néphrologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Service d'immunologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Hématologie Biologique [Béclère], AP-HP - Hôpital Antoine Béclère [Clamart], Etablissement Français du Sang (CS/2002/009), GIS-Institut des Maladies Rares (GIS MR0428)., Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-PRES Université de Toulouse, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hôpital Charles Nicolle [Rouen], Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Service de Médecine Interne [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Centre de Référence des microangiopathies thrombotiques ( CNR-MAT ), service d'hématologie-CHU Saint-Antoine [APHP], Epidémiologie des maladies infectieuses et modélisation ( ESIM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'immunologie et hématologies biologiques, CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP)-Université Pierre et Marie Curie - Paris 6 ( UPMC ), Centre Hospitalier Universitaire de Reims ( CHU Reims ) -Hôpital Maison Blanche, CHU Amiens-Picardie-Hôpital Sud, Assistance Publique - Hôpitaux de Marseille ( APHM ) -Hôpital de la Conception [CHU - APHM] ( LA CONCEPTION ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Université de Nantes ( UN ) -Hôtel-Dieu-Centre hospitalier universitaire de Nantes ( CHU Nantes ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ) -Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ), Service de Réanimation Médicale, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Tenon [APHP], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de réanimation médicale [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, De Villemeur, Hervé, and Service d'immunologie et hématologies biologiques [CHU Saint-Antoine]
Subjects: [SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology, Adult, Male, medicine.medical_specialty, Thrombotic thrombocytopenic purpura, ADAMTS13 Protein, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, rituximab, Internal medicine, plasma exchange, medicine, Humans, [ SDV.MHEP.HEM ] Life Sciences [q-bio]/Human health and pathology/Hematology, Registries, thrombotic thrombocytopenic purpura, prognostic factor, Aged, Purpura, Thrombocytopenic, Idiopathic, Framingham Risk Score, Acquired Thrombotic Thrombocytopenic Purpura, Models, Statistical, business.industry, Reproducibility of Results, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, Middle Aged, medicine.disease, Prognosis, ADAMTS13, 3. Good health, Surgery, ADAM Proteins, ROC Curve, Cohort, Rituximab, Female, Caplacizumab, Original Articles and Brief Reports, business, 030215 immunology, medicine.drug, Cohort study
Abstract: Acquired thrombotic thrombocytopenic purpura is still associated with a 10-20% death rate. It has still not been possible to clearly identify early prognostic factors of death. This study involved thrombotic thrombocytopenic purpura patients with acquired severe (10% of normal activity) ADAMTS13 deficiency and aimed to identify prognostic factors associated with 30-day death.The study involved a prospective cohort of patients and was carried out between October 2000 and August 2010. A validation cohort of patients was set up from September 2010 to August 2011. Altogether, 281 (analysis cohort) and 66 (validation cohort) consecutive adult thrombotic thrombocytopenic purpura patients with acquired severe ADAMTS13 deficiency were enrolled. The study evaluated 30-day mortality after treatment initiation according to characteristics at inclusion.Non-survivors (11%) were older (P=10(-6)) and more frequently presented arterial hypertension (P=5.10(-4)) and ischemic heart disease (P=0.013). Prognosis was increasingly poor with age (P=0.004). On presentation, cerebral manifestations were more frequent in non-survivors (P=0.018) and serum creatinine level was higher (P=0.008). The most significant independent variables determining death were age, severe cerebral involvement and LDH level 10 N or over. A 3-level risk score for early death was defined and confirmed in the validation cohort using these variables, with higher values corresponding to increased risk of early death.A risk score for early death was defined in patients with thrombotic thrombocytopenic purpura and validated on an independent cohort. This score should help to stratify early treatment and identify patients with a worse prognosis.
Published: 2012
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209. Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy

Author: Antoine Roch, Daniel Pulina, Karine Barrau, Gilles Perrin, Arnaud Gacouin, Jean-Marie Forel, Jean-Michel Arnal, Samir Jaber, Laurent Papazian, Elie Azoulay, Pascal Auquier, François Voillet, M. Fathallah, Service de Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique - Hôpitaux de Marseille (APHM), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation Médicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de Réanimation des Urgences, Laboratoire de Santé Publique, Université de la Méditerranée - Aix-Marseille 2, Service de Réanimation Chirurgicale, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, Service de Réanimation polyvalente, Hopital Font-Pre, Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and BMC, Ed.
Subjects: Male, medicine.medical_specialty, ARDS, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Critical Care and Intensive Care Medicine, Statistics, Nonparametric, law.invention, Placebos, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, Risk Factors, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Glasgow Coma Scale, Prospective Studies, Prospective cohort study, Intensive care medicine, Cross Infection, Respiratory Distress Syndrome, Lung, Chi-Square Distribution, business.industry, Incidence (epidemiology), Incidence, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, bacterial infections and mycoses, Respiration, Artificial, 3. Good health, respiratory tract diseases, Pneumonia, Intensive Care Units, medicine.anatomical_structure, 030228 respiratory system, Commentary, Female, France, business
Abstract: International audience; ABSTRACT: INTRODUCTION: Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated using a strictly standardized lung-protective strategy. METHODS: This prospective epidemiological study was done in all patients included in the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis. RESULTS: Ninety-eight patients (28.9%) presented at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared to 74 (30.7%) of the 241 patients without VAP (P=0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex, and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition and the use of a subglottic secretion drainage device were protective. CONCLUSIONS: In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment.
Published: 2012
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210. Congenital heart defects in La Réunion Island: a 6-year survey within a EUROCAT-affiliated congenital anomalies registry

Author: Karim Jamal-Bey, Edouard Kauffmann, Françoise Wuillai, Alain Fourmaintraux, Dominique Caillet, Pierre-Yves Robillard, Fabrice Cuillier, Patrick Gérardin, Yasmina Touret, Claire Bernede-Bauduin, Hélène Bourdial, Jean-Luc Alessandri, Brahim Boumahni, Abdelhafid Edmar, Hanitra Randrianaivo, Annick Laffitte, CHR La réunion, Centre d'Études Périnatales de l'Océan Indien (CEPOI), Université de La Réunion (UR)-Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Service de gynécologie-obstétrique [La réunion], Groupe Hospitalier Sud-CHR La réunion, Groupe Hospitalier Sud Réunion (GHSR), Service de Réanimation Néonatale et Pédiatrique, CHD Félix Guyon, CIC régional épidémiologie clinique/essais cliniques - Ile de la Réunion (CIC-EC), Institut National de la Santé et de la Recherche Médicale (INSERM), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation néonatologique et pédiatrique [La Réunion], Service de médecine foetale et foetopathologie, Centre d'Études Périnatales de l'Océan Indien ( CEPOI ), Université de la Réunion ( UR ) -Centre Hospitalier Universitaire de La Réunion ( CHU La Réunion ), Groupe Hospitalier Sud Réunion ( GHSR ), Centre d'Investigation Clinique Regional Epidemiologie Clinique/essais Cliniques - Ile de la Reunion, Institut National de la Santé et de la Recherche Médicale ( INSERM ), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), and Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )
Subjects: Heart Defects, Congenital, Pediatrics, medicine.medical_specialty, Down syndrome, Pregnancy Complications, Cardiovascular, Coarctation of the aorta, [ SDV.MHEP.PED ] Life Sciences [q-bio]/Human health and pathology/Pediatrics, 030204 cardiovascular system & hematology, Cardiovascular, Atrial septal defects, 03 medical and health sciences, Congenital, 0302 clinical medicine, Pregnancy, medicine, Prevalence, Humans, Atrioventricular Septal Defect, Registries, Fetal Death, Perinatal Mortality, Heart Defects, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, 030219 obstetrics & reproductive medicine, business.industry, Infant, Newborn, Infant, General Medicine, medicine.disease, Newborn, 3. Good health, Pregnancy Complications, medicine.anatomical_structure, Ventricle, Pediatrics, Perinatology and Child Health, Pulmonary valve stenosis, Gestation, Female, Cardiology and Cardiovascular Medicine, business, Live Birth, Reunion
Abstract: ObjectivesThis study compares the prevalence and perinatal mortality of congenital heart defects on La Réunion with European (EUROCAT) standards.Methods and resultsData were extracted from a EUROCAT-affiliated congenital malformations registry, covering 88,025 births during the period 2002–2007, on the whole island territory. A total of 512 congenital heart defects were registered, including 424 live births, 18 foetal deaths from 16 weeks of gestation, and 70 terminations of pregnancy. The total prevalence of congenital heart defects was 5.8 per 1000 births and live birth prevalence was 4.8 per 1000. The total prevalence of non-chromosomal congenital heart defects was 5.1 per 1000 births, of which 3% were perinatal deaths, 33.3% prenatally diagnosed, and 11.6% termination of pregnancy. Severe non-chromosomal congenital heart defects – excluding ventricular septal defects, atrial septal defects, and pulmonary valve stenosis – occurred in 2.1 per 1000 births, of which 10.3% were perinatal deaths, 59.1% prenatally diagnosed, and 24.3% termination of pregnancy. Of the severe congenital heart defects, the rates of single ventricle (0.20‰), Ebstein anomaly (0.11‰), common arterial trunk (0.25‰), and atrioventricular septal defect (0.62‰) exceeded averages found in Europe, although coarctation of the aorta was infrequent. Conversely, rates of ventricular septal defects, atrial septal defects, and pulmonary valve stenosis were inferior to European standards. Slightly less than half of the congenital heart defects of chromosomal origin were associated with Down syndrome.ConclusionIn La Réunion, the total prevalence of congenital heart defects is far inferior to that found in Europe. The difference can be attributable to lower prevalences of mild congenital heart defects.
Published: 2012
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211. Outboard consulting colleague for end of life decision in the intensive care

Author: Cremer, Robin, Graftieaux, Jean-Pierre, Renault, Anne, Le Gall, Guy, Haddad, Lise, Bollaert, Edouard, Réanimation pédiatrique [Lille], Hôpital Jeanne de Flandre [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Espace éthique hospitalier et universitaire de Lille (EEHU de Lille), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d’anesthésiologie [Reims], Centre Hospitalier Universitaire de Reims (CHU Reims), Service de réanimation médicale [Brest], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Service de réanimation polyvalente [Morlaix], Centre Hospitalier des Pays de Morlaix, Service d’anesthésie-réanimation [AP-HP Hôpital Saint-Louis], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicochirurgicale [Colombes], Hôpital Louis Mourier - AP-HP [Colombes], groupe de travail de l’EEHU de Lille, and Lefranc, Hélène
Subjects: [SDV.ETH] Life Sciences [q-bio]/Ethics, [SDV.ETH]Life Sciences [q-bio]/Ethics
Abstract: International audience; La loi du 22 avril 2005 relative aux droits des malades et à la fin de vie (dite loi Leonetti) a donné un cadre légal aux décisions de limitation et d’arrêt de traitement (LAT) en réanimation et a instauré l’obligation d’une délibération collégiale pour les patients incapables d’exprimer leur volonté. Les modalités de cette collégialité ont été précisées en 2006 par un décret d’application qui impose notamment au médecin en charge du patient de prendre l’avis motivé d’un consultant avant toute décision de LAT. L’objet de ce texte est de préciser la vision qu’a la commission d’éthique de la Société de réanimation de langue française du rôle et du positionnement de ce consultant et de proposer des éléments d’orientation pour en guider le choix en pratique.
Published: 2012
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212. Determinants of temperature abnormalities and influence on outcome of critical illness

Author: Carole Schwebel, Maité Garrouste-Orgeas, Dany Goldgran-Toledano, Michael Darmon, Samir Jamali, Yves Cohen, Jean-Ralph Zahar, Elie Azoulay, Jean-François Timsit, Bertrand Souweine, Christophe Adrie, Kevin B. Laupland, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Peter Lougheed Ctr, Calgary, AB, Canada, Unité d'hygiène hospitalière, Service de microbiologie, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Service de Réanimation Polyvalente, Centre Hospitalier de Gonesse, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service d'anesthésie-réanimation [Avicenne], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Service de réanimation médicale - soins intensifs, Hôpital Dourdan, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation médicale, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Faculté de Médecine-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Service de Réanimation Médicale [CHU Saint-Etienne], and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
Subjects: Male, MESH: Logistic Models, Hypothermia, Critical Care and Intensive Care Medicine, Logistic regression, Severity of Illness Index, law.invention, Cohort Studies, 0302 clinical medicine, MESH: Hypothermia, law, Risk Factors, MESH: Risk Factors, Medicine, 030212 general & internal medicine, MESH: Cohort Studies, MESH: Aged, MESH: Statistics, Nonparametric, MESH: Middle Aged, Confounding, Middle Aged, Intensive care unit, 3. Good health, Intensive Care Units, Surgical Procedures, Operative, MESH: Critical Illness, Female, medicine.symptom, Cohort study, medicine.medical_specialty, Fever, Critical Illness, Statistics, Nonparametric, MESH: Surgical Procedures, Operative, 03 medical and health sciences, Internal medicine, MESH: Severity of Illness Index, Severity of illness, MESH: Fever, Humans, Aged, MESH: Humans, business.industry, 030208 emergency & critical care medicine, MESH: Male, Surgery, Logistic Models, Critical illness, MESH: Intensive Care Units, Mild fever, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; OBJECTIVE: To determine the occurrence and determinants of temperature abnormalities among patients presenting (39.5 °C). Normothermia was present in 6,133 (55%) and mixed fever/hypothermia abnormalities occurred in 347 (3%) patients overall. Medical patients had the highest occurrence of any fever, whereas hypothermia was more common in surgical patients. The overall intensive care unit case-fatality was 1,944 of 10,962 (18%) and 828 of 6,133 (14%) for normothermia, 235 of 1,046 (22%) for mild hypothermia, 205 of 541 (38%) for moderate hypothermia, 43 of 72 (60%) for severe hypothermia, 412 of 2,264 (18%) for mild fever, 117 of 559 (21%) for high fever, and 104 of 347 (30%) for those with mixed temperature abnormalities. After controlling for confounding variables in logistic regression analyses, fever at presentation was not associated with any significantly increased risk for death. However, hypothermia was a significant independent predictor for death in medical patients. CONCLUSIONS: Temperature abnormalities are common among patients presenting to the intensive care unit. Hypothermia is a major, potentially modifiable factor associated with increased risk for death.
Published: 2012
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213. Vascular access sites for acute renal replacement in intensive care units

Author: Audrey E, Dugué, Stéphanie P, Levesque, Marc-Olivier, Fischer, Bertrand, Souweine, Jean-Paul, Mira, Bruno, Megarbane, Cédric, Daubin, Damien, du Cheyron, Jean-Jacques, Parienti, L, Auvray, Unité de Biostatistique et de Recherche Clinique (UBRC), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Département d'anesthésiologie [CHU Caen], Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Service de médecine d'urgence [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Neuropsychopharmacologie des addictions. Vulnérabilité et variabilité expérimentale et clinique (NAVVEC - UM 81 (UMR 8206/ U705)), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Institut des sciences du Médicament -Toxicologie - Chimie - Environnement (IFR71), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Diderot - Paris 7 (UPD7), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Service de Soins Intensifs [CHU Caen], Interactions hôte et microorganismes des épithéliums, Normandie Université (NU)-Normandie Université (NU), Biostatistics and Clinical Research, Centre Hospitalier Universitaire de Caen, Département d'anesthésiologie [Caen], Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -CHU Caen, CHU Clermont-Ferrand-Hôpital Gabriel Montpied, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Neuropsychopharmacologie des addictions. Vulnérabilité et variabilité expérimentale et clinique ( NAVVEC (UM 81) ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut des sciences du Médicament -Toxicologie - Chimie - Environnement ( IFR71 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Centre de Référence des microangiopathies thrombotiques ( CNR-MAT ), service d'hématologie-CHU Saint-Antoine [APHP], Service de Réanimation Médicale, Service des soins intensives, Normandie Université ( NU ) -Normandie Université ( NU ), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Diderot - Paris 7 (UPD7), and CHU Saint-Antoine [APHP]
Subjects: Male, Epidemiology, medicine.medical_treatment, MESH : Aged, 030232 urology & nephrology, Femoral vein, MESH: Femoral Vein, Critical Care and Intensive Care Medicine, MESH : Renal Replacement Therapy, Catheters, Indwelling, 0302 clinical medicine, MESH : Catheters, Indwelling, Urea, MESH : Female, 030212 general & internal medicine, MESH: Aged, Cross-Over Studies, Catheter insertion, MESH: Middle Aged, MESH : Adult, Middle Aged, 3. Good health, Renal Replacement Therapy, Intensive Care Units, Catheter, Nephrology, Anesthesia, Female, MESH : Intensive Care Units, Adult, medicine.medical_specialty, MESH : Male, Urea reduction ratio, MESH: Catheters, Indwelling, MESH: Cross-Over Studies, 03 medical and health sciences, MESH : Urea, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Intensive care, medicine, Humans, MESH : Middle Aged, Renal replacement therapy, Dialysis, MESH: Urea, Aged, Transplantation, MESH: Humans, business.industry, MESH : Jugular Veins, MESH : Humans, MESH: Adult, Original Articles, Femoral Vein, MESH : Cross-Over Studies, Crossover study, MESH: Male, Surgery, MESH : Femoral Vein, MESH: Intensive Care Units, MESH: Renal Replacement Therapy, Jugular Veins, MESH: Jugular Veins, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Summary Background and objectives Several temporary venous catheterizations are sometimes required for acute renal replacementtherapy(RRT)intheintensivecareunit(ICU).This studycompares firstandsecondcatheterizations in the femoral and jugular veins in terms of patient safety. Design, setting, participants, & measurements A crossover study from the catheter-dialysis randomized study (Cathedia), which was conducted among 736 critically ill adults requiring RRT, was performed. Catheter insertion complications, catheter-tip colonization, catheter dysfunction and urea reduction ratio (URR) were analyzed considering the crossover and longitudinal designs. ResultsThisstudyanalyzed134patientswhounderwenttwodifferentsitesofcatheterization,57and77ofwhom were initially randomized in the femoral and jugular site, respectively. Using anatomic landmarks, time to insert a femoral catheter was shorter (P=0.01) and more successful (P=0.003) compared with catheterization in the jugular site. Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion (median, 14 days in both groups; hazard ratio, 0.99; 95% confidence interval, 0.61–1.59; P=0.96), as well as time to dysfunction. URRs were analyzed from 395 dialysis sessions (n=48 patients). No significant difference (P=0.49) in mean URR was detected between sessions performed through femoral (n=213; 50.9%) and jugular (n=182; 49.5%) dialysis catheters. Conclusions These results validate prior results of this study group and extend external validity to the second catheter used for RRT in the ICU. Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU. Clin J Am Soc Nephrol 7: 70–77, 2012. doi: 10.2215/CJN.06570711
Published: 2012
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214. Interest of a simple on-line screening registry for measuring ICU burden related to an Influenza pandemic

Author: Jean-Christophe M. Richard, Alain Combes, Gaetan Beduneau, Jean Reignier, Yves Le Tulzo, Christian Brun-Buisson, Tài Pham, Bernard Regnier, Bruno Mourvillier, Matthias Castanier, Christophe Guitton, Laurent Brochard, Alain Mercat, BMC, Ed., Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Department of Intensive Care, Geneva University Hospital and Geneva University, Groupe de Recherche sur le Handicap Ventilatoire (GRHV), Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de Réanimation Polyvalente, CH Départemental Vendée, Service de Réanimation Médicale et de médecine hyperbare, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), LUNAM Université [Nantes Angers Le Mans], Service de réanimation médicale et infectieuse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service de Réanimation Médicale, Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Réanimation, détresses respiratoires et infections sévères, Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital nord, Service de Réanimation Médicale [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), The REVA registry was funded in part by the French Ministry of Health, the Inserm-Institut des Maladies Infectieuses, and the SRLF., for the REVA study group, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Assistance Publique - Hôpitaux de Marseille (APHM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-CHU Rouen, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Critical Illness, Critical Care and Intensive Care Medicine, Online Systems, law.invention, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intensive care, Pandemic, Influenza, Human, Extracorporeal membrane oxygenation, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Registries, Intensive care medicine, Prospective cohort study, Pandemics, Bed Occupancy, Mechanical ventilation, business.industry, Research, Middle Aged, Intensive care unit, Respiration, Artificial, 3. Good health, Intensive Care Units, 030228 respiratory system, Cohort, Emergency medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, France, business
Abstract: International audience; ABSTRACT: INTRODUCTION: The specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs. METHODS: A prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden. RESULTS: Among the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated to a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. 391 critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas. CONCLUSIONS: The peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.
Published: 2012
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215. Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices

Author: Jean-Pierre Quenot, Arnaud Pavon, Jean-Philippe Rigaud, Sébastien Prin, Bernard Blettery, Nicolas Jacquiot, Pierre Emmanuel Charles, Saber Barbar, Mael Hamet, Grégoire Moutel, Christian Hervé, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Réanimation Polyvalente, Centre hospitalier de Dieppe, Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), Centre Hospitalier Universitaire de Dijon (CHU Dijon), Centre Hospitalier de Dieppe, and Duchange, Nathalie
Subjects: Adult, Male, medicine.medical_specialty, Population, Burnout, Critical Care and Intensive Care Medicine, Article, Hospitals, University, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Nursing, 030202 anesthesiology, Intensive care, Anesthesiology, Surveys and Questionnaires, Depersonalization, Health care, medicine, Medical Staff, Hospital, Humans, 030212 general & internal medicine, education, Emotional exhaustion, Depression (differential diagnoses), education.field_of_study, Terminal Care, business.industry, communication, Middle Aged, [SDV.ETH] Life Sciences [q-bio]/Ethics, critical care organisation, ethics, 3. Good health, [SDV.ETH]Life Sciences [q-bio]/Ethics, Intensive Care Units, Physical therapy, Female, Interdisciplinary Communication, France, medicine.symptom, business, Stress, Psychological
Abstract: International audience; PURPOSE: Burnout syndrome (BOS) has frequently been reported in healthcare workers, and precipitating factors include communication problems in the workplace and stress related to end-of-life situations. We evaluated the effect of an intensive communication strategy on BOS among caregivers working in intensive care (ICU). METHODS: Longitudinal, monocentric, before-and-after, interventional study. BOS was evaluated using the Maslach Burnout Inventory (MBI) and depression using the Centre for Epidemiologic Studies Depression Scale (CES-D) in 2007 (period 1) and 2009 (period 2). Between periods, an intensive communication strategy on end-of-life practices was implemented, based on improved organisation, better communication, and regular staff meetings. RESULTS: Among 62 caregivers in the ICU, 53 (85%) responded to both questionnaires in period 1 and 49 (79%) in period 2. We observed a significant difference between periods in all three components of the MBI (emotional exhaustion, p = 0.04; depersonalization p = 0.04; personal accomplishment, p = 0.01). MBI classified burnout as severe in 15 (28%) caregivers in period 1 versus 7 (14%) in period 2, p
Published: 2012
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216. Identification of SPOCK2 as a susceptibility gene for bronchopulmonary dysplasia

Author: Pierre-Henri Jarreau, Emmanuelle Bouzigon, Johanna M. Huusko, Roberto Incitti, Ines Layouni, Jacques R. Bourbon, Richard Lenclen, Claude Danan, Florence Demenais, Mikko Hallman, Alice Hadchouel, Juliana Patkai, Christophe Delacourt, Xavier Durrmeyer, Marie-Laure Franco-Montoya, INSERM U955, équipe 4, Service de Pneumologie Allergologie [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-PremUp Foundation, Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-CHI Créteil-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-CHI Créteil-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de réanimation néonatale de Créteil, CHI Créteil, Variabilité Génétique et Maladies Humaines, Institut Universitaire d'Hématologie (IUH), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Department of pediatrics, Oulu University Hospital-Institute of Clinical Medicine, PremUp Foundation, Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-CHI Créteil-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation néonatale Port-Royal, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Néonatale, CHI Poissy-Saint-Germain, Unité Fonctionnelle de Recherche Clinique, Programme Hospitalier de Recherche Clinique AOR 07 018, Assistance Publique - Hôpitaux de Paris. Hadchouel was funded by INSERM., CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-PremUp Foundation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5)-CHI Créteil-Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5)-CHI Créteil-Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5)-CHI Créteil-Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP]-PremUp Foundation, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Sorbonne Universités-Université Paris Descartes - Paris 5 ( UPD5 ) -CHI Créteil-Institut de Recherche pour le Développement ( IRD ) -Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Sorbonne Universités-Université Paris Descartes - Paris 5 ( UPD5 ) -CHI Créteil-Institut de Recherche pour le Développement ( IRD ) -Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Sorbonne Universités-Université Paris Descartes - Paris 5 ( UPD5 ) -CHI Créteil-Institut de Recherche pour le Développement ( IRD ) -Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ), and CHU Cochin [AP-HP]
Subjects: Male, Pathology, Gene Expression, MESH : Genotype, Disease, Critical Care and Intensive Care Medicine, MESH: Animals, Newborn, MESH: Genotype, 0302 clinical medicine, Polymorphism (computer science), MESH : Female, MESH: Animals, MESH: Bronchopulmonary Dysplasia, Finland, Bronchopulmonary Dysplasia, 0303 health sciences, education.field_of_study, MESH : Rats, MESH : Animals, Newborn, MESH: Polymorphism, Single Nucleotide, MESH: Finland, MESH : Polymorphism, Single Nucleotide, Respiratory disease, MESH: Infant, Newborn, MESH: Genetic Predisposition to Disease, Gestational age, MESH: European Continental Ancestry Group, MESH : Proteoglycans, 3. Good health, MESH : Infant, Premature, medicine.anatomical_structure, MESH: Proteoglycans, Female, Proteoglycans, MESH : Genome-Wide Association Study, Infant, Premature, MESH : Finland, MESH : Bronchopulmonary Dysplasia, Pulmonary and Respiratory Medicine, MESH: Infant, Premature, medicine.medical_specialty, MESH: Gene Expression, Genotype, MESH: Rats, MESH : Lung, MESH : Male, Population, Black People, MESH : Infant, Newborn, Polymorphism, Single Nucleotide, White People, Article, MESH : African Continental Ancestry Group, premature, lung, MESH : European Continental Ancestry Group, 03 medical and health sciences, 030225 pediatrics, Intensive care, medicine, Animals, Humans, Genetic Predisposition to Disease, MESH: Lung, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, education, [ SDV.BBM ] Life Sciences [q-bio]/Biochemistry, Molecular Biology, development, 030304 developmental biology, Lung, MESH: Humans, business.industry, MESH : Humans, Infant, Newborn, medicine.disease, infant, MESH: Male, Rats, MESH : Gene Expression, Animals, Newborn, Bronchopulmonary dysplasia, Immunology, MESH: Genome-Wide Association Study, MESH : Genetic Predisposition to Disease, MESH : Animals, MESH: African Continental Ancestry Group, DNA microarrays, business, MESH: Female, Genome-Wide Association Study
Abstract: International audience; RATIONALE: Bronchopulmonary dysplasia is the most common chronic respiratory disease in premature infants. Genetic factors might contribute to bronchopulmonary dysplasia susceptibility. OBJECTIVES: To identify genetic variants involved in bronchopulmonary dysplasia through a genome-wide association study. METHODS: We prospectively evaluated 418 premature neonates (gestational age
Published: 2011
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217. Transfer of take-home messages in graduate ICU education

Author: Jean-François Timsit, Carole Schwebel, Bertrand Souweine, Didier Gruson, Alexandre Lautrette, R. W. Talbot, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation, CHU Bordeaux [Bordeaux]-Hôpital Pellegrin-Tripode, Climate Change Research Center [Durham], University of New Hampshire (UNH), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), and Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: 020205 medical informatics, Critical Care, media_common.quotation_subject, [SHS.EDU]Humanities and Social Sciences/Education, 02 engineering and technology, MESH: Education, Medical, Graduate, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Presentation, 0302 clinical medicine, Knowledge translation, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, Learning, Quality (business), Relevance (information retrieval), 030212 general & internal medicine, Prospective Studies, MESH: Intensive Care, MESH: Teaching, media_common, Medical education, Enthusiasm, MESH: Humans, business.industry, 4. Education, Teaching, MESH: Prospective Studies, MESH: France, Intensive Care Units, Education, Medical, Graduate, Observational study, MESH: Intensive Care Units, MESH: Learning, France, Raw data, business, Knowledge transfer, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; PURPOSE: Teaching by lecture (lecture format) is widely used at congresses and in medical educational programmes. The process involves the transfer of take-home messages. The aim of this study was to assess the number of take-home messages identified by postgraduate critical care junior doctors (juniors) during lectures. METHODS: This was a prospective observational study of 13 lectures. Lecturers were not informed in advance of the study. At the end of the lecture (30 or 50 min), the lecturer (senior doctor) and juniors listed the three main take-home messages on a form. Subjective elements of the juniors' appraisal (quality of the presentation, explanation of the topic's relevance, enthusiasm of the lecturer, background, case-based, delivery and personality, comprehensibility, practical applicability of information given, prioritization, presence of raw data, references, overall satisfaction) and objective elements (length of lecture, number of take-home messages written on the slides) of the lectures were recorded. Successful knowledge transfer was assessed by matching lecturers' and juniors' take-home messages. RESULTS: In total, 367 forms completed by 367 juniors were analysed. A match equal to 3 (highest match), 2, 1 or 0 was observed in 3.8, 26.7, 48.2 and 21.2% of the forms, respectively. No single subjective or objective element of the lecture was associated with the number of identified take-home messages. CONCLUSIONS: Two-thirds of critical care junior doctors identified at best only one of the three main take-home messages of a lecture, suggesting that knowledge transfer is poor during passive format learning. These results suggest that there is a need to develop strategies to improve the performance of lecture-based learning.
Published: 2011
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218. Impact of an intensive communication strategy on end-of-life practices in the intensive care unit

Author: Jean-Philippe Rigaud, Arnaud Pavon, Christian Hervé, Saber Barbar, Grégoire Moutel, Pierre Emmanuel Charles, Sébastien Prin, Nicolas Jacquiot, Jean-Pierre Quenot, Bernard Blettery, Mael Hamet, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Réanimation Polyvalente, Centre hospitalier de Dieppe, Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), and Duchange, Nathalie
Subjects: MESH: Decision Making, Male, Pediatrics, Medical audit, Critical Care and Intensive Care Medicine, MESH: Medical Audit, law.invention, 0302 clinical medicine, law, 030212 general & internal medicine, Hospital Mortality, Practice Patterns, Physicians', MESH: Aged, Medical Audit, Terminal Care, Withholding Treatment, MESH: Middle Aged, Medical record, MESH: Withholding Treatment, Middle Aged, 16. Peace & justice, Intensive care unit, Icu admission, MESH: Terminal Care, Intensive Care Units, MESH: Interdisciplinary Communication, Female, France, medicine.medical_specialty, Decision Making, Article, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Humans, MESH: Hospital Mortality, MESH: Physician's Practice Patterns, Aged, MESH: Humans, business.industry, 030208 emergency & critical care medicine, [SDV.ETH] Life Sciences [q-bio]/Ethics, MESH: Male, [SDV.ETH]Life Sciences [q-bio]/Ethics, MESH: France, Median time, MESH: Intensive Care Units, Interdisciplinary Communication, business, MESH: Female
Abstract: International audience; PURPOSE: Since the 2005 French law on end of life and patients' rights, it is unclear whether practices have evolved. We investigated whether an intensive communication strategy based on this law would influence practices in terms of withholding and withdrawing treatment (WWT), and outcome of patients hospitalised in intensive care (ICU). METHODS: This was a single-centre, two-period study performed before and after the 2005 law. Between these periods, an intensive strategy for communication was developed and implemented, comprising regular meetings and modalities for WWT. We examined medical records of all patients who died in the ICU or in hospital during both periods. RESULTS: In total, out of 2,478 patients admitted in period 1, 678 (27%) died in the ICU and 823/2,940 (28%) in period 2. In period 1, among patients who died in the ICU, 45% died subsequent to a decision to WWT versus 85% in period 2 (p < 0.01). Among these, median time delay between ICU admission and initiation of decision-making process was significantly different (6-7 days in period 1 vs. 3-5 days in period 2, p < 0.05). Similarly, median time from admission to actual WWT decision was significantly shorter in period 2 (11-13 days in period 1 vs. 4-6 days in period 2, p < 0.05). Finally, median time from admission to death in the ICU subsequent to a decision to WWT was 13-15 days in period 1 versus 7-8 days in period 2, p < 0.05. Reasons for WWT were not significantly different between periods. CONCLUSION: Intensive communication brings about quicker end-of-life decision-making in the ICU. The new law has the advantage of providing a legal framework.
Published: 2011
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219. Influence of tracheal suctioning systems on health care workers' gloves and equipment contamination: A comparison of closed and open systems

Author: Jean-Damien Ricard, Didier Dreyfuss, Yolaine Martin, Catherine Branger, Guilène Barnaud, Matthieu Eveillard, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Ecologie et Evolution des Microorganismes (EEM), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Université d'Angers (UA), Service de Réanimation Médico-Chirurgicale [Hôpital Louis Mourier], Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Muséum national d'Histoire naturelle (MNHN), Service de réanimation médicale [Mourier], UFR médecine - Bichat, and Université Paris Diderot - Paris 7 (UPD7)-PRES Sorbonne Paris Cité
Subjects: Cross infection, Artificial ventilation, Suction (medicine), medicine.medical_specialty, Staphylococcus aureus, Epidemiology, medicine.medical_treatment, Health Personnel, [SDV]Life Sciences [q-bio], education, 030501 epidemiology, Suction, law.invention, airway secretion management, 03 medical and health sciences, Health personnel, 0302 clinical medicine, Mechanical ventilation, law, Drug Resistance, Multiple, Bacterial, Health care, nosocomial infections, Medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Cross Infection, Ventilators, Mechanical, Acinetobacter, business.industry, Health Policy, cross contamination, Public Health, Environmental and Occupational Health, Contamination, medicine.disease, Intensive care unit, Respiration, Artificial, Ventilation, 3. Good health, Intensive Care Units, Infectious Diseases, Pseudomonas aeruginosa, Equipment Contamination, Medical emergency, 0305 other medical science, business, Gloves, Protective
Abstract: International audience; The impact of tracheal suctioning with an open or a closed system on equipment and health care workers contamination with multidrug-resistant pathogens was compared. Only the closed system reduced hand and equipment contamination during tracheal suctioning. This equipment could be systematically used to reduce risk of cross contamination in the intensive care unit.
Published: 2011
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220. Helium in the adult critical care setting

Author: Christophe Faisy, Emmanuel Guerot, JL Diehl, Vincent Peigne, Alain Mercat, Laurent Lecourt, Risque Thrombotique et Mecanismes de l'Hemostase (U765), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement (IFR71), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Département de recherche, Air Liquide Santé International, Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Risque Thrombotique et Mécanismes de l'Hémostase (U765), Institut de Recherche pour le Développement (IRD)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Risque Thrombotique et Mecanismes de l'Hemostase ( U765 ), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement ( IFR71 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), CHU Angers, and BMC, Ed.
Subjects: medicine.medical_specialty, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, Context (language use), Review, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Work of breathing, 0302 clinical medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Intubation, 030212 general & internal medicine, Intensive care medicine, [ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], business.industry, Tracheal intubation, Airway obstruction, respiratory system, medicine.disease, 3. Good health, respiratory tract diseases, 030228 respiratory system, Acute severe asthma, Breathing, medicine.symptom, business, Hypercapnia
Abstract: International audience; ABSTRACT: Helium is a low-density inert gas whose physical properties are very different from those of nitrogen and oxygen. Such properties could be clinically useful in the adult critical care setting, especially in patients with upper to more distal airway obstruction requiring moderate to intermediate levels of FiO2. However, despite decades of utilization and reporting, it is still difficult to give any firm clinical recommendation in this setting. Numerous case reports are available in the context of upper airway obstruction of different origins, but there is a lack of controlled studies for this indication. One study reported a helium-induced beneficial effect on surrogates of work of breathing after extubation in non-COPD patients, possibly in relation to laryngeal consequences of tracheal intubation. Physiological benefits of helium-oxygen breathing have been demonstrated in the context of acute severe asthma, but there is a lack of large controlled studies demonstrating an effect on pertinent clinical endpoints, except for a study reported only as an abstract, which mentioned a reduction in the intubation rate in helium-treated patients. Finally, there are a number of physiological studies in the context of COLD-COPD patients demonstrating a beneficial effect, mainly by a reduction in the resistive inspiratory work of breathing but also by a reduction in hyperinflation. Reduction of hypercapnia was mainly observed in spontaneously breathing and noninvasively ventilated helium-treated patients but not in intubated patients during controlled ventilation, suggesting that the decrease in PaCO2 was mainly in relation to a diminution in CO2 production, related to the diminution in work of breathing and not an improved alveolar ventilation. Moreover, there is little evidence that helium-oxygen could improve parameters of heterogeneity in such patients. Two RCTs were unable to demonstrate a reduction in the intubation rate in such setting, but they were likely underpowered. An adequately powered international multicentric study is ongoing and will help to determinate the exact place of the helium-oxygen mixture in the future. The place of the mixture during the weaning period will deserve further evaluation.
Published: 2011
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221. An integrated approach for prescribing fewer chest x-rays in the ICU

Author: Ludivine Chalumeau-Lemoine, Vincent Ioos, Gilles Hejblum, Arnaud Galbois, Eric Maury, Bertrand Guidet, Service de Réanimation Polyvalente, Hôpital Delafontaine, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Epidémiologie des maladies infectieuses et modélisation (ESIM), Pôle de Pharmacie - Santé Publique - Information médicale [Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Université Pierre et Marie Curie - Paris 6 (UPMC), BMC, Ed., Pôle de Pharmacie - Santé Publique - Information médicale [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: medicine.medical_specialty, Capnography, medicine.diagnostic_test, business.industry, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, 030208 emergency & critical care medicine, Auscultation, Review, Integrated approach, Critical Care and Intensive Care Medicine, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Imaging Tool, 030228 respiratory system, Intensive care, Anesthesiology, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Medical prescription, Intensive care medicine, business, Central venous catheter
Abstract: Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns inherent to their use, considering both healthcare organization and patient perspectives. In recent years, several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes: a raw reduction of CXRs due to the elimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU.
Published: 2011
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222. Diagnostic performance of fractional excretion of urea in the evaluation of critically ill patients with acute kidney injury: a multicenter cohort study

Author: Laurent Brochard, Benoit Schlemmer, Yves Cohen, François Vincent, Fabrice Zeni, Frédéric Gonzalez, Vincent Das, Frédérique Schortgen, Gilles Bernardin, Michael Darmon, Jean Dellamonica, Service de réanimation polyvalente, urgences, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], INSERM U955, équipe 13, Medical-Surgical Intensive Care Unit, Geneva University Hospital (HUG)-Geneva University Hospital (HUG)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Financial support consisted of a grant from the Assistance-Publique Hôpitaux de Paris (CRC 07 011), a nonprofit, government-funded organization., Université Paris 13 (UP13)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Nice Sophia Antipolis (... - 2019) (UNS), and BMC, Ed.
Subjects: Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, Critical Care and Intensive Care Medicine, urologic and male genital diseases, Gastroenterology, Cohort Studies, 0302 clinical medicine, Urea, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, MESH: Sepsis, MESH: Cohort Studies, MESH: Aged, MESH: Middle Aged, Acute kidney injury, Acute Kidney Injury, Middle Aged, female genital diseases and pregnancy complications, MESH: Predictive Value of Tests, Intensive Care Units, acute tubular necrosis, MESH: Critical Illness, Female, Cohort study, medicine.medical_specialty, MESH: Hemodynamics, Fractional excretion of sodium, Critical Illness, MESH: Acute Kidney Injury, Sepsis, Excretion, fractional excretion of sodium, 03 medical and health sciences, Predictive Value of Tests, acute kidney failure, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, MESH: Diuretics, Intensive care medicine, Acute tubular necrosis, MESH: Urea, Aged, MESH: Humans, business.industry, urogenital system, Research, Hemodynamics, MESH: Biological Markers, 030208 emergency & critical care medicine, medicine.disease, diuretics, MESH: Male, MESH: Prospective Studies, sensitivity and specificity, ICU, MESH: Intensive Care Units, Diuretic, business, MESH: Female, Biomarkers
Abstract: International audience; INTRODUCTION: Several factors, including diuretic use and sepsis, interfere with the fractional excretion of sodium, which is used to distinguish transient from persistent acute kidney injury (AKI). These factors do not affect the fractional excretion of urea (FeUrea). However, there are conflicting data on the diagnostic accuracy of FeUrea. METHODS: We conducted an observational, prospective, multicenter study at three ICUs in university hospitals. Unselected patients, except those with obstructive AKI, were admitted to the participating ICUs during a six-month period. Transient AKI was defined as AKI caused by renal hypoperfusion and reversal within three days. The results are reported as medians (interquartile ranges). RESULTS: A total of 203 patients were included. According to our definitions, 67 had no AKI, 54 had transient AKI and 82 had persistent AKI. FeUrea was 39% (28 to 40) in the no-AKI group, 41% (29 to 54) in the transient AKI group and 32% (22 to 51) in the persistent AKI group (P = 0.12). FeUrea was of little help in distinguishing transient AKI from persistent AKI, with the area under the receiver operating characteristic curve being 0.59 (95% confidence interval, 0.49 to 0.70; P = 0.06). Sensitivity was 63% and specificity was 54% with a cutoff of 35%. In the subgroup of patients receiving diuretics, the results were similar. CONCLUSIONS: FeUrea may be of little help in distinguishing transient AKI from persistent AKI in critically ill patients, including those receiving diuretic therapy. Additional studies are needed to evaluate alternative markers or strategies to differentiate transient from persistent AKI.
Published: 2011
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223. Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis

Author: Samir Jamali, Molière Nguile-Makao, Dany Golgran-Toledano, Christophe Clec’h, Adrien Descorps-Declere, Maité Garrouste-Orgeas, Frank Chemouni, Jean-François Timsit, Elie Azoulay, Rebecca Hamidfar-Roy, Frédéric Gonzalez, Alexandre Lautrette, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Service d'anesthésie-réanimation [Avicenne], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Service de réanimation médicale, Hôpital Saint-Joseph-Hôpital Saint-Joseph, Service de réanimation médicale - soins intensifs, Hôpital Dourdan, Hôpital de Gonesse, Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon, OUTCOMEREA is a nonprofit organization supported by nonexclusive grants from four pharmaceutical companies (Aventis Pharma, Wyeth, Pfizer, and MSD) and by research grants from three publicly funded French agencies (Centre National de la recherche Scientifique [CNRS], Institut National pour la Santé et la Recherche Médicale [INSERM], and the French Ministry of Health)., Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinique de réanimation médicale, and BMC, Ed.
Subjects: Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, 030232 urology & nephrology, Critical Care and Intensive Care Medicine, MESH: Risk Assessment, Cohort Studies, 0302 clinical medicine, MESH: Aged, 80 and over, Hospital Mortality, MESH: Cohort Studies, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Mortality rate, Acute kidney injury, Acute Kidney Injury, Middle Aged, 3. Good health, Intensive Care Units, MESH: Critical Illness, Female, SOFA score, France, Cohort study, Adult, medicine.medical_specialty, Critical Illness, MESH: Acute Kidney Injury, Risk Assessment, 03 medical and health sciences, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Rifle, Renal replacement therapy, MESH: Hospital Mortality, Aged, MESH: Humans, business.industry, Research, 030208 emergency & critical care medicine, MESH: Adult, medicine.disease, Confidence interval, MESH: Male, Surgery, MESH: France, Respiratory failure, MESH: Intensive Care Units, business, MESH: Female
Abstract: International audience; INTRODUCTION: In this study, we aimed to assess the association between acute kidney injury (AKI) and mortality in critically ill patients using an original competing risks approach. METHODS: Unselected patients admitted between 1997 and 2009 to 13 French medical or surgical intensive care units were included in this observational cohort study. AKI was defined according to the RIFLE criteria. The following data were recorded: baseline characteristics, daily serum creatinine level, daily Sequential Organ Failure Assessment (SOFA) score, vital status at hospital discharge and length of hospital stay. Patients were classified according to the maximum RIFLE class reached during their ICU stay. The association of AKI with hospital mortality with "discharge alive" considered as a competing event was assessed according to the Fine and Gray model. RESULTS: Of the 8,639 study patients, 32.9% had AKI, of whom 19.1% received renal replacement therapy. Patients with AKI had higher crude mortality rates and longer lengths of hospital stay than patients without AKI. In the Fine and Gray model, independent risk factors for hospital mortality were the RIFLE classes Risk (sub-hazard ratio (SHR) 1.58 and 95% confidence interval (95% CI) 1.32 to 1.88; P < 0.0001), Injury (SHR 3.99 and 95% CI 3.43 to 4.65; P < 0.0001) and Failure (SHR 4.12 and 95% CI 3.55 to 4.79; P < 0.0001); nonrenal SOFA score (SHR 1.19 per point and 95% CI 1.18 to 1.21; P < 0.0001); McCabe class 3 (SHR 2.71 and 95% CI 2.34 to 3.15; P < 0.0001); and respiratory failure (SHR 3.08 and 95% CI 1.36 to 7.01; P < 0.01). CONCLUSIONS: By using a competing risks approach, we confirm in this study that AKI affecting critically ill patients is associated with increased in-hospital mortality.
Published: 2011
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224. Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial

Author: Nicolas Fage, Julien Demiselle, Valérie Seegers, Hamid Merdji, Fabien Grelon, Bruno Mégarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, Remi Coudroy, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Jean Pierre Bedos, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien Du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher, Pierre Asfar, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), LUNAM Université [Nantes Angers Le Mans], CHU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Regenerative NanoMedicine [Strasbourg] (RNM), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Service de Médecine Intensive et Réanimation [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Centre Hospitalier Le Mans (CH Le Mans), COVID-Mucor study group, Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA), Sorbonne Université (SU), Université de Caen Normandie (UNICAEN), Normandie Université (NU), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pontchaillou, Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), and Université catholique de Lille (UCL)
Subjects: Lactate clearance, Arterial lactate Lactate clearance Mean arterial pressure Microcirculation Mottling Septic shock, Microcirculation, Septic shock, [SDV]Life Sciences [q-bio], Mottling, Critical Care and Intensive Care Medicine, Arterial lactate, Mean arterial pressure
Abstract: Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient’s outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling Conclusion Compared with low MAP target, higher MAP target did not alter mottling and lactate course. Mottling lasting for more than 6 h was associated with higher mortality. Compared to arterial lactate, mottling duration appears to be a better marker of mortality.
Published: 2022
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225. Investigation of the Mechanisms of Tramadol-Induced Seizures in Overdose in the Rat

Author: Camille Lagard, Dominique Vodovar, Lucie Chevillard, Jacques Callebert, Fabien Caillé, Géraldine Pottier, Hao Liang, Patricia Risède, Nicolas Tournier, Bruno Mégarbane, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), Université Paris Cité (UPCité), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Biochimie et Biologie Moleculaire [AP-HP Hôpital Lariboisière] (IFR6), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], LaBoratoire d'Imagerie biOmédicale MultimodAle Paris-Saclay (BIOMAPS), Service Hospitalier Frédéric Joliot (SHFJ), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Variabilité de réponse aux Psychotropes (VariaPsy - U1144), Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal, ANR-16-CE17-0011,ISOTOPK,Imagerie fonctionnelle des transporteurs SLCO (Solute Carrier O) chez l'Homme : implication dans la variabilité d'élimination et de distribution tissulaire des médicaments(2016), Université Paris Cité - UFR Médecine [Santé] (UPCité UFR Médecine), Chevillard, Lucie, Imagerie Moléculaire in Vivo (IMIV - U1023 - ERL9218), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Mégarbane, Bruno, Imagerie fonctionnelle des transporteurs SLCO (Solute Carrier O) chez l'Homme : implication dans la variabilité d'élimination et de distribution tissulaire des médicaments - - ISOTOPK2016 - ANR-16-CE17-0011 - AAPG2016 - VALID, Laboratoire d’imagerie biomédicale multimodale [Orsay] (BioMaps), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS), Institut des Sciences Chimiques de Rennes (ISCR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Ecole Nationale Supérieure de Chimie de Rennes (ENSCR)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), and Unité BioMaps (BIOMAPS)
Subjects: [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, tramadol, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, positron emission tomography, seizure, Pharmaceutical Science, GABA, overdose, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Drug Discovery, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Molecular Medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract
Abstract: International audience; Tramadol overdose is frequently associated with the onset of seizures, usually considered as serotonin syndrome manifestations. Recently, the serotoninergic mechanism of tramadol-attributed seizures has been questioned. This study’s aim was to identify the mechanisms involved in tramadol-induced seizures in overdose in rats. The investigations included (1) the effects of specific pretreatments on tramadol-induced seizure onset and brain monoamine concentrations, (2) the interaction between tramadol and $\gamma$-aminobutyric acid (GABA)$_A$ receptors in vivo in the brain using positron emission tomography (PET) imaging and $^{11}$C-flumazenil. Diazepam abolished tramadol-induced seizures, in contrast to naloxone, cyproheptadine and fexofenadine pretreatments. Despite seizure abolishment, diazepam significantly enhanced tramadol-induced increase in the brain serotonin (p < 0.01), histamine (p < 0.01), dopamine (p < 0.05) and norepinephrine (p < 0.05). No displacement of $^{11}$C-flumazenil brain kinetics was observed following tramadol administration in contrast to diazepam, suggesting that the observed interaction was not related to a competitive mechanism between tramadol and flumazenil at the benzodiazepine-binding site. Our findings do not support the involvement of serotoninergic, histaminergic, dopaminergic, norepinephrine or opioidergic pathways in tramadol-induced seizures in overdose, but they strongly suggest a tramadol-induced allosteric change of the benzodiazepine-binding site of GABA$_A$ receptors. Management of tramadol-poisoned patients should take into account that tramadol-induced seizures are mainly related to a GABAergic pathway.
Published: 2022
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226. Peripheral Tissue Hypoperfusion Predicts Post Intubation Hemodynamic Instability

Author: Vincent Dubée, Geoffroy Hariri, Jérémie Joffre, Julien Hagry, Lisa Raia, Vincent Bonny, Paul Gabarre, Sebastien Ehrminger, Naike Bigé, Jean-Luc Baudel, Bertrand Guidet, Eric Maury, Guillaume Dumas, Hafid Ait-Oufella, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Gestionnaire, Hal Sorbonne Université
Subjects: [SDV] Life Sciences [q-bio], Tissue perfusion, [SDV]Life Sciences [q-bio], Mottling, Hemodynamic, Critical Care and Intensive Care Medicine, Intubation, Outcome
Abstract: Background Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic instability (PIHI). Methods Prospective observational monocenter study conducted in an 18-bed medical ICU. Consecutive patients requiring tracheal intubation were eligible for the study. Global hemodynamic parameters (blood pressure, heart rate, cardiac function) and tissue perfusion parameters (arterial lactate, mottling score, capillary refill time [CRT], toe-to-room gradient temperature) were recorded before, 5 min and 2 h after tracheal intubation (TI). Post intubation hemodynamic instability (PIHI) was defined as any hemodynamic event requiring therapeutic intervention. Results During 1 year, 120 patients were included, mainly male (59%) with a median age of 68 [57–77]. The median SOFA score and SAPS II were 6 [4–9] and 47 [37–63], respectively. The main indications for tracheal intubation were hypoxemia (51%), hypercapnia (13%), and coma (29%). In addition, 48% of patients had sepsis and 16% septic shock. Fifty-one (42%) patients develop PIHI. Univariate analysis identified several baseline factors associated with PIHI, including norepinephrine prior to TI, sepsis, tachycardia, fever, higher SOFA and high SAPSII score, mottling score ≥ 3, high lactate level and prolonged knee CRT. By contrast, mean arterial pressure, baseline cardiac index, and ejection fraction were not different between PIHI and No-PIHI groups. After adjustment on potential confounders, the mottling score was associated with a higher risk for PIHI (adjusted OR: 1.84 [1.21–2.82] per 1 point increased; p = 0.005). Among both global haemodynamics and tissue perfusion parameters, baseline mottling score was the best predictor of PIHI (AUC: 0.72 (CI 95% [0.62–0.81]). Conclusions In non-selected critically ill patients requiring invasive mechanical ventilation, tissue hypoperfusion parameters, especially the mottling score, could be helpful to predict PIHI.
Published: 2022
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227. Infection of lung megakaryocytes and platelets by SARS-CoV-2 anticipate fatal COVID-19

Author: Aiwei Zhu, Fernando Real, Claude Capron, Arielle R. Rosenberg, Aymeric Silvin, Garett Dunsmore, Jaja Zhu, Andréa Cottoignies-Callamarte, Jean-Marc Massé, Pierre Moine, Simon Bessis, Mathieu Godement, Guillaume Geri, Jean-Daniel Chiche, Silvana Valdebenito, Sandrine Belouzard, Jean Dubuisson, Geoffroy Lorin de la Grandmaison, Sylvie Chevret, Florent Ginhoux, Eliseo A. Eugenin, Djillali Annane, Elisabeth Cramer Bordé, Morgane Bomsel, Institut Cochin [IC UM3 (UMR 8104 / U1016)], Université de Versailles Saint-Quentin-en-Yvelines [UVSQ], Hôpital Ambroise Paré [AP-HP], Hôpital Cochin [AP-HP], Immunologie anti-tumorale et immunothérapie des cancers [ITIC], Institut Gustave Roussy [IGR], Infection et inflammation [2I], The University of Texas Medical Branch [UTMB], Institut Pasteur de Lille, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 [CIIL], Hôpital Raymond Poincaré [Garches], Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) [SBIM], Singapore Immunology Network [SIgN], Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Service d'Hématologie et d'Immunologie [AP-HP Hôpital Ambroise Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Institut Gustave Roussy (IGR), Immunologie des tumeurs et immunothérapie (UMR 1015), Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection et inflammation (2I), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], The University of Texas Medical Branch (UTMB), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), 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)-Centre National de la Recherche Scientifique (CNRS), Réseau International des Instituts Pasteur (RIIP), Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer [Boulogne] (INCA)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Hopital Saint-Louis [AP-HP] (AP-HP), Singapore Immunology Network (SIgN), Biomedical Sciences Institute (BMSI), Agency for science, technology and research [Singapore] (A*STAR), ANR-20-COVI-0024,MUCOLUNG,Rôle des cellules pulmonaires infectées par le SRAS-CoV-2 et réponse humoral dans l' évolution du COVID-19: de la physiopathologie au test de médicaments candidats dans les modèles de cellules muqueuses(2020), Immunologie anti-tumorale et immunothérapie des cancers (ITIC), Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), School of Medicine [Shanghai Jiaotong University], Shanghai Jiaotong University, Accident Compensation Corporation, ACC, Fondation pour la Recherche Médicale, FRM, China Scholarship Council, CSC, The authors thank Professor John F. Martin (University College of London, UK) for fruitful advice and discussion on the role of NRP1 receptor and VEGF in COVID19 and resultant therapeutical implications, and for English editing. The authors greatly acknowledge Karine Bailly and Muriel Andrieu of the Cochin Cytometry and Immunobiology Facility for cytokine analyses, as well as Thomas Guilbert from the Imag’IC facility for instruction on the IXplore Spin Confocal Imaging Microscope System (Olympus) and Livine Duban from Luminex corp for instruction on the Guava easyCyte 12HT base system (Millipore) during the COVID-19 confinement period. We also thank also Dr. Nicolas Chapuis (Hôpital Cochin, Paris, France) and Pr. Nicholas Heming (Hôpital Raymond Poincaré, Garches, France) for helpful discussion., Joint funding by the Agence Nationale de la Recherche (France) and Fondation pour la Recherche Médicale (France): Flash COVID ANR-FRM: ANR-20-COVI-0024. Funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. AZ was supported by the China Scholarship Council and ACC by the Fondation pour la Recherche Médicale., and REAL, Fernando
Subjects: Blood Platelets, Pharmacology, Platelets, SARS-CoV-2, Macrophages, [SDV]Life Sciences [q-bio], Membrane Proteins, RNA-Binding Proteins, COVID-19, Thrombosis, Cell Biology, [SDV] Life Sciences [q-bio], Lung, Megakaryocytes, Cellular and Molecular Neuroscience, Humans, Molecular Medicine, Molecular Biology
Abstract: SARS-CoV-2, although not being a circulatory virus, spread from the respiratory tract resulting in multiorgan failures and thrombotic complications, the hallmarks of fatal COVID-19. A convergent contributor could be platelets that beyond hemostatic functions can carry infectious viruses. Here, we profiled 52 patients with severe COVID-19 and demonstrated that circulating platelets of 19 out 20 non-survivor patients contain SARS-CoV-2 in robust correlation with fatal outcome. Platelets containing SARS-CoV-2 might originate from bone marrow and lung megakaryocytes (MKs), the platelet precursors, which were found infected by SARS-CoV-2 in COVID-19 autopsies. Accordingly, MKs undergoing shortened differentiation and expressing anti-viral IFITM1 and IFITM3 RNA as a sign of viral sensing were enriched in the circulation of deadly COVID-19. Infected MKs reach the lung concomitant with a specific MK-related cytokine storm rich in VEGF, PDGF and inflammatory molecules, anticipating fatal outcome. Lung macrophages capture SARS-CoV-2-containing platelets in vivo. The virus contained by platelets is infectious as capture of platelets carrying SARS-CoV-2 propagates infection to macrophages in vitro, in a process blocked by an anti-GPIIbIIIa drug. Altogether, platelets containing infectious SARS-CoV-2 alter COVID-19 pathogenesis and provide a powerful fatality marker. Clinical targeting of platelets might prevent viral spread, thrombus formation and exacerbated inflammation at once and increase survival in COVID-19.
Published: 2022
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228. Impaired skin microvascular endothelial reactivity in critically ill COVID-19 patients

Author: Lisa Raia, Tomas Urbina, Paul Gabarre, Vincent Bonny, Geoffroy Hariri, Sebastien Ehrminger, Naïke Bigé, Jean-Luc Baudel, Bertrand Guidet, Eric Maury, Jeremie Joffre, Hafid Ait-Oufella, Gestionnaire, Hal Sorbonne Université, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)
Subjects: [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, SARS-CoV-2, Endothelial reactivity, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Tissue perfusion, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intensive care medicine, Critical Care and Intensive Care Medicine
Abstract: Background Some clinical and histological studies have reported that SARS-CoV-2 infection may damage the endothelium. However, the impact of this virus on endothelial function in vivo remains poorly characterized. In this single-center pilot observational study, we performed iontophoresis of acetylcholine coupled with Laser doppler to investigate microvascular endothelial reactivity in COVID-19 patients compared to patients with non-COVID-19 bacterial pneumonia (NCBP) patients. Results During three consecutive months, 32 COVID-19 patients and 11 control NCBP patients with acute respiratory failure were included. The median age was 59 [50–68] and 69 [57–75] years in COVID-19 and NCBP groups, respectively (P = 0.11). There was no significant difference in comorbidities or medications between the two groups, except for body mass index, which was higher in COVID-19 patients. NCBP patients had a higher SAPS II score compared to COVID-19 patients (P P = 0.51). Global hemodynamic and peripheral tissue perfusion parameters were not different between groups. COVID-19 patients had significantly lower skin microvascular basal blood flow than NCBP patients (P = 0.02). In addition, endothelium-dependent microvascular reactivity was threefold lower in COVID-19 patients than NCBP patients (P = 0.008). Conclusions Both baseline skin microvascular blood flow and skin endothelial-dependent microvascular reactivity were impaired in critically ill COVID-19 patients compared to NCBP patients, despite a lower disease severity score supporting a specific pathogenic role of SARS-CoV-2 on the endothelium.
Published: 2022
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229. Case series of massive direct oral anticoagulant ingestion—Treatment and pharmacokinetics data

Author: Maxime Delrue, Lucie Chevillard, Alain Stépanian, Alessandra Dragoni, Laurence Camoin‐Jau, Sébastien Voicu, Isabelle Malissin, Nicolas Deye, Marc Gainnier, Virginie Siguret, Bruno Mégarbane, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hopital Saint-Louis [AP-HP] (AP-HP), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital de la Timone [CHU - APHM] (TIMONE), Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis (IThEM - U1140), and Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal
Subjects: Pyridones, Clinical Biochemistry, Administration, Oral, Anticoagulants, Hemorrhage, General Medicine, Middle Aged, Biochemistry, Dabigatran, Cohort Studies, Eating, Rivaroxaban, Charcoal, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Atrial Fibrillation, Humans
Abstract: Direct oral anticoagulants (DOAC) are widely used due to favourable benefit/risk ratio. However, consequences of massive ingestion have been poorly investigated.We aimed to report outcome and pharmacokinetic parameters in patients who massively ingested DOACs.We conducted a 5-year cohort study including consecutive massive DOAC ingestion patients admitted to two critical care departments. Patients were managed in accordance with standards of care. We collected the main history, clinical, laboratory, management and outcome data. The time-course of plasma DOAC concentrations measured using specific assays was modelled.Twelve patients (3F/9M; age, 55 years [41-63], median [25th-75th percentiles]) were included. Ingestions involved rivaroxaban (n = 7), apixaban (n = 3) and dabigatran (n = 2), with presumed doses of 9.4-fold [5.0-22.0] the full daily dose. Six patients received activated charcoal but no antidote nor blood-derived product. No bleeding was observed. One patient died due to refractory cardiogenic shock related to bisoprolol co-intoxication. Highest observed peak plasma concentrations were 1720 ng/ml (rivaroxaban), 750 ng/ml (apixaban) and 644 ng/ml (dabigatran). Times to reach DOAC concentration below 50 ng/ml were ~20-45 h (rivaroxaban), ~125 h (apixaban) and ~30-50 h (dabigatran). Elimination half-lives were 2.5-25.5 h (rivaroxaban), 22.0 and 36.5 h (apixaban), and 5.8 and 15.5 h (dabigatran), with substantial interindividual variability and prolongation in case of cardiovascular failure related to co-intoxicants. Charcoal administration, even if delayed, may have contributed to limit toxicity, possibly by reducing absorption and/or enteroenteric recycling.No bleeding was observed in this series of massive DOAC ingestions despite elevated plasma concentrations. No patient required specific haemostatic agents. Charcoal administration should be considered to limit toxicity.
Published: 2022
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230. Association between hypernatraemia acquired in the ICU and mortality: a cohort study

Author: Samir Jamali, Yves Cohen, Adrien Français, Elie Azoulay, Michael Darmon, Anne-Sylvie Dumenil, Jean-François Timsit, Maité Garrouste-Orgeas, Molière Nguile-Makao, Bernard Allaouchiche, Bertrand Souweine, Christine Cheval, Dany Goldgran-Toledano, Christophe Adrie, Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Medical ICU, CHU Saint-Etienne, INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon, Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), General ICU, Hôpital Delafontaine, Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Medical-Surgical ICU, Hôpital Gonesse, Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Hôpital de Dourdan, Medical-surgical ICU, Centre Hospitalier d’Hyères, Surgical ICU, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe Hospitalier Paris Saint-Joseph (hpsj), Centre Hospitalier de Gonesse, and Vesin, Aurélien
Subjects: Male, medicine.medical_specialty, Pediatrics, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, law, Risk Factors, Internal medicine, Severity of illness, medicine, Prevalence, Humans, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Simplified Acute Physiology Score, Prospective cohort study, Aged, Retrospective Studies, Transplantation, Sex Characteristics, Hypernatremia, business.industry, Sodium, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Intensive care unit, 3. Good health, Survival Rate, Intensive Care Units, Nephrology, SAPS II, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Cohort study
Abstract: International audience; BACKGROUND: The aim of this study is to describe the prevalence and outcomes of intensive care unit (ICU)-acquired hypernatraemia (IAH). METHODS: A retrospective analysis was performed on a prospectively collected database fed by 12 ICUs. Subjects are unselected patients with ICU stay >48 h. Mild and moderate to severe hypernatraemia were defined as serum sodium >145 and >150 mmol/L, respectively. IAH was hypernatraemia occurring >/=24 h after ICU admission in patients with normal serum sodium at ICU admission. RESULTS: Of the 8441 patients, 301 were excluded because they had hypernatraemia at ICU admission. Of the remaining 8140 patients, 901 (11.1%) experienced mild hypernatraemia, and 344 (4.2%) experienced moderate to severe hypernatraemia. Factors independently associated with IAH were male gender, severity at admission as assessed by the Simplified Acute Physiology Score version II (SAPS II), and organ failure or life-supporting treatment at ICU admission. Unadjusted hospital mortality was 15.2% in patients without hypernatraemia compared to 29.5% in patients with mild IAH and 46.2% in those with moderate to severe IAH (P < 0.0001). When any degree of IAH was handled as a time-dependent variable in a subdistribution hazard model, the subdistribution hazard ratio (SHR) for ICU mortality was 4.26 [95% confidence interval (CI), 3.74-4.84]. After stratification by centre and adjustment for confounders, both mild IAH and moderate to severe IAH were independently associated with mortality [SHR 2.03 (95% CI 1.73-2.39) and 2.67 (95% CI 2.19-3.26), respectively]. CONCLUSION: IAH is frequent and associated with mortality after adjustment on severity at ICU admission.
Published: 2010
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231. Randomized trial evaluating serial protein C levels in severe sepsis patients treated with variable doses of drotrecogin alfa (activated)

Author: Andrew F Shorr, Jonathan M Janes, Antonio Artigas, Jyrki Tenhunen, Duncan LA Wyncoll, Emmanuelle Mercier, Bruno Francois, Jean-Louis Vincent, Burkhard Vangerow, Darell Heiselman, Amy G Leishman, Yajun E Zhu, Konrad Reinhart, for the RESPOND Investigators, BMC, Ed., Washington Hospital Center, Lilly Research Laboratories, Eli Lilly and Company, Critical Care Center, Universitat Autònoma de Barcelona (UAB)-Sabadell Hospital, Critical Care Medicine Research Group, Tampere University Hospital, Adult Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, Service de Réanimation Polyvalente, Hôpital Bretonneau-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d'Investigation Clinique de Limoges (CIC1435), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Limoges, Service de Réanimation Polyvalente [CHU Limoges], CHU Limoges, Department of Intensive Care, Université libre de Bruxelles (ULB)-Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB), Department of Anesthesiology and Intensive Care, Friedrich-Schiller-Universität = Friedrich Schiller University Jena [Jena, Germany], Eli Lilly and Company provided financial support for this study, and funded the article-processing charge, the RESPOND investigators, Sabadell Hospital-Autonomous University of Barcelona, CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Erasme [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau
Subjects: Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Critical Care and Intensive Care Medicine, Gastroenterology, law.invention, MESH: Recombinant Proteins, 0302 clinical medicine, Randomized controlled trial, law, Biological Markers -- blood, MESH: Double-Blind Method, MESH: Sepsis, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, musculoskeletal, neural, and ocular physiology, Sciences bio-médicales et agricoles, Middle Aged, 3. Good health, Treatment Outcome, Female, medicine.symptom, medicine.drug, medicine.medical_specialty, macromolecular substances, MESH: Drug Administration Schedule, Drug Administration Schedule, Sepsis, 03 medical and health sciences, Pharmacotherapy, Double-Blind Method, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Aged, MESH: Humans, business.industry, Septic shock, Drotrecogin alfa, Research, Organ dysfunction, MESH: Biological Markers, 030208 emergency & critical care medicine, medicine.disease, MESH: Male, Surgery, Clinical trial, Protein C -- administration & dosage -- metabolism, Recombinant Proteins -- administration & dosage, Sepsis -- blood -- drug therapy, 030228 respiratory system, nervous system, business, MESH: Female, Protein C, MESH: Protein C
Abstract: Serial alterations in protein C levels appear to correlate with disease severity in patients with severe sepsis, and it may be possible to tailor severe sepsis therapy with the use of this biomarker. The purpose of this study was to evaluate the dose and duration of drotrecogin alfa (activated) treatment using serial measurements of protein C compared to standard therapy in patients with severe sepsis., Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2010
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232. Comparison of albicans vs. non-albicans candidemia in French intensive care units

Author: Philippe Montravers, Olivier Lortholary, Olivier Leroy, Jean Paul Mira, Jean-Pierre Gangneux, Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Service de Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire ( CNRMA ), Institut Pasteur [Paris], for the AmarCand Study Group, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Institut Pasteur [Paris]-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 Mycologie et Antifongiques-Mycologie Moléculaire (CNRMA), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Rennes (UR), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP), and BMC, Ed.
Subjects: Male, Pediatrics, MESH : Aged, MESH : Prospective Studies, Patient characteristics, Critical Care and Intensive Care Medicine, MESH: Candidemia, Severity of Illness Index, law.invention, 0302 clinical medicine, law, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Epidemiology, Candida albicans, MESH : Female, 030212 general & internal medicine, Prospective Studies, MESH: Aged, 0303 health sciences, MESH: Middle Aged, biology, Middle Aged, Intensive care unit, Corpus albicans, 3. Good health, Intensive Care Units, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, SAPS II, Female, MESH : Severity of Illness Index, France, MESH : Intensive Care Units, medicine.medical_specialty, Neutropenia, MESH: Neutropenia, MESH : Candida albicans, MESH : Male, MESH : Neutropenia, 03 medical and health sciences, Intensive care, Internal medicine, MESH: Severity of Illness Index, medicine, Humans, MESH : Candidemia, MESH : Middle Aged, MESH : France, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Aged, MESH: Humans, 030306 microbiology, business.industry, MESH: Candida albicans, Research, MESH : Humans, Candidemia, biology.organism_classification, MESH: Prospective Studies, MESH: Male, MESH: France, Non albicans candida, MESH: Intensive Care Units, business, MESH: Female
Abstract: The AmarCand Study Group (ICU physicians): Drs. Allaouchiche (Lyon), Amigues (Montpellier), Ausseur (Saint Herblain), Azoulay (Paris), Badet (Lyon), Baldesi (Aix-en-Provence), Bastien (Bron), Baudin (Paris), Bayle (Lyon), Bazin (Clermont-Ferrand), Benayoun (Clichy), Blondeau (Roubaix), Bodin (Paris), Bollaert (Nancy), Bonadona (La Tronche), Bonnaire (Aulnay Sous Bois), Bonnivard (Montauban), Borne (Paris), Brabet (Montpellier), Branche (Lyon), Braud (Rouen), Bret (Lyon), Bretonnière (Nantes), Brocas (Evry), Brun (Bron), Bruneel (Versailles), Canevet (Armentières), Cantais (Toulon Armées), Carlet (Paris), Charbonneau (Caen), Charles (Dijon), Chastagner (Chamberry), Corne (Montpellier), Courte (Saint-Brieuc), Cousson (Reims), Cren (Morlaix), Diconne (Saint Etienne), Drouet (Saint-Denis), Dube (Angers), Duguet (Paris), Dulbecco (Antibes), Dumenil (Clamart), Dupont (Amiens), Durand (Grenoble), Durand-Gasselin (Toulon), Durocher (Lille), Fangio (Poissy), Fattouh (Mulhouse), Favier (Metz Armées), Fieux (Paris), Fleureau (Pessac), Freys (Strasbourg), Fulgencio (Paris), Gally (Mulhouse), Garnaud (Orléans), Garot (Tours), Gilhodes (Créteil), Girault (Rouen), Gouin (Marseille), Gouin (Rouen), Guidon (Marseille), Hérault (Grenoble), Hyvernat (Nice), Jobard (Monaco), Jospe (Saint Etienne), Kaidomar (Fréjus), Karoubi (Bobigny), Kherchache (Agen), Lacherade (Poissy), Lakermi (Paris), Lambiotte (Maubeuge), Lamia (Le Kremlin-Bicêtre), Lasocki (Paris), Launoy (Strasbourg), Le Guillou (Paris), Lefort (Saint-Denis), Lefrant (Nîmes), Lemaire (Roubaix), Lepape (Pierre-Bénite), Lepoutre (Lomme), Leroy (Lille), Leroy (Tourcoing), Loriferne (Bry-sur-Marne), Mahe (Nantes), Mandin (Gap), Marighy (Saint- Denis), Mathieu (Lille), Mathonnet (Paris), Megarbane (Paris), Mercat (Angers), Michel (Saint Herblain), Michelet (Marseille), Mimoz (Poitiers), Mohammedi (Lyon), Mouquet (Paris), Mourvillier (Paris), Navellou (Besançon), Novara (Paris), Obadia (Montreuil), Perrigault (Montpellier), Perrin (Marseille), Petit (Valence), Poussel (Metz), Rahmani (Strasbourg), Renard (La Roche sur Yon), Robert (Poitiers), Robert (Lyon), Saliba (Villejuif ), Sannini (Marseille), Santré (Annecy), Seguin (Rennes), Souweine (Clermont-Ferrand), Trouillet (Paris), Valentin (Besançon), Volatron (Rennes), Voltz (Vandoeuvre les Nancy), Winer (Saint Pierre), and Winnock (Bordeaux).; International audience; INTRODUCTION: Candidemia raises numerous therapeutic issues for intensive care physicians. Epidemiological data that could guide the choice of initial therapy are still required. This analysis sought to compare the characteristics of intensive care unit (ICU) patients with candidemia due to non-albicans Candida species with those of ICU patients with candidemia due to Candida albicans. METHODS: A prospective, observational, multicenter, French study was conducted from October 2005 to May 2006. Patients exhibiting candidemia developed during ICU stay and exclusively due either to one or more non-albicans Candida species or to C. albicans were selected. The data collected included patient characteristics on ICU admission and at the onset of candidemia. RESULTS: Among the 136 patients analyzed, 78 (57.4%) had candidemia caused by C. albicans. These patients had earlier onset of infection (11.1 +/- 14.2 days after ICU admission vs. 17.4 +/- 17.7, p = 0.02), higher severity scores on ICU admission (SOFA: 10.4 +/- 4.7 vs. 8.6 +/- 4.6, p = 0.03; SAPS II: 57.4 +/- 22.8 vs. 48.7 +/- 15.5, P = 0.015), and were less often neutropenic (2.6% vs. 12%, p = 0.04) than patients with candidemia due to non-albicans Candida species. CONCLUSIONS: Although patients infected with Candida albicans differed from patients infected with non-albicans Candida species for a few characteristics, no clinical factor appeared pertinent enough to guide the choice of empirical antifungal therapy in ICU.
Published: 2010
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233. Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

Author: Jarlier, Vincent, Trystram, David, Brun-Buisson, Christian, Fournier, Sandra, Carbonne Berger, Anne, Marty, Laurence, Andremont, Antoine, Arlet, Guillaume, Buu-Hoi, Annie, Carlet, Jean, Decré, Dominique, Gottot, Serge, Gutmann, Laurent, Joly-Guillou, Marie-Laure, Legrand, Erick, Nicolas-Chanoine, Marie-Hélène, Soussy, Claude-James, Wolff, Michel, Lucet, Jean-Christophe, Aggoune, Michelle, Brücker, Gilles, Régnier, Bernard, de France, Collégiale, CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Emergence de la résistance bactérienne in vivo (EA3964), Université Paris Diderot - Paris 7 (UPD7), Université Pierre et Marie Curie - Paris 6 (UPMC), Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité d'Epidémiologie Clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Université d'Angers (UA), Groupe d'Études Remodelage Osseux et bioMatériaux (GEROM), Service de Microbiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de recherche biomédicale Bichat-Beaujon (CRB3), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Soins Intensifs et de Maladies Infectieuses, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Hôpital Bichat - Claude Bernard, Hôpital Delafontaine, Objectif Recherche Vaccin Sida, Service de réanimation médicale et infectieuse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Groupe Hospitalier Paris Saint-Joseph (hpsj)
Subjects: Methicillin-Resistant Staphylococcus aureus, medicine.medical_specialty, Pediatrics, Meticillin, [SDV]Life Sciences [q-bio], Prevalence, Drug resistance, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Epidemiology, Internal Medicine, medicine, Infection control, Humans, 030212 general & internal medicine, Hospitals, Teaching, 0303 health sciences, Infection Control, 030306 microbiology, business.industry, Incidence (epidemiology), Teaching, Staphylococcal Infections, Methicillin-resistant Staphylococcus aureus, Hospitals, 3. Good health, Emergency medicine, France, business, medicine.drug
Abstract: International audience; BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period.
Published: 2010
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234. Comparison of Circulating Immune Cells Profiles and Kinetics Between Coronavirus Disease 2019 and Bacterial Sepsis*

Author: Etienne Gayat, Romain Barthélémy, Bruno Mégarbane, Caren Brumpt, Sehmi Mansouri, Sebastian Voicu, Candice Fontaine, Marie Neuwirth, Benjamin G. Chousterman, Alexandre Mebazaa, Charles de Roquetaillade, Matthieu Le Dorze, Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, 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), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre hospitalier Saint-Joseph [Paris], Hôpital Lariboisière-Fernand-Widal [APHP], and Mégarbane, Bruno
Subjects: Male, CD14, Receptor expression, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, sepsis, Sepsis, coronavirus disease 2019, Immunophenotyping, Immune system, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Humans, Immunologic Factors, Eosinophilia, Longitudinal Studies, Aged, Retrospective Studies, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, flow cytometry, Editorials, COVID-19, Middle Aged, immune endotypes, medicine.disease, Neutrophilia, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Intensive Care Units, Kinetics, Basophilia, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Immunology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, France, medicine.symptom, business, severe acute respiratory syndrome coronavirus 2
Abstract: International audience; Objectives: Although clinical presentation of coronavirus disease 2019 has been extensively described, immune response to severe acute respiratory syndrome coronavirus 2 remains yet not fully understood. Similarities with bacterial sepsis were observed; however, few studies specifically addressed differences of immune response between both conditions. Here, we report a longitudinal analysis of the immune response in coronavirus disease 2019 patients, its correlation with outcome, and comparison between severe coronavirus disease 2019 patients and septic patients.Design: Longitudinal, retrospective observational study.Setting: Tertiary-care hospital during the first 2020 coronavirus disease 2019 outbreak in France.Patients: All successive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection admitted to the emergency department, medical ward, and ICU with at least one available immunophenotyping performed during hospital stay.Measurements and main results: Between March and April 2020, 247 patients with coronavirus disease 2019 were included and compared with a historical cohort of 108 severe septic patients. Nonsevere coronavirus disease 2019 patients (n = 153) presented normal or slightly altered immune profiles. Severe coronavirus disease 2019 (n = 94) immune profile differed from sepsis. Coronavirus disease 2019 exhibited profound and prolonged lymphopenia (mostly on CD3, CD4, CD8, and NK cells), neutrophilia, and human leukocyte antigen D receptor expression on CD14+ monocytes down-regulation. Surprisingly, coronavirus disease 2019 patients presented a unique profile of B cells expansion, basophilia, and eosinophilia. Lymphopenia, human leukocyte antigen D receptor expression on CD14+ monocytes down-regulation, and neutrophilia were associated with a worsened outcome, whereas basophilia and eosinophilia were associated with survival. Circulating immune cell kinetics differed between severe coronavirus disease 2019 and sepsis, lack of correction of immune alterations in coronavirus disease 2019 patients during the first 2 weeks of ICU admission was associated with death and nosocomial infections.Conclusions: Circulating immune cells profile differs between mild and severe coronavirus disease 2019 patients. Severe coronavirus disease 2019 is associated with a unique immune profile as compared with sepsis. Several immune features are associated with outcome. Thus, immune monitoring of coronavirus disease 2019 might be of help for patient management.
Published: 2021
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235. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Author: Nseir, Saad, Martin-Loeches, Ignacio, Povoa, Pedro, Metzelard, Matthieu, Du Cheyron, Damien, Lambiotte, Fabien, Tamion, Fabienne, Labruyere, Marie, Makris, Demosthenes, Boulle Geronimi, Claire, Pinetonde Chambrun, Marc, Nyunga, Martine, Pouly, Olivier, Mégarbane, Bruno, Saade, Anastasia, Gomà, Gemma, Magira, Eleni, Llitjos, Jean-François, Torres, Antoni, Ioannidou, Iliana, Pierre, Alexandre, Coelho, Luis, Reignier, Jean, Garot, Denis, Kreitmann, Louis, Baudel, Jean-Luc, Voiriot, Guillaume, Contou, Damien, Beurton, Alexandra, Asfar, Pierre, Boyer, Alexandre, Thille, Arnaud, Mekontso-Dessap, Armand, Tsolaki, Vassiliki, Vinsonneau, Christophe, Floch, Pierre-Edouard, Le Guennec, Loïc, Ceccato, Adrian, Artigas, Antonio, Bouchereau, Mathilde, Labreuche, Julien, Duhamel, Alain, Rouzé, Anahita, Favory, Raphaël, Préau, Sébastien, Jourdain, Mercé, Poissy, Julien, Leger, Piehr Saint, van der Linden, Thierry, Veinstein, Anne, Azoulay, Elie, Pene, Frédéric, Martin, Maelle, Razazi, Keyvan, Plantefeve, Gaëtan, Fartoukh, Muriel, Thevenin, Didier, Guidet, Bertrand, Weiss, Nicolas, Kouatchet, Achille, Salmon, Charlotte, Brunin, Guillaume, Nemlaghi, Safaa, Meguerditchian, David, Argaud, Laurent, Voicu, Sebastian, Luyt, Charles-Edouard, Kowalski, Benjamin, Moglia, Edgar, Morales, Luis, Koutsoukou, Antonia, Mentzelopoulos, Spyros, Nora, David, Boyd, Sean, Maizel, Julien, Cuchet, Pierre, Delforge, Quentin, Quenot, Jean-Pierre, Boyer, Déborah, Cilloniz, Catia, CHU Lille, Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), CHU Amiens-Picardie, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier [Valenciennes, Nord], CHU Rouen, Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier [Douai, Nord], Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier de Roubaix, Hôpital Saint Philibert [Lomme], Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), 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), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Cochin [AP-HP], Centre Hospitalier de Lens, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Centre Hospitalier Victor Dupouy, CHU Charles Foix [AP-HP], Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Bordeaux [Bordeaux], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Hôpital Duchenne, CH Boulogne sur Mer, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), coVAPid study group, Mégarbane, Bruno, and Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor [Créteil]
Subjects: Male, medicine.medical_treatment, Pneumònia, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pneumonia, Ventilator-Associated/epidemiology, Medicine, Hospital Mortality, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, education.field_of_study, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, COVID-19/mortality, Mortality rate, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Europe, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Intensive Care Units, Length of Stay/statistics & numerical data, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, medicine.medical_specialty, Respiration, Artificial/statistics & numerical data, Coronavirus disease 2019 (COVID-19), Population, Europe/epidemiology, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Mortalitat, Humans, Mortality, education, Aged, Retrospective Studies, Mechanical ventilation, business.industry, RC86-88.9, Research, COVID-19, 030208 emergency & critical care medicine, Retrospective cohort study, Pneumonia, Length of Stay, bacterial infections and mycoses, medicine.disease, Respiration, Artificial, respiratory tract diseases, 030228 respiratory system, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, business
Abstract: Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p = 0.013), but not in influenza (1.74 (0.99–3.06), p = 0.052), or no viral infection groups (1.13 (0.68–1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.
Published: 2021
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236. Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

Author: Mowry, James, Shepherd, Greene, Hoffman, Robert, Lavergne, Valery, Gosselin, Sophie, Nolin, Thomas, Vijayan, Anitha, Kielstein, Jan, Roberts, Darren, Ghannoum, Marc, Alhatali, Badria, Anseeuw, Kurt, Bird, Steven, Berling, Ingrid, Bouchard, Josée, Bunchman, Timothy, Calello, Diane, Chin, Paul, Doi, Kent, Galvao, Tais, Goldfarb, David, Hassanian, Hossein, Hoegberg, Lotte, Kallab, Siba, Kebede, Sofia, Lewington, Andrew, Li, Yi, Macedo, Etienne, Maclaren, Rob, Mégarbane, Bruno, Ostermann, Marlies, Peng, Ai, Roy, Jean‐philippe, Walsh, Steven, Wong, Anselm, Wood, David, Yates, Christopher, 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), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Extracorporeal Treatments in Poisoning workgroup: Badria Alhatali, Kurt Anseeuw, Steven Bird, Ingrid Berling, Josée Bouchard, Timothy E Bunchman, Diane P Calello, Paul K Chin, Kent Doi, Tais Galvao, David S Goldfarb, Hossein Hassanian, Lotte C Hoegberg, Siba Kallab, Sofia Kebede, Andrew Lewington, Yi Li, Etienne M Macedo, Rob MacLaren, Bruno Megarbane, Marlies E Ostermann, Ai Peng, Jean-Philippe Roy, Steven J Walsh, Anselm Wong, David M Wood, Christopher Yates, and Mégarbane, Bruno
Subjects: 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, 030106 microbiology, 030204 cardiovascular system & hematology, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Extracorporeal, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Renal Dialysis, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Isoniazid, medicine, Animals, Humans, Pharmacology (medical), Dosing, Dialysis, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Poisoning, Pyridoxine, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Systematic review, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Practice Guidelines as Topic, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Hemodialysis, business, medicine.drug
Abstract: Isoniazid toxicity from self-poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence-based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty-three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as "Moderately Dialyzable" by hemodialysis for patients with normal kidney function (quality of evidence = C) and "Dialyzable" by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).
Published: 2021
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237. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial

Author: Nicolas de Prost, Saber Barbar, Stéphane Gaudry, Jean-Pierre Quenot, Christophe Vinsonneau, Laurent Argaud, Eric Boulet, Didier Thevenin, Didier Dreyfuss, Marion Beuzelin, Adrien Robine, Cyril Cadoz, Steven Grangé, Béatrice La Combe, Dimitri Titeca-Beauport, Julien Mayaux, Julio Badie, Saad Nseir, Guillaume Chevrel, Karim Asehnoune, Florent Poirson, Kada Klouche, Sébastien Moschietto, Guillaume Louis, Guillaume Thiery, Marc Leone, David Hajage, Pascal Andreu, Elisabeth Coupez, Bertrand Pons, Said Lebbah, Jean-Damien Ricard, Jean-Marie Forel, Laurent Martin-Lefevre, Julien Bohé, Guillaume Geri, Sébastien Besset, Karim Lakhal, Nicolas Chudeau, Alain Combes, Bertrand Rozec, Nadia Aissaoui, Guillaume Lacave, Jean Reignier, CarMeN, laboratoire, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), UFR Santé, Médecine et Biologie Humaine (UFR SMBH), Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Laboratoire Informatique, Image et Interaction - EA 2118 (L3I), La Rochelle Université (ULR), Centre Hospitalier Henri Duffaut (Avignon), CHU Amiens-Picardie, Université de Bretagne Sud - Lorient (UBS Lorient), Université de Bretagne Sud (UBS), Centre d'Etudes Lasers Intenses et Applications (CELIA), Université de Bordeaux (UB)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Hôpital Henri Mondor, Laboratoire Sciences Analytiques, Bioanalytiques, et Miniaturisation (LSABM), Chimie-Biologie-Innovation (UMR 8231) (CBI), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier de Dieppe, CH Belfort-Montbéliard, Centre Hospitalier Sud Francilien, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Le Mans (CH Le Mans), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Assistance Publique - Hôpitaux de Marseille (APHM), Centre Hospitalier de Lens, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Géomécanique, Matériaux et Structures (GEOMAS), 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), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre Hospitalier de Versailles André Mignot (CHV), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Ambroise Paré [AP-HP], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Louis Mourier - AP-HP [Colombes], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Programme Hospitalier de Recherche Clinique., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Université de La Rochelle (ULR), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Bordeaux (UB), Laboratoire de Tribologie et Dynamique des Systèmes (LTDS), École Centrale de Lyon (ECL), Université de Lyon-Université de Lyon-École Nationale des Travaux Publics de l'État (ENTPE)-Ecole Nationale d'Ingénieurs de Saint Etienne-Centre National de la Recherche Scientifique (CNRS), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Centre Hospitalier Fleyriat [Bourg en Bresse], Centre Hospitalier Sud Francilien [Corbeil-Essonnes] (CH Sud Francilien), Centre Hospitalier de Béthune Beuvry (CH Béthune Beuvry), Hôpital Nord [CHU - APHM], GH Carnelle Portes de l'Oise, Hôpital Lapeyronie [Montpellier] (CHU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord
Subjects: medicine.medical_specialty, MESH: Acute Kidney Injury, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, urologic and male genital diseases, MESH: Severity of Illnes Index, 03 medical and health sciences, MESH: Aged, 80 and over, 0302 clinical medicine, Oliguria, Intensive care, Internal medicine, Medicine, MESH: Time-to-Treatment, 030212 general & internal medicine, Renal replacement therapy, education, Blood urea nitrogen, MESH: Aged, education.field_of_study, MESH: Humans, MESH: Middle Aged, business.industry, Hazard ratio, Acute kidney injury, General Medicine, medicine.disease, MESH: Male, MESH: Prospective Studies, 3. Good health, [SDV] Life Sciences [q-bio], MESH: France, MESH: Intensive Care Units, medicine.symptom, MESH: Renal Remplacement Therapy, business, MESH: Female, Kidney disease
Abstract: International audience; BACKGROUND: Delaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury and no severe complication is safe and allows optimisation of the use of medical devices. Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy. METHODS: This was an unmasked, multicentre, prospective, open-label, randomised, controlled trial done in 39 intensive care units in France. We monitored critically ill patients with severe acute kidney injury (defined as Kidney Disease: Improving Global Outcomes stage 3) until they had oliguria for more than 72 h or a blood urea nitrogen concentration higher than 112 mg/dL. Patients were then randomly assigned (1:1) to either a strategy (delayed strategy) in which RRT was started just after randomisation or to a more-delayed strategy. With the more-delayed strategy, RRT initiation was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen concentration reached 140 mg/dL. The primary outcome was the number of days alive and free of RRT between randomisation and day 28 and was done in the intention-to-treat population. The study is registered with ClinicalTrial.gov, NCT03396757 and is completed. FINDINGS: Between May 7, 2018, and Oct 11, 2019, of 5336 patients assessed, 278 patients underwent randomisation; 137 were assigned to the delayed strategy and 141 to the more-delayed strategy. The number of complications potentially related to acute kidney injury or to RRT were similar between groups. The median number of RRT-free days was 12 days (IQR 0-25) in the delayed strategy and 10 days (IQR 0-24) in the more-delayed strategy (p=0·93). In a multivariable analysis, the hazard ratio for death at 60 days was 1·65 (95% CI 1·09-2·50, p=0·018) with the more-delayed versus the delayed strategy. The number of complications potentially related to acute kidney injury or renal replacement therapy did not differ between groups. INTERPRETATION: In severe acute kidney injury patients with oliguria for more than 72 h or blood urea nitrogen concentration higher than 112 mg/dL and no severe complication that would mandate immediate RRT, longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm. FUNDING: Programme Hospitalier de Recherche Clinique.
Published: 2021
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238. Pulmonary effects of keratinocyte growth factor in newborn rats exposed to hyperoxia.: KGF effects in hyperoxia-exposed rat pups

Author: Franco-Montoya, Marie-Laure, Bourbon, Jacques, Durrmeyer, Xavier, Lorotte, Stephanie, Jarreau, Pierre-Henri, Delacourt, Christophe, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), PremUp Foundation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5)-CHI Créteil-Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7), Service de réanimation néonatale de Créteil, CHI Créteil, Service de réanimation néonatale Port-Royal, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-CHI Créteil-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Institut de Recherche pour le Développement ( IRD ) -Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ) -CHI Créteil-Université Paris Descartes - Paris 5 ( UPD5 ) -Sorbonne Universités-Institut National de la Santé et de la Recherche Médicale ( INSERM ), and CHU Cochin [AP-HP]
Subjects: MESH: Pulmonary Surfactant-Associated Protein B, MESH: Pulmonary Alveoli, lung protection, MESH : DNA, MESH: Rats, Sprague-Dawley, MESH: Animals, Newborn, MESH: Pregnancy, developing lung, MESH : Receptor, Epidermal Growth Factor, MESH : Cell Proliferation, MESH: CCAAT-Enhancer-Binding Protein-alpha, MESH : CCAAT-Enhancer-Binding Protein-alpha, MESH : Female, MESH: Animals, MESH : Fibroblast Growth Factor 7, MESH : Bronchoalveolar Lavage Fluid, MESH : Gene Expression Regulation, MESH : Rats, MESH : Animals, Newborn, MESH: DNA, respiratory system, MESH: Gene Expression Regulation, MESH: Survival Analysis, MESH : Hyperoxia, MESH: Cell Adhesion Molecules, MESH: Rats, MESH : Lung, MESH : Transforming Growth Factor alpha, MESH: Transforming Growth Factor alpha, MESH: Receptor, Epidermal Growth Factor, MESH : Phospholipids, MESH : Cell Adhesion Molecules, MESH: Hyperoxia, MESH: Cell Proliferation, bronchopulmonary dysplasia, MESH: Lung, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, alveolar epithelial cell, [ SDV.BBM ] Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Phospholipids, MESH: Humans, MESH: Bronchoalveolar Lavage Fluid, MESH: Apoptosis, MESH : Humans, lung inflammation, MESH: Fibroblast Growth Factor 7, MESH : Rats, Sprague-Dawley, respiratory tract diseases, MESH : Pregnancy, MESH : Animals, MESH : Survival Analysis, MESH : Pulmonary Alveoli, MESH : Pulmonary Surfactant-Associated Protein B, MESH: Female, MESH : Apoptosis
Abstract: International audience; Acute lung injury and compromised alveolar development characterize bronchopulmonary dysplasia (BPD) of the premature neonate. High levels of keratinocyte growth factor (KGF), a cell-cell mediator with pleiotrophic lung effects, are associated with low BPD risk. KGF decreases mortality in hyperoxia-exposed newborn rodents, a classic model of injury-induced impaired alveolarization, although the pulmonary mechanisms of this protection are poorly defined. These were explored through in vitro and in vivo approaches in the rat. Hyperoxia decreased by 30% the rate of wound closure of a monolayer of fetal alveolar epithelial cells, due to cell death, which was overcome by recombinant human KGF (100 ng/ml). In rat pups exposed to >95% O2 from birth, increased viability induced by intraperitoneal injection of KGF (2 microg/g body wt) every other day was associated with prevention of neutrophil influx in bronchoalveolar lavage (BAL), prevention of decreases in whole lung DNA content and cell proliferation rate, partial prevention of apoptosis increase, and a markedly increased proportion of surfactant protein B-immunoreactive cells in lung parenchyma. Increased lung antioxidant capacity is likely to be due in part to enhanced CAAT/enhancer binding protein alpha expression. By contrast, KGF neither corrected changes induced by hyperoxia in parameters of lung morphometry that clearly indicated impaired alveolarization nor had any significant effect on tissue or BAL surfactant phospholipids. These findings evidence KGF alveolar epithelial cell protection, enhancing effects on alveolar repair capacity, and anti-inflammatory effects in the injured neonatal lung that may account, at least in part, for its ability to reduce mortality. They argue in favor of a therapeutic potential of KGF in the injured neonatal lung.
Published: 2009
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239. Study of prone positioning to reduce ventilator-associated pneumonia in hypoxemic patients

Author: Mounier, Roman, Adrie, Christophe, Français, Adrien, Garrouste-Orgeas, Maïté, Cheval, Christine, Allaouchiche, Bernard, Jamali, Samir, Dinh-Xuan, Anh-Tuan, Goldgran-Toledano, Dany, Cohen, Yves, Azoulay, Elie, Timsit, Jean-François, Ricard, Jean-Damien, Outcomerea Study Group, On Behalf Of The, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), General ICU, Hôpital Delafontaine, Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Medical-Surgical ICU, Hôpital Saint-Joseph, Medical-surgical ICU, Centre Hospitalier d’Hyères, Surgical ICU, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hôpital de Dourdan, Hôpital Gonesse, Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Epidémiologie pronostique des cancers et affections graves, Ecologie et Evolution des Microorganismes (EEM), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Gonesse, Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Epidémiologie pronostique des cancers et affections graves, Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Vesin, Aurélien
Subjects: Pulmonary and Respiratory Medicine, Artificial ventilation, Male, medicine.medical_specialty, Databases, Factual, medicine.medical_treatment, Kaplan-Meier Estimate, Lung injury, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Intensive care, Prone Position, Medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Simplified Acute Physiology Score, Intensive care medicine, Hypoxia, Aged, Proportional Hazards Models, Mechanical ventilation, Respiratory distress, business.industry, Incidence, Respiratory disease, Ventilator-associated pneumonia, Pneumonia, Middle Aged, medicine.disease, Respiration, Artificial, 3. Good health, Intensive Care Units, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Anesthesia, Case-Control Studies, Acute Disease, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Respiratory Insufficiency
Abstract: The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2,409 prospectively included patients were admitted over 9 yrs (2000-2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios300 during the first 48 h. Controls were matched to PP patients on the PP propensity score (+/-10%), MV duration longer than that in PP patients before the first turn prone, and centre. VAP incidence was similar in the PP and control groups (24 versus 13 episodes.1,000 patient-days MV(-1) respectively, p = 0.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64 (95% CI 0.70-3.84); p = 0.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p = 0.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score50). In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP1 day might decrease mortality, particularly in the sickest patients.
Published: 2009
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240. Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study

Author: Ousmane Traore, Bruno Aublet, Marcel Benedit, Michèle Bonnard, Georges Amat, Claire Aumeran, Alexandre Lautrette, Richard Bonnet, Bertrand Souweine, Jean-Michel Constantin, Dominique Guelon, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Service de Reanimation Hôpital de Moulins Yzeure, Moulins, France, Service de Réanimation Adulte, Hôtel Dieu, Clermont-Ferrand, France, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Institut National de la Recherche Agronomique (INRA)-Université d'Auvergne - Clermont-Ferrand I (UdA), CHU Clermont-Ferrand-Hôpital Gabriel Montpied, Service de Réanimation Médicochirurgicale, CHU de Clermont- Ferrand, Clermont-Ferrand, France, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte - Clermont Auvergne (M2iSH), and Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne)
Subjects: Adult, Male, Methicillin-Resistant Staphylococcus aureus, Hand washing, medicine.medical_specialty, media_common.quotation_subject, education, Critical Care and Intensive Care Medicine, 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Hygiene, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Surveys and Questionnaires, Intensive care, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, Intensive care medicine, Hand disinfection, ComputingMilieux_MISCELLANEOUS, Aged, Skin, media_common, Cross Infection, Ethanol, integumentary system, Guideline adherence, business.industry, 010102 general mathematics, Drug Tolerance, Middle Aged, 3. Good health, Intensive Care Units, Emergency medicine, Anti-Infective Agents, Local, Female, Disease prevention, Guideline Adherence, business, Hand Disinfection
Abstract: We compared handwashing (HW) and alcohol-based handrub (ABH) for skin tolerance, acceptability, and hand hygiene compliance in health-care workers (HCWs) in a multicentric study.Before/after study over two periods (P1 and P2) in seven ICUs. Monitoring of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in two ICUs (U4 and U6).All HCWs of the seven ICUs, and the patients of U4 and U6 without MRSA carriage on admission.Handwashing was available in P1 and P2. ABH was introduced after P1 and available throughout P2. HCWs completed questionnaires on skin tolerance in P1 and P2, and on acceptability in P2. Compliance with hand hygiene was assessed in P1 and P2 using a standardized method. ICU-acquired MRSA colonization/infection in U4 and U6 was recorded.Hand erythema was reported during P1 and P2 by 21.7 and 11% of HCWs, respectively (P = 0.01), itching by 15.8 and 7.1% (P = 0.02), oozing by 0.8 and 1.1% (P = 0.82), and bleeding by 4.2 and 1.1% (P = 0.1). ABH was considered easier and quicker than HW (P0.01), but overall acceptability did not differ between the two. Compliance increased from 51% (334/647) in P1 to 60% (251/418) in P2, P0.01. No significant reduction in MRSA colonization/infection between P1 and P2 (P = 0.30) was observed, but the study was underpowered.Self-report questionnaires show that when ABH is available in ICUs, fewer unpleasant skin sensations are reported. ABH is considered to be easier and quicker to use than HW and compliance is improved after glove removal.
Published: 2009

241. Acces grave à Plasmodium malariae chez un militaire de retour de Côte d'Ivoire

Author: Bellanger, Anne-Pauline, Bruneel, Fabrice, Bardot, Olivier, Mira, Jean Paul, Houzé, Sandrine, Millon, Laurence, Faucher, Jean-François, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), réanimation chirurgicale, CH Versailles, Ministère de la santé, urgences médicales, CHU J Minjoz Besançon, Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], laboratoire parasitologie, CHU Bichat Paris, services de maladies infectieuses, CHU J Minjoz, Besançon, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: [SDE.ES]Environmental Sciences/Environmental and Society, ComputingMilieux_MISCELLANEOUS, [ SDE.ES ] Environmental Sciences/Environmental and Society
Abstract: National audience
Published: 2009

242. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006)

Author: Leroy , Olivier, Gangneux , Jean-Pierre, Montravers , Philippe, Mira , Jean-Paul, Gouin , François, Sollet , Jean-Pierre, Carlet , Jean, Reynes , Jacques, Rosenheim , Michel, Regnier , Bernard, Lortholary , Olivier, Renseigné , Non, Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, Régulations des équilibres fonctionnels du foie normal et pathologique, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département anesthésie-réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), service de réanimation polyvalente, Centre Hospitalier Victor Dupuy, Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Groupe Hospitalier Paris Saint-Joseph (hpsj), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1)
Subjects: Male, critically ill, MESH : Aged, MESH : Prospective Studies, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Case fatality rate, Hospital Mortality, Prospective Studies, MESH: Incidence, Fungemia, MESH: Treatment Outcome, Cause of death, Aged, 80 and over, Cross Infection, 0303 health sciences, MESH: Middle Aged, Incidence, Candidiasis, MESH: Follow-Up Studies, MESH : Incidence, 3. Good health, Survival Rate, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Young Adult, MESH: Critical Illness, MESH : Intensive Care Units, MESH : Cross Infection, medicine.medical_specialty, MESH: Probability, Critical Illness, MESH : Young Adult, MESH : Cohort Studies, Statistics, Nonparametric, MESH : Hospital Mortality, 03 medical and health sciences, MESH: Critical Care, MESH: Fungemia, Intensive care, MESH : Adolescent, Humans, MESH : Middle Aged, MESH: Hospital Mortality, MESH : Aged, 80 and over, Mycosis, Aged, MESH: Adolescent, MESH: Humans, 030306 microbiology, MESH : Humans, MESH: Adult, MESH : Follow-Up Studies, MESH: Antifungal Agents, medicine.disease, chemistry, MESH: Female, Fluconazole, Antifungal Agents, MESH : Critical Illness, Cohort Studies, MESH: Cause of Death, chemistry.chemical_compound, MESH : Candidiasis, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Cause of Death, MESH : Female, 030212 general & internal medicine, MESH: Cohort Studies, MESH : Critical Care, Candida, intensive care, MESH: Aged, MESH: Statistics, Nonparametric, fungemia, Middle Aged, MESH : Adult, MESH : Survival Rate, MESH : Risk Factors, MESH: Candidiasis, Intensive Care Units, Treatment Outcome, Female, epidemiology, France, medicine.drug, Adult, Adolescent, Critical Care, MESH: Survival Rate, MESH : Male, MESH : Probability, MESH : Antifungal Agents, MESH : Treatment Outcome, Young Adult, Internal medicine, medicine, MESH : France, MESH : Statistics, Nonparametric, Probability, MESH : Cause of Death, Voriconazole, business.industry, MESH: Cross Infection, MESH: Male, MESH: Prospective Studies, Surgery, MESH: France, MESH : Fungemia, MESH: Intensive Care Units, Caspofungin, business, Follow-Up Studies
Abstract: International audience; OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.
Published: 2009
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243. A bench study of intensive-care-unit ventilators: new versus old and turbine-based versus compressed gas-based ventilators

Author: Jean-Christophe M. Richard, Arnaud W. Thille, Fabrice Galia, Laurent Brochard, Aissam Lyazidi, INSERM U955, équipe 13, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe de Recherche sur le Handicap Ventilatoire (GRHV), CHU Rouen, Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-CHU Rouen, Guellaen, Georges, Hôpital Charles Nicolle [Rouen], Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), and Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Bench study, medicine.medical_specialty, Pressure-support ventilation, medicine.medical_treatment, Pressure support ventilation, Critical Care and Intensive Care Medicine, Turbine, Models, Biological, Article, law.invention, Hospitals, University, 03 medical and health sciences, Work of breathing, 0302 clinical medicine, Mechanical ventilation, Cabin pressurization, law, Intensive care, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Medicine, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Intensive care medicine, Work of Breathing, business.industry, 030208 emergency & critical care medicine, Equipment Design, Intensive care unit, Respiration, Artificial, Intensive Care Units, 030228 respiratory system, Anesthesia, business, Airway, Inspiratory trigger
Abstract: International audience; OBJECTIVE: To compare 13 commercially available, new-generation, intensive-care-unit (ICU) ventilators in terms of trigger function, pressurization capacity during pressure-support ventilation (PSV), accuracy of pressure measurements, and expiratory resistance. DESIGN AND SETTING: Bench study at a research laboratory in a university hospital. METHODS: Four turbine-based ventilators and nine conventional servo-valve compressed-gas ventilators were tested using a two-compartment lung model. Three levels of effort were simulated. Each ventilator was evaluated at four PSV levels (5, 10, 15, and 20 cm H2O), with and without positive end-expiratory pressure (5 cm H2O). Trigger function was assessed as the time from effort onset to detectable pressurization. Pressurization capacity was evaluated using the airway pressure-time product computed as the net area under the pressure-time curve over the first 0.3 s after inspiratory effort onset. Expiratory resistance was evaluated by measuring trapped volume in controlled ventilation. RESULTS: Significant differences were found across the ventilators, with a range of triggering delays from 42 to 88 ms for all conditions averaged (P < 0.001). Under difficult conditions, the triggering delay was longer than 100 ms and the pressurization was poor for five ventilators at PSV5 and three at PSV10, suggesting an inability to unload patient's effort. On average, turbine-based ventilators performed better than conventional ventilators, which showed no improvement compared to a bench comparison in 2000. CONCLUSION: Technical performance of trigger function, pressurization capacity, and expiratory resistance differs considerably across new-generation ICU ventilators. ICU ventilators seem to have reached a technical ceiling in recent years, and some ventilators still perform inadequately.
Published: 2009
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244. [Formal recommendations by the experts. Glycemic control in intensive care unit and during anaesthesia. Société française d'anesthésie et de réanimation. Société de réanimation de langue française]

Author: Ichai, Carole, Léone, Marc, Veber, Benoît, Cariou, Alain, Barnoud, Didier, Annane, Djillali, Bouglé, A., Chioléro, René, Damoisel, Charles, Devos, P., Gunst, J., Halimi, Serge, Jacqueminet, S., Kalfon, Pierre, Lacherade, Jean-Claude, Laudenbach, Vincent, Leverve, Xavier, Losser, Marie-Reine, Ouattara, Alexandre, Payen de La Garanderie, Didier, Preiser, Jean-Charles, Seematter, Gérald, Tappy, Luc, van den Berghe, G., Vanhorebeek, I., Wion-Barbot, Nelly, Service de réanimation médicochirurgicale, Centre Hospitalier Universitaire de Nice (CHU Nice), Société française d'anesthésie et de réanimation (SFAR), SFAR, General ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Société de réanimation de langue française (SRLF), SRLF, Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service de Réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], Service de médecine intensive adulte, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Diabétologie, Université Joseph Fourier - Grenoble 1 (UJF), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of General Intensive Care, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Institute of Physiology, Université de Lausanne (UNIL), Neurosciences précliniques, Université de Lausanne = University of Lausanne (UNIL), and Hamant, Sarah
Subjects: Adult, Blood Glucose, MESH: Inflammation, MESH: Diabetes Mellitus, MESH: Hypoglycemia, Critical Care, MESH: Monitoring, Physiologic, MESH: Insulin, Perioperative Care, MESH: Anesthesiology, Postoperative Complications, Anesthesiology, Stress, Physiological, MESH: Postoperative Complications, MESH: Child, MESH: Hypoglycemic Agents, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Diabetes Mellitus, Humans, Hypoglycemic Agents, Insulin, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, MESH: Intensive Care, MESH: Perioperative Care, Child, Intraoperative Complications, MESH: Stress, Physiological, ComputingMilieux_MISCELLANEOUS, Monitoring, Physiologic, Inflammation, MESH: Cytokines, MESH: Humans, Contraindications, MESH: Adult, Hypoglycemia, MESH: Glucose, MESH: Insulin Resistance, Glucose, Hyperglycemia, MESH: Blood Glucose, MESH: Intraoperative Complications, Cytokines, Insulin Resistance, MESH: Hyperglycemia
Abstract: International audience
Published: 2009
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245. Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

Author: Eve Tognet, Philippe Vanhems, Nicolas Voirin, Adrien Français, Caroline Landelle, Jean-François Timsit, Alain Lepape, Hélène Thizy, Guillaume Monneret, ThEMAS, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Unité de qualitique et d'évaluation médicale - pole Santé Publique, CHU Grenoble-CHU Grenoble, Service de Réanimation (Nord), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale - Centre Hospitalier Lyon Sud, Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), CIC CHU Lyon (inserm), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Clinique de pneumologie, CHU Grenoble, Laboratoire d'Immunologie, Hôpital Edouard Herriot [CHU - HCL], Service d'Hygiène, Epidémiologie et Prévention [Hôpital Edouard Herriot - HCL], VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Unité de qualitique et d'évaluation médicale - pole Santé Publique, Service de réanimation chirurgicale, Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinique de réanimation médicale, and Vesin, Aurélien
Subjects: Male, Microbiology (medical), medicine.medical_specialty, Epidemiology, [SDV]Life Sciences [q-bio], Population, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, law, Intensive care, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Intensive care medicine, education, ComputingMilieux_MISCELLANEOUS, Aged, Cross Infection, education.field_of_study, Septic shock, business.industry, Incidence, Incidence (epidemiology), Hazard ratio, 030208 emergency & critical care medicine, Length of Stay, Middle Aged, medicine.disease, Shock, Septic, Intensive care unit, Confidence interval, 3. Good health, Intensive Care Units, Infectious Diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business
Abstract: Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.
Published: 2008
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246. A web-based Delphi study on the indications of chest radiographs for patients in ICUs

Author: Ludivine Chalumeau-Lemoine, Bertrand Guidet, Gilles Hejblum, Alain-Jacques Valleron, Christos Chouaid, Vincent Ioos, Jean-François Vibert, Pierre-Yves Boëlle, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle de Pharmacie - Santé Publique - Information médicale [Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Réanimation Polyvalente, Hôpital Delafontaine, Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), G Hejblum, V Ioos, JF Vibert, PY Boëlle, L-Lemoine Chalumeau, C Chouaid, Valleron AJ, and B Guidet
Subjects: Pulmonary and Respiratory Medicine, Paris, medicine.medical_specialty, Delphi Technique, Critical Illness, Radiography, MEDLINE, Delphi method, Intensivist, Critical Care and Intensive Care Medicine, MESH: Delphi Technique, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Web application, 030212 general & internal medicine, MESH: Respiration, Artificial, Intensive care medicine, Retrospective Studies, computer.programming_language, Internet, MESH: Humans, medicine.diagnostic_test, business.industry, MESH: Paris, Retrospective cohort study, MESH: Retrospective Studies, MESH: Radiography, Thoracic, medicine.disease, Respiration, Artificial, 3. Good health, Intensive Care Units, MESH: Internet, 030228 respiratory system, MESH: Critical Illness, Radiography, Thoracic, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Medical emergency, Cardiology and Cardiovascular Medicine, Chest radiograph, business, computer, Delphi
Abstract: International audience; BACKGROUND: Strategies for ordering bedside chest radiographs (CXRs) have substantial logistic and financial consequences in the ICU. Many of the indications for CXRs in the ICU are controversial, such as the ordering of daily routine CXRs for intubated patients. The opinions of intensivists about ordering CXRs have not been reported. Comparing these opinions to established guidelines and identifying situations where opinions diverge in the absence of guidelines are of considerable interest. METHODS: We asked 190 intensivists from 34 ICUs in the area of Paris, France, to anonymously complete a 29-item questionnaire about their opinions regarding the ordering of CXRs; each item described a clinical scenario. Of the 29 scenarios, 10 dealt with the placement of medical devices, 8 with the presence of medical devices, and 11 with other clinical situations. The study was based on a Delphi process deployed over the Internet through an original software application. Three Delphi rounds were run between January and March 2006, using the same questionnaire. Detailed feedback for the answers given during the previous round was supplied to each intensivist solicited for updating his answers. RESULTS: Eighty-two intensivists from 32 ICUs completed the study. A consensus emerged that routine CXRs were necessary for eight scenarios and unnecessary for two scenarios. The study also shed light on items without a consensus. In particular, 75% of intensivists (58% on the first round) did not support obtaining daily routine CXRs in intubated patients. CONCLUSION: The study underlines situations in which intensivists do not support the guidelines and outlines recommendations likely to be followed in clinical practice.
Published: 2008
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247. Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study

Author: Quenot, Jean-Pierre, Mentec, Hervé, Feihl, François, Annane, Djillali, Melot, Christian, Vignon, Philippe, Brun-Buisson, Christian, TECLA Study Group, ., Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Victor Dupouy, Service de Réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], Department of Intensive Care, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Université de Limoges (UNILIM), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), and Université d'Angers (UA)
Subjects: Male, [SDV]Life Sciences [q-bio], Psychological intervention, Stress ulcer prophylaxis, Critical Care and Intensive Care Medicine, Intensive / Critical Care Medicine, Pediatrics, Practice guidelines, law.invention, 0302 clinical medicine, law, Anesthesiology, Medicine, 030212 general & internal medicine, Aged, 80 and over, Pressure Ulcer, Middle Aged, Intensive care unit, 3. Good health, Europe, Clinical Practice, Intensive Care Units, Practice Guidelines as Topic, Emergency Medicine, Female, Guideline Adherence, Algorithms, Adult, Canada, medicine.medical_specialty, Adolescent, Respiratory distress syndrome, Pain medicine, Pneumology/Respiratory System, Pain Medicine, Young Adult, 03 medical and health sciences, Intensive care, Tidal Volume, Humans, Blood Transfusion, Intensive care medicine, Aged, business.industry, Transfusion, 030208 emergency & critical care medicine, Cross-Sectional Studies, business
Abstract: International audience; Objective To assess adherence to clinical practice guidelines for three interventions routinely used in critical care medicine. Design and setting Multicenter, 1-day cross-sectional observational study in 44 intensive care units in four countries. Patients A total of 419 patients hospitalized in participating ICUs on the day of the survey. Measurements and results Red blood cell transfusion (n = 29) was performed appropriately in 22 patients (76%), while among the 390 patients who received no transfusion 4 (1%) had a valid indication. Setting of tidal volume in acute respiratory distress syndrome, assessed in 45 patients, was deemed appropriate in 37 cases (82%). Prescription of stress ulcer prophylaxis (n = 128) was appropriate in only 24 patients (19%), while among the 268 patients who were not treated 28 (10%) had an indication. Conclusions The implementation of recommendations varies across different domains of care. While the adherence to current recommendations in routine practice is acceptable as regards tidal volume settings in acute respiratory distress syndrome, it is suboptimal for blood transfusion and prevention of upper gastrointestinal bleeding. Practice surveys are useful to inform strategies currently developed to assess practices of health-care professionals and develop strategies for more effective dissemination of medical knowledge.
Published: 2008
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248. Epidemiology, management and risk factors for death of invasive Candida infections in critical care units: a multicenter, prospective, observational study in France (2005-2006)

Author: Lortholary, Olivier, Gangneux, Jean-Pierre, Montravers, Philippe, Mira, Jean-Paul, Gouin, François, Sollet, Jean-Pierre, Carlet, Jean, Reynes, J., Regnier, B., Rosenheim, Michel, Leroy, Olivier, Centre d'infectiologie Necker-Pasteur [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, Service de Parasitologie-Mycologie [Rennes], Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Département d'Anesthésie Réanimation, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université Paris Diderot - Paris 7 ( UPD7 ), Service de Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Service d'Orthopédie-Traumatologie, Pôle Ostéo-articulaire, service de réanimation polyvalente, Centre Hospitalier Victor Dupuy, Service de réanimation polyvalente, Groupe Hospitalier Paris Saint-Joseph, Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, 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), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes (UR), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Centre hospitalier universitaire de Nantes (CHU Nantes), Groupe Hospitalier Paris Saint-Joseph (hpsj), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology
Published: 2008

249. Overcoming a stigma: the lung cancer patient in the intensive care unit

Author: N. Schönfeld, Jean-François Timsit, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Service de réanimation cardio-vasculaire et thoracique, Hôpital Michallon-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Hôpital Michallon, Vesin, Aurélien, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de réanimation cardio-vasculaire et thoracique, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon
Subjects: Pulmonary and Respiratory Medicine, MESH: Ethics, Medical, medicine.medical_specialty, Lung Neoplasms, Time Factors, Referral, MESH: Attitude to Health, Pulmonary disease, Disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Bias, law, Intensive care, medicine, Humans, Ethics, Medical, MESH: Lung, Lung cancer, Intensive care medicine, Lung, ComputingMilieux_MISCELLANEOUS, MESH: Humans, Critically ill, business.industry, MESH: Patient Admission, MESH: Time Factors, MESH: Bias (Epidemiology), medicine.disease, Intensive care unit, 3. Good health, MESH: Lung Neoplasms, Intensive Care Units, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, Interdisciplinary Communication, MESH: Intensive Care Units, MESH: Interdisciplinary Communication, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Complication, business, Attitude to Health
Abstract: Before embarking on a discussion of the lung cancer patient in intensive care, it is important to clarify that this editorial will not be referring to the group of patients with a good prognosis having undergone surgery with a curative intent, but to patients whose malignancies more or less determine the outcome in terms of survival time, and who are suffering from acute or subacute deterioration in the form of a complication resulting either from the underlying disease or tumour or from treatment-related sequelae. In such cases, most doctors' knowledge and experience will be confounded with those dark emotions that serve to sustain a misconception that is still associated with lung cancer patients, despite certain advances in treatment achieved through multimodal regimes and “new drugs”. As the technical possibilities of intensive medicine, including in particular the improvement of ventilation techniques with varying degrees of invasiveness, increase, it seems desirable to take a fresh look at the survival and prognostic factors in lung cancer patients admitted to a medical intensive care unit (ICU). Adam and Soubani 1 have taken up this challenge. Their results are reported in the present issue of the European Respiratory Journal . At first sight, the range of reasons leading to referral for intensive care appears quite familiar and unspectacular: first, pneumonia, followed by exacerbated chronic obstructive pulmonary disease, pulmonary oedema and haemoptysis. As with most studies of this kind 2, 3, the analysis is retrospective. However, that does not, by any means, detract from its evidential value, since the criteria on which referrals of critically ill patients with nonmalignant disease to intensive care have been based to date fail to do justice to lung cancer patients with their complex requirements 4, 5. As in other recent studies published in the field 2 …
Published: 2008
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250. Outbreak of NDM-1-producing Klebsiella pneumoniae in the intensive care unit during the COVID-19 pandemic: Another nightmare

Author: R. Amarsy, Manel Merimèche, Hervé Jacquier, Bruno Mégarbane, Béatrice Berçot, Anne-Lise Munier, Mégarbane, Bruno, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal, Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP]
Subjects: Epidemiology, Klebsiella pneumoniae, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Disease Outbreaks, law.invention, Enterobacterales, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, law, Pandemic, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, biology, Transmission (medicine), Brief Report, Health Policy, Intensive care unit, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Anti-Bacterial Agents, Nightmare, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Intensive Care Units, Infectious Diseases, [SDV.TOX]Life Sciences [q-bio]/Toxicology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine.symptom, Hospital infection control, medicine.medical_specialty, Microbial Sensitivity Tests, beta-Lactamases, Carbapenemase, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Bacterial Proteins, medicine, Transmission, Humans, Pandemics, SARS-CoV-2, business.industry, Public Health, Environmental and Occupational Health, COVID-19, Outbreak, biology.organism_classification, Dreams, Klebsiella Infections, Resistome, ICU, Emergency medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Multilocus sequence typing, business, Multilocus Sequence Typing
Abstract: International audience; An outbreak of Klebsiella pneumoniae producing the carbapenemase NDM-1 occurred in our ICU during the last COVID-19 wave. Twelve patients were tested positive, seven remained asymptomatic whereas 5 developed an infection. Resistome and in silico multilocus sequence typing confirmed the clonal origin of the strains. The identification of a possible environmental reservoir suggested that difficulties in observing optimal bio-cleaning procedures due to workload and exhaustion contributed to the outbreak besides the inappropriate excessive glove use.
Published: 2021
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