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201. Referred shoulder pain (C4 dermatome) can adversely impact diaphragm pacing with intramuscular electrodes

Author: Jésus Gonzalez-Bermejo, Thomas Similowski, Françoise Le Pimpec-Barthes, Capucine Morélot-Panzini, and Fabrice Menegaux
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Diaphragm, Cohort Studies, Clinical study, Young Adult, Shoulder Pain, medicine, Humans, Aged, Phrenic nerve, Referred pain, business.industry, Hypoventilation, Middle Aged, Respiration, Artificial, Electrodes, Implanted, Diaphragm (structural system), Surgery, Phrenic Nerve, Diaphragm pacing, medicine.anatomical_structure, Dermatome, Anesthesia, Female, Pain, Referred, Central hypoventilation, business
Abstract: Diaphragm pacing with intramuscular electrodes causes pain in central hypoventilation patients without spinal lesions http://ow.ly/IItjY
Published: 2015

202. Multidimensional approach to dyspnea

Author: Pierantonio Laveneziana, Thomas Similowski, and Capucine Morélot-Panzini
Subjects: Pulmonary and Respiratory Medicine, Dyspnea, business.industry, Health Status, Emotions, Quality of Life, Affective distress, Humans, Medicine, business, respiratory tract diseases, Domain (software engineering), Cognitive psychology
Abstract: This review focuses on sensory-perceptual and affective/emotional domains of dyspnea.Recent studies have underscored the multidimensional aspect of dyspnea, which comprises three major dimensions: the sensory-perceptual domain, the affective distress, and the symptom impact or burden. Sensory-perceptual dimension includes ratings of dyspnea intensity and its quality, that is, 'how breathing feels like.' Affective distress addresses the question of 'how distressing breathing is' and focuses on the perception of immediate unpleasantness or the cognitive evaluative response about the potential consequence of what is perceived. Symptom impact evaluates how dyspnea impacts on functional ability/disability, health status, and/or quality of life.Dyspnea is a debilitating symptom and the major reason for seeking medical attention in patients with cardiorespiratory diseases. Dyspnea predicts morbidity, quality of life, and mortality in several different conditions. Notwithstanding sometimes patients neglect to report dyspnea to their clinician because they feel it is not sufficiently relevant to be documented. The relationship between what the patients feel, how they express themselves about the disease, and how caregivers interpret their complaints is complex and not easy to decipher. It is important to correctly recognize dyspnea, and optimize and individualize its clinical management.
Published: 2015

203. Electroencephalographic evidence for a respiratory-related cortical activity specific of the preparation of prephonatory breaths

Author: Lysandre Tremoureux, Thomas Similowski, Mathieu Raux, Pierre Pouget, Anja Ranohavimparany, and Capucine Morélot-Panzini
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Physiology, Rest, Motor Activity, Electroencephalography, Audiology, Loudness, Young Adult, medicine, Humans, Speech, Respiratory system, Prosody, medicine.diagnostic_test, Supplementary motor area, Respiration, General Neuroscience, digestive, oral, and skin physiology, Brain, Exhalation, medicine.anatomical_structure, Reading, Spirometry, Control of respiration, Breathing, Female, Psychology
Abstract: Speech is a major disturbance to automatic breathing control. Speech occurs during exhalation, involving controlled inhibition of automatic inspiration. Additionally, utterances are preceded by prephonatory inspirations that must be prepared to account for prosody and loudness. We hypothesized that the speech-related breathing control activities shaping prephonatory breaths originate in cortical pre-motor areas and should be associated with corresponding EEG evidence. We studied 10 normal subjects (4 men, age 23-27) during spontaneous breathing, sniff manoeuvres, and while reading out loud. Fronto-median inspiratory potentials (Cz EEG derivation) were consistently present before voluntary inspirations and large prephonatory breaths, while these potentials were generally absent during resting breathing or small prephonatory breaths. We conclude that the preparation of prephonatory breaths during speech has a cortical substrate, involving the cortical sources of premotor potentials. These results have important implications to validate whether co-modulation of the pre-motor cortex and breathing during speech are incidental or whether these cortical modulations are necessary for initiation of "speech breathing".
Published: 2014

204. Dyspnoea modifies the recognition of fearful expressions by healthy humans

Author: Thomas Similowski, Capucine Morélot-Panzini, and Fabien Vinckier
Subjects: 0301 basic medicine, Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Audiology, Facial recognition system, Hypercapnia, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Risk Factors, Healthy volunteers, Respiration, medicine, Humans, Respiratory system, Young adult, Facial expression, business.industry, Fear, Carbon Dioxide, Healthy Volunteers, Facial Expression, 030104 developmental biology, Dyspnea, Stroop Test, Female, medicine.symptom, business, Facial Recognition, 030217 neurology & neurosurgery, Stroop effect
Abstract: Do respiratory diseases alter emotional interactions? Becoming dyspnoeic distorts our identification of others9 fearhttp://ow.ly/JkxF30hJGFH
Published: 2017

205. Prevalence and Prognosis Impact of Patient-Ventilator Asynchrony in Early Phase of Weaning according to Two Detection Methods

Author: Marc Clavel, Nicolas Terzi, Achille Kouatchet, Camille Rolland-Debord, Sébastien Perbet, Tymothée Poitou, Alexandre Demoule, Thomas Similowski, Lisa Belin, and Côme Bureau
Subjects: Male, medicine.medical_specialty, Pressure support ventilation, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Interquartile range, law, Risk Factors, Internal medicine, medicine, Neurally adjusted ventilatory assist, Prevalence, Weaning, Humans, Interactive Ventilatory Support, Aged, business.industry, 030208 emergency & critical care medicine, Middle Aged, Prognosis, Respiration, Artificial, Asynchrony (computer programming), Diaphragm (structural system), Anesthesiology and Pain Medicine, 030228 respiratory system, Cardiology, Female, France, business, Early phase, Ventilator Weaning
Abstract: Background Patient–ventilator asynchrony is associated with a poorer outcome. The prevalence and severity of asynchrony during the early phase of weaning has never been specifically described. The authors’ first aim was to evaluate the prognosis impact and the factors associated with asynchrony. Their second aim was to compare the prevalence of asynchrony according to two methods of detection: a visual inspection of signals and a computerized method integrating electromyographic activity of the diaphragm. Methods This was an ancillary study of a multicenter, randomized controlled trial comparing neurally adjusted ventilatory assist to pressure support ventilation. Asynchrony was quantified at 12, 24, 36, and 48 h after switching from controlled ventilation to a partial mode of ventilatory assistance according to the two methods. An asynchrony index greater than or equal to 10% defined severe asynchrony. Results A total of 103 patients ventilated for a median duration of 5 days (interquartile range, 3 to 9 days) were included. Whatever the method used for quantification, severe patient–ventilator asynchrony was not associated with an alteration of the outcome. No factor was associated with severe asynchrony. The prevalence of asynchrony was significantly lower when the quantification was based on flow and pressure than when it was based on the electromyographic activity of the diaphragm at 0.3 min–1 (interquartile range, 0.2 to 0.8 min–1) and 4.7 min–1 (interquartile range, 3.2 to 7.7 min–1; P < 0.0001), respectively. Conclusions During the early phase of weaning in patients receiving a partial ventilatory mode, severe patient–ventilator asynchrony was not associated with adverse clinical outcome, although the prevalence of patient–ventilator asynchrony varies according to the definitions and methods used for detection.
Published: 2017

206. Apnoea and postural equilibrium: at which lung volume?

Author: Philippe Rouch, Olivier Jacq, Thomas Similowski, Baptiste Sandoz, Marie-Cécile Niérat, Valérie Attali, and Louis Clavel
Subjects: medicine.medical_specialty, Respiratory rate, business.industry, respiratory system, Trunk, Frequency spectrum, respiratory tract diseases, Functional residual capacity, Internal medicine, Breathing, Cardiology, Medicine, Lung volumes, Respiratory system, business, Balance (ability)
Abstract: Introduction: In healthy subjects, quiet breathing induces specific centre of pressure (CP) oscillations (Caron, O. et al. j neulet 2004; 366:6-9). The aim of this study was to assess if apnoea-induced improved control of balance, is dependent on lung volume. Methods: 26 healthy subjects (10F; 32.9±13y.o.; BMI: 23,7±2,6 kg.m-2) were studied in seating position, during natural breath (NB) and apnoeas at functional residual capacity (FRC), total lung capacity (TLC) and residual volume (RV). CP displacement was recorded with force plate [AMTI] synchronized to optoelectronic system [Vicon] measuring ventilation (41 markers on the trunk). CP Antero-Posterior (AP) range frequency analysis was computed with Fourier transform sampled at 0.02Hz. The apnoeas were compared to NB with a non-parametrical test (Wilcoxon) at the RF±0.1Hz (11 comparison points). Results: Mean breathing frequency (BF) was 15.2±4.2/min. FRC apnoea significantly reduced CP AP range compared to NB; while FRC and TLC apnoeas increased it (Figure 1). Figure 1: CP AP range frequency spectrum centred on BF (*p Conclusion: Apnoea postural stabilization strategy depends on lung volume. It is optimal at FRC with significant decrease of AP range compared to NB; while perturbations appear at higher or lower volumes. Postural disabilities in some chronic respiratory diseases may be partly related to abnormal lung volume relaxation.
Published: 2017

207. Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic

Author: Dan Adler, François-Xavier Blanc, Marc Beaumont, Jean-Paul Janssens, Alain Didier, Laurence Dangers, Sandra Van den Broecke, Cécile Chenivesse, Marjolaine Georges, Pierantonio Laveneziana, Claudine Peiffer, Christian Straus, Grégory Ninot, Philippe Devillier, Alexandre Demoule, Jean-François Muir, Etienne Allard, Capucine Morélot-Panzini, Thomas Similowski, Louis Laviolette, Nathalie Bautin, Bruno Housset, Thierry Perez, Bernard Aguilaniu, Camille Taillé, Nicolas Roche, Matthieu Schmidt, Christophe Delclaux, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpitaux Universitaires de Genève (HUG), Université Grenoble Alpes (UGA), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), CHU Lille, CH Morlaix, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Institut du Thorax [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], Hôpital Robert Debré, Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Laboratoire de recherche sur les mécanismes moléculaires et pharmacologiques de l’obstruction bronchique (LOBIP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Foch [Suresnes], Service Pneumologie-Allergologie [CHU Toulouse], Pôle Clinique des Voies respiratoires [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHI Créteil, 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 Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval [Québec] (ULaval), Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Paul-Valéry - Montpellier 3 (UPVM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (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)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Université libre de Bruxelles (ULB), Biologie, Physiologie et Pathologies respiratoires (EA 2511), Université Paris Descartes - Paris 5 (UPD5), Hôpital Cochin [AP-HP], and MORELOT-PANZINI, Capucine
Subjects: Pulmonary and Respiratory Medicine, Chronic Obstructive, Pediatrics, medicine.medical_specialty, [SDV]Life Sciences [q-bio], education, MEDLINE, Alternative medicine, Pulmonary disease, Pulmonary Disease, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, medicine, Humans, Relevance (information retrieval), 030212 general & internal medicine, Intensive care medicine, health care economics and organizations, ddc:616, business.industry, respiratory system, Pathophysiology, respiratory tract diseases, [SDV] Life Sciences [q-bio], Institutional repository, Chronic disease, Dyspnea, 030228 respiratory system, Chronic Disease, business
Abstract: Breathlessness” or “dyspnoea”. The discussion regarding this has already been described in detail in the Perspective piece [1]. The consensus relates to the internationally recognised name of the syndrome in English. The consensus was that the term should be that used by the lay public rather than healthcare professionals. Professionals will understand both, whereas the lay public may not understand “dyspnoea”, as one of the aims of a syndrome is to empower patients and their families to bring this concern to clinical notice. At least in English, “breathlessness” and “dyspnoea” are not interchangeable. For there to be a cultural and linguistic translation to languages other than English, it should be a term used by their lay public. “Optimal treatment”. After much discussion during the consensus process and workshop, the term “optimal” used in the Perspective referred to the available, tolerated and patient-accepted evidence-based intervention(s) targeting the primary pathophysiological processes of the underlying disease [1]. This is not sufficiently clear in the Perspective piece, although touched on in table S1 [1]. There is no intention that patients should be deprived of interventions targeted at the symptomatic management of their breathlessness because they do not tolerate, refuse or cannot access state of the art treatment for their medical condition. On the contrary, one of the aims of defining such a clinical syndrome is to draw attention to the available breathlessness-targeted treatments. These should be used systematically alongside disease-directed treatments both whilst disease treatments are being optimised and thereafter. This also mandates the review of how breathlessness is being managed regularly in order to gain the best possible outcomes for patients and their families. For people with chronic breathlessness syndrome, attention to the need for and use of breathlessness-targeted treatment will still be reviewed regularly with each clinical encounter.
Published: 2017

208. Early evolution of the diaphragm in caseids: The diaphragm as an adaptation to mixed aquatic-terrestrial lifestyle

Author: Thomas Similowski
Subjects: 0301 basic medicine, Pulmonary and Respiratory Medicine, Physiology, business.industry, General Neuroscience, Acclimatization, Diaphragm, Diaphragm (mechanical device), Anatomy, Adaptation, Physiological, Biological Evolution, 03 medical and health sciences, 030104 developmental biology, Medicine, Adaptation, business, Life Style
Published: 2017

209. Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation from Mechanical Ventilation in Medical Intensive Care Unit Patients

Author: Thomas Similowski, Danielle Reuter, Martin Dres, Julie Delemazure, Alexandre Demoule, Julien Mayaux, Laurent Brochard, Bruno-Pierre Dubé, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), St. Michael's Hospital, University of Toronto, dres, martin, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital L'Hotel-Dieu de Québec, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), HAL-UPMC, Gestionnaire, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Weakness, diaphragm dysfunction, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Diaphragm, Critical Care and Intensive Care Medicine, law.invention, Spontaneous breathing trial, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, medicine, weaning from mechanical ventilation, Humans, Muscle, Skeletal, Ultrasonography, Mechanical ventilation, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Muscle Weakness, business.industry, Muscle weakness, 030208 emergency & critical care medicine, Extremities, Odds ratio, Length of Stay, Middle Aged, Intensive care unit, Respiration, Artificial, Confidence interval, Diaphragm (structural system), Surgery, [SDV] Life Sciences [q-bio], Intensive Care Units, Treatment Outcome, 030228 respiratory system, intensive care unit–acquired weakness, Cardiology, Female, medicine.symptom, business, Ventilator Weaning, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Rationale: Intensive care unit (ICU)- and mechanical ventilation (MV)-acquired limb muscle and diaphragm dysfunction may both be associated with longer length of stay and worse outcome. Whether they are two aspects of the same entity or have a different prevalence and prognostic impact remains unclear.Objectives: To quantify the prevalence and coexistence of these two forms of ICU-acquired weakness and their impact on outcome.Methods: In patients undergoing a first spontaneous breathing trial after at least 24 hours of MV, diaphragm dysfunction was evaluated using twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (a pressure
Published: 2017

210. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications

Author: Julien Mayaux, Thomas Similowski, Bruno-Pierre Dubé, Martin Dres, Suela Demiri, Alexandre Demoule, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, Phrenic nerve stimulation, medicine.medical_treatment, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, Diaphragm function, 0302 clinical medicine, law, Ultrasonography, intensive care, ultrasound, Ultrasound, Middle Aged, Prognosis, musculoskeletal system, Intensive care unit, Uncorrelated, Diaphragm (structural system), Phrenic Nerve, Intensive Care Units, diaphragm, Cardiology, phrenic nerve stimulation, outcome, Female, Muscle Contraction, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, mechanical ventilation, Sensitivity and Specificity, 03 medical and health sciences, Sepsis, Intensive care, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Aged, Mechanical ventilation, business.industry, echography, 030208 emergency & critical care medicine, Length of Stay, Respiration, Artificial, Surgery, Magnetic Fields, ROC Curve, 030228 respiratory system, business
Abstract: International audience; Rationale: In intensive care unit (ICU) patients, diaphragm dysfunction is associated with adverse clinical outcomes. Ultrasound measurements of diaphragm thickness, excursion (EXdi) and thickening fraction (TFdi) are putative estimators of diaphragm function, but have never been compared with phrenic nerve stimulation. Our aim was to describe the relationship between these variables and diaphragm function evaluated using the change in endotracheal pressure after phrenic nerve stimulation (Ptr,stim), and to compare their prognostic value.Methods: Between November 2014 and June 2015, Ptr,stim and ultrasound variables were measured in mechanically ventilated patients
Published: 2017

211. Increased Diaphragmatic Contribution to Inspiratory Effort during Neurally Adjusted Ventilatory Assistance versus Pressure Support

Author: Matthieu Schmidt, Jérôme Cecchini, Thomas Similowski, and Alexandre Demoule
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, Physical medicine and rehabilitation, medicine.diagnostic_test, business.industry, medicine, Neurally adjusted ventilatory assist, Physical therapy, Diaphragmatic breathing, Electromyography, business, Diaphragm (structural system)
Abstract: Background: Neurally adjusted ventilatory assist (NAVA), regulated exclusively by the electromyographic activity (EA) of the diaphragm (EAdi), could affect the distribution of neural drive to the various inspiratory muscles. The objective of this study was to compare EAdi, EA of the scalene (EAscal), and EA of the alae nasi (EAan), according to the ventilatory mode and assist level in 12 mechanically ventilated patients. Methods: Seven assist levels of pressure support ventilation (PSV) and NAVA were sequentially applied. EAdi, EAscal, and EAan were quantified and expressed as a percentage of their maximum values. The relative contributions of extradiaphragmatic muscles to inspiratory efforts were assessed by calculating EAscal/EAdi and EAan/EAdi ratios. Three assist levels for each of the two ventilatory modes that resulted in EAdi values of 80 to 100%, 60 to 80%, and 40 to 60% were assigned to three groups (N1, N2, and N3). Results are expressed as median and interquartile range. Results: EA of inspiratory muscles decreased during PSV and NAVA (P < 0.0001). Although EAdi remained constant within groups (P = 0.9), EAscal was reduced during NAVA compared with PSV in N1 and N3 (65% [62 to 64] and 27% [18 to 34] in NAVA vs. 90% [81 to 100] and 49% [40 to 55] in PSV, P = 0.007). Altogether, EAscal/EAdi and EAan/EAdi ratios were lower in NAVA than PSV (0.7 [0.6 to 0.7] and 0.7 [0.6 to 0.8] in NAVA vs. 0.9 [0.8 to 1.1] and 0.9 [0.7 to 1.1] in PSV, P < 0.05). Conclusions: NAVA and PSV both reduced extradiaphragmatic inspiratory muscle activity, in proportion to the level of assistance. Compared with PSV, NAVA resulted in a predominant contribution of the diaphragm to inspiratory effort.
Published: 2014

212. Chirurgie et tuberculose multi/ultrarésistante : une revue de la littérature réhabilite une intervention adjuvante à l’antibiothérapie chez des patients sélectionnés

Author: Jérôme Robert, Thomas Similowski, D. Le Dû, Nicolas Veziris, Eric Caumes, Marc Riquet, Mathilde Fréchet-Jachym, S. Morel, Pierre Mordant, Benoît Henry, and F. Le Pimpec-Barthes
Subjects: Pulmonary and Respiratory Medicine
Abstract: Resume Introduction L’emergence de souches de Mycobacterium tuberculosis resistantes aux antibiotiques (MDR-TB) pose a nouveau la question du traitement chirurgical des cavernes pulmonaires localisees et difficiles a steriliser medicalement. Dans ce contexte, la place exacte de la resection chirurgicale reste debattue. Objectifs et methodes Afin de determiner la place de la resection chirurgicale dans la prise en charge des patients atteints de MDR-TB, une revue de la litterature a ete menee a partir des termes Multidrug-resistant tuberculosis et Surgery, en se limitant a la base de donnees Pubmed et aux articles publies en francais et en anglais, apres 1993. Etat de l’art Cette revue de la litterature a permis de retrouver 177 publications, dont 35 articles originaux consacres a la prise en charge chirurgicale des patients porteurs de MDR-TB, et 24 etudes de cohorte reunies en une meta-analyse. Les series chirurgicales rapportent un taux de succes (guerison ou traitement complet) compris entre 47 et 100 %, un taux de complication compris entre 0 et 29 %, et un taux de mortalite compris entre 0 et 8 %. La meta-analyse retrouve une association significative entre la chirurgie et le succes du traitement (OR 2,24, IC 95 % 1,68–2,97). Cependant, toutes ces etudes presentent des biais de selection. Les recommandations consensuelles au niveau international comprennent une prise en charge pluridisciplinaire dans un centre de reference, un traitement antibiotique personnalise et prolonge et une discussion medicochirurgicale des dossiers au cas par cas. Perspectives Nous avons mis en place ces recommandations consensuelles de prise en charge pluridisciplinaire et rapportons a titre d’exemple les cas cliniques de trois patients operes de MDR-TB. Des etudes complementaires sont necessaires afin de limiter l’emergence de resistance, et de determiner la chronologie optimale des traitements dans la MDR-TB.
Published: 2014

213. Severely impaired health-related quality of life in chronic hyperventilation patients: Exploratory data

Author: Benoit Wallaert, Sophie Robin, Thierry Perez, N. Bautin, Cécile Chenivesse, Thomas Similowski, and Clement Fournier
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Hyperventilation syndrome, Health Status, Health-related quality of life, Context (language use), Quality of life, Risk Factors, Surveys and Questionnaires, medicine, Humans, Hyperventilation, Asthma, COPD, business.industry, Cardiorespiratory fitness, Middle Aged, medicine.disease, Mental health, Plethysmography, Spirometry, Idiopathic hyperventilation, Chronic Disease, Physical therapy, Quality of Life, Female, Ventilatory threshold, business, Breathlessness
Abstract: Summary Patients with hyperventilation syndrome (HVS) report severe symptom-related suffering and often complain from insufficient medical attention. However, quality of life data in this context are scarce. We aimed at assessing the health-related quality of life (HRQoL) of HVS patients. Twenty-one HVS patients with extensive cardiorespiratory workup including cardiopulmonary exercise testing (CPET) filled in the generic SF-36 questionnaire and the results were compared to French normal values. Correlations between SF36 dimensions and clinical and functional data were established. All SF-36 scores were markedly decreased in HVS patients compared to healthy subjects: Physical Functioning: 44 ± 24, Social Functioning: 57 ± 27, Role Physical: 21 ± 32, Role Emotional: 48 ± 42, Mental Health: 51 ± 27, Vitality: 34 ± 20, Body Pain: 41 ± 21, General Health: 42 ± 21. These figures were all significantly lower in the HVS patients respective to the normal reference population. They were also lower than corresponding values published in patients with asthma or chronic obstructive pulmonary disease (COPD). "Vitality" and "Physical Functioning" scores were correlated with Nijmegen score ( r = −0.594, p = 0.047) and peak respiratory frequency during CPET ( r = −0.644, p = 0.019). The SF-36 Social Functioning score was correlated with the ventilatory threshold ( r = 0.629, p = 0.034), peak V′E/V′CO 2 (ventilation/CO 2 production) ( r = 0.650, p = 0.016) and peak P aCO 2 ( r = −0.664, p = 0.027). In conclusion, this study shows that HRQoL can be severely impaired in patients with HVS, which is one more reason to take this condition seriously.
Published: 2014
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214. Variabilité ventilatoire et assistance ventilatoire en réanimation

Author: Matthieu Schmidt, F. Kindler, Thomas Similowski, Alexandre Demoule, and J. Cecchini
Subjects: Philosophy, Emergency Medicine, Emergency Nursing, Humanities
Abstract: La ventilation n’est pas un phenomene monotone; elle est au contraire variable dans le temps, non seulement au gre des ajustements homeostasiques aux besoins de l’organisme, mais aussi d’un cycle a l’autre (periodicite dite « anharmonique »). Cette variabilite cycle-a-cycle du volume courant et de ses composantes est liee a la nature complexe, pseudochaotique — au sens mathematique de ces termes — de la dynamique de la commande respiratoire centrale qui genere le debit ventilatoire. Une certaine variabilite respiratoire est synonyme de « bonne sante » respiratoire, et la diminution de la variabilite du comportement ventilatoire est pathologique. Cette diminution peut traduire soit des modifications centrales, soit le « filtrage » de la variabilite de la commande par des modifications de charge mecanique: la complexite du debit ventilatoire et la variabilite cycle-a-cycle de la ventilation sont liees au couplage neuromecanique respiratoire et a l’equilibre charge-capacite. Ainsi, en reanimation, une faible variabilite ventilatoire predit l’echec du sevrage la ventilation mecanique. Elle est de plus un facteur independant de surmortalite. De plus, dans des modeles animaux, l’adjonction artificielle d’une variabilite extrinseque ameliore la mecanique respiratoire et les echanges gazeux. La restauration de la variabilite ventilatoire naturelle par certains modes d’assistance pourrait ainsi s’averer benefique.
Published: 2014

215. New insights in gill/buccal rhythm spiking activity and CO2 sensitivity in pre- and postmetamorphic tadpoles (Pelophylax ridibundus)

Author: Thomas Similowski, Brigitte Quenet, Marie-Noëlle Fiamma, Christian Straus, G. Horcholle-Bossavit, Isabelle Rivals, Equipe de Statistique Appliquée (UMRS 1158) (ESA), 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)-Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Pneumologie – Réanimation Médicale [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Gills, Pulmonary and Respiratory Medicine, Time Factors, Physiology, [SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology, Pelophylax ridibundus, Action Potentials, FOS: Physical sciences, In Vitro Techniques, CWT spectrum, Hypercapnia, Rhythm, stomatognathic system, biology.animal, Amphibian buccal ventilation, Spiking activity, medicine, Animals, Spectral analysis, Physics - Biological Physics, Neurons, Fourier Analysis, biology, Respiration, General Neuroscience, Metamorphosis, Biological, Central pattern generator, Anatomy, Buccal administration, Respiratory Center, Co2 sensitivity, biology.organism_classification, Tadpole, Fast oscillations, Facial Nerve, stomatognathic diseases, Biological Physics (physics.bio-ph), Central CO2chemosensitivity, Quantitative Biology - Neurons and Cognition, Larva, FOS: Biological sciences, Neurons and Cognition (q-bio.NC), medicine.symptom, [STAT.ME]Statistics [stat]/Methodology [stat.ME]
Abstract: International audience; tCentral CO2chemosensitivity is crucial for all air-breathing vertebrates and raises the question of itsrole in ventilatory rhythmogenesis. In this study, neurograms of ventilatory motor outputs recorded infacial nerve of premetamorphic and postmetamorphic tadpole isolated brainstems, under normo- andhypercapnia, are investigated using Continuous Wavelet Transform spectral analysis for buccal activityand computation of number and amplitude of spikes during buccal and lung activities. Buccal burstsexhibit fast oscillations (20-30 Hz) that are prominent in premetamorphic tadpoles: they result from thepresence in periodic time windows of high amplitude spikes. Hypercapnia systematically decreases thefrequency of buccal rhythm in both pre- and postmetamorphic tadpoles, by a lengthening of the interburstduration. In postmetamorphic tadpoles, hypercapnia reduces buccal burst amplitude and unmasks smallfast oscillations. Our results suggest a common effect of the hypercapnia on the buccal part of the CentralPattern Generator in all tadpoles and a possible effect at the level of the motoneuron recruitment inpostmetamorphic tadpoles.
Published: 2014

216. Analgesic effects of dyspnoea: 'Air hunger' does not inhibit the spinal nociception reflex in humans

Author: Thomas Similowski, François Hug, Julien Mayaux, Capucine Morélot-Panzini, and Jean-Claude Willer
Subjects: Adult, Male, Nociception, Pulmonary and Respiratory Medicine, Physiology, Withdrawal reflex, Stimulation, Electromyography, Hypercapnia, Reflex, Sensation, Humans, Medicine, Tidal volume, medicine.diagnostic_test, business.industry, General Neuroscience, Neural Inhibition, Carbon Dioxide, Dyspnea, Spinal Cord, Anesthesia, Breathing, Female, Analgesia, business
Abstract: Dyspnoea has distinct sensory modalities, including air hunger and the sensation of excessive breathing "work/effort". Both have analgesic properties. In the case of work/effort, spinal mechanisms have been documented (inhibitory effect on the spinal nociceptive flexor reflex, RIII). This mechanism involves C-fibres. As C-fibres are unlikely to play a major role in air hunger, we hypothesised that inducing this type of dyspnoea would not result in RIII inhibition. Eight healthy volunteers were exposed to a hypercapnic hyperoxic gas mixture (5% CO2 and 95% O2) and asked to voluntarily fight the corresponding ventilatory reflex response by reducing tidal volume below its spontaneous level. Ventilatory variables and dyspnoea intensity (ordinal scale) were measured. Electromyography of the biceps femoris was used to record the amplitude of RIII in response to painful electrical sural nerve stimulation. Air hunger failed to inhibit the RIII reflex. We conclude that the mechanisms of air hunger induced analgesia do not include a spinal contribution and are therefore mostly central.
Published: 2014

217. How to compare clinical outcome of complementary modes of mechanical ventilation?

Author: Alexandre Demoule, Christer Sinderby, and Thomas Similowski
Subjects: medicine.medical_specialty, business.industry, Pain medicine, MEDLINE, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Outcome (game theory), Respiration, Artificial, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Anesthesiology, Modes of mechanical ventilation, Medicine, Humans, business, Intensive care medicine
Published: 2016

218. Intravenous Immunoglobulins Improve Survival in Monoclonal Gammopathy-Associated Systemic Capillary-Leak Syndrome

Author: Marc Pineton de Chambrun, Marie Gousseff, Wladimir Mauhin, Jean-Christophe Lega, Marc Lambert, Sophie Rivière, Antoine Dossier, Marc Ruivard, François Lhote, Gilles Blaison, Laurent Alric, Christian Agard, David Saadoun, Julie Graveleau, Martin Soubrier, Marie-Josée Lucchini-Lecomte, Christine Christides, Annick Bosseray, Hervé Levesque, Jean-François Viallard, Nathalie Tieulie, Pierre-Yves Lovey, Sylvie Le Moal, Béatrice Bibes, Giuseppe Malizia, Pierre Abgueguen, François Lifermann, Jacques Ninet, Pierre-Yves Hatron, Zahir Amoura, Arnaud Hot, Laurent Argaud, Romain Hernu, Sylvie de la Salle, Stanislas Ledochowski, Anne-Sophie Moreau, Thomas Papo, Romain Sonneville, Bruno Verdière, Sybille Merceron, Nathalie Zappella, Mickael Landais, Nicolas Limal, Damien Contou, Thomas Similowski, Alexandre Demoule, Bertrand Souweine, Julien Haroche, Julien Boileau, Bernard Lecomte, Thomas Hanslik, Antoine Vieillard-Baron, Nicolas Terzi, Caroline Bulte, Aline Talasczka, Eric Hachulla, Olivier Decaux, Florent Ibouanga, Bertrand Arnulf, Matthieu Groh, Elie Azoulay, Marcel Benedit, Assaad Maalouf, Bruno Moulin, Fleur Cohen-Aubart, Raymond Friolet, Sylvie le Moal, Micheline Pha, Georges-Etienne Rivard, Eric Rondeau, Philippe Debourdeau, Marc Puidupin, François Beloncle, Jérôme Devaquet, Claire Presne, François Liferman, Jean-Marc Mazou, Maude Andrieu, Sylvie Paulus, Yannick Fedun, Jean-Paul Mira, Jean-Herlé Raphalen, Oscar Len Abad, Hervé Devilliers, Alister Rogers, Pascal Godmer, Charles-Edouard Luyt, Alain Combes, Miguel Hie, Alexis Mathian, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Centre de recherche en myologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS), Department of Internal Medicine, Hôpital pasteur [Colmar], CHU Toulouse [Toulouse], Service de médecine interne [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Immunologie - Immunopathologie - Immunothérapeutique (I3), Centre hospitalier de Saint-Nazaire, CHU Clermont-Ferrand, Centre hospitalier d'Ajaccio, Centre Hospitalier Henri Duffaut (Avignon), Clinique de médecine interne, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Service de Médecine Interne [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Hôpital l'Archet, Centre Hospitalier du Valais Romand [Sion, Switzerland], CHU de Saint-Brieuc, CHP Saint Grégoire, Service des maladies infectieuses et tropicales [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Médecine Interne Dax (MEDECINE INTERNE), Hopital, Service de Médecine Interne, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de médecine interne [Lille], Immunité et Infection, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Analyse Comparée des Pouvoirs (ACP), Université Paris-Est Marne-la-Vallée (UPEM), Université Paris Diderot - Paris 7 (UPD7), Hôpital Bichat - Claude Bernard, Service de soins intensifs, Centre Hospitalier de Versailles André Mignot (CHV), 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), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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 médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Department of Clinical Immunology, CHU Strasbourg, Médecine générale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré], Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Pontchaillou [Rennes], Service d'hématologie biologique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service des maladies infectieuses et tropicales, 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), Medical ICU, Service de néphrologie, Service de Département de médecine interne et immunologie clinique [CHU Pitié-Salpêtrière] (DMIIC), Service d'Hématologie-Oncologie, Hôpital Ste-Justine, Département d'Oncologie (Dep Oncol - AVIGNON), Institut Ste Catherine, Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Service de Néphrologie - Médecine Interne, CHU Amiens-Picardie-hôpital Sud, 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 de Médecine Interne (SOC 1 et SOC 2) [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de médecine interne [CHU Bretagnes Atlantique], CHU Bretagnes Atlantique, 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) (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), Centre de recherche en Myologie – U974 SU-INSERM, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Service de Medecine Interne, CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), Université Paris Diderot - Paris 7 (UPD7)-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), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), and Service de médecine interne et d'immunologie clinique [CHU Pitié-Salpêtrière]
Subjects: Male, medicine.medical_specialty, Paraproteinemias, Context (language use), Intravenous immunoglobulins, Monoclonal gammopathy-associated systemic capillary-leak syndrome, Systemic capillary-leak syndrome, 030204 cardiovascular system & hematology, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Theophylline, Interquartile range, Internal medicine, medicine, Terbutaline, Systemic capillary leak syndrome, Humans, 030212 general & internal medicine, Multiple myeloma, Clarkson disease, business.industry, Hazard ratio, Immunoglobulins, Intravenous, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, General Medicine, Middle Aged, medicine.disease, Survival Analysis, 3. Good health, Surgery, Cohort, Monoclonal, Female, business, Capillary Leak Syndrome, Cohort study
Abstract: International audience; Background: Monoclonal gammopathy-associated systemic capillary-leak syndrome, also known as Clarkson disease, is a rare condition characterized by recurrent life-threatening episodes of capillary hyperpermeability in the context of a monoclonal gammopathy. This study was conducted to better describe the clinical characteristics, natural history, and long-term outcome of monoclonal gammopathy-associated systemic capillary-leak syndrome.Methods: We conducted a cohort analysis of all patients included in the European Clarkson disease (EurêClark) registry between January 1997 and March 2016. From diagnosis to last follow-up, studied outcomes (eg, the frequency and severity of attacks, death, and evolution toward multiple myeloma) and the type of preventive treatments administered were monitored every 6 months.Results: Sixty-nine patients (M/F sex ratio 1:1; mean ± SD age at disease onset 52 ± 12 years) were included in the study. All patients had monoclonal gammopathy of immunoglobulin G type, with kappa light chains in 47 (68%). Median (interquartile range) follow-up duration was 5.1 (2.5-9.7) years. Twenty-four patients (35%) died after 3.3 (0.9-8) years. Fifty-seven (86%) patients received at least one preventive treatment, including intravenous immunoglobulins (IVIg) n = 48 (73.8%), theophylline n = 22 (33.8%), terbutaline n = 22 (33.8%), and thalidomide n = 5 (7.7%). In the 65 patients with follow-up, 5- and 10-year survival rates were 78% (n = 35) and 69% (n = 17), respectively. Multivariate analysis found preventive treatment with IVIg (hazard ratio 0.27; 95% confidence interval, 0.10-0.70; P = .007) and terbutaline (hazard ratio 0.35; 95% confidence interval, 0.13-0.96; P = .041) to be independent predictors of mortality.Conclusions: We describe the largest cohort to date of patients with well-defined monoclonal gammopathy-associated systemic capillary-leak syndrome. Preventive treatment with IVIg was the strongest factor associated with survival, suggesting the use of IVIg as the first line in prevention therapy.
Published: 2016

219. Patterns of diaphragm function in critically ill patients receiving prolonged mechanical ventilation: a prospective longitudinal study

Author: Gerald Chanques, Alexandre Demoule, Nicolas Molinari, Julien Mayaux, Boris Jung, Thomas Similowski, Samir Jaber, Stefan Matecki, Hélène Prodanovic, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), 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), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: medicine.medical_specialty, medicine.medical_treatment, Sedation, Diaphragmatic breathing, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, law, Anesthesiology, Sepsis, medicine, Intubation, Intensive care unit, ComputingMilieux_MISCELLANEOUS, Outcome, Phrenic nerve stimulation, Diaphragm Respiratory muscles function, business.industry, Research, 030208 emergency & critical care medicine, 3. Good health, Diaphragm (structural system), Surgery, 030228 respiratory system, Anesthesia, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study
Abstract: Background In intensive care unit (ICU) patients, diaphragmatic dysfunction (DD) can occur on admission or during the subsequent stay. The respective incidence of these two phenomena has not been previously studied in humans. The study was designed to describe temporal trends in diaphragm function in mechanically ventilated (MV) patients. Methods Ancillary study of a prospective, 6-month, observational cohort study conducted in two ICUs. MV patients were studied within 24 h following intubation (day-1) and every 48–72 h thereafter. Diaphragm function was assessed by twitch tracheal pressure (Ptr,stim) in response to bilateral anterior magnetic phrenic nerve stimulation. Diaphragm dysfunction was defined as Ptr,stim
Published: 2016

220. Management of Dyspnea in the Noncommunicative Patients

Author: Thomas Similowski, Maxens Decavèle, Margaret L. Campbell, Alexandre Demoule, Martin Dres, Romain Persichini, and Capucine Morélot-Panzini
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, MEDLINE, Terminally ill, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Severity of illness, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published: 2018

221. La charge mécanique au niveau des voies aériennes supérieures, induite par un déplacement de fluides, est-elle compensée à niveau cortical à l’éveil ?

Author: C. Launois, Thomas Similowski, I. Arnulf, and Stefania Redolfi
Subjects: Behavioral Neuroscience, Neuropsychology and Physiological Psychology, Neurology, Cognitive Neuroscience, Neurology (clinical)
Abstract: Objectif Nous avons precedemment montre, chez des patients en position assise ayant un syndrome d’apnees obstructives du sommeil, la presence de potentiels pre-moteurs inspiratoires (PPI) sur l’electroencephalogramme d’eveil, traduisant l’existence d’une compensation corticale de la charge mecanique situee au niveau de leurs voies aeriennes superieures (VAS). Il a ete montre que le deplacement des fluides des membres inferieurs vers la region cervicale (DF) augmente la charge mecanique au niveau des VAS et favorise la survenue d’apnees obstructives. Notre objectif est d’evaluer si le DF entraine l’apparition d’une compensation corticale. Methodes Nous avons induit un DF par le passage de la position assise a allongee puis par l’application d’un pantalon anti-gravite (PAG) chez des sujets sains, a l’eveil, et recherche l’apparition d’un PPI. Resultats Nous avons inclus 12 hommes sains (âge median 27 ± 6 ans ; IMC 21,7 ± 4,6 kg/m2). Le passage de la position assise a la position allongee a provoque un DF de 410 ± 140 mL et le PAG de 95 ± 143 mL Un PPI etait retrouve chez 1 sujet en position assise, chez 5 sujets en position allongee et chez 0 sujet apres application du PAG. Les sujets ayant un PPI en position allongee avait un DF plus important lors du passage de la position assise a allongee que les sujets sans PPI en position allongee (440 ± 90 vs 320 ± 45 mL, p = 0,02), sans difference d’âge et d’IMC. Conclusion Le passage de la position assise a allongee entraine un DF et est associe a l’apparition d’une compensation corticale transitoire chez le sujet sain a l’eveil.
Published: 2018

222. Intérêt de l’IRM dynamique du diaphragme avant et après plicature pour éventration unilatérale : à propos de 18 cas

Author: Thomas Similowski, I. Bouassida, Antoine Legras, Alex Arame, Ciprian Pricopi, Alain Badia, Giuseppe Mangiameli, B. Grand, C. Morelot Panzini, F. Le Pimpec-Barthes, J.-C. Das Neves Pereira, Anne Hernigou, and S. Diatta
Subjects: Pulmonary and Respiratory Medicine
Abstract: Introduction Il n’existe pas de recommandation concernant l’evaluation preoperatoire des eventrations diaphragmatiques. L’objectif de cette etude a ete d’evaluer l’interet de l’IRM dynamique du diaphragme faite avant et apres plicature de coupole, en developpant des criteres standardises d’analyse. Methodes De 2006 a 2017, 18 patients (Gp1) operes d’une eventration diaphragmatique unilaterale gauche (Gp1L, n = 15) ou droite (Gp1R, n = 3) ont eu une evaluation pre- et post-operatoire incluant une IRM dynamique. Cinq volontaires sains ont aussi eu cet examen. La course diaphragmatique au niveau de 3 points fixes (S1-S2-S3) et l’evolution perioperatoire de la fleche de chaque coupole (n = 41) en vue sagittale ont ete les 2 criteres principaux d’analyse. Resultats Sur l’IRM preoperatoire, toutes les coupoles avec une eventration (Gp1) avaient une course significativement reduite voire nulle en comparaison avec leur cote sain (p Figure 1 ). Conclusion L’IRM dynamique est un examen non invasif qui parait utile pour ameliorer nos connaissances en eventrations unilaterales du diaphragme et evaluer nos resultats chirurgicaux. Bien qu’il s’agisse d’une petite serie de patients, cet examen nous permet de valider l’existence d’un impact negatif significatif de l’eventration unilaterale sur la coupole saine controlaterale. Il met en lumiere le benefice local et controlateral de la plicature diaphragmatique. La grille standardisee que nous avons developpee peut aider les cliniciens dans leur approche chirurgicale et leurs futures evaluations.
Published: 2018

223. Intensity and quality of exertional dyspnoea in patients with stable pulmonary hypertension

Author: Laurent Savale, Capucine Morélot-Panzini, Jason Weatherald, Thomas Similowski, Gilles Garcia, Olivier Sitbon, Marc Humbert, Pierantonio Laveneziana, David Montani, Xavier Jaïs, and Athénaïs Boucly
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Hypertension, Pulmonary, Hyperinflation, Respiratory physiology, medicine.disease, Pulmonary hypertension, Inspiratory Capacity, Pulmonary Disease, Chronic Obstructive, Dyspnea, Internal medicine, Exercise Test, Respiratory Mechanics, Tidal Volume, Cardiology, Breathing, Humans, Medicine, Lung volumes, business, Dynamic hyperinflation, Tidal volume
Abstract: Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea. The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated.26 patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Minute ventilation (V′E), breathing pattern, operating lung volumes and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially assessed during exercise using a three-item questionnaire (dyspnoea descriptors). The inflection point of tidal volume (VT) relative to V′E was determined for each incremental test. Changes in inspiratory capacity during exercise defined two groups of patients: hyperinflators (65%) and non-hyperinflators (35%). Multidimensional characterisation of dyspnoea was performed after exercise using the Multidimensional Dyspnea Profile.In hyperinflators, inspiratory capacity decreased progressively throughout exercise by 0.36 L, while remaining stable in non-hyperinflators. The “work/effort” descriptor was most frequently selected throughout exercise in both types of patients (65% of all responses). At the VT/V′E inflection, work/effort plateaued while “unsatisfied inspiration” descriptors became selected predominantly only in hyperinflators (77% of all responses). In the affective domain, the emotion most frequently associated with dyspnoea was anxiety.In pulmonary hypertension patients who develop hyperinflation during exercise, dyspnoea descriptors referring to unsatisfied inspiration become predominant following the VT/V′E inflection. As these descriptors are generally associated with more negative emotional experiences, delaying or preventing the VT/V′E inflection may have important implications for symptom management in patients with pulmonary hypertension.
Published: 2019

224. Postoperative dMRI in the same patient (Figure 1)— coronal plane after left plication

Author: Caroline Rivera, Alain Badia, Aurélie Vilfaillot, Thomas Similowski, Giuseppe Mangiameli, Juan Carlos Das Neves Pereira, Françoise Le Pimpec-Barthes, Antonio Mazzella, Antoine Legras, Imen Bouacida, Capucine Morélot-Panzini, Alex Arame, Anne Hernigou, and Marc Riquet
Subjects: business.industry, Coronal plane, Materials Chemistry, Medicine, Anatomy, business
Published: 2019

225. Preoperative dMRI in a patient with left eventration— coronal plane

Author: Thomas Similowski, Antoine Legras, Imen Bouacida, Alain Badia, Marc Riquet, Caroline Rivera, Françoise Le Pimpec-Barthes, Anne Hernigou, Alex Arame, Aurélie Vilfaillot, Capucine Morélot-Panzini, Giuseppe Mangiameli, Juan Carlos Das Neves Pereira, and Antonio Mazzella
Subjects: business.industry, Coronal plane, Materials Chemistry, Medicine, Nuclear medicine, business
Published: 2019

226. Effets du haut débit nasal sur une dyspnée expérimentale par charge thoracoabdominale élastique

Author: Camille Rolland-Debord, Capucine Morélot-Panzini, C. Bianquis, and Thomas Similowski
Subjects: Pulmonary and Respiratory Medicine
Abstract: Introduction La dyspnee est un symptome frequent, pour lequel il existe peu de traitement specifique alors qu’elle represente un facteur independant predictif de mortalite et d’hospitalisation. L’oxygene nasal a haut debit s’est revele efficace pour soulager la dyspnee aux urgences. Neanmoins des resultats suggerent que cela ne resulterait pas d’une meilleure oxygenation, et seraient plutot en faveur de l’implication d’afferences respiratoires des voies aeriennes superieures. Nous avons evalue, chez le sujet sain au repos, l’efficacite du haut debit nasal (HDN) sur un nouveau modele de dyspnee experimentale destine a provoquer une sensation de constriction thoracique, avec et sans apport d’oxygene. Methodes Lors de cette etude randomisee, controlee en simple aveugle, les sujets etaient soumis a une dyspnee experimentale induite par charge thoracoabdominale elastique lors de 3 sessions espacees d’une semaine, la premiere etant destinee a entrainer le sujet a cette dyspnee, les deux autres a tester l’effet de l’intervention therapeutique. Les sujets etaient alors soumis a 2 blocs de dyspnee experimentale de 8 minutes sans et sous HDN (avec ou sans oxygene selon randomisation). Les sujets cotaient l’intensite de chaque composante de la dyspnee (affective et sensorielle) a l’aide d’une echelle visuelle analogique (EVA) en continu. Resultats Trente-deux sujets ont ete inclus. La charge elastique induisait une sensation de constriction thoracique et une dyspnee a 3,5 [2,7–5,2] mm pour sa composante affective, et a 4,4 [3,0–5,0] mm pour sa composante sensorielle stable a partir de la 3e minute, et reduisait la CVF de 463 ± 273 mL. L’HDN s’accompagnait des la 3e minute d’une reduction significative des 2 composantes de la dyspnee, cet effet etant independant de l’adjonction d’oxygene. Conclusion Le haut debit nasal soulage la dyspnee induite par une charge thoracoabdominale elastique chez le sujet sain au repos, l’oxygene n’ayant aucun effet additif. Ce resultat suggere un benefice de l’HDN sur la dyspnee par l’intermediaire de la stimulation des mecanorecepteurs des voies aeriennes superieures permettant une augmentation des afferences respiratoires et, d’autre part, par stimulation des afferences sensitives trigeminales a l’origine d’un probable phenomene de gating. Cette etude permet d’envisager d’etendre les indications de l’HDN aux dyspnees persistantes notamment lors d’atteintes restrictives pulmonaires.
Published: 2019

227. Factor analysis in predominantly severe COPD: Identification of disease heterogeneity by easily measurable characteristics

Author: Barry J. Make, Ollie Östlund, Peter M.A. Calverley, Thomas Similowski, Antonio Anzueto, Christine Jenkins, Dirkje S. Postma, Göran Eriksson, and Groningen Research Institute for Asthma and COPD (GRIAC)
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Vital capacity, Exacerbation, Vital Capacity, Peak Expiratory Flow Rate, Disease, OBSTRUCTIVE PULMONARY-DISEASE, Body Mass Index, CLINICAL-TRIAL, Exacerbations, Pulmonary Disease, Chronic Obstructive, Sex Factors, HYPERRESPONSIVENESS, Internal medicine, Forced Expiratory Volume, Medicine, Humans, Asthma, Randomized Controlled Trials as Topic, COPD, HEALTH-STATUS, business.industry, Chronic obstructive pulmonary disease, Smoking, Middle Aged, GLOBAL BURDEN, CARE, medicine.disease, EFFICACY, METERED-DOSE INHALER, BUDESONIDE/FORMOTEROL, Bronchodilator Agents, respiratory tract diseases, Blood pressure, Cohort, Acute Disease, Physical therapy, ASTHMA, Female, Heterogeneity, Factor analysis, business, Factor Analysis, Statistical, Body mass index
Abstract: Background: The clinical and demographic variables defining the heterogeneity of chronic obstructive pulmonary disease (COPD) are unclear. A post-hoc analysis of five randomised studies in patients with a history of previous exacerbations examined the clinical and demographic characteristics describing moderate-to-very-severe COPD.Methods: Factor analysis was performed on all continuous baseline demographic and clinical data, without variable selection. Analyses were based on the full cohort and on stratifications by pack-years smoked, smoking status, gender, and comorbidities; patient exacerbation history was analysed in two of the five studies.Findings: 6162 COPD patients were evaluated (70% male; 40% current smokers; mean pre-bronchodilator forced expiratory volume in 1 s [FEV1] 35.2% predicted). Baseline clinical and demographic variables loaded differentially on six factors with minimal overlap, explaining 60.4% of the heterogeneity: 1) symptoms (cough, dyspnoea, steep disturbance), health status, reliever use; 2) pre-bronchodilator FEV1, FEV1/forced vital capacity, morning peak expiratory flow (PEF), body mass index (BMI); 3) blood pressure; 4) age, months since first COPD symptoms; 5) PEF variability; 6) pulse, FEV1 reversibility. Most factors loaded similarly in stratified and exacerbation analyses. BMI loaded with reversibility in females, and with age and months since first COPD symptoms in ex-smokers. Exacerbations loaded to factor 6.Interpretation: Readily available data can explain similar to 60% of COPD heterogeneity in a large dataset of predominantly severe COPD patients. Factors were robust over determinants of disease outcome; gender, smoking status, pack-years smoked, and comorbidities. The main factors were largely unchanged by adding exacerbations. Only BMI loaded to other factors. (C) 2013 Published by Elsevier Ltd.
Published: 2013
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228. Neurally adjusted ventilatory assist improves patient-ventilator synchrony during prophylactic helmet ventilation following aortic surgery

Author: Alexandre Demoule, Olivier Langeron, C. Ibanez-Esteve, Mathieu Raux, Thomas Similowski, F. Kindler, and A. Almayrac
Subjects: Leak, business.industry, Diaphragmatic breathing, Pressure support ventilation, General Medicine, Aortic surgery, Diaphragm (structural system), Anesthesiology and Pain Medicine, Anesthesia, Ventilator settings, Breathing, Neurally adjusted ventilatory assist, Medicine, business
Abstract: Introduction During postoperative non-invasive ventilation (NIV), following abdominal aortic surgery, leaks and diaphragmatic dysfunction jeopardize patient-ventilator interaction. We hypothesized that neurally adjusted ventilatory assist (NAVA) would be efficient to perform NIV with a helmet, and would reduce triggering and cycling-off delays as well as major patient-ventilator asynchronies compared to pressure support ventilation (PSV). Methods Nine postoperative patients receiving NIV with a helmet following abdominal aortic surgery were included. After optimization of ventilator settings, 15-min recording were performed with PSV (H-PSV) and NAVA mode (H-NAVA) in a non-random order. Breathing pattern descriptors, diaphragm electrical activity, leak volume, inspiratory trigger delay and cycling-off delay and the five main asynchronies were quantified. Asynchrony index (AI) and asynchrony index influenced by leaks (AILEAKS) were computed. Data is displayed as a median [25–75 interquartiles]. Results Trigger delays were lower with H-NAVA than with H-PSV (respectively 143 [54; 244] and 804 [406; 906] ms, P = 0.02), as were the cycling-off delays (respectively −702 [−780; −534] and 437 [176; 695] ms, P = 0.004). Although it had no effect on AI, H-NAVA decreased AILEAKS (5 [2; 10] vs. 16 [8; 28] %, P = 0.004), mostly due to a drastic reduction of the prevalence of ineffective triggering (0.6 [0.1; 1.15] vs. 1.7 [1.1; 4.5] min−1, P = 0.009). Tidal volumes and ventilatory command remained unchanged, but peak pressure level was lower with the H-NAVA than with H-PSV (16 [15–19] vs. 22 [20; 23] cmH2O, P = 0.004). Conclusion NAVA mode is sensitive enough to ensure ventilation despite postoperative diaphragmatic dysfunction. In combination with a helmet, NAVA improves patient-ventilator interaction during prophylactic postoperative NIV. The impact on patient outcome remains yet to be determined.
Published: 2013

229. Unrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients

Author: Thomas Similowski, Alexandre Demoule, Matthieu Schmidt, Laurence Dangers, Mathieu Raux, Capucine Morélot-Panzini, and Robert B. Banzett
Subjects: medicine.medical_specialty, Critical Care, Visual Analog Scale, Visual analogue scale, Pain medicine, Pain, Anxiety, Critical Care and Intensive Care Medicine, Article, law.invention, law, Anesthesiology, Tidal Volume, medicine, Humans, Pain Management, Intensive care medicine, Pulmonary Gas Exchange, business.industry, Pain management, Respiration, Artificial, Intensive care unit, Intensive Care Units, Dyspnea, Breathing, business
Abstract: Intensive care unit (ICU) patients are exposed to many sources of discomfort. Although increasing attention is being given to the detection and treatment of pain, very little is given to the detection and treatment of dyspnea (defined as "breathing discomfort").Published information on the prevalence, mechanisms, and potential negative impacts of dyspnea in mechanically ventilated patients are reviewed. The most appropriate tools to detect and quantify dyspnea in ICU patients are also assessed.Growing evidence suggests that dyspnea is a frequent issue in mechanically ventilated ICU patients, is highly associated with anxiety and pain, and is improved in many patients by altering the ventilator settings.Future studies are needed to better delineate the impact of dyspnea in the ICU and to define diagnostic, monitoring and therapeutic protocols.
Published: 2013

230. Can diaphragm pacing improve gas exchange? Insights from quadriplegic patients

Author: Thomas Similowski, Jésus Gonzalez-Bermejo, Marjolaine Georges, Capucine Morélot-Panzini, and Alexandre Demoule
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, Adolescent, medicine.medical_treatment, Diaphragm, Diaphragmatic breathing, Electric Stimulation Therapy, Lung injury, Quadriplegia, Positive-Pressure Respiration, Young Adult, Oxygen Consumption, medicine, Humans, Phrenic nerve, Mechanical ventilation, Pulmonary Gas Exchange, business.industry, Middle Aged, Respiratory Paralysis, Diaphragm (structural system), Phrenic Nerve, Diaphragm pacing, Anesthesia, Breathing, Female, Energy Metabolism, business
Abstract: To the Editor: Diaphragm pacing, as obtained by phrenic nerve stimulation through implanted electrodes, is a valid alternative to positive pressure mechanical ventilation (PPV) in patients with high spinal cord injuries [1]. Diaphragm pacing allows such patients to be weaned from PPV, but, to date, the respective effects of diaphragm pacing and PPV on gas exchange have not been compared. PPV is known to reduce ventilation in the lung bases [2]. By contrast, diaphragm pacing, like spontaneous breathing, should direct a larger proportion of the inspired volume to the lung bases. This should improve ventilation/perfusion matching. If this is the case, diaphragm pacing could be of interest as an adjunct to PPV in patients with lung injury. Indeed, in this setting, preserving diaphragmatic activity during mechanical ventilation can improve arterial oxygenation [3]. However, this can be difficult to achieve from a comfort point of view. In a proof-of-concept perspective, we compared blood gases and energy expenditure during PPV and diaphragm pacing in 10 quadriplegics. 10 consecutive, stable and well-nourished tracheotomised quadriplegic patients were studied (six males, aged 15–46 years, mean±sd body mass index 21.9±4.0 kg·m−2). All had a phrenic nerve stimulator (Atrostim; Atrotech, Tampere, Finland) implanted at least 6 months earlier and were considered fully reconditioned. They were studied during planned routine visits, after approval of the ethics committee of the French Learned Society for Intensive Care Medicine. All patients gave their informed consent. Measurements were performed at least 3 h after a meal, with the tracheal cuff inflated. Oxygen consumption ( V ′O2), carbon dioxide production ( V ′CO2) and respiratory quotient were …
Published: 2013

231. Prognostic value of efficiently correcting nocturnal desaturations after one month of non-invasive ventilation in amyotrophic lateral sclerosis: A retrospective monocentre observational cohort study

Author: François Salachas, Capucine Morélot-Panzini, Salah Kraoua, Thomas Similowski, Jésus Gonzalez-Bermejo, Nathalie Arnol, and Vincent Meininger
Subjects: Male, medicine.medical_specialty, Every Three Months, Kaplan-Meier Estimate, Cohort Studies, Internal medicine, medicine, Humans, Oximetry, Respiratory system, Amyotrophic lateral sclerosis, Aged, Retrospective Studies, Oxygen saturation (medicine), Noninvasive Ventilation, business.industry, Amyotrophic Lateral Sclerosis, Retrospective cohort study, Middle Aged, Prognosis, medicine.disease, Surgery, Treatment Outcome, Neurology, Breathing, Arterial blood, Female, Neurology (clinical), Respiratory Insufficiency, Sleep, business, Cohort study
Abstract: NIV adherence ('quantity' of ventilation) has a prognostic impact in amyotrophic lateral sclerosis (ALS). We hypothesized that NIV effectiveness ('quality') could also have a similar impact. NIV effectiveness was evaluated in 82 patients within the first month (M1) and every three months (symptoms, arterial blood bases, and nocturnal pulsed oxygen saturation - SpO2). Kaplan-Meier survival and risk factors for mortality one year after NIV initiation were evaluated. Forty patients were considered 'correctly ventilated' at M1 (Group 1, less than 5% of nocturnal oximetry time with an SpO2
Published: 2013

232. Acute bronchodilation increases ventilatory complexity during resting breathing in stable COPD: Toward mathematical biomarkers of ventilatory function?

Author: Marion Teulier, Marie-Noëlle Fiamma, Thomas Similowski, Christian Straus, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Neurophysiologie Respiratoire Expérimentale et Clinique, and Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Pulmonary and Respiratory Medicine, Time Factors, Respiratory rate, Physiology, medicine.drug_class, [SDV]Life Sciences [q-bio], Rest, Pulmonary function testing, Pulmonary Disease, Chronic Obstructive, Bronchodilator, Bronchodilation, medicine, Humans, Albuterol, Respiratory system, Tidal volume, Aged, COPD, Dose-Response Relationship, Drug, business.industry, Respiration, General Neuroscience, Middle Aged, medicine.disease, Bronchodilator Agents, Respiratory Function Tests, respiratory tract diseases, Nonlinear Dynamics, Anesthesia, Respiratory Mechanics, Breathing, Female, Pulmonary Ventilation, business
Abstract: Human tidal breathing features mathematical complexity and breath-by-breath variability. Fluctuations in these descriptors from one state to another are related to the load imposed on the respiratory system. We hypothetized that bronchodilators would increase ventilatory complexity and variability in patients suffering from chronic obstructive pulmonary disease (COPD). Eleven patients with stable COPD (9 men; age 48-79; FEV1 42-80%; FRC above 120%) were studied before and after 400 μg salbutamol. Breath-by-breath variability (coefficient of variation of tidal volume and breathing frequency -f) and ventilatory complexity (noise limit - NL, a quantifier of nonlinearity and complexity; largest Lyapunov exponent - LLE, an indicator of the sensitivity of the system to initial conditions) were described. Acute bronchodilation revealed or increased nonlinearity (NL 31% [20-38] to 43% [35-58], P=0.0051). Little changes in variability were observed (increased coefficient of variation of f). These observations might open new avenues toward resting breathing pulmonary function testing and novel respiratory biomarkers suitable for home-based lung disease monitoring.
Published: 2013

233. Dyspnée au cours de l’assistance ventilatoire mécanique

Author: Matthieu Schmidt, Alexandre Demoule, Mathieu Raux, Thomas Similowski, and Capucine Morélot-Panzini
Subjects: Emergency Medicine, Emergency Nursing
Abstract: Optimiser le confort des patients hospitalises en reanimation est un objectif majeur pour tout clinicien. La prise en charge de la douleur fait ainsi l’objet d’une attention particuliere, mais tel n’est pas le cas de l’inconfort respiratoire en general et de la dyspnee en particulier. Pourtant, les quelques donnees publiees a ce sujet suggerent que la dyspnee est frequente et severe chez les patients recevant une assistance ventilatoire mecanique. A moyen terme, la dyspnee participe a l’experience traumatisante que constitue un sejour en reanimation et pourrait contribuer a la genese du syndrome de stress post-traumatique correspondant. De plus, la dyspnee est associee a un allongement de la duree de ventilation. Outre les stimuli centraux comme la fievre et l’anemie, les principaux determinants de la dyspnee en reanimation sont l’anxiete et l’assistance ventilatoire elle-meme. Ainsi, dans 35 % des cas, optimiser les reglages du ventilateur diminue l’intensite de la dyspnee. Ces informations plaident pour une integration de la dyspnee aux schemas de surveillance des patients de reanimation. Ils plaident aussi pour la realisation de plus larges etudes evaluant la prevalence et les consequences de la dyspnee en reanimation ainsi que l’impact de mesures visant a la minimiser.
Published: 2013

234. Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness

Author: David C. Currow, John Hansen-Flaschen, Janelle Yorke, Thomas Similowski, Miriam J. Johnson, Robert W. Lansing, and Magnus Ekström
Subjects: Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, Consensus, Delphi Technique, International Cooperation, Psychological intervention, MEDLINE, Delphi method, Alternative medicine, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Pulmonary Medicine, Medicine, Humans, 030212 general & internal medicine, Clinical syndrome, Health policy, Evidence-Based Medicine, business.industry, Health Policy, Evidence-based medicine, Syndrome, Service provider, Congresses as Topic, Models, Theoretical, Hospitals, United States, Europe, Dyspnea, 030228 respiratory system, Family medicine, business
Abstract: Breathlessness that persists despite treatment for the underlying conditions is debilitating. Identifying this discrete entity as a clinical syndrome should raise awareness amongst patients, clinicians, service providers, researchers and research funders.Using the Delphi method, questions and statements were generatedviaexpert group consultations and one-to-one interviews (n=17). These were subsequently circulated in three survey rounds (n=34, n=25, n=31) to an extended international group from various settings (clinical and laboratory; hospital, hospice and community) and working within the basic sciences and clinical specialties. Thea prioritarget agreement for each question was 70%. Findings were discussed at a multinational workshop.The agreed term, chronic breathlessness syndrome, was defined as breathlessness that persists despite optimal treatment of the underlying pathophysiology and that results in disability. A stated duration was not needed for “chronic”. Key terms for French and German translation were also discussed and the need for further consensus recognised, especially with regard to cultural and linguistic interpretation.We propose criteria for chronic breathlessness syndrome. Recognition is an important first step to address the therapeutic nihilism that has pervaded this neglected symptom and could empower patients and caregivers, improve clinical care, focus research, and encourage wider uptake of available and emerging evidence-based interventions.
Published: 2016

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

Author: Odile Fremin-Batteux, Juliette Clarissou-Philippe, Benoît Jauhlac, Severine Guyetand, Jacques Gasnault, Corinne Haioun, Liamine Aissaoui, Marie-Christine Pages, Marie-Pierre Fos, Christian Rose, Didier Hubert, Marie-Rose Rothe, N. Bouziges, Benoît Huc, François Devianne, Sabine Bidart, Anne Forest, Kevin Bertrand, Mohamed Eldeghedy, Annick Verhaeghe, Caroline Malderet, Anne Bertrou, Bernard Guerquin, Catherine Duche, Muriel Archambaud, Rabea Cotteret, Olivier Toullalan, Yves Devaux, Smail Bergheul, Valérie Sivadon-Tardy, Pierre-Gilles Merville, Geneviève Blanchard-Marche, Didier Raoult, Bernard Hory, Florence Richardin, Evelyne Belle, Mohamed Menouar, K Guitteaud, Mohamad Mohty, Ambroise Montcriol, Max Laurin, Aurélia Picard, Jean-Paul Mira, Marie-Charlotte Chopin, Richard Bonnet, Michel Wolff, Sébastien Maillez, Jeanne Maugein, Véronique Leblond, Nicola Walid, Bernard Gauche, Mathieu Evillard, Hassen Jeddi, Anne Bourlet, Isabelle Grawey, Thierry Jault, Sandrine Hiret, Valerie Gaborieau, Véronique Boin-Gay, An Kim, Thierry Constans, Jean-François Gaide, Martine Giraud, Eric Meaudre Desgouttes, Alain Fur, Abdallah Maakaroun, Olivier Matray, Bertrand Maubert, Frédérique Péchinot, Aurelie Garbi, Claire Delbrouck, Benoît Grandclerc, Vincent Cadiergue, Hervé Lécuyer, Bernadette Grignon, Thierry Bensaid, Nicole Constantin, Yannick Chevalier, Hassène Rahmani, Thierry Levent, Joelle Desliers, Florence Van de Velde, Xavier Adhoute, Clara Andriau, Christophe Charasse, Rémi Vatan, Benoît Martha, Alain Lecis, Didier Albert, Romain Jacobs, Hélène Lefranc, Christian Martin, Nasseur Rezgui, Bertrand Pigeon, Catherine Le Henaff, Dominique Cassignard, Françoise Cotes, Eric Pujade Lauraine, Jean-François Gattault, Nicole Ferreira-Maident, Noémie Jourde-Chiche, Hélène Garrec, Olivier Darchen, Carole Schwebel, Marie-Christine Bezian, Patrick Daoud, Tsouria Becaid, Simone Laluque, David Broche, Christine Boisselier, Pascale Martres, Sarah Hammami, Brigitte Olivier, Jean-Marie Nkunzimana, Eric Monlun, Isabelle Marterl-Lafay, Marion Carboni, Marie-Françoise Mattei, Sandrine Castelin, Isabelle Barillot, Marie-Noelle Cufi, Thomas Kaiser, Catherine Herry, Pascal Hutin, Jean-Pierre Bronowicki, Bernard Branger, Pierre Thomas, Elie Zagdoun, Anne Goquelin, Ziad Assaf, Ingrid Croquet, Bruno Pozzetto, Thomas Similowski, Anne-Isabelle Briere, Marie-Thérèse Albertini, Mariam Blaka, Christelle Tassot, Anne Gaschet, Jean-Philippe Lavigne, Antoine Pujol, Philippe Colombat, Edouard Devaud, Hana Talabani-Boizot, François Barière, Anne-Marie Cordier, Philippe Gueudet, Georges Simon, Anne-Sophie Lipovac, Françoise Bandaly, Anne Beauplet-Lepage, Sylvie Prince, Charlotte Jouzel, Jean-Luc Deboutin, Patrick Zavadil, Louis Puybasset, Marie-Cécile Petit, Loïc Guillevin, Kamel Touati, Christophe Ntalu Nkato, Sylvie Carette, Jacques Vaucel, Chantal Delasalle, Marine Gross Goupil, Laurent Gutmann, Christiane Payen, Annick Barboteau, Firouzé Bani-Sadr, Christophe Legendre, Philippe Roulier, Elie Azria, Ibrahim Farah, Isabelle Rouquette-Vincent, Anne-Sophie Erena-Penet, Philippe Labadie, Eric Josien, Aicha Derragui, Mathieu Legrand, Odile Beyne-Rauzy, Jean-Marc Nabholtz, Marie-Joelle Demarcq, Olivier Garosi, Michel Deiber, Fabrice Chaix, Bertrand Souweine, Anne Collignon, Gisèle Renard, Mickael Jego, Gilles Bernardin, Anne Allart, Jocelyn Barrier, Marc Vasse, Philippe Ménager, Marc Wurmser, Abderkader Ouazir, Olivier Gontieron, Yvon Berland, Sébastien Trouiller, David Leysenne, Christophe Ozanon, Fanny Autret, Tahar Saghi, Loïc Dopeux, Sophie Benoit-Coustou, T. Fraisse, Christine Maillard, Karine Nikodijevic, Georges Kaltenbach, Angéline Jamet, Philippe Aucher, Julie Bottero, Marie-Claude Piffaut, Marianne Besnard, Florence Courillon, Marie Bonfils, Christine Ghevaert, Marie Destors, Eliette Jeanmaire, Franck Zerbib, Manuel-Luis Gameiro, T Prazuck, Laurent Mandin, Olivier Guisset, Marguerite Fines, Toufik Feddal, Agnès Jouffret, Louis Mesnard, Thomas Bourrée, Hasinrina Razafimahefa, Sylvestre Tigaud, Vincent Estève, Philippe Malherbe, Jean-Michel Salord, Pascal Adam, Bertrand Rozec, Michel Fuillet, Olivier Lemenand, Denis Quinsat, Ana Danalaché, Véronique Vialette, François Brosset, Patrick Messner Pellenc, Nicolas Heisel, Edouard Girard, Régine Martin, Olivier Garesslin, Catherine Mille, Alexandre Gascon, Marc Nicolino, Laurence Mouly, Claire Fabre, Bénédicte Ponceau, Marie-Etiennette Emeriau, Pascal Cathebras, Bérangère Bernardaud, Michèle Pérouse de Montclos, O. Arsene, Karine Grenet, Yazdan Yazdanpanah, Sten De Witte, Anne Scemla, Laurence Bouillet, Christophe Burucoa, Vincent Loffeier, Séverine Visentin, Luc Desfrere, Miloud Arabi, Frédérique Costa, Sylvie Lechat, Ali Chekroun, Raymond Ruimy, Marie, Jérôme Bizet, Xavier Nassif, Baihas Dib, Patrick Bert-Marcaz, Laurent Martin Lefèvre, Nicholas Sedillot, Blandine Cattier, Emilie Boidin, Daniel Sondag, Aude Bourrouillou, Alain Noirot, Franck Desemerie, Fréderic Heluwaert, Catherine Tamalet, Marc G. Berger, Jean-Daniel Lelièvre, Dominique Perotin, Abdelkader Bemrah, Alain Lozniewski, Bernard Borstein, Hanna Eid, Diana Suatean, Virginie Mignaut, Jean-Claude N'guyen, Valérie Le Goff, Laurent Teillet, Christophe Rolland, Gwenaël Alfonsi, Florence Lachenal, Philippe Bossi, Yves Botreau, Florence Doucet Populaire, Henry Jardel, Nicolas Gallo, Elias Jabre-Sikias, Michel Dupon, Hélène Brihier, Isabelle Patry, Alexandre Leclercq, Bernadette Tourrand, Christophe Roussel, Jean-Emmanuel Kurtz, Bénédicte Paindaveine, Simon Elhadad, Richard Sanchez, Eric Sgro, Pierre Berger, Valérie Murbach, Anne Holstein, Florence Martin, Taoufik Merabet, Amélie Benbara, Milagros Ferreyra, Laure Esposito, Pierre Delobel, Antoine Andremont, Marc Bourlière, Carole-Anne Boudy, Jean-Baptiste Gaulthier, Laurent Tacchini, Olivier Marpeau, Sonia Tesseydre, Marie-Pierre Coulhon, Nathalie Hodee, Marie-Chrsitine Conroy, Pierre Weinbreck, Roland Leclercq, Laurent Souply, Christian Bidault, Annie Elbez, Marie-Annick Lebreton, Patrick Brisou, Agnès Ferroni, Jean-Louis Pourriat, Nadia Anguel, Christian Noel, Philippe Jouvencel, Eric Pichard, Xavier Martin, Mathieu Coste, Pierre Zuber, Catherine Neuwirth, Jean-Pierre Hacot, Paul Aye, Jérôme Guinard, Yves Pean, Jean-Christophe Dengo, Fabrice Petassou, Didier Viole, Thierry Messiaen, Jean Beytout, Philippe Petitjean, Ferdinand Savare, Patrice Cuvillier, Sophie Coignard, Hélène Anglaret, Nassim Kamar, Elisabeth Chachaty, Karine Guimard, Louis Braem, Hacene Fezoui, Pierre Martin, Jean-Paul Viard, Claire Larroche, Nicolai Claudiu-Plesa, Thierry Benoit-Cattin, Olivier Moquet, Thierry Pasdeloup, David Rosay, Rodolphe Jean, Jean-Bernard Mariette, Marc Debouverie, Hervé Peltier, Mustapha Terki, Jacques Daleas, Valérie Dattin-Dorrière, Michel Vergnaud, Emmanuel Grimprel, Sylvène Rosselli, Jean-Marc Didier, Pierre Faurie, Luc Frimat, Aziza Mandjee, Sabine Etchemendy, Pierre Tissières, Jean Nakhleh, Sylvie Mariette, Christian Perronne, Bruno Carbonne, Nathalie Houssiaux-Maisonneuve, Tristan Ferry, S Beague, Anthony Sebban, Marie-Thérèse Hili, Jean-Michel De Kermadec, Lucien Brasme, Gilles Blaison, Caroline Garandeau, Jean-Pierre Sollet, Laurent Tronchon, Thierry Samson, Julien Gesquière, Nicolas Ettahar, Alain Créange, Etienne Laurens, Véronique Equy, Fréderic Bart, Bernard Bouffandeau, Christine Vaillant, Valerie Pesque, Jean-Marc Lalot, Marc Levy, Michel Kaidomar, Mihaela Saplacan, Sterenn Yvenou, Marie-Isabelle Steibach, Emmanuelle Cambau, Agnès Riche, François Fourrier, François Raffi, Mélissa Lalu, Henri Bérard, Danielle Clave, Jean-Claude Mouries, Martine Porcheron, Jean Cabalion, Richard Lamarca, Nathalie Canu, Jean-Baptiste Roseau, Annabelle Stoclin, Luca Luminitan Elena Lupean, Rémi Gebeile, Celia Salanoubat, Carole Marmouset, Pierre Bigot, Anne-Laure Breton, Pierre Kalfon, Colette Vincent, Sophie Marty, Olivier Tandonnet, Alexis Redor, Xavier Valette, Ourida Aoudia, Jacques-Arnaud Seyrig, Bertrand Beaune, Hugues Aumaitre, Georges Pinon, Yann Leveneur, Sylvie Charachon, Raoul Herbrecht, Henriette de Valk, Gary David, Julien Pouyanne, Marc Dommergues, Majed Al Chaar, Véronique Blanc-Amrane, Pascale Guillarmé Grossmann, Bruno Abraham, Yves Morel, Philippe Suel, Denis Sautereau, Olivier Guilloy, Tu Anh Tran, Frédéric Laurent, Zahir Amoura, Jacques-Olivier Bay, Zoubida Elharie-Heraux, Joyce Sibony-Prat, Bernard Guillois, Dominique Rohmer-Heitz, Audrey Barrelet, Jérémie Courouble, Jean-Paul Herry, Daniel Vittecoq, Annie Vermesch-Langlin, Jean Auroux, Claude Aubert, Thierry Harvey, Ghislaine Lamoine-Gimet, J. Riahi, Florence Soraudeau, Bachar Al-Jalaby, Caroline Périsson, Khélifa Ayouz, Florence Cardot, François Maillet, Alain Goux, Théophile Magna, Bertille de Barbeyrac, Adrien May, Dominique Andreotti, Olivier Jonquet, Hélène Dumouchel, Didier Thibaud, Philippe Morlat, Pascal Chevalet, Pascal Ancelin, Guy Chambreuil, Cécile Le Boterff, Anne Ceriez, Olivier Detante, B Pangon, Claude C.A. Bernard, Vincent Cailleaux Pierre-Etienne Cailleux, Jordi Miatello, Pierre-Yves le Berruyer, Sylvain Kouaho, Michel Briaud, Hélène Delaby, Patrick Herbecq, Christine Segonds, Véronique Jault, Pascale Brunel, Christine Dussopt, Jean Thore, Jean-Marc Thouret, Jean-Marc Kerleau, François Le Baron, Slavius Matica, Sophie Leautez-Nainville, Matthieu Pecquet, Laurent Bret, Yacine Sedjelmaci, Pierre Metton, Habiboulaye Diallo, Jany Rey Zermati, Arnaud Delahaye, Hélène Chaussade, Laurent Mandelbrot, Emilie Bessede, Olivier Casanovas, Paul Pierrot, Annick Legras, Dominique Lauque, Hélène Gatti, Jean Catineau, Ebutu Likose, Gilles Capellier, Eric Kibbrecht, Freddy Thibaut, Patrick Valadier, Chantal Lemble, Joël Gaudelus, Joelle Mellier, Joëlle Brochen, Emmanuel Gascou, Stéphane Bonacorsi, Stéphanie Bannier, Bruno Fantin, Didier Raffenot, Valérie Revel, Hakim Amroun, Huguette Negrery, Anne-Laure Fauchais, Paul Mercury, Michel Chuzeville, Christian Zumbo, Nicolas Després, Pascal Roblot, Jérôme Pasche, Jean Claude Boufetteau, Jocelyne Caillon, Julien Boileau, V. Rabier, Benjamin Manéglier, Emilie Jourdes, Franck Ceppa, Christine Recule, Nicolas Degand, Benoît Henry, Thierry Baranger, Dominique Pateron, Agnès Pélaquier, Gérard Bouchet, Hélène Fiette, Ozel Guiden, Dana Ranta, Etienne Ruppé, Nabil Chiouk, Jacques Breuil, Dominique Leduc, Véronique Loustaud, Hervé Métenier, Michel Durand, Isabelle Mahé, Leila Karaoui, Marie-José Collus, Mehran Monchi, Olivier Belmonte, Romain Blondet, Jacques Thierry, Karine Humbert, Gilles Salama, Marie-Noelle Heurtaux, Cécile Goujard, Bruno Sivery, Martial Boisseau, Redouane Dahoumane, Pierre Delour, Christian Niels Meyer, Anne Faudon-Gibelin, Gérard Poulain, Roger-Charles Luciani, J.-C. Souquet, Olivier Grossi, François Vandenesch, Sylvain Mermont, Jacques Bronner, Sonia Dahan, Paul Marzouk, Pascal Pouedras, Noureddine Djafari, François-Xavier Caroli-Bosc, Jean-François Dessin, Brigitte Gruffat, Armelle Morin-Fatome, Sylvie Thoinet, Bano Konate, Jean-Winoc Decousser, Claire Poyart, Patrick Plessis, Olivier Millet, Vincent Cattoir, Françoise Geffroy, Manica Vasseur, Pierre Carli, Isabelle Citony, Christian Richard, Nicolas Sigur, Patrick Marthelet, Luwawu Mbimba, Pierre Feugier, Philippe Sauder, Hama Djerad, Evelyne Bourgerette, Hanen Chahtour, Adrien Lemaignen, Dominique Bechade, Patrick Ochocki, Antoine Vieillard Baron, Dominique Astruc, Marie-Pierre Moiton, Nicolas Dubois, Sylvie Ledru, Corinne Seknazi, Hélène Poupet, Jean-Philippe Brieux, Gérard Barthélémy, Aihem Yehia, Louis-Jean Couderc, Ahmed, Françoise Rigaux, Yohann N'guyen, Philippe Bethery, Damien Corberand, Etienne Auvray, Paul-Louis Woerther, Christian Combe, Sophie Delesalle, Jean-Marie Piala, Faraj Al Freijat, Philippe Juvin, Malcolm Lemyze, Hyacine Rey, Claire Larible, Noel Milpied, Lémia Zgarni, Julia Gaillard, Agnès Juven, Paola Otean, Adrien Melis, André Pechinot, Olivier Bouchaud, Olivier Chassin, Pierre Hausfater, Asma Trabelsi-Jnifen, Vincent Grobost, Didier Lemery, Pierre Soury, Françoise Brevet, Jacques Tankovic, Dominique Sansot, Jean Louis Salomon, Charlotte Cordonnier, Brigitte Lamy, Antoine Maisonneuve, Dominique Pressac, Claude Rémy, Rodolphe Sobesky, Stéphanie Cognet, Pierre Cougoul, Didier Jan, Dominique Perrotin, Cécile Hombrouk-Alet, Thierry André, Gilbert Pochmalicki, Serge Girard, Vincent Zerr, Guillaume Cadiot, Claudine Lasbasses, Michel Slama, Abderrazak El Yamani, Sophie Brovedani, Jean Armengaud, Romain Hernu, Géraldine Mascade, Aurélien Lorléa'ch, Ali Akkari, Mathieu Tourdjman, Christopher Payan, Eric Jullian, Nathalie Fonsale, Frédéric Riehl, Paul Strock, Geneviève Grise, Philippe Mottaz, Christian Floriot, Marie-Noëlle Ungeheuer, Denis Caillot, Arnaud Chalvon-Demersay, Catherine Branger, Stanislas Bruley des Varannes, Marc Paccalin, Marie-Pierre Danjean, Alexandre Mebazaa, Xavier Brunet, Roland De Varax, Laurence Delhoustal, Sophie Haro, Bruno Chabanon-Pouget, Isabelle Goidin, Dominique Chudersky, Corinne Costes, Delphine Chatellier, Maud Gelez, Damien Dassant, Pascal Joly, Jean-Michel Arnal, Zakaria Hamitou, Philippe Rondepierre, Carole Pignon, Valérie Crombe, Amanda Lopes, Chrystelle Kemenar, Olivia Raulin, Anne-Cécile Hochart, Sandrine Gérart Pons, Valérie Zeller, Guillermo Reyes Ortega, Mathilde Guérin, Audrey Migraine Bouvagnet, Florence Eboue, Isabelle Loury-Lariviere, Sophie Leotard, Suzanne Lima, Marie Kassis, Jean-Luc Donay, Jean-Pierre Audié, Guillaume Cartron, Arnaud Ribier, Fanny Buron, Mirela Tuca, Marius Semenescu, Arnaud Serre, Vincent Quentin, Denise Bouyssou-Destriau, Violaine Bresson, Christine Chandesris Joséphine Chapalain-Cagnon, Eric Cua, Henri Courtade, François Bénézit, Sébastien Lamache, Philippe Bonnefoy, Francis Schneider, Richard Monarchi, Adeline Schendel, Paramasiven Mootien, Ghislaine Gardes, Pierre-François Westeel, Jean-François Magny, François Caron, Jocelyn Michon, Didier Eyer, Isabelle Ronda, Pierre-Yves Robillard, Frédéric Renou, Anna Faucher, Jean-Robert Harlé, Anne Debernardi, Grégory Akerman, Benoît Fontenel, Pierre Hourdebaigt-Larrusse, Marie-Noëlle Adam, Aude Lessene, Abdelkader Hrichi, François Blot, Athéna Le Pierres, Romain Lemarie, Françoise Granier, Véronique Tardy, Marc Gatfosse, Pierre-Marie Roger, François Goupil, Saïd Aberrane, Franck Bernardi, Isabelle Plantier, Nathalie Funakoshi, Jean-Gilles Delecalle, Patricia Barbut, Jacques Reynes, Christophe Roy, Sophie Perreve, Michel Garre, David Ribes, Cyrille Ede, Jean-Claude Dausset, Francis Duchene, Jean Caussin, Michelle Becker-Schneider, Gilles Berthelot, Damien Dupont, Jean-Michel Gillot, Aurélie Messager, Jean-Marie Pannecouck, Jean-Christian Roussel, Alain Reynaud, Sylvie Cariou, Anne Dao, François Guillemot, Martin Martinot, Patrick Casali, Anne-Sophie Poirier, Aissa Kerchache, Necera Sakek, Eric Porthault, Christophe Decoene, Chantal Ache-Papillon, Brigitte Bicais, Jean-Claude Feugier, Thierry Masseron, Charles Marty-Ane, Daniele Goldgran Toledano, Jean-Christophe Dubus, Damien du Cheyron, Dominique Decré, Jean-Loup Pennaforte, Ahmed Tigaizin, Bernard Vache, Eric Oswald, Claire Moulinoux, Anne-Christine Jaouen, Caroline Charlier, Anne-Laure Virlouvet, Ali Kara, Jean-Luc Sicsic, Sylvie Goffart, Mathieu Zuber, Claudine Fèbre, Olivier Lortholary, Mathieu Dupont, Annie Vessieres, Thierry Helvadjian, Thomas Signouret, Cedric Daupin, Sandrine Essouri, Jean-Louis Jacob, Pascal Boileau, Caroline Blazejewski, Quentin Lepiller, Juan-Pablo Maureira, Eddy Lebas, Christophe Deschamps, Amévi Ananivi, Clovis Foguem, Daniel Adoue, Abdourahim Chamouine, Alain Michault, Bruno Guérin, Olivier Baud, Clara Vinci, Thierry Weitten, Jean-Marc Eychene, Marie Froidure, Julien Obiols, Patricia Roussellier, Marc Lecuit, André Cabié, Saskia Foucart, Karim Belhadj, Michel Cingotti, Bruno Dumoulard, Jean Puyhardy, Etienne Danquechin Dorval, Lucile Mendes-Martin, Enrique Casalino, Luc Jarrige, Fabien Lambiotte, Philippe Masson, Mohammed Mansouria, Pierre Thouvenot, Katy Jeannot, Martine Nyunga, Valérie Macci, Florent Masia, Claire Briere de la Hosseraye, Wassila Anteur, André Sommabère, Marie-Claude Germain, Isabelle Arnault, Bernard Carbonelle, Philippe Devos, Daniel Protar, Tiphaine Gaillart, Ludovic Lassel, Laurence Hamou-Plotkine, David Trystram, Thierry Bureau, Olivier Collard, Fanny Vuotto, Sophie Malhiere, Frederique Canis, Gillles Plainfosse, Catherine Lechiche, Bertrand Lassere, Martine Chouraqui, Jean Baptiste Michot, Fethi Radhouane-Khanjari, Carole Barbier, Pascal Bonitchi, Abdelaziz Benkhelil, Odile Salmon, Laurent Damaj Gandhi, Bertrand Minguet, Michel Wagner, Odile Falguières, Zahr-Eddine Ali Chaouche, Eric Zaoui, Isabelle Guichard, Bernard Huttin, Apollinaire Karirisi, Gaël Cinquetti, Christophe Plane, Lionel Rostaing, Yanne Henry-Andrieu, Daniel Re, Virginie Verrier, Pascal Bolot, Michel De Biasi, Laurence Vrigneaud, Mathilde Turpin, Marie-Claude Demachy, Etienne Roussel, Michèle Blancs, Olivier Join-Lambert, Yves Ville, Thierry Granger, Gilles Hilbert, Virginie Medeau, Daniel Villers, Benoit Pilmis, François Gouraud, Emmanuel Ardiet, Catherine Heyraud-Blanchet, Alain Devidas, Hélène Dieye, Julie Cremniter, Jean-François Bergmann, Rozenn Le Berre, Virginie Leguen, Daniel Royer, Gilles Le Maout, Christian Harou, Sylvie Gabriel-Soléan, Yves Regouby, Martine Pestel-Caron, Patrick Brunet, David Boutoille, Emmanuelle Bonnin, Patrice Coulon, Marc Sullice, Marianne Barbieux, Gilles Cambonie, Joëlle Tricoire, Marie-Nadège Bachelier, Delphine Briend, Céline Ramanantsoa, Nathalie Bednarek, Didier Lebreton, Julien Lagrandeur, Damien M'Bey, Philippe Audeguy, Elie Saliba, Lena Damaj, Hassan Fallouh, Pascal Couturier, Fabrice Prévost, Yves Domart, Marie-Odile Lafforgue, Anne Le Du, C. Beuscart, Pierre Guillet, Fabrice Larrazet, Marie-Hélène Hausermann, Henri Robert, Nicolas Fanjaud, François Goehringer, Thomas Bachelot Philippe Badia, Jean-Michel Coulaud, Cristel Fissore Magdelein, Renaud Defebvre, Anne-Sohie Moreau, Johan Courjon, Gilles Salles, Michel Mialon, Silvia Iacobelli, Emmanuelle Bille, Marie-Christine Barbier, Yves Aubard, Patrice Badila, Jean-Philippe Rasigade, Alban Deroux, Evelyne Lecaillon-Thibon, Michel Godin, Abdelmajid Djeffal, Viorica Badurescu, Meriem Canitrot, Pierre Blanchard, Antoine Legros, Laurence Got, Françoise Duluc, Mylène M. Maury, Gilles Dassieu, Nordine Khodeir, Jean-Marie Duez, Mathieu Morincomme, Jérôme Lacroix, Mathieu Revest, Koffi Blewoussi, Isabelle Barazer, Françoise Poitevin, Camille Seignovert, Stéphanie Honore Bouakline, Anne Heidt, Brigitte Malbruny, Julien Desblache, Christian Cattoen, Eric Jaunait, Bruno Chaminade, Claude Bazin, Jonathan Chelly, Anne Pottier, Alain Schmitt, Alain Tissot, Karim Dadoun, P. Rebattu, Claudine Contamin, Arnaud Guerard, Nathalie Ravet, Sandrine Khalifa-Thellier, Marlène Chatron, Gaëlle Dörr, Hélène Biessy, Emmanuel Forestier, Bruno Devaux, Jean-Jacques Grelaud, Xavier Tchenio, Marie-Cécile Ploy, Jérémie Violette, Michèle Burdin, Lionel Falchero, Dominique Jacomy, Jean-Christophe Rozé, Damien Labarriere, Stéphane Leroux, Corinne Meregnani, Assia Ferhat Carre, Paul Orode, Jean-Gabriel Paul, Catherine Godon, Agnès Vinay, Régine Barraduc, Dominique Dallay, Alexandre Ampère, Anne-Gaelle Kervegant, Guillaume Louart, Dominique Beal Ardisson, Francoise Leonetti, Jean-Yves Baril, Stéphanie Haiat, Bincy Darre, Jérôme Bay, Yvan Gauthier, Sylvie Radenne, Pierre-Yves Gueugniaud, Philippe Ravaud, Luc Landraud, Guillaume Ranchon, Loïc Chimot, Véronique Duval, Ilhem Agha-Mir, Sabine Camiade, Estelle Wafo, Jean-Patrick Laporte, Mariam Roncato-Saberane, Camille Bron, Patrice Laudat, Samir Kennouche, Nawel Afroukh, Dominique Neri, Hakim Kherouf, Yoar Hichri, Pierre-Edouard Bollaert, Gwenaelle Vary, Denis Castaing, Christine Lefort, Sébastien Rouget, René Robert, Christelle Guillet-Caruba, Catherine Simonin, Alain Vighetto, Severine Cabasson, Alain Brusset, Alexandra Doloy, Christel Cherlet, Ahmed Rouidi, Marina Salvucci, Réginald Pordes, René-Gilles Patrigeon, Emmanuelle Dupre-Narlet, Jacques Minet, Fethi Taleb, Anne-Marie Colingorski, Tahar Hadou, Sylvain Diamantis, Isabelle Glorieux, Thierry May, Jean-Claude Colombani, Anne Berth-Farges, Nicole Desplaces, Renaud de Tayrac, Elisabeth Walter, Fabienne Lorge, Pascal Reboul, Nathalie Dournon, Laurence Estépa, Marie-Lina Toubia, Mathilde Flahault, Thierry Delacour, Dominique Hurel, Hélinoro Andriamaneo, Cécile Bébéar, Denis Grasset, Miloud Serier, Oléna Orléva, Nadine Dubroca, Hervé Gentilhomme, Jean-Luc Baudel, Isabelle Lavenu, Salim Smati, Carlo Saroufim, Eric Placidi, Albert Sotto, Benoît Libeau, Hélène Leroy, François Golfier, Christophe Dollon, Laurence Desnoulez, Eric Barre, Daniel Cohen, Pascal Priollet, Thierry Marsepoil, Benoît Lionnet, Jacques Tebib, Pascale Penn, Antoine Bouissou, Christian Roth, Olivier Martinet, Anna Schmitt, Nathalie Fruleux, Fouzia Radaoui, Jean-Marc Lessinger, Virginie Morando, Jean-Jacques Maillet, Christophe Fruchart, François Boué, François Goffinet, Franck Lellouche, Martin Demarchi, Alain Geissler, Jean-Charles Picaud, David Assouline, Patricia Brazille, Philippe Guimier, Marie-Françoise Dabysing, Bruno Delpeuch, Vanessa Tran, Guy Gengembre, Delphine Deligne, Dominique Vodovar, Yvan Touze, Sabrina Parent, Anne Decoster, Camille Dewitte, Emmanuel Weiss, Thierry Lambert, Thomas Guimard, Vincent Caille, Claude Guérin, Françoise Evreux, Geneviève Barjon, Basile Ondze, Damien Fournier, Olivia Bandin, Sophie Mignart, Henri Demontclos, Didier Perez, Jacques Croize, Nicole Desbois-Nogard, Guenièvre Imbert, Clarisse Dupin, Khalid Ridah, Marie-Christine Varin, Guillaume Arlet, Edith De Clareuil, Marie-Line Eustache, Patricia Le Pimpec, Louise Fortin, Eugène Ngami, Fabrice Mihout, Cecilia Esnault, Vincent Bouden, Véronique Annaix, Yves Poinsignon, Aurélien Lorchleac'h, Jean-Marc Degreff, Marie Garofano, Renaud Mesnage, Anne-Marie Roque-Afonso, Alain Chevailler, Stéphane Hominal, Thierry Charbonnier, Adrianna Bildea, Fabien Fily, Benjamin Davido, Emmanuel Rassiat, Assi Assi, Stéphanie Brunet, Hervé Jacquier, Catherine Claise, Annie Durand, Yannick Monceau, Pierre Blanc, Jean-Marie Sire, Yves Sucin, Jean-Pierre Zarski, Nathalie Bronet, Ingrid Lafon, Philippe Rey, Jacques Markarian, Eric Sennevile, Olivier Wink, Guilène Barnaud, Anne-Sophie Peultier, Sabine Taylor, Rim Savatier, Patrick Valayer, Claude Negrier, Selim Jennane, Edouard Begon, Laura Hyerle, Delphine Bridoux, Claire Daurel, Benoît Dalle, Mathilde Lescat, Philippe Stolidi, Elodie Perrodeau, Xavier Heches, Pierre Castelnau, Philippe Bray, Jean-Claude Texier, Serge Rossignol, Maud Brung-Lefebvre, Jean-François Subra, Jean-Marie Delarbre, Morgane Schneerson, Guyro Jang, Mona Mehri, Nathalie Landgraf, Pierre-Marie Girard, Armand Goll, Zaineb Bekguesmia, Christophe Clement, Michel Collet, Vincent Maze, Amine Benjelloul, Solène Durliat-Ellie, Vincent Letouzey, François Schmitt, Valérie Martinez, Sarah Watson, Abderrezak Bouasria, François Barbier, Raphael Lauretta, Mirana Razafimahery, Cristina Sirbu, Patrick Malherbe, Anne Wuillai, Ludovic Lesecq, Philippe Gaudard, Serge Houssaye, Jacques Monsegu, Gilles Rival, Chantal Chaplain, Jean-Didier Grangé, Oana Zamfiri, Florence Nguyen-Khac, Marc Portneuf, Jean-Michel Pawlotsky, Delphine Bonnet, Laurent Traissac, Sophie Hamon-Charles, Didier Dreyfuss, Louis Bernard, Laurence Detourmignies, Olivier Martineau, François Pettinelli, Marc Zandecki, Michel Dreyfus, Alain Chapelle, Sébastien Sabbat, Anne-Sophie Labussiere, Jean-Louis Gaillard, Chloé Plouzeau-Jayle, Patrick Zoveda, Véronique Leflon, Marie Levy, Aurélie Labé, Bruno Soulie, Raoul Jacques Bensaude, Hecham Moussa, Sylviane Catteu, Nathalie Biron, Loïc Masson, Georges Mourad, Nejla Aissa, Dragos Ciocan, Hubert De Boysson, Jean-Luc Bouyer, Patrick Yeni, Thierry-Pascal Zame, Caroline Thomas, François Cavalié, Laurence Koulmann, Christophe Rioux, Olivier Barraud, François Bricaire, Marguerite Le Poulain, Marie-Noelle Noulard, René Thomas, Guy Semet, Laurent Mosser, Olivier Marret, Brigitte Rivière, Vincent Jarlier, Jean-Philippe Coindre, Marc Villemain, Martin Pierre, Yacine Benkaci, Philippe Chiron, Hoang Vu-Thien, Jérôme Gournay, Andrea Labaune-Kiss, Brigitte Lauzanne, Fanny Lemercier, Souad Silhadi, Imad Kansau, Christophe Poncelet, Olivier Baldesi, Francis Thuet, Olivier Leroy, Aurore Lamberet, Camille Petit Hoang, Sophie Micheli, Ayman Abokasem, Hakima Nesrine, Pierre Lureau, Christian Chidiac, Vincent Piriou, Fabien Zoulim, Dieudonné Nicobaharaye, Anne Tixier, Isabelle Matheron, Soumeth Abasse, Victoria Cacheux, Serge Herson, Christine Fuhrmann, Olivier Proost, Bernard Bedock, Olivier Rogeaux, Mostapha Hajjar, Anne Reverseau, René Courcol, Françoise Carmagnol, Yves Guénard, Céline Ménard, Bouchra Lamia, Bruno Lemmens, Damien Bouhour, L. Lequen, Gaëlle Baty, Cédric Bouet, Dominique Guerrot, Stéphane Blanc, Catherine Chirouze, Anne-Hélène Reboux, A. Vachée, Gregory Taurin, Myriam Mein-Bottini, Jean-Pierre Belot, Alain Lafeuillade, Patricia Gabez-Therou, Philippe Labrousse, Bernard Jarrousse, Philippe Noto, Vincent Brunot, Philippe Condominas, Marion Challier, Béatrice Berçot, Delphine Anuset, Mélanie Daval Cote, François Bernasconi, Y. Costa, Chandrah Goburdhun, Bernard Gressier, Alban Michaud-herbst, Franck Charlier, Moussa Hecham, Luc Boulain, Hélène Corneloup, Alix Greder Belan, Nicolas Boussekey, Claire-Antoinette Dupuy, Yannick Rouquet, Benoit Renard, Benifla Jl, Etienne Javouhey, Michèle Granier, Marie-Christine Jaffarbandjee, Emilie Piet, Benoît Bergues, Claire Malbrunot, Catherine Tiry, Philippe Mérigot, Mouna Ben Soltana, Chantal Roure Sobas, Florian Radenac, Yves Thomas, Agathe Blaise, Sylvie De Martino, Laurence Legout, Gabriel Choukroun, Jean-François Muir, Peggy Dupretz, Patrick Dupont, François Guichart, Julie Jean, Jean-Michel Descamps, Bernard Kittschke, Anne Gruson, Gerard Viquesnel, Marie Keller, Pascal Chavanet, Françis Vallet, Yvan Vaschalde, Jean-Luc Hanouz, Gerard Lina, Françoise Loison, Simon Vincent, Jean-Paul Thellier, Moncef Afi, Dominique Zagozda, Hélène Sokeng-Affoule, Marc Le Bideau, Jean-François Loriferne, Alain Gravet, Sophie Deprecq, Tarik Naceur, Severine Mielczarek, René-Jean Bensadoun, Bernard Karkous, Yves Bléher, Jocelyne Poulain, Véronique Goulet, Laurence Nicolet, Sophie Arista, Antônio Lúcio Teixeira, Jean-François Schved, Laurent Nicolet, Claire Lecomte, Faiza Benddif-Fin, Michel Aumersier, Laurence Burc-Struxiano, Maxime Thouvenin, Samia Harbi, Mathieu Detave, Catherine Rebeyrotte, Jean-Paul Kisterman, Bruno Berdin, Pascal Vincent, Laurent Argaud, Elisabeth Parisi-Duchene, Geneviève Julienne, Fernanda Farto-Bensasson, Georges-Fabrice Blum, Sad Gaizi, Tali-Anne Szwebel, Raphaël Lepeule, Marie-Thérèse Climas, Anne-Françoise Dillies, Amar Boudhane, Umberto Simeoni, Pierre-François Dequin, Gérard Oliviero, Alain Gourlaouen, Caroline Piau, Marie-France Lutz-Murphy, Benoît Claude, Jean-Paul Aubry, Nadine Dubosc-Marchenay, Kamilla Chraibi, Emmanuelle Heusse, Sylvain Le Chevallier, Nathalie Brieu, Farid Sifaoui, Lorraine Letranchant, Hélène Durox, Jean-Pierre Lagasse, Adel Ghedira, Xavier Roubert, Fatma Magdoud, Hélène Jean-Pierre, Etienne Carbonelle, Olivier Dereeper, Lionel Carbillon, Christophe Billy, Mélanie Roblin, Marie-José Kodzin, Philippe Niel, Solène Makdessi, Matteo Vassallo, Maryse Archambaud, Fabian Haccourt, Didier Blaise, Stéphane Bourgeois, Elena Marcu, Charles Kubiak, Brisse Castel, François Guinet, Marie Pouzoullic, Frédérique Nathan-Bonnet, Vincent Gendrin, Céline Becherrawy, Aline Secher, Pierre Abgueguen, Clarence Eloy, Jean-Marc Tourani, Frédéric Klapczynski, Bernard Montmasson, Philippe Real, Joanna Pofelski, Yves Welker, Karim Krechiem, Eric Caumes, Martine Elena-Daumas, Christophe Saigne, Gilles Hittinger, Chantal Delesalle, Jonathan Messika, Fabrice Lesage, Daniela Pop, Daniel Coetmeur, Renato Colamarino, Chetaou Mahaza, Patrick Plésiat, Isabelle Fredenucci, Mylène Baret, Guy Mager, Pascale Chavel, Isabelle Labourdette, Anne-Claude Menguy, Nicolas Fortineau, Ludovic Le Sec, Valérie Gauduchon, Francis Barraud, Nicolas Letellier, Didier Vincent, Janine Frey, Philippe Riegel, Michel Pavic, Jean-Luc Fabre, Jean-Pierre Fauchart, Alain Goudeau, Stéphanie Husson-Wetzel, Philippe Eymerit, Mohamed Camara, Nathalie Seta, Elisabeth Carole Ngo Bell, Philippe Repellin, Laurent Alric, Vincent Leroy, Françoise Delisle Mizon, Jean-Philippe Emond, Marie-Françoise Borie, Lise Crémet, Wladimir Chelle, Elisabeth Brottier-Mancini, Bernard Garrigues, Claire Letellier, Loïc Geffray, Frédéric Méchaï, Julien Bador, Benoit Guery, Alain-Charles Fouilhoux, Corinne Dagada, Pierre Duhaut, Julien Goustille, Arnaud Sément, Francis Carcenac, Isabelle Girard-Buttaz, Claire Chapuzet, Fabienne Jouatte, Bruno Riou, Fabrice Hayoun, Chloé Di Meglio, Youssef Ali, Michel Leneveu, Nathalie Montagne, Yves Garcera, Audrey Moustache, Pierre-Eric Danin, Geneviève Le Lay, Dominique Courouge-Dorcier, Isabelle Worcel, Emmanuel Morelon, Vincent Pestre, Jean-Pierre Vilque, Jean-Christophe Paquet, Lucien Bodson, Anne-Marie Forest, Fabrice Pierre, Christian Pommier, Fabien Dutasta, Pierre Fournel, Stéphanie Courtois, Elodie Dubois, Serge Vanden Einjden, Patrick Honderlick, Pascal Richette, Fabienne Tamion, Véronique Chassy, Richard Megbemado, Anne-Marie Le Reste, Bernard Simian, Henri Osman, Anthony Texier, Badih Ayach, François Simon, Jean-Michel Filloux, Béatrice Dubourdieu, Jean-Claude Semet, Sarah Kubab, Tawfiq Henni, Patrick Dudeffant, Delphine Hequet, Olivier Mimoz, Marc Auburtin, Amélie Chabrol, Mickael Bonnan, Caroline Léonnet, Claire Wintenberger, Serge Ilunga, Patrice Lanba, Sophie Rosello, Alexandre Damage, Flore Bouche, Michel Thibault, Frederic Faibis, Chantal Dhennain, Jean-Philippe Talarmin, Armelle Lamour, Remi Boussier, Fabien Garnier, Marie-Laure Brival, Nourredine Hedjem, Philippe Vande-perre, Raphaël Coint, Jean-Claude Reveil, Eva Weinbronn, Emmanuelle Lavalard, Alexandra Fille, Françoise Le Turdu, Lionel Leroux, Jean-Yves Lefrant, Jean Berthet, Radia Bouaziz, Alain Ravaud, Sylvaine Rousseau, Yacine Merrouche, Alain Le Coustumier, Bertrand Guider, Gisèle Dewulf, Jean-Marc Faucheux, Jacques Piquet, Franck Leibinger, Charles Cerf, Robin Stephan, Jean-Philippe Redonnet, Jean-Paul Stahl, Ella Dzeing, Simona Pavel, Guy Vernet, Ghada Hatem, Samer Kayal, Jacques Deschamps, Dominique Descamps, Marion Levast, Marc Bouiller, Sylvie Dargere, Claire Dingremont, Stéphane Gaudry, François Maillot, Sylvie Odent, Nathalie Cervantes, Hélène Zanaldi, Laurence Gachassin, Olivier Ruyer, David Patin, Benoît Cazenave, Pascal Jacquier, Michelle Boyer, Béatrice Berteaux, Virginie Zarrouk, Jacques Bor, Isabelle Legoff, Hélène Albinet, Florence Rousseau, Gilles Pialoux, Guenaelle Salaun-Beretta, Alexandra Moura, Véronique Vernet Garnier, Didier Lepelletier, Pierre-Alexandre Hauss, Joëlle Belaisch-Amart, Didier Lepeletier, Jacob Xavier, Aline Nare, Annie Motard-Picheloup, Alain Améri, Bertrand Lioger, Jean-Valère Malfuson, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Listeria - National Reference Center Listeria (CNRL), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria (CC-OMS / WHO-CC), Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Département de Médecine interne [Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Biologie des Infections - Biology of Infection, Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources (ICAReB), Institut Pasteur [Paris] (IP), Infectious Disease Department [Saint Maurice], Agence Nationale de la Santé Publique [Saint-Maurice] (ANSP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, MONALISA study group, Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency., ROZIER, marie-Claire, CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections (CNRL), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria - Biologie des Infections (CCOMS), CHU Pitié-Salpêtrière [APHP], Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections ( CNRL ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre collaborateur de l'OMS (CCOMS) des Listeria ( CCOMS ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Biologie des Infections, Institut Pasteur [Paris]-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources ( ICAReB ), Agence Nationale de la Santé Publique [Saint-Maurice] ( ANSP ), Assistance Publique - Hôpitaux de Paris, Assistance publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Paris 5 ( UPD5 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris]-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)
Subjects: Bacteremia/epidemiology/mortality, 0301 basic medicine, Male, Pediatrics, bacteraemia, Infectious Disease Transmission, [SDV]Life Sciences [q-bio], Bacteremia, France/epidemiology, Infant, Newborn, Diseases, Foodborne Diseases, Meningoencephalitis, Pregnancy, Risk Factors, Vertical, Medicine, Listeriosis, Prospective Studies, Pregnancy Complications, Infectious, Prospective cohort study, ddc:618, diabetes, alcoholism, Hazard ratio, Foodborne Diseases/microbiology, immuno suppressive therapies, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Hospitalization, Infectious Diseases, isolates, Population Surveillance, Female, France, Listeria monocytogenes/classification/isolation & purification, Cohort study, Adult, medicine.medical_specialty, 030106 microbiology, Notifiable disease, Listeriosis/diagnosis/epidemiology/microbiology, Context (language use), macromolecular substances, 03 medical and health sciences, Humans, study, Aged, [ SDV ] Life Sciences [q-bio], business.industry, Public health, cirrhosis, Infant, Newborn, Infant, Diseases/epidemiology/microbiology, HIV, Mandatory Reporting, Newborn, medicine.disease, Listeria monocytogenes, infection, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious/epidemiology/microbiology, Meningoencephalitis/epidemiology/microbiology/mortality, Observational study, business, prognostic, mellitus
Abstract: International audience; Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (
Published: 2016

236. Normal sleep on mechanical ventilation in adult patients with congenital central alveolar hypoventilation (Ondine's curse syndrome)

Author: Valérie, Attali, Christian, Straus, Michel, Pottier, Marie-Annick, Buzare, Capucine, Morélot-Panzini, Isabelle, Arnulf, and Thomas, Similowski
Subjects: Adult, Male, Congenital central hypoventilation syndrome, Research, Ondine’s curse syndrome, Polysomnography, Local sleep, Sleep structure, Hypoventilation, Respiration, Artificial, Sleep Apnea, Central, Young Adult, Mechanical ventilation, Slow wave sleep, Case-Control Studies, Humans, Female, Sleep
Abstract: Background The purpose of this study was to describe the sleep structure (especially slow wave sleep) in adults with congenital central hypoventilation syndrome (CCHS), a rare genetic disease due to mutations in the PHOX2B gene. Fourteen patients aged 23 (19.0; 24.8) years old (median [1rst-3rd quartiles]) with CCHS underwent a sleep interview and night-time attended polysomnography with their ventilatory support. Their sleep variables were compared to those collected in 15 healthy control subjects matched for age, sex and body mass index. Results The latency to N3 sleep was shorter in patients (26.3 min [24.0; 30.1]) than in controls (49.5 min [34.3; 66.9]; P = 0.005), and sleep onset latency tended to be shorter in patients (14.0 min [7.0; 20.5]) than in controls (33.0 min [18.0; 49.0]; P = 0.052). Total sleep time, sleep stage percentages, sleep fragmentation as well as respiratory and movement index were within normal ranges and not different between groups. Conclusions Normal sleep in adult patients with CCHS and adequate ventilator support indicates that the PHOX2 gene mutations do not affect brain sleep networks. Consequently, any complaint of disrupted sleep should prompt clinicians to look for the usual causes of sleep disorders, primarily inadequate mechanical ventilation. Shorter N3 latency may indicate a higher need for slow wave sleep, to compensate for the abnormal respiratory-related cortical activity during awake quiet breathing observed in patients with CCH.
Published: 2016

237. Lung function and treatment patterns of symptomatic patients with moderate COPD in the CRYSTAL study

Author: Claus Vogelmeier, Timm Greulich, Walter Castellani, Thomas Similowski, Mina Gaga, Konstantinos Kostikas, Maryam Aalamian-Mattheis, Stephen J. Lane, Vincent Ninane, Jose M. Marin, Andreas Clemens, and Xavier Nunez
Subjects: medicine.medical_specialty, COPD, education.field_of_study, biology, business.industry, Fixed-dose combination, Population, Lama, biology.organism_classification, medicine.disease, respiratory tract diseases, Surgery, Clinical trial, Internal medicine, medicine, Indacaterol, In patient, business, education, Lung function, medicine.drug
Abstract: Background: Differences in treatment patterns in symptomatic COPD patients with moderate airflow limitation have been shown in real-life studies. Methods: CRYSTAL is a prospective multicenter randomized pragmatic clinical trial addressing the efficacy and safety of the direct switch from previous therapy to glycopyrronium or indacaterol/glycopyrronium fixed dose combination over 12 weeks in non-exacerbating symptomatic patients (mMRC≥1) with FEV 1 50-80% pred. We report baseline lung function and COPD treatment of patients recruited in the first year in the CRYSTAL study. Results: 3183 patients were recruited, of which 39.3% had mMRC≥2. Patients with mMRC≥2 were more often female and had lower FEV 1 values. Most commonly used treatments in this population were LAMA, LABA and LABA/ICS (Table). LABA/ICS were more commonly used in patients with mMRC≥2, whereas LAMA in those with mMRC=1. Conclusion: In the clinical practice population of the CRYSTAL trial, differences in COPD treatments were observed between less and more symptomatic patients. Approximately 1 out of 4 of these non-exacerbating patients with moderate airflow limitation were on ICS, in contrast to guidelines.
Published: 2016

238. Preflight hypoxia test with portable oxygen concentrators: when new technologies require more technology

Author: Thomas Similowski, Frederic Choin, Capucine Morélot-Panzini, Serge Roblin, Cindy Smith, Jésus Gonzalez, Vincent Bunel, and Amr Shoukri
Subjects: Altitude, business.industry, Oxygen therapy, medicine.medical_treatment, Anesthesia, Oxygen concentrator, Room air distribution, medicine, Use of technology, Effects of high altitude on humans, Hypoxia (medical), medicine.symptom, business
Abstract: Patients with respiratory insufficiency are at risk of hypoxic accidents during commercial flights. Pre-flight hypoxia tests are recommended to identify the risk and titrate oxygenotherapy. Portable oxygen concentrators (POC) are practical for in-flight oxygenotherapy, but their performances at high altitude are imperfectly known. The objective of the present study was to validate the use of a normobaric hypoxic tent as a new modality of evaluation of oxygen therapy devices under flight conditions, before using this system to test patients with their POC. The normobaric hypoxic test was performed with a hypoxic generator connected to an airtight tent. As control, a hypobaric hypoxic test was performed with an altitude chamber specifically designed in order to test a POC, in collaboration with Airbus Defence and Space . Oxygen production of 4 FAA approved POC were measured in these conditions, and compared wih normoxic conditions. In an hypoxic tent simulating an altitude of 2,438 meters, none of the apparatuses tested was able to achieve an FO 2 greater than 80%. The FO 2 was globally 17 [17-18]% lower than that measured in room air (75 [75-76]% versus 93 [92-94]%, p In the altitude chamber, all of the POCs obtained FO 2 values greater than 90%, only 1% [1-2]% lower than that measured in room air (92% [89-92] versus 93% [92-94], p This study indicates that currently flight conditions with a POC cannot be reproduced on the ground without using simple tests as hypobaric hypoxic conditions, which require a disproportionate use of technology.
Published: 2016

239. Top-10 comorbidities of symptomatic patients with moderate COPD in the clinical setting of the CRYSTAL study

Author: Jose M. Marin, Timm Greulich, Stephen J. Lane, Konstantinos Kostikas, Mina Gaga, Claus Vogelmeier, Xavier Nunez, Maryam Aalamian-Mattheis, Vincent Ninane, Walter Castellani, Andreas Clemens, and Thomas Similowski
Subjects: medicine.medical_specialty, COPD, business.industry, Osteoporosis, Fixed-dose combination, Disease, medicine.disease, Internal medicine, Diabetes mellitus, medicine, Physical therapy, Indacaterol, business, Depression (differential diagnoses), Dyslipidemia, medicine.drug
Abstract: Background: In most COPD trials a selected patient population is evaluated. The CRYSTAL study collects information on patients managed in a clinical setting. As COPD patient outcomes are partly driven by comorbidities there is a need to understand their pattern in clinical practice. Methods: CRYSTAL evaluates efficacy and safety of switch from previous therapy directly to glycopyrronium or indacaterol/glycopyrronium fixed dose combination over 12 weeks in non-exacerbating symptomatic patients (mMRC≥1) with moderate airflow limitation (FEV1 50-80% pred.). We evaluated the Top-10 comorbidities in patients included in CRYSTAL after 1 year of recruitment. Results: 3183 patients (mean FEV1 64.6% pred.) were recruited, of which 39.3% had mMRC≥2. Most common comorbidities were hypertension, hypercholesterolemia/hyperlipidemia, cardiovascular disease, diabetes, osteoarthritis, benign prostate hyperplasia, depression, gastroesophageal reflux disease, dyslipidemia, and osteoporosis. Cardiometabolic comorbidities were more frequent in patients with a higher mMRC grade (Table). Conclusion: In a clinical practice setting, the majority of patients with moderate airflow limitation had significant comorbidities that were more common in more symptomatic ones. Since comorbidities have impact on patient outcomes, there is a need for careful identification and management of these, especially in the more symptomatic COPD patients.
Published: 2016

240. Early diaphragm pacing to delay non-invasive ventilation in patients with amyotrophic lateral sclerosis (RespiStimALS): A multicenter, triple-blind, randomized controlled trial

Author: Thomas Similowski, Valérie Attali, Jesus Gonzalez Bermejo, Vincent Meininger, Capucine Morélot-Panzini, Nathalie Guy, Tanguy Marie Laure, Christophe Perrin, Claude Desnuelle, François Salachas, Hélène Prigent, Nierat Marie-Cecile, and Philippe Couratier
Subjects: medicine.medical_specialty, Vital capacity, Randomization, business.industry, medicine.disease, Surgery, law.invention, Diaphragm pacing, Respiratory failure, Randomized controlled trial, law, Medicine, Respiratory system, Amyotrophic lateral sclerosis, business, Phrenic nerve
Abstract: Background. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with respiratory muscle weakness and respiratory failure. Non invasive ventilation (NIV) alleviates respiratory symptoms and prolongs life but delaying NIV in ALS is therefore desirable. We aimed to establish whether early diaphragm pacing could achieve this objective. Methods. Multicenter randomized controlled trial involving 12 French multidisciplinary ALS centers. Eligible patients had moderate ALS-related respiratory involvement (forced vital capacity 60-80 % predicted). All patients were operated laparoscopically and received an intradiaphragmatic phrenic nerve stimulator (NeuRxRA4®, Synapse Biomedical, USA). They were then randomly assigned to active or sham stimulation. The primary outcome was NIV free survival. Investigators and patients were blinded to treatment. NIV was decided by an external allocation panel (triple blind design). Results. we randomly assigned 74 participants to active (n=37) or sham (n=37) stimulation. The median NIV free survival since randomization was 6.0 months in the active stimulation group, vs. 8.8 months in the sham stimulation group (p = 0.02). Sixty-five percent of the patients in the active group experienced severe adverse events, vs. 59%. Median overall survival from randomization was 15.6 months (95%CI 9-27) in the active group, vs. more than 33 months (p = 0.007). Conclusions. Early diaphragm pacing in ALS patients with incipient respiratory involvement did not delay NIV and was associated with decreased survival.
Published: 2016

241. Can human breathing be measured under true ecological conditions?

Author: Thomas Similowski, Pierantonio Laveneziana, Bruno-Pierre Dubé, Ros Kiri Ing, and Marie-Cécile Niérat
Subjects: Expiratory Time, Respiratory rate, business.industry, Ecology, Instrumentation, Ultrasound, Breathing, Medicine, business, Sonar, Signal, Mouthpiece
Abstract: Human respiratory behaviour is extremely sensitive to instrumentation and observation. The use of a mouthpiece to measure ventilatory flow with a pneumotachograph (PNT) introduces a major perturbation to breathing. Likewise, the emotional and cognitive impacts of being observed are bound to induce breathing modifications. Measuring human breathing under true ecological conditons is currently impossible. This study evaluates the feasibility and reliability of sonar-derived measurements of chest wall displacements (no physical contact with the subject, no visible signal emitted). Such measurements were compared with PNT measurements of ventilatory flow in 21 healthy subjects during tidal breathing. Inspiratory time (TI), expiratory time (TE), and breathing frequency ( f ) were simultaneously measured with a PNT and derived from the mathematical treatment of the thoraco-abdomnimal motion signals obtained from an ultrasound emitting-receiving device projecting non-audiblle acoustic waves through the air on the chest wall. Data were tested for interchangeability using Passing-Bablock regression analysis. All the measurements proved interchangeable, as follows: sonar vs PNT (median and [IQR] in sec): TI 1.93 [1.6-2.29] vs 1.68 [1.43-2.07], TE 2.78 [2.2-3.36] vs 2.48 [2.49-3.67], f 13.09 [10.69-16.03] vs 13.18 [10.98-16.03]. We conclude that a sonar device can be reliably used to assess breathing pattern. In physiological studies, this has the potential to eliminate both the “instrumental” and the “observer” effects and therefore to provide descriptions of breathing under true ecological conditions. Beyond this, our results pave the way to multiple medical and non-medical applications of non-contact respiratory measurements.
Published: 2016

242. Desogestrel enhances ventilation in ondine patients: Animal data involving serotoninergic systems

Author: Fanny Joubert, Isabelle Rivals, Christian Straus, Emilienne Verkaeren, Alain Frugière, Laurence Bodineau, Anne-Sophie Perrin-Terrin, Marie-Noëlle Fiamma, Philippe J.P. Cardot, Thomas Similowski, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hypoxie et Poumon : pneumopathologies fibrosantes, modulations ventilatoires et circulatoires (H&P), Université Paris 13 (UP13)-UFR SMBH, Equipe de Statistique Appliquée (UMRS 1158) (ESA), 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)-Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée - R3S', Pôle PRAGUES, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Explorations Fonctionnelles de la Respiration, de l’Exercice et de la Dyspnée [CHU Pitié-Salpêtrière], and HAL-UPMC, Gestionnaire
Subjects: Male, 0301 basic medicine, Ex vivo medullary-spinal cord preparations, Mice, 0302 clinical medicine, Medicine, Respiratory system, Medulla Oblongata, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Hypoventilation, Sleep Apnea, Central, 3. Good health, Spinal Cord, Cardiology, Breathing, Female, medicine.symptom, Serotonergic Neurons, medicine.drug, Adult, medicine.medical_specialty, Central congenital hypoventilation syndrome, Serotonergic, Young Adult, 03 medical and health sciences, Cellular and Molecular Neuroscience, Animal data, Organ Culture Techniques, Desogestrel, Internal medicine, In vivo, Animals, Humans, Plethysmograph, GABA-A Receptor Agonists, Etonogestrel, Pharmacology, Dose-Response Relationship, Drug, Raphe, business.industry, Progestin, 030104 developmental biology, Endocrinology, Animals, Newborn, Pulmonary Ventilation, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Central congenital hypoventilation syndrome (CCHS) is a neurorespiratory disease characterized by life-threatening sleep-related hypoventilation involving an alteration of CO2/H+ chemosensitivity. Incidental findings have suggested that desogestrel may allow recovery of the ventilatory response to CO2. The effects of desogestrel on resting ventilation have not been reported. This study was designed to test the hypothesis that desogestrel strengthens baseline ventilation by analyzing the ventilation of CCHS patients. Rodent models were used in order to determine the mechanisms involved. Ventilation in CCHS patients was measured with a pneumotachometer. In mice, ventilatory neural activity was recorded from ex vivo medullary-spinal cord preparations, ventilation was measured by plethysmography and c-fos expression was studied in medullary respiratory nuclei. Desogestrel increased baseline respiratory frequency of CCHS patients leading to a decrease in their PETCO2. In medullary spinal-cord preparations or in vivo mice, the metabolite of desogestrel, etonogestrel, induced an increase in respiratory frequency that necessitated the functioning of serotoninergic systems, and modulated GABAA and NMDA ventilatory regulations. c-FOS analysis showed the involvement of medullary respiratory groups of cell including serotoninergic neurons of the raphe pallidus and raphe obscurus nuclei that seem to play a key role. Thus, desogestrel may improve resting ventilation in CCHS patients by a stimulant effect on baseline respiratory frequency. Our data open up clinical perspectives based on the combination of this progestin with serotoninergic drugs to enhance ventilation in CCHS patients.
Published: 2016

243. Should we use gait speed in COPD, FEV 1 in frailty and dyspnoea in both?

Author: C. Robalo-Cordeiro, Thomas Similowski, Mario Barbagallo, Anh Tuan Dinh-Xuan, Joël Ankri, Jacques Mercier, Jean Bousquet, Leocadio Rodríguez-Mañas, Bruno Vellas, João O. Malva, Marc Humbert, Leonardo M. Fabbri, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Paris Descartes - Paris 5 (UPD5), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), 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 of Coimbra [Portugal] (UC), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Università degli studi di Palermo - University of Palermo, University - Hospital of Modena and Reggio Emilia [Modena, Italy], Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique, Centre chirurgical Marie Lannelongue-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Getafe University Hospital, Madrid, Service de Médecine Interne et de Gérontologie Clinique, CHU Toulouse [Toulouse]-Hôpital La Grave-Casselardit, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Bousquet, Jean, Dinh-Xuan, Anh Tuan, Similowski, Thoma, Malva, João, Ankri, Joël, Barbagallo, Mario, Fabbri, Leonardo, Humbert, Marc, Mercier, Jacque, Robalo-Cordeiro, Carlo, Rodriguez-Manas, Leocadio, and Vellas, Bruno
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Osteoporosis, Disease, Idoso Fragilizado, Dispneia, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Internal medicine, Forced Expiratory Volume, medicine, Humans, 030212 general & internal medicine, Loss function, Organ system, ComputingMilieux_MISCELLANEOUS, Aged, Aged, 80 and over, COPD, Frailty, business.industry, medicine.disease, 3. Good health, Gait speed, Walking Speed, Preferred walking speed, Dyspnea, 030228 respiratory system, Sarcopenia, Physical therapy, Cardiology, Doença Pulmonar Obstrutiva Crónica, Volume Expiratório Forçado, business, Human
Abstract: Frailty is a progressive physiological decline in multiple organ systems marked by loss of function, loss of physiological reserve and increased vulnerability to disease [1]. Biological (inflammation and loss of hormones), clinical ( e.g. sarcopenia and osteoporosis) and social factors are involved in frailty onset, evolution and prognosis [2, 3]. Links between frailty, dyspnoea and chronic respiratory diseases represent a novel and practical approach
Published: 2016

244. Neurophysiological Evidence for a Cortical Contribution to the Wakefulness-Related Drive to Breathe Explaining Hypocapnia-Resistant Ventilation in Humans

Author: Mathieu Raux, Jacques Martinerie, Gilles Garcia, Thomas Similowski, Marie-Cécile Niérat, Mario Chavez, Xavier Navarro-Sune, Cécile Chenivesse, Matthieu Dubois, and Adrian Morales-Robles
Subjects: Male, medicine.medical_treatment, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Hypocapnia, Hyperventilation, medicine, Humans, Normocapnia, Wakefulness, Mechanical ventilation, Cerebral Cortex, Drive, Brain Mapping, General Neuroscience, Respiration, Apnea, Electroencephalography, Articles, Carbon Dioxide, medicine.disease, Respiration, Artificial, 030228 respiratory system, Control of respiration, Anesthesia, Breathing, Female, medicine.symptom, Psychology, Sleep, 030217 neurology & neurosurgery
Abstract: Spontaneous ventilation in mammals is driven by automatic brainstem networks that generate the respiratory rhythm and increase ventilation in the presence of increased carbon dioxide production. Hypocapnia decreases the drive to breathe and induces apnea. In humans, this occurs during sleep but not during wakefulness. We hypothesized that hypocapnic breathing would be associated with respiratory-related cortical activity similar to that observed during volitional breathing, inspiratory constraints, or in patients with defective automatic breathing (preinspiratory potentials). Nineteen healthy subjects were studied under passive (mechanical ventilation,n= 10) or active (voluntary hyperventilation,n= 9) profound hypocapnia. Ventilatory and electroencephalographic recordings were performed during voluntary sniff maneuvers, normocapnic breathing, hypocapnia, and after return to normocapnia. EEG recordings were analyzed with respect to the ventilatory flow signal to detect preinspiratory potentials in frontocentral electrodes and to construct time-frequency maps. After passive hyperventilation, hypocapnia was associated with apnea in 3 cases and ventilation persisted in 7 cases (3 and 6 after active hyperventilation, respectively). No respiratory-related EEG activity was observed in subjects with hypocapnia-related apneas. In contrast, preinspiratory potentials were present at vertex recording sites in 12 of the remaining 13 subjects (p< 0.001). This was corroborated by time-frequency maps. This study provides direct evidence of a cortical substrate to hypocapnic breathing in awake humans and fuels the notion of corticosubcortical cooperation to preserve human ventilation in a variety of situations. Of note, maintaining ventilatory activity at low carbon dioxide levels is among the prerequisites to speech production insofar as speech often induces hypocapnia.SIGNIFICANCE STATEMENTHuman ventilatory activity persists, during wakefulness, even when hypocapnia makes it unnecessary. This peculiarity of human breathing control is important to speech and speech-breathing insofar as speech induces hypocapnia. This study evidences a specific respiratory-related cortical activity. This suggests that human hypocapnic breathing is driven, at least in part, by cortical mechanisms similar to those involved in volitional breathing, in breathing against mechanical constraints or with weak inspiratory muscle, and in patients with defective medullary breathing pattern generators. This fuels the notion that the human ventilatory drive during wakefulness often results from a corticosubcortical cooperation, and opens new avenues to study certain ventilatory and speech disorders.
Published: 2016

245. Reduced Phrenic Motoneuron Recruitment during Sustained Inspiratory Threshold Loading Compared to Single-Breath Loading: A Twitch Interpolation Study

Author: Alexandre Demoule, Stefania Redolfi, Thomas Similowski, Capucine Morelot-Panzini, Mathieu Raux, Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Service des Pathologies du sommeil [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Service de Pathologies du sommeil [CHU Pitié-Salpêtrière]
Subjects: medicine.medical_specialty, Physiology, lcsh:Physiology, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, control of breathing, Habituation, Original Research, Diaphragm contraction, Supplementary motor area, lcsh:QP1-981, business.industry, inspiratory drive, Twitch interpolation, Single breath, Anatomy, musculoskeletal system, twitch interpolation, Diaphragm (structural system), Intensity (physics), inspiratory loading, medicine.anatomical_structure, 030228 respiratory system, Control of respiration, diaphragm, Cardiology, cerebral cortex, business, phrenic motor neuron, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; In humans, inspiratory constraints engage cortical networks involving the supplementary motor area. Functional magnetic resonance imaging (fMRI) shows that the spread and intensity of the corresponding respiratory-related cortical activation dramatically decrease when a discrete load becomes sustained. This has been interpreted as reflecting motor cortical reorganization and automatisation, but could proceed from sensory and/or affective habituation. To corroborate the existence of motor reorganization between single-breath and sustained inspiratory loading (namely changes in motor neurones recruitment), we conducted a diaphragm twitch interpolation study based on the hypothesis that motor reorganization should result in changes in the twitch interpolation slope. Fourteen healthy subjects (age: 21–40 years) were studied. Bilateral phrenic stimulation was delivered at rest, upon prepared and targeted voluntary inspiratory efforts (“vol”), upon unprepared inspiratory efforts against a single-breath inspiratory threshold load (“single-breath”), and upon sustained inspiratory efforts against the same type of load (“continuous”). The slope of the relationship between diaphragm twitch transdiaphragmatic pressure and the underlying transdiaphragmatic pressure was −1.1 ± 0.2 during “vol,” −1.5 ± 0.7 during “single-breath,” and −0.6 ± 0.4 during “continuous” (all slopes expressed in percent of baseline.percent of baseline−1) all comparisons significant at the 5% level. The contribution of the diaphragm to inspiration, as assessed by the gastric pressure to transdiaphragmatic pressure ratio, was 31 ± 17% during “vol,” 22 ± 16% during “single-breath” (p = 0.13), and 19 ± 9% during “continuous” (p = 0.0015 vs. “vol”). This study shows that the relationship between the amplitude of the transdiaphragmatic pressure produced by a diaphragm twitch and its counterpart produced by the underlying diaphragm contraction is not unequivocal. If twitch interpolation is interpreted as reflecting motoneuron recruitment, this study supports motor reorganization compatible with “diaphragm sparing” when an inspiratory threshold load becomes sustained.
Published: 2016

246. Early diaphragm pacing in patients with amyotrophic lateral sclerosis (RespiStimALS): a randomised controlled triple-blind trial

Author: Christophe Perrin, Marie-Cécile Niérat, Thomas Similowski, Jésus Gonzalez-Bermejo, Philippe Couratier, Catherine Fargeot, Claude Desnuelle, Capucine Morélot-Panzini, Marie-Laure Tanguy, Timothée Lenglet, Gaëlle Bruneteau, Catherine Royer, Valérie Attali, Vincent Meininger, François Salachas, Nathalie Guy, Nadine Le Forestier, Pierre-François Pradat, Hélène Prigent, and Fabrice Menegaux
Subjects: Male, medicine.medical_specialty, Population, Diaphragm, Electric Stimulation Therapy, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, medicine, Humans, Respiratory system, education, Phrenic nerve, Aged, education.field_of_study, business.industry, Amyotrophic Lateral Sclerosis, Middle Aged, Respiration Disorders, Respiration, Artificial, Hypoventilation, Diaphragm (structural system), Surgery, Phrenic Nerve, Diaphragm pacing, 030228 respiratory system, Respiratory failure, Anesthesia, Early Termination of Clinical Trials, Female, Laparoscopy, Neurology (clinical), medicine.symptom, business, Respiratory Insufficiency, 030217 neurology & neurosurgery
Abstract: Summary Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with respiratory muscle weakness and respiratory failure. Non-invasive ventilation alleviates respiratory symptoms and prolongs life, but is a palliative intervention. Slowing the deterioration of diaphragm function before respiratory failure would be desirable. We aimed to assess whether early diaphragm pacing could slow down diaphragm deterioration and would therefore delay the need for non-invasive ventilation. Methods We did a multicentre, randomised, controlled, triple-blind trial in patients with probable or definite ALS in 12 ALS centres in France. The main inclusion criterion was moderate respiratory involvement (forced vital capacity 60–80% predicted). Other key eligibility criteria were age older than 18 years and bilateral responses of the diaphragm to diagnostic phrenic stimulation. All patients were operated laparoscopically and received phrenic stimulators. Clinicians randomly assigned patients (1:1) to receive either active or sham stimulation with a central web-based randomisation system (computer-generated list). Investigators, patients, and an external outcome allocation committee were masked to treatment. The primary outcome was non-invasive ventilation-free survival, analysed in the intention-to-treat population. Safety outcomes were also assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01583088. Findings Between Sept 27, 2012, and July 8, 2015, 74 participants were randomly assigned to receive either active (n=37) or sham (n=37) stimulation. On July 16, 2015, an unplanned masked analysis was done after another trial showed excess mortality with diaphragm pacing in patients with hypoventilation (DiPALS, ISRCTN 53817913). In view of this finding, we analysed mortality in our study and found excess mortality (death from any cause) in our active stimulation group. We therefore terminated the study on July, 16, 2015. Median non-invasive ventilation-free survival was 6·0 months (95% CI 3·6–8·7) in the active stimulation group versus 8·8 months (4·2–not reached) in the control (sham stimulation) group (hazard ratio 1·96 [95% CI 1·08–3·56], p=0·02). Serious adverse events (mainly capnothorax or pneumothorax, acute respiratory failure, venous thromboembolism, and gastrostomy) were frequent (24 [65%] patients in the active stimulation group vs 22 [59%] patients in the control group). No treatment-related death was reported. Interpretation Early diaphragm pacing in patients with ALS and incipient respiratory involvement did not delay non-invasive ventilation and was associated with decreased survival. Diaphragm pacing is not indicated at the early stage of the ALS-related respiratory involvement. Funding Hospital Program for Clinical Research, French Ministry of Health; French Patients' Association for ALS Research (Association pour la Recherche sur la Sclerose Laterale Amyotrophique); and Thierry de Latran Foundation.
Published: 2016

247. Nefopam, a non-opioid analgesic, does not alleviate experimental work/effort dyspnoea in healthy humans: A randomised controlled trial

Author: Capucine Morélot-Panzini, Beny Charbit, Louis Laviolette, Thomas Similowski, and Laurence Dangers
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, Visual Analog Scale, Visual analogue scale, Analgesic, law.invention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Nefopam, Quality of life, Randomized controlled trial, Double-Blind Method, law, Medicine, Humans, Pharmacology (medical), Young adult, Evoked Potentials, Cross-Over Studies, business.industry, Biochemistry (medical), respiratory system, Analgesics, Non-Narcotic, Crossover study, respiratory tract diseases, Dyspnea, 030228 respiratory system, Anesthesia, Morphine, Quality of Life, business, 030217 neurology & neurosurgery, Inspiratory Capacity, medicine.drug
Abstract: Dyspnoea is a distressing and debilitating symptom with a major impact on quality of life. Alleviation of dyspnoea therefore constitutes a major clinical challenge. When causative physiological disorders cannot be corrected ("persistent dyspnoea"), nonspecific treatment must be considered. Morphine alleviates dyspnoea but has numerous side-effects including ventilatory depression, which justifies looking for alternatives. Certain forms of dyspnoea involve C-fibres, and can be attenuated by C-fibres blockade. We hypothesised that nefopam, a non-sedative benzoxazocine analgesic known to block the transient receptor potential vanilloid subtype 1 abundantly present on C-fibres, would attenuate dyspnoea.We conducted a randomised, double-blind, placebo-controlled crossover study of nefopam in healthy subjects submitted to experimental work/effort dyspnoea by inspiratory threshold loading (15 healthy male volunteers; age 23-41). We studied a perceptual outcome (dyspnoea visual analogue scale -D-VAS-) and a neurophysiological outcome (effect of nefopam on dyspnoea-pain counter-irritation as assessed by laser-evoked potentials; an effect of nefopam on dyspnoea was hypothetised to reduce the ability of dyspnoea to inhibit pain). Somaesthetic evoked potentials (SEPs) were studied as a control.A statistically significant decrease in LEP amplitude was observed in response to loading with nefopam (F = 19.1; p 0.001) and placebo (F = 5.73 and p 0.001), with no significant difference between nefopam and placebo and no change in SEP characteristics.In this study, nefopam did not exhibit any effects on dyspnoea.
Published: 2016

248. Differential Perceptions of Noninvasive Ventilation in Intensive Care among Medical Caregivers, Patients, and Their Relatives: A Multicenter Prospective Study-The PARVENIR Study

Author: Matthieu, Schmidt, Emmanuelle, Boutmy-Deslandes, Sébastien, Perbet, Nicolas, Mongardon, Martin, Dres, Keyvan, Razazi, Emmanuel, Guerot, Nicolas, Terzi, Pierre, Andrivet, Mikael, Alves, Romain, Sonneville, Christophe, Cracco, Vincent, Peigne, Francois, Collet, Benjamin, Sztrymf, Cedric, Rafat, Danielle, Reuter, Xavier, Fabre, Vincent, Labbe, Guillaume, Tachon, Clémence, Minet, Matthieu, Conseil, Elie, Azoulay, Thomas, Similowski, and Alexandre, Demoule
Subjects: Adult, Male, Inpatients, Noninvasive Ventilation, Critical Care, Attitude of Health Personnel, Nurses, Intensive Care Units, Physicians, Surveys and Questionnaires, Humans, Family, Female, Prospective Studies, Respiratory Insufficiency
Abstract: Noninvasive ventilation (NIV) requires a close "partnership" between a conscious patient and the patient's caregivers. Specific perceptions of NIV stakeholders and their impact have been poorly described to date. The objectives of this study were to compare the perceptions of NIV by intensive care unit (ICU) physicians, nurses, patients, and their relatives and to explore factors associated with caregivers' willingness to administer NIV and patients' and relatives' anxiety in relation to NIV.This is a prospective, multicenter questionnaire-based study.Three hundred and eleven ICU physicians, 752 nurses, 396 patients, and 145 relatives from 32 ICUs answered the questionnaire. Nurses generally reported more negative feelings and more frequent regrets about providing NIV (median score, 3; interquartile range, [1 to 5] vs. 1 [1 to 5]; P0.0001) compared to ICU physicians. Sixty-four percent of ICU physicians and only 32% of nurses reported a high level of willingness to administer NIV, which was independently associated with NIV case-volume and workload. A high NIV session-related level of anxiety was observed in 37% of patients and 45% of relatives. "Dyspnea during NIV," "long NIV session," and "the need to have someone at the bedside" were identified as independent risk factors of high anxiety in patients.Lack of willingness of caregivers to administer NIV and a high level of anxiety of patients and relatives in relation to NIV are frequent in the ICU. Most factors associated with low willingness to administer NIV by nurses or anxiety in patients and relatives may be amenable to change. Interventional studies are now warranted to evaluate how to reduce these risk factors and therefore contribute to better management of a potentially traumatic experience. (Anesthesiology 2016; 124:1347-59).
Published: 2016

249. Relieving dyspnoea by non-invasive ventilation decreases pain thresholds in amyotrophic lateral sclerosis

Author: Louis Laviolette, Thomas Similowski, Jésus Gonzalez-Bermejo, Capucine Morélot-Panzini, Marjolaine Georges, Isabelle Rivals, Laurence Dangers, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval [Québec] (ULaval), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL), and MORELOT-PANZINI, Capucine
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, Pain Threshold, Visual analogue scale, [SDV]Life Sciences [q-bio], Deltoid curve, 03 medical and health sciences, 0302 clinical medicine, Sensation, Medicine, Humans, Pain Management, In patient, Perception of Asthma/Breathlessness, Respiratory system, Amyotrophic lateral sclerosis, Aged, Pain Measurement, Noninvasive Ventilation, business.industry, Amyotrophic Lateral Sclerosis, Non invasive ventilation, Middle Aged, medicine.disease, [SDV] Life Sciences [q-bio], Dyspnea, 030228 respiratory system, Respiratory failure, Anesthesia, Breathing, Female, France, business, 030217 neurology & neurosurgery
Abstract: International audience; Background: Dyspnoea is a threatening sensation of respiratory discomfort that presents many similarities with pain. Experimental dyspnoea in healthy subjects induces analgesia. This 'dyspnoea-pain counter-irritation' could, in reverse, imply that relieving dyspnoea in patients with chronic respiratory diseases would lower their pain thresholds.Methods: We first determined pressure pain thresholds in 25 healthy volunteers (22-31 years; 13 men; handheld algometer), during unloaded breathing (BASELINE) and during inspiratory threshold loading (ITL). Two levels of loading were used, adjusted to induce dyspnoea self-rated at 60% or 80% of a 10 cm visual analogue scale (ITL6 and ITL8). 18 patients with chronic respiratory failure due to amyotrophic lateral sclerosis (ALS) were then studied during unassisted breathing and after 30 and 60 min of non-invasive ventilation-NIV30 and NIV60-(same dyspnoea evaluation).Results: In healthy volunteers, pressure pain thresholds increased significantly in the deltoid during ITL6 (p
Published: 2016

250. Long-lasting bradypnea induced by repeated social defeat

Author: Thomas Similowski, Pascal Carrive, Jean-Jacques Benoliel, Françoise Camus, Caroline Sévoz-Couche, Charly Brouillard, Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-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 of New South Wales [Sydney] (UNSW), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC)-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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), HAL-UPMC, Gestionnaire, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, Elevated plus maze, Respiratory rate, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Physiology, Population, Bradypnea, 030204 cardiovascular system & hematology, Anxiety, Social defeat, Rats, Sprague-Dawley, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, Physiology (medical), Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Animals, education, Social Behavior, education.field_of_study, Behavior, Animal, business.industry, Hypoventilation, Rats, Endocrinology, Hypothalamus, Anesthesia, Breathing, Serotonin, medicine.symptom, business, 030217 neurology & neurosurgery, Stress, Psychological
Abstract: Repeated social defeat in the rat induces long-lasting cardiovascular changes associated with anxiety. In this study, we investigated the effects of repeated social defeat on breathing. Respiratory rate was extracted from the respiratory sinus arrhythmia (RSA) peak frequency of the ECG in rats subjected to social defeat for 4 consecutive days. Respiratory rate was recorded under anesthesia 6 days (D+10) or 26 days (D+30) after social defeat. At D+10, defeated (D) rats spent less time in the open arms of the elevated plus maze test, had heavier adrenal glands, and displayed bradypnea, unlike nondefeated animals. At D+30, all signs of anxiety had disappeared. However, one-half of the rats still displayed bradypnea (DL rats, for low respiratory rate indicated by a lower RSA frequency), whereas those with higher respiratory rate (DH rats) had recovered. Acute blockade of the dorsomedial hypothalamus (DMH) or nucleus tractus solitarii (NTS) 5-HT3 receptors reversed bradypnea in all D rats at D+10 and in DL rats at D+30. Respiratory rate was also recorded in conscious animals implanted with radiotelemetric ECG probes. DH rats recovered between D+10 and D+18, whereas DL rats remained bradypneic until D+30. In conclusion, social stress induces sustained chronic bradypnea mediated by DMH neurons and NTS 5-HT3 receptors. These changes are associated with an anxiety-like state that persists until D+10, followed by recovery. However, bradypnea may persist in one-half of the population up until D+30, despite apparent recovery of the anxiety-like state.
Published: 2016

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