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1. Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage

Author

Bay, Pierre, Fihman, Vincent, Woerther, Paul-Louis, Peiffer, Bastien, Gendreau, Ségolène, Arrestier, Romain, Labedade, Pascale, Moncomble, Elsa, Gaillet, Antoine, Carteaux, Guillaume, de Prost, Nicolas, Mekontso Dessap, Armand, and Razazi, Keyvan

Published
2024
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4. Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage

Author

Pierre Bay, Vincent Fihman, Paul-Louis Woerther, Bastien Peiffer, Ségolène Gendreau, Romain Arrestier, Pascale Labedade, Elsa Moncomble, Antoine Gaillet, Guillaume Carteaux, Nicolas de Prost, Armand Mekontso Dessap, and Keyvan Razazi

Subjects
Ventilator-associated pneumonia, Multiplex PCR, Antimicrobial stewardship, ESBL, Nosocomial pneumonia, Carbapenem, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP) in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) carriers is challenging. BioFire® FilmArray® Pneumonia plus Panel (mPCR) can detect bacteria and antibiotic resistance genes, including bla CTX-M, the most common ESBL-encoding gene. Methods This monocentric, prospective study was conducted on a group of ESBL-E carriers from March 2020 to August 2022. The primary objective was to evaluate the concordance between the results of mPCR and conventional culture performed on respiratory samples of ESBL-E carriers to investigate suspected VAP/vHAP. The secondary objective was to appraise the impact of performing or not mPCR on initial antibiotic therapy adequacy in ESBL-E carriers with confirmed VAP/vHAP. Results Over the study period, 294 patients with ESBL-E carriage were admitted to the ICU, of who 168 (57%) were mechanically ventilated. (i) Diagnostic performance of mPCR was evaluated in suspected 41 episodes of VAP/vHAP: bla CTX-M gene was detected in 15/41 (37%) episodes, where 9/15 (60%) were confirmed ESBL-E-induced pneumonia. The culture and bla CTX-M were concordant in 35/41 (85%) episodes, and in all episodes where bla CTX-M was negative (n = 26), the culture never detected ESBL-E. (ii) The impact of mPCR on initial antibiotic therapy adequacy was assessed in 95 episodes of confirmed VAP/vHAP (22 episodes were tested with mPCR and 73 without); 47 (49%) episodes were ESBL-E-induced, and 24 (25%) were carbapenem-resistant bacteria-induced. The use of mPCR was significantly associated with higher prescription of adequate empirical antibiotic therapy in the multivariable logistic regression (adjusted odds ratio (aOR) (95% CI) of 7.5 (2.1–35.9), p = 0.004), propensity-weighting (aOR of 5.9 (1.6–22.1), p = 0.008), and matching-cohort models (aOR of 5.8 (1.5–22.1), p = 0.01). Conclusion mPCR bla CTX-M showed an excellent diagnostic value to rule out the diagnosis of ESBL-E related pneumonia in ESBL-E carriers with suspected VAP/vHAP. In addition, in patients with confirmed VAP/vHAP, a mPCR-based antibiotic therapy was associated with an increased prescription of adequate empirical antibiotic therapy. Performing mPCR on respiratory samples seems to be a promising tool in ESBL-E carriers with suspected vHAP/VAP. However, if mPCR is used in very low pre-test clinical probability of pneumonia, due to the high sensitivity and the rate of overdiagnosed pneumonia, the risk of overconsumption of carbapenem may prevail. Further studies are warranted.

Published
2024
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10. SARS-CoV-2 variants and mutational patterns: relationship with risk of ventilator-associated pneumonia in critically ill COVID-19 patients in the era of dexamethasone

Author

Razazi, Keyvan, Martins Bexiga, Anissa, Arrestier, Romain, Peiffer, Bastien, Voiriot, Guillaume, Luyt, Charles-Edouard, Urbina, Tomas, Mayaux, Julien, Pham, Tài, Roux, Damien, Bellaiche, Raphael, AIt Hamou, Zakaria, Gaudry, Stéphane, Azoulay, Elie, Mekontso Dessap, Armand, Rodriguez, Christophe, Pawlotsky, Jean-Michel, Fourati, Slim, and de Prost, Nicolas

Published
2023
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11. Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Author

Bourcier, Simon, Coutrot, Maxime, Ferré, Alexis, Van Grunderbeeck, Nicolas, Charpentier, Julien, Hraiech, Sami, Azoulay, Elie, Nseir, Saad, Aissaoui, Nadia, Messika, Jonathan, Fillatre, Pierre, Persichini, Romain, Carreira, Serge, Lautrette, Alexandre, Delmas, Clément, Terzi, Nicolas, Mégarbane, Bruno, Lascarrou, Jean-Baptiste, Razazi, Keyvan, Repessé, Xavier, Pichereau, Claire, Contou, Damien, Frérou, Aurélien, Barbier, François, Ehrmann, Stephan, de Montmollin, Etienne, Sztrymf, Benjamin, Morawiec, Elise, Bigé, Naïke, Reuter, Danielle, Schnell, David, Ellrodt, Olivier, Dellamonica, Jean, Combes, Alain, and Schmidt, Matthieu

Published
2023
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12. Restrictive use of Restraints and Delirium Duration in the Intensive Care Unit (R2D2-ICU): protocol for a French multicentre parallel-group open-label randomised controlled trial

Author

Jean-François Timsit, Damien Contou, Julien Schmidt, Carine Roy, Romain Sonneville, Lila Bouadma, Armand Mekontso Dessap, Michel Djibré, Camille Couffignal, Juliette Audibert, Pierre Jaquet, Virginie Godard, Romane Bellot, Fariza Lamara, Tchoubou Tona, Florian Sigaud, Adam Celier, Claire Bourel, Fatiha Essardy, Renaud Cornic, ABGRALL Gwenole, ARRESTIER Romain, AUDIBERT Juliette, AUGY Jean loup, BAGATE François, BAY Pierre, BEGOT Erwan, BEN SALAH Adel, BENELLI Brice, BERTI Enora, BERTIER Astrid, BEURTON Alexandra, BILLIET Pierre-Antoine, BOUADMA Lila, BOUGNAUD Joanna, BOUILLAND Anne Laure, BOUJELBEN Mohamed, BUREAU Côme, CANDILLE Clara, CARIOU Erwann, CARTEAUX Guillaume, CATANO Jenifer, CAVALEIRO Pedro, CELIER Adam, CHAFIOTTE Pierre, CIRILLO Giulia, CLERC Sébastien, CONIA Alexandre, CORDIER Charlotte, COUPRY Louis-Marie, DA SILVA Daniel, DARTEVEL Anais, DE MONTMOLLIN Etienne, DE MONTMOLLIN Nina, DE PROST Nicolas, DECAVELE Maxens, DELERIS Robin, DEMOULE Alexandre, DESNOS Cyrielle, DESSAJAN Julien, DIEMOZ Marie-Claire, DO REGO Hermann, DO VALE Julien, DRES Martin, DUFRANC Etienne, EJZENBERG Michael, ELABBADI Alexandre, FLOCH Pierre Edouard, FOSSE Quentin, FRAPARD Thomas, GAILLET Antoine, GALERNEAU Louis-Marie, GENDREAU Ségolène, GONCALVES CAVALEIRO Pedro, GONTIER Olivier, HAMROUNI Mouldi, HAUDEBOURG Anne-Fleur, HAUDEBOURG Luc, JOLLY Florian, LA MAREC Julien, LABEDADE Pascale, LAVILLEGRAND Jean-Rémi, LECRONIER Marie, LOPINTO Julien, MASI Paul, MAYAUX Julien, MENAT Sophie, MONCOMBLE Elsa, MORAWIEC Elise, NAGLE Sophie, NEMLAGHI Safaa, PICARD Benjamin, PICHON Jeremie, PLAIS Henri, RAZAZI Keyvan, RIGAULT Guillaume, SIGAUD Florian, SONNEVILLE Romain, THY Michael, TIMSIT Jean-François, TUFFET Samuel, TURPIN Matthieu, VINCENT Xavier, VOIRIOT Guillaume, WICKY Paul-Henri, and WINDSOR Camille

Subjects
Medicine
Abstract

Introduction Physical restraint (PR) is prescribed in patients receiving invasive mechanical ventilation in the intensive care unit (ICU) to avoid unplanned removal of medical devices. However, it is associated with an increased risk of delirium. We hypothesise that a restrictive use of PR, as compared with a systematic use, could reduce the duration of delirium in ICU patients receiving invasive mechanical ventilation.Methods and analysis The Restrictive use of Restraints and Delirium Duration in ICU (R2D2-ICU) study is a national multicentric, parallel-group, randomised (1:1) open-label, controlled, superiority trial, which will be conducted in 10 ICUs. A total of 422 adult patients requiring invasive mechanical ventilation for an expected duration of at least 48 hours and eligible for prescription of PR will be randomly allocated within 6 hours from intubation to either the restrictive PR use group or the systematic PR use group, until day 14, ICU discharge or death, whichever comes first. In both groups, PR will consist of the use of wrist straps. The primary endpoint will be delirium or coma-free days, defined as the number of days spent alive in the ICU without coma or delirium within the first 14 days after randomisation. Delirium will be assessed using the Confusion Assessment Method-ICU twice daily. Key secondary endpoints will encompass agitation episodes, opioid, propofol, benzodiazepine and antipsychotic drug exposure during the 14-day intervention period, along with a core outcome set of measures evaluated 90 days postrandomisation.Ethics and dissemination The R2D2-ICU study has been approved by the Comité de Protection des Personnes (CPP) ILE DE FRANCE III—PARIS (CPP19.09.06.37521) on June 10th, 2019). Participant recruitment started on 25 January 2021. Results will be published in international peer-reviewed medical journals and presented at conferences.Trial registration number NCT04273360.

Published
2024
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13. In-hospital outcomes after acute myocardial infarction with obstructive coronary artery disease in critically ill patients hospitalized for non-cardiac disease

Author

Morgan Roué, Alexis F. Guédon, Nathanaël Lapidus, Keyvan Razazi, Geoffroy Hariri, Elise Morawiec, Cyrielle Desnos, Stéphane Ederhy, Ariel Cohen, Armand Mekontso Dessap, Muriel Fartoukh, and Vincent Labbé

Subjects
Acute myocardial infarction, Intensive care unit, Ischemic risk, Bleeding risk, Outcomes, Coronary artery disease, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Acute myocardial infarction (AMI) is one of the major cardiac complications in patients hospitalized in the intensive care unit (ICU) for non-cardiac disease. A better knowledge of ischemic and bleeding risks in these patients is needed to identify those most likely to benefit from specific cardiac management. We therefore assessed the incidence and predictors of a composite outcome of severe ischemic event (AMI recurrence, ischemic stroke), major bleeding, or all-cause death in this setting. Methods In this multicenter retrospective study, all consecutive adult patients admitted for non-cardiac disease to four French university hospital ICUs between January 2012 and December 2018 who had an AMI with obstructive coronary artery disease (OCAD) during the ICU stay were considered for inclusion. AMI with OCAD was defined as an elevated cardiac troponin value associated with at least one sign (clinical, electrocardiographic, or echocardiographic) suggestive of myocardial ischemia and presence of OCAD on coronary angiography. The primary endpoint was in-hospital occurrence of the composite outcome. Results Ninety-six patients [median age 69 years, 22 women (23%), 59 with sepsis (61%), 35 with ST elevation (37%), median sequential organ failure assessment (SOFA) of 8 on the day of AMI] were included. The median peak cardiac troponin value was 131 (IQR 44–303) times the upper reference limit. Dual antiplatelet, therapeutic anticoagulation, and early mechanical reperfusion therapies were administered in 61 (64%), 68 (71%), and 47 (49%) patients, respectively. The composite outcome occurred in 48 (50%) patients. Severe ischemic events occurred in 17 (18%) patients and major bleeding in 26 (27%) patients; 26 patients (27%) died in the hospital. AMI management was not significantly different in patients with and without the composite outcome. A history of arterial hypertension (HR 2.05, 95% CI 1.01–4.16) and high SOFA score at the time of AMI (HR 1.07, 95% CI 1.00–1.15) were independent risk factors for the composite outcome. Conclusions Patients who have an AMI with OCAD during an ICU stay for non-cardiac disease are at risk of a composite outcome of severe ischemia, major bleeding, and death. A history of arterial hypertension and high SOFA scores were independent hazards for poor prognosis. Graphical Abstract

Published
2023
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14. Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial

Author

Djillali, ANNANE, Christian, BRUN-BUISSON, Benoit, MISSET, Jean, CHASTRE, François, BRIVET, Julien, BOHE, Carole, SCHWEBEL, Shidasp, SIAMI, Michel, SLAMA, Olivier, LEROY, Gilles, CAPELLIER, Michel, WOLFF, Mohamed, ALI BEN ALI, François, ANTONINI, Jean-François, LORIFERNE, Franck, PETITPAS, Claire, CHARPENTIER, Jean-Michel, CONSTANTIN, Gilles, D'HONNEUR, Bertrand, SOUWEINE, Xavier, FORCEVILLE, Bruno, MEGARBANE, Francois, BAUDIN, Gwenhaël, COLIN, Karim, ASEHNOUNE, Jean-Pierre, QUENOT, Bruno, FRANCOIS, Thierry, BOULAIN, Emmanuelle, MERCIER, Jean, REIGNIER, Roland, AMATHIEU, Fabrice, COOK, Alain, CARIOU, Loic, CHIMOT, Fouad, Fadel, Andrea, Polito, Bernard, Clair, Virginie, Maxime, David, Luis, Tarek, Sharshar, David, Orlikowski, Keyvan, RAZAZI, Nicolas, DE PROST, Guillaume, CARTEAUX, Maité, GARROUSTE ORGEAS, François, Philippart, Alain, Combes, Ania, Nieszkowska, Frederic, Jacobs, Dominique, Prat, Patrick, Lafforgue, Claire, ARA SOMOHANO, Clémence, MINET, Maxime, LUGOSI, Julien, Maizel, Jean Christophe, Navellou, Bruno, Mourvillier, Lila, Bouadma, Jean François, Timsit, Claude Denis, Martin, Julien, Textoris, Sandrine, Wiramus, Clément, BRUN, Benoît, RAGONNET, Ali, Ait-Hssain, Samia, Touati, Jean, Kuba, Vincent, Willems, Pierre, Lahillaire, Mohammed, Lassi, Marion, ANTONA, Alia, MEGHENEM, Marine, DEMESMAY, Eric, Boulet, Olivier, LOUTREL, Romain, DUMONT, Antoine, ROQUILLY, Pierre-Joachim, MAHE, Dominique, DEMEURE dit LATTE, Philippe, CHAMPIN, Jean François, ARNOULD, Raphaël, CINOTTI, Ronan, Le FLOCH, Marc, Clavel, Philippe, Vignon, Nicolas, Pichon, Emmanuelle, BEGOT, Anne-Laure, FEDOU, Catherine, CHAPELLAS, Antoine, GALY, Dalila, Benzekri Lefevre, Armelle, Mathonnet, Anne, Bretagnol, Isabelle, Runge, François, BARBIER, Grégoire, MULLER, Denis, GAROT, Pierre François, DEQUIN, Dominique, PERROTIN, Annick, LEGRAS, Julie, MANKIKIAN, Patrice, TALEC, Stephan, EHRMANN, Aurélie, JORET, Claire, LHOMMET, Emmanuelle, ROUVE, Laetitia, BODET-CONTENTIN, Youenn, JOUAN, Charlotte, SALMONGANDONNIERE, Laurent, MARTIN-LEFEVRE, Matthieu, HENRY-LAGARRIGUE, Aihem, YEHIA, Jean-Baptiste, LASCARROU, Christine, LEBERT, Jean-Claude, LACHERADE, Eric, LEVESQUE, Yen-Lan, NGUYEN, Fabrice, DAVIAUD, Adrien, BOUGLE, Jean Paul, MIRA, Jean Daniel, CHICHE, Frederic, PENE, Tristan, MORICHAU-BEAUCHANT, Guillaume, GERI, Pierre Henri, DESSALLES, Yannick, MONSEAU, Mélanie, SAINT-LEGER, Sandrine, BEDON-CARTE, Laetitia, Bodet-Contentin, Walid, Darwiche, Stephan, Ehrmann, Denis, Garot, Antoine, Guillon, Youenn, Jouan, Annick, Legras, Julie, Mankikian, Emmanuelle, Mercier, Marlene, Morisseau, Yonatan, Perez, Emmanuelle, Rouve, Charlotte, Salmon-Gandonniere, Julie, Helms, Hassene, Rahmani, Alexandra, Monnier, Hamid, Merdji, Raphael, Clere-Jehl, Laure, Stiel, Antoine, Studer, Pascal, Andreu, Jean-Baptiste, Roudaut, Marie, Labruyere, Marine, Jacquier, Francois, Barbier, Dalila, Benzekri, Thierry, Boulain, Sophie, Jacquier, Gregoire, Muller, Mai-Anh, Nai, Sophie, Tollec, Damien, Roux, Jonathan, Messika, Constance, Vuillard, Louis-Marie, Dumont, Laura, Federici, Noemie, Zucman, Marc, Amouretti, Djillali, Annane, Pierre, Moine, Paris, Meng, Rania, Bounab, Muriel-Sarah, Fartoukh, Michel, Djibre, Alexandre, Elabbadi, Marie-Ange, Azais, Konstantinos, Bachoumas, Arthur, Bailly, Remi, Bernardon, Gauthier, Blonz, Luc, Desmedt, Brian, Emonet, Maud, Fiancette, Matthieu, Henry, Jean-Claude, Lacherade, Jean-Baptiste, Lascarrou, Christine, Lebert, Julien, Lorber, Laurent Martin-, Lefevre, Caroline, Pouplet, Isabelle, Vinatier, Aihem, Yehia, Sarah, Benghanem, Julien, Charpentier, Clara, Vigneron, Anne-Laure, Fedou, Claire, Mancia, Emmanuelle, Begot, Thomas, Daix, Antoine, Galy, Celine, Gonzalez, Marine, Goudelin, Bruno, Evrard, Arnaud, Desachy, Julien, Vaidie, Guillaume, Gilbert, Cedric, Darreau, Benoit, Derrien, Marjorie, Saint-Martin, Patrice, Tirot, Mickael, Landais, Nicolas, Chudeau, Jean Christophe, Callahan, Dominique, Vivier, Charlene, Le Moal, Pierre-Yves, Olivier, Remy, Marnai, Francis, Schneider, Nicolas, Sedillot, Xavier, Tchenio, Adrien, Robine, Yves, Poncelin, Remi, Bruyere, Heming, Nicholas, Renault, Alain, Kuperminc, Emmanuelle, Brun-Buisson, Christian, Megarbane, Bruno, Quenot, Jean-Pierre, Siami, Shidasp, Cariou, Alain, Forceville, Xavier, Schwebel, Carole, Leone, Marc, Timsit, Jean-Francois, Misset, Benoît, Benali, Mohamed Ali, Colin, Gwenhael, Souweine, Bertrand, Asehnoune, Karim, Mercier, Emmanuelle, Chimot, Loïc, Charpentier, Claire, François, Bruno, Boulain, Thierry, Petitpas, Frank, Constantin, Jean Michel, Dhonneur, Gilles, Baudin, François, Combes, Alain, Bohé, Julien, Loriferne, Jean-François, Cook, Fabrice, Slama, Michel, Leroy, Olivier, Capellier, Gilles, Dargent, Auguste, Hissem, Tarik, Bounab, Rania, Maxime, Virginie, Moine, Pierre, Bellissant, Eric, and Annane, Djillali

Published
2024
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15. Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study

Author

Tabah, Alexis, Lipman, Jeffrey, Pollock, Hamish, Ben Margetts, Udy, Andrew, Young, Meredith, Bhadange, Neeraj, Tyler, Steven, Ledtischke, Anne, Finnis, Mackenzie, Dwivedi, Jyotsna, Saxena, Manoj, Biradar, Vishwanath, Soar, Natalie, Sarode, Vineet, Brewster, David, Regli, Adrian, Weeda, Elizabeth, Ahmed, Samiul, Fourie, Cheryl, Laupland, Kevin, Ramanan, Mahesh, Walsham, James, Meyer, Jason, Litton, Edward, Maria Palermo, Anna, Yap, Timothy, Eroglu, Ege, George Attokaran, Antony, Jaramillo, C'havala, Nafees, Khalid Mk, Nafees, Khalid Mahmood Khan, Aqilah Haji Abd Rashid, Nurhikmahtul, Adi Muhamad Ibnu Walid, Haji, Mon, Tomas, Dhakshina Moorthi, P., Sudhirchandra, Shah, Sridharan, Dhadappa Damodar, Haibo, Qiu, Xie, Jianfeng, Jianfeng, Xie, Wei-Hua, Lu, Zhen, Wang, Qian, Chuanyun, Luo, Jili, Chen, Xiaomei, Wang, Hao, Zhao, Peng, Zhao, Juan, Wusi, Qiu, Mingmin, Chen, Xu, Lei, Yin, Chengfen, Wang, Ruilan, Wang, Jinfeng, Yin, Yongjie, Zhang, Min, Ye, Jilu, Hu, Chungfang, Zhou, Suming, Huang, Min, Yan, Jing, Wang, Yan, Qin, Bingyu, Ye, Ling, Weifeng, Xie, Peije, Li, Geng, Nan, Ling, Lowell, Hayashi, Yoshiro, Karumai, Toshiyuki, Yamasaki, Masaki, Hashimoto, Satoru, Hosokawa, Koji, Makino, Jun, Matsuyoshi, Takeo, Kuriyama, Akira, Shigemitsu, Hidenobu, Mishima, Yuka, Nagashima, Michio, Yoshida, Hideki, Fujitani, Shigeki, Omori, Koichiro, Rinka, Hiroshi, Saito, Hiroki, Atobe, Kaori, Kato, Hideaki, Takaki, Shunsuke, Sulaiman, Helmi, Shahnaz Hasan, M., Fadhil Hadi Jamaluddin, Muhamad, Pheng, Lee See, Visvalingam, Sheshendrasurian, Thing Liew, Mun, Ling Danny Wong, Siong, Khang Fong, Kean, Bt Abdul Rahman, Hamizah, Md Noor, Zuraini, Lee, Kok Tong, Hamid Azman, Abd., Zulfakar Mazlan, Mohd, Ali, Saedah, Hernandez, Aaron Mark, Abello, Anton, Jeon, Kyeongman, Lee, Sang-Min, Park, Sunghoon, Park, Seung Yong, Yoon Lim, Sung, Kwa, Andrea Lay Hoon, Yuan Goh, Qing, Ng, Shin Yi, An Lie, Sui, Junyang Goh, Ken, Yunkai Li, Andrew, Ong, Caroline Yu Ming, Yan Lim, Jia, Lishan Quah, Jessica, Ng, Kangqi, Xiang Long Ng, Louis, Yeh, Tony Yu-Chang, Chang Yeh, Yu, Chou, Nai-Kuan, Cia, Cong-Tat, Hu, Ting-Yu, Kuo, Li-Kuo, Ku, Shih-Chi, Wongsurakiat, Phunsup, Apichatbutr, Yutthana, Chiewroongroj, Supattra, Alsisi, Adel, Nadeem, Rashid, El Houfi, Ashraf, Elhadidy, Amr, Barsoum, Mina, Osman, Nermin, Mostafa, Tarek, Elbahnasawy, Mohamed, Saber, Ahmed, Aldhalia, Amer, Elmandouh, Omar, Elsayed, Ahmed, Elbadawy, Merihan A., Awad, Ahmed K., Hemead, Hanan M., Zand, Farid, Ouhadian, Maryam, Hamid Borsi, Seyed, Mehraban, Zahra, Kashipazha, Davood, Ahmadi, Fatemeh, Savaie, Mohsen, Soltani, Farhad, Rashidi, Mahboobeh, Baghbanian, Reza, Javaherforoosh, Fatemeh, Amiri, Fereshteh, Kiani, Arash, Amin Zargar, Mohammad, Mahmoodpoor, Ata, Aalinezhad, Fatemeh, Dabiri, Gholamreza, Sabetian, Golnar, Sarshad, Hakimeh, Masjedi, Mansoor, Tajvidi, Ramin, Nasirodin (S.M.N.) Tabatabaei, Dr Seyed Mohammad, Ahmed, Abdullah Khudhur, Singer, Pierre, Kagan, Ilya, Rigler, Merav, Belman, Daniel, Levin, Phillip, Harara, Belal, Diab, Adei, Abillama, Fayez, Abilama, Fayez, Ibrahim, Rebecca, Fares, Aya, Elhadi, Muhammed, Buimsaedah, Ahmad, Gamra, Marwa, Aqeelah, Ahmed, Ali Mohammed Ali, Almajdoub, Gaber Sadik Homaidan, Ahmed, Almiqlash, Bushray, Bilkhayr, Hala, Bouhuwaish, Ahmad, Sa Taher, Ahmed, Abdulwahed, Eman, Abousnina, Fathi A., Khaled Hdada, Aisha, Jobran, Rania, Ben Hasan, Hayat, Shaban Ben Hasan, Rabab, Khalid Abidi, Serghini, Issam, Seddiki, Rachid, Boukatta, Brahim, Kanjaa, Nabil, Mouhssine, Doumiri, Ahmed Wajdi, Maazouzi, Dendane, Tarek, Ali Zeggwagh, Amine, Housni, Brahim, Younes, Oujidi, Hachimi, Abdelhamid, Ghannam, A., Belkhadir, Z., Abu Jayyab, Mustafa, Aithssain, Ali, Lance, Marcus, Nissar, Shaikh, Sallam, Hend, Elrabi, Omar, Almekhlafi, Ghaleb A., Awad, Maher, Aljabbary, Ahmed, Karam Chaaban, Mohammad, Abu-Sayf, Natalia, Al-Jadaan, Mohammad, Bakr, Lubna, Mounir Bouaziz, Bouaziz, Mounir, Turki, Olfa, Sellami, Walid, Vidal, Gabriela, Centeno, Pablo, Morvillo, Natalia, Oscar Acevedo, José, Mabel Lopez, Patricia, Fernández, Rubén, Segura, Matías, Aparicio, Marta, Alonzo, Irene, Nuccetelli, Yanina, Montefiore, Pablo, Arias, Mario, Felipe Reyes, Luis, Ñamendys-Silva, Silvio A., Romero-Gonzalez, Juan P., Hermosillo, Mariana, Alejandro Castillo, Roberto, Nicolás Pantoja Leal, Jesús, Garcia Aguilar, Candy, Ocotlan Gonzalez Herrera, Mara, Vladimir Espinoza Villafuerte, Missael, Lomeli-Teran, Manuel, Dominguez-Cherit, Jose G., Davalos-Alvarez, Adrian, Sánchez-Hurtado, Luis, Tejeda-Huezo, Brigitte, Perez-Nieto, Orlando R., Deloya Tomas, Ernesto, De Bus, Liesbet, De Waele, Jan, Francois, Guy, Hollevoet, Isabelle, Denys, Wouter, Bourgeois, Marc, Vanderhaeghen, Sofie F.M., Mesland, Jean-Baptiste, Henin, Pierre, Haentjens, Lionel, Biston, Patrick, Noel, Cindérella, Layos, Nathalie, Misset, Benoît, De Schryver, Nicolas, Serck, Nicolas, Wittebole, Xavier, De Waele, Elisabeth, Opdenacker, Godelive, Kovacevic, Pedja, Zlojutro, Biljana, Ina, Filipovic-Grcic, Custovic, Aida, Filipovic-Grcic, Ina, Radonic, Radovan, Vujaklija Brajkovic, Ana, Persec, Jasminka, Sakan, Sanja, Nikolic, Mario, Lasic, Hrvoje, Leone, Marc, Timsit, Jean-François, Ruppe, Etienne, Ruckly, Stephane, Montravers, Philippe, Arbelot, Charlotte, Patrier, Juliette, Zappela, N., Montravers, P., Dulac, Thierry, Castanera, Jérémy, Auchabie, Johann, Le Meur, Anthony, Marchalot, A., Beuzelin, M., Massri, Alexandre, Guesdon, Charlotte, Escudier, Etienne, Mateu, Philippe, Rosman, Jérémy, Leroy, Olivier, Alfandari, Serge, Nica, Alexandru, Souweine, Bertrand, Coupez, Elisabeth, Duburcq, Thibault, Kipnis, Eric, Bortolotti, Perrine, Le Souhaitier, Mathieu, Mira, Jean-Paul, Garcon, Pierre, Duprey, Matthieu, Thyrault, Martial, Paulet, Rémi, Philippart, François, Tran, Marc, Bruel, Cédric, Weiss, Emmanuel, Janny, Sylvie, Foucrier, Arnaud, Perrigault, Pierre-François, Djanikian, Flora, Barbier, François, Gainnier, Marc, Bourenne, Jérémy, Louis, Guillaume, Smonig, Roland, Argaud, Laurent, Baudry, Thomas, Mekonted Dessap, Armand, Razazi, Keyvan, Kalfon, Pierre, Badre, Gaëtan, Larcher, Romaric, Lefrant, Jean-Yves, Roger, Claire, Sarton, Benjamine, Silva, Stein, Demeret, Sophie, Le Guennec, Loïc, Siami, Shidasp, Aparicio, Christelle, Voiriot, Guillaume, Fartoukh, Muriel, Dahyot-Fizelier, Claire, Imzi, Nadia, Klouche, Kada, Bracht, Hendrik, Hoheisen, Sandra, Bloos, Frank, Thomas-Rueddel, Daniel, Petros, Sirak, Pasieka, Bastian, Dubler, Simon, Schmidt, Karsten, Gottschalk, Antje, Wempe, Carola, Lepper, Philippe, Metz, Carlos, Viderman, Dmitriy, Umbetzhanov, Yerlan, Mugazov, Miras, Bazhykayeva, Yelena, Kaligozhin, Zhannur, Babashev, Baurzhan, Merenkov, Yevgeniy, Temirov, Talgat, Arvaniti, Kostoula, Smyrniotis, Dimitrios, Psallida, Vasiliki, Fildisis, Georgios, Soulountsi, Vasiliki, Kaimakamis, Evangelos, Iasonidou, Cristina, Papoti, Sofia, Renta, Foteini, Vasileiou, Maria, Romanou, Vasiliki, Koutsoukou, Vasiliki, Kristina Matei, Mariana, Moldovan, Leora, Karaiskos, Ilias, Paskalis, Harry, Marmanidou, Kyriaki, Papanikolaou, M., Kampolis, C., Oikonomou, Marina, Kogkopoulos, Evangelos, Nikolaou, Charikleia, Sakkalis, Anastasios, Chatzis, Marinos, Georgopoulou, Maria, Efthymiou, Anna, Chantziara, Vasiliki, Sakagianni, Aikaterini, Athanasa (Athanassa), Zoi (Zoe), Papageorgiou, Eirini, Ali, Fadi, Dimopoulos, Georges, Panagiota Almiroudi, Mariota, Malliotakis, Polychronis, Marouli, Diamantina, Theodorou, Vasiliki, Retselas, Ioannis, Kouroulas, Vasilios, Papathanakos, Georgios, Bassetti, Matteo, Giacobbe, Daniele, Montrucchio, Giorgia, Sales, Gabriele, De Pascale, Gennaro, Maria Montini, Luca, Carelli, Simone, Vargas, Joel, Di Gravio, Valentina, Roberto Giacobbe, Daniele, Gratarola, Angelo, Porcile, Elisa, Mirabella, Michele, Daroui, Ivan, Lodi, Giovanni, Zuccaro, Francesco, Grazia Schlevenin, Maria, Pelosi, Paolo, Battaglini, Denise, Cortegiani, Andrea, Ippolito, Mariachiara, Bellina, Davide, Di Guardo, Andrea, Pelagalli, Lorella, Covotta, Marco, Rocco, Monica, Fiorelli, Silvia, Cotoia, Antonella, Chiara Rizzo, Anna, Adam Mikstacki, Mikstacki, Adam, Tamowicz, Barbara, Kaptur Komorowska, Irmina, Szczesniak, Anna, Bojko, Jozef, Kotkowska, Anna, Walczak-Wieteska, Paulina, Wasowska, Dominika, Nowakowski, Tomasz, Broda, Hanna, Mariusz Peichota, Assoc, Pietraszek-Grzywaczewska, Iwona, Martin-Loeches, Ignacio, Bisanti, Alessandra, Paiva, José Artur, Póvoa, Pedro, Cartoze, Nuno, Pereira, Tiago, Guimarães, Nádia, Alves, Madalena, Josefina Pinheiro Marques, Ana, Rios Pinto, Ana, Krystopchuk, Andriy, Teresa, Ana, Manuel Pereira de Figueiredo, António, Botelho, Isabel, Duarte, Tiago, Costa, Vasco, Pedro Cunha, Rui, Molinos, Elena, Tito da Costa, Ledo, Sara, Queiró, Joana, Pascoalinho, Dulce, Nunes, Cristina, Pedro Moura, José, Pereira, Énio, Carvalho Mendes, António, Valeanu, Liana, Bubenek-Turconi, Serban, Marina Grintescu, Ioana, Cobilinschi, Cristian, Carmen Filipescu, Daniela, Elena Predoi, Cornelia, Tomescu, Dana, Popescu, Mihai, Marcu, Alexandra, Grigoras, Ioana, Lungu, Olguta, Gritsan, Alexey, Anderzhanova, Anastasia, Meleshkina, Yulia, Magomedov, Marat, Zubareva, Nadezhda, Tribulev, Maksim, Gaigolnik, Denis, Eremenko, Aleksandr, Vistovskaya, Natala, Chukina, Maria, Belskiy, Vladislav, Furman, Mikhail, Ferrer Rocca, Ricard, Martinez, Maria, Casares, Vanessa, Mellado Artigas, Ricard, Vera, Paula, Flores, Matias, Amador Amerigo, Joaquin, Gracia Arnillas, Maria Pilar, Munoz Bermudez, Rosana, Armestar, Fernando, Catalan, Beatriz, Roig, Regina, Raguer, Laura, Dolores Quesada, María, Diaz Santos, Emilio, Gomà, Gemma, Ubeda, Alejandro, Salgado, Maria, Forcelledo Espina, Lorena, Garcia Prieto, Emilio, Asensio, Mj, Rodriguez, M., Maseda, Dr Emilio, Suarez De La Rica, Alejandro, Ignacio Ayestaran, J., Novo, Mariana, Blasco-Navalpotro, Miguel Angel, Orejas Gallego, Alberto, Sjovall, Fredrik, Sjövall, Fredrik, Spahic, Dzana, Johan Svensson, Carl, Haney, Michael, Edin, Alicia, Åkerlund, Joyce, De Geer, Lina, Prazak, Josef, Buetti, Niccolò, Jakob, Stephan, Pagani, Jl, Abed-Maillard, S., Akova, Murat, Tarık Aslan, Abdullah, Tarik Aslan, Abdullah, Timuroglu, Arif, Kocagoz, Sesin, Kusoglu, Hulya, Mehtap, Selcuk, Ceyhun, Solakoğlu, Altintas, Dr. Neriman Defne, Talan, Leyla, Kayaaslan, Bircan, Kaya Kalem, Ayşe, Kurt, Dr. Ibrahim, Telli, Murat, Ozturk, Barcin, Erol, Çiğdem, Dindar Demiray, Emine Kubra, Çolak, Sait, Akbas, Türkay, Dr. Kursat Gundogan, Sari, Ali, Agalar, Canan, Çolak, Onur, Baykam, Nurcan (N), Akdogan, Ozlem (O), Yilmaz, Mesut, Tunay, Burcu, Cakmak, Rumeysa, Saltoglu, Nese, Karaali, Ridvan, Iftihar Koksal, Firdevs Aksoy, Eroglu, Ahmet, Tolga Saracoglu, Kemal, Bilir, Yeliz, Guzeldag, Seda, Ersoz, Gulden, Evik, Guliz, Sungurtekin, Hulya, Ozgen, Cansu, Erdoğan, Cem, Gürbüz, Yunus, Altin, Nilgün, Bayindir, Yasar, Ersoy, Yasemin, Goksu, Senay, Akyol, Ahmet, Dr, Kartal, Batirel, Ayse, Cagan Aktas, Sabahat, Morris, Andrew Conway, Conway Morris, Andrew, Routledge, Matthew, Ercole, Ari, Antcliffe, David, Rojo, Roceld, Tizard, Kate, Faulkner, Maria, Cowton, Amanda, Kent, Melanie, Raj, Ashok, Zormpa, Artemis, Tinaslanidis, George, Khade, Reena, Torlinski, Tomasz, Mulhi, Randeep, Goyal, Shraddha, Bajaj, Manan, Soltan, Marina, Yonan, Aimee, Dolan, Rachael, Johnson, Aimee, Macfie, Caroline, Lennard, James, Templeton, Maie, Sousa Arias, Sonia, Franke, Uwe, Hugill, Keith, Angell, Hollie, Benjamin J Parcell, Cobb, Katherine, Cole, Stephen, Smith, Tim, Graham, Clive, Cerman, Jaroslav, Keegan, Allison, Ritzema, Jenny, Sanderson, Amanda, Roshdy, Ashraf, Szakmany, Tamas, Baumer, Tom, Longbottom, Rebecca, Hall, Daniel, Tatham, Kate, Loftus, S., Husain, A., Black, E., Jhanji, S., Rao Baikady, R., Mcguigan, Peter, Mckee, Rachel, Kannan, Santhana, Antrolikar, Supriya, Marsden, Nicholas, Della Torre, Valentina, Banach, Dorota, Zaki, Ahmed, Jackson, Matthew, Chikungwa, Moses, Attwood, Ben, Patel, Jamie, Rebecca E Tilley, Humphreys, Sally K., Jean Renaud, Paul, Sokhan, Anton, Burma, Yaroslava, Sligl, Wendy, Baig, Nadia, McCoshen, Lorena, Kutsogiannis, Demetrios J., Thompson, Patricia, Hewer, Tayne, Rabbani, Raihan, Huq, Shihan Mahmud Redwanul, Hasan, Rajib, Motiul Islam, Mohammad, Gurjar, Mohan, Baronia, Arvind, Kothari, Nikhil, Sharma, Ankur, Karmakar, Saurabh, Sharma, Priya, Nimbolkar, Janardan, Samdani, Pratit, Vaidyanathan, R., Ahmedi Rubina, Noor, Jain, Nikhilesh, Pahuja, Madhumati, Singh, Ritu, Shekhar, Saurav, Syed, Nabeel Muzaffar, Ozair, Ahmad, Sarwar Siddiqui, Suhail, Bose, Payel, Datta, Avijatri, Rathod, Darshana, Patel, Mayur, MK, Renuka, Sailaja, K Baby, Dsilva, Carol, Chandran, Jagadish, Ghosh, Pralay, Mukherjee, Sudipta, Sheshala, Kaladhar, Chandra Misra, Krushna, Adekola, Oyebola O., Yusuf Yakubu, Saidu, Mgbosoro Ugwu, Euphemia, Olatosi, John (O), Desalu, Ibironke, Asiyanbi, Gabriel, Oladimeji, Motunrayo, Idowu, Olusola, Adeola, Fowotade, Mer, Mervyn, Mc Cree, Melanie, El Sanousi, Dr. Bashir, Adil Ali Karar, Ali, Saidahmed, Elfayadh, Hamid, Hytham K.S., Loiodice, Ambre, Bailly, Sébastien, Ruckly, Stéphane, and Staiquly, Quentin

Published
2024
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16. Effect of MoS2 Addition on High Temperature Wear Behavior of NiCrBSi Coating Produced by Thermal Spraying

Author

Mohammad Razazi Boroujeni, Hind Khalaf Shayea Al Fadhli, and Farhad Azimifar

Subjects
thermal spray, molybdenum sulfide, wear, wear mechanism, 304 stainless steel, Materials of engineering and construction. Mechanics of materials, TA401-492
Abstract

Abstract Introduction: The thermal spraying method with the aim of increasing the working life of steel parts is one of the most important solutions in surface engineering to solve the problem of wear. Methods In this research, NiCrBSi and NiCrBSi-MoS2 coatings were applied on 304 stainless steel by thermal spraying, and then the wear behavior was evaluated at ambient temperature and 500 degrees. Phase investigations were done by X-ray diffraction test. The chemical composition of the coatings was checked with the help of energy dispersive spectrometer analysis. Porosity was investigated with the help of optical microscope and scanning electron microscope images. The hardness of the samples was measured using a microhardness test. In order to check the adhesion and tribological behavior of the coatings, VDI3198 and ASTM-G99 pin-on-disk tests were used, respectively, and finally, the wear mechanism was evaluated using SEM images and EDS analysis of the wear surfaces of the samples. Findings: Phase analysis (XRD) and chemical composition (EDS) showed that the coating has an amorphous and crystalline phase and the most important phases of the coating are nickel-gamma, carbide and boride. Porosity measurement results with the help of image analysis software showed higher porosity of NiCrBSi-MoS2 coating. The results of hardness measurement from the cross-section of the samples indicated an increase in the hardness of the substrate in the presence of coatings, and the addition of MoS2 particles decreased the hardness of the NiCrBSi coating. The coating with MoS2 has better adhesive behavior due to its crystalline structure and better plastic deformation ability. The tribological results indicated the superiority of the NiCrBSi-MoS2 coating due to the appropriate ability of plastic deformation as well as the intrinsic lubrication property (based on the crystal structure) in this test. It was found that at ambient temperature, the samples mainly had lamellar wear mechanism, and at high temperature, oxidation wear as a secondary mechanism helped to destroy the surface. Conclusion: The addition of MoS2 to NiCrBSi coating caused more porosity, more roughness, less hardness and better wear behavior of the coating. The addition of MoS2 to the coating improved the wear resistance of the coating at high temperature.

Published
2023
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17. Decreased risk of underdosing with continuous infusion versus intermittent administration of cefotaxime in patients with sickle cell disease and acute chest syndrome.

Author

Keyvan Razazi, Enora Berti, Jerome Cecchini, Guillaume Carteaux, Anoosha Habibi, Pablo Bartolucci, Romain Arrestier, Ségolène Gendreau, Nicolas de Prost, Anne Hulin, and Armand Mekontso Dessap

Subjects
Medicine, Science
Abstract

ObjectiveUnderdosing of antibiotics is common in patients with sickle cell disease (SCD). We hypothesized that in critically-ill patients with SCD receiving cefotaxime during acute chest syndrome, the continuous infusion may outperform the intermittent administration in achieving pharmacokinetic/pharmacodynamic targets.DesignProspective before-after study.SettingsIntensive-care unit of a French teaching hospital and sickle cell disease referral center.PatientsSixty consecutive episodes of severe acute chest syndrome in 58 adult patients with sickle cell disease.InterventionsPatients were treated with intermittent administration during the first period (April 2016 -April 2018) and with continuous infusion during the second period (May 2018 -August 2019).Measurements and main resultsWe included 60 episodes of acute chest syndrome in 58 patients (29 [25-34] years, 37/58 (64%) males). Daily dose of cefotaxime was similar between groups (59 [48-88] vs. 61 [57-64] mg/kg/day, p = 0.84). Most patients (>75%) presented a glomerular hyperfiltration with no difference between groups (p = 0.25). More patients had a cefotaxime trough level ≥2 mg/L with continuous infusion than intermittent administration: 28 (93%) vs. 5 (16%), pConclusionAs compared to intermittent administration, continuous infusion of cefotaxime maximizes the pharmacokinetic/pharmacodynamic parameters in patients with SCD. The clinical outcome did not differ between the two administration methods; however, the study was underpowered to detect such a difference.

Published
2024
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18. Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis

Author

Vaara, Suvi T., Serpa Neto, Ary, Bellomo, Rinaldo, Adhikari, Neill K. 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Hu, Chenghuan, Li, Jing, Deng, Fuxing, Qiu, Haibo, Yang, Yi, Mo, Min, Pan, Chun, Wu, Changde, Huang, Yingzi, Huang, Lili, Liu, Airan, Pettilä, Ville, Vaara, Suvi T., Korhonen, Anna-Maija, Törnblom, Sanna, Sutinen, Sari, Pettilä, Leena, Heinonen, Jonna, Lappi, Eliria, Suhonen, Taria, Karlsson, Sari, Hoppu, Sanna, Jalkanen, Ville, Kuitunen, Anne, Levoranta, Markus, Långsjö, Jaakko, Ristimäki, Sanna, Malila, Kaisa, Wootten, Anna, Varila, Simo, Järvisalo, Mikko J, Inkinen, Outi, Kentala, Satu, Leivo, Keijo, Haltia, Paivi, Dreyfuss, Didier, Ricard, Jean-Damien, Messika, Jonathan, Tiagarajah, Abirami, Emery, Malo, Dechanet, Aline, Gernez, Coralie, Roux, Damien, Martin-Lefevre, Laurent, Fiancette, Maud, Vinatier, Isabelle, Claude Lacherade, Jean, Colin, Gwenhaël, Lebert, Christine, Azais, Marie-Ange, Yehia, Aihem, Pouplet, Caroline, Henry- Lagarrigue, Matthieu, Seguin, Amélie, Crosby, Laura, Maizel, Julien, Titeca-Beauport, Dimitri, Combes, Alain, Nieszkowska, Ania, Masi, Paul, Demoule, Alexandre, Mayaux, Julien, Dres, Martin, Morawiec, Elise, Decalvele, Maxens, Demiri, Suela, Faure, Morgane, Marios, Clémence, Mallet, Maxime, Amélie Ordon, Marie, Morizot, Laura, Cantien, Marie, Pousset, François, Gaudry, Stéphane, Poirson, Florent, Cohen, Yves, Argaud, Laurent, Cour, Martin, Bitker, Laurent, Simon, Marie, Hernu, Romain, Baudry, Thomas, De La Salle, Sylvie, Robine, Adrien, Sedillot, Nicholas, Tchenio, Xavier, Bouisse, Camille, Roux, Sylvie, Barbar, Davide, Trusson, Rémi, Tamion, Fabienne, Grangé, Steven, Carpentier, Dorothée, Chevrel, Guillaume, Ensenyat-Martin, Luis, Marque, Sophie, Quenot, Jean-Pierre, Andreu, Pascal, Dargent, Auguste, Large, Audrey, Chudeau, Nicolas, Landais, Mickael, Derrien, Benoit, Christophe Callahan, Jean, Guitton, Christophe, Le Moal, Charlène, Robert, Alain, Asehnoune, Karim, Cinotti, Raphaël, Grillot, Nicolas, Demeure, Dominique, Vinsonneau, Christophe, Rahmani, Imen, Marzouk, Mehdi, Dekeyser, Thibault, Sejourne, Caroline, Verlay, Mélanie, Thevenin, Fabienne, Delecolle, Lucie, Didier Thevenin, Lens, Souweine, Bertrand, Coupez, Elisabeth, Adda, Mireille, Eraldi, Jean-Pierre, Marchalot, Antoine, De Prost, Nicolas, Mekontso Dessap, Armand, Razazi, Keyvan, Meziani, Ferhat, Boisrame-Helms, Julie, Clere-Jehl, Raphael, Delabranche, Xavier, Kummerlen, Christine, Merdji, Hamid, Monnier, Alexandra, Rabouel, Yannick, Rahmani, Hassene, Allam, Hayat, Chenaf, Samir, Franja, Vincenta, Pons, Bertrand, Carles, Michel, Martino, Frédéric, Richard, Régine, Zuber, Benjamin, Lacave, Guillaume, Lakhal, Karim, Rozec, Bertrand, Dang Van, Hoa, Boulet, Éric, Dubos, René, Fadel, Fouad, Cleophax, Cedric, Dufour, Nicolas, Grant, Caroline, Thuong, Marie, Reignier, Jean, Canet, Emmanuel, Nicolet, Laurent, Boulain, Thierry, Nay, Mai-Anh, Benzekri, Dalila, Barbier, François, Bretagnol, Anne, Kamel, Toufik, Mathonnet, Armelle, Muller, Grégoire, Skarzynski, Marie, Rossi, Julie, Pradet, Amandine, Dos Santos, Sandra, Guery, Aurore, Muller, Lucie, Felix, Luis, Bohé, Julien, Thiéry, Guillaume, Aissaoui, Nadia, Vimpere, Damien, Commeureuc, Morgane, Diehl, Jean-Luc, Guerot, Emmanuel, Liangos, Orfeas, Wittig, Monika, Zarbock, Alexander, Küllmar, Mira, van Waegeningh, Thomas, Rosenow, Nadine, Nichol, Alistair D., Brickell, Kathy, Doran, Peter, Murray, Patrick T., Landoni, Giovanni, Lembo, Rosalba, Zangrillo, Alberto, Monti, Giacomo, Tozzi, Margherita, Marzaroli, Matteo, Lombardi, Gaetano, Paternoster, Gianluca, Vitiello, Michelangelo, McGuinness, Shay, Parke, Rachael, Butler, Magdalena, Gilder, Eileen, Cowdrey, Keri-Anne, Wallace, Samantha, Hallion, Jane, Woolett, Melissa, Neal, Philippa, Duffy, Karina, Long, Stephanie, McArthur, Colin, Simmonds, Catherine, Chen, Yan, McConnochie, Rachael, Newby, Lynette, Knight, David, Henderson, Seton, Mehrtens, Jan, Morgan, Stacey, Morris, Anna, Vander Hayden, Kymbalee, Burke, Tara, Bailey, Matthew, Freebairn, Ross, Chadwick, Lesley, Park, Penelope, Rolls, Christine, Thomas, Liz, Buehner, Ulrike, Williams, Erin, Albrett, Jonathan, Kirkham, Simon, Jackson, Carolyn, Browne, Troy, Goodson, Jennifer, Jackson, David, Houghton, James, Callender, Owen, Higson, Vicki, Keet, Owen, Dominy, Clive, Young, Paul, Hunt, Anna, Judd, Harriet, Lawrence, Cassie, Olatunji, Shaanti, Robertson, Yvonne, Latimer-Bell, Charlotte, Hendry, Deborah, Mckay-Vucago, Agnes, Beehre, Nina, Lesona, Eden, Navarra, Leanlove, Robinson, Chelsea, Jang, Ryan, Junge, Andrea, Lambert, Bridget, Schneider, Antoine G., Thibault, Michel, Eckert, Philippe, Kissling, Sébastien, Polychronopoulos, Erietta, Poli, Elettra, Altarelli, Marco, Schnorf, Madeleine, Abed Mallaird, Samia, Heidegger, Claudia, Perret, Aurelie, Montillier, Philippe, Sangla, Frederic, Neils, Seigenthaller, De Watteville, Aude, Phull, Mandeep-Kaur, George, Aparna, Hussain, Nauman, Pogreban, Tatiana, Lobaz, Steve, Daniels, Alison, Cunningham, Mishell, Kerr, Deborah, Nicholson, Alice, Shanmugasundaram, Pradeep, Abrams, Judith, Manso, Katarina, Hambrook, Geraldine, McKerrow, Elizabeth, Salva, Juvy, Foulkes, Stephen, Wise, Matthew, Morgan, Matt, Brooks, Jenny, Cole, Jade, Michelle Davies, Tracy, Hill, Helen, Thomas, Emma, Vizcaychipi, Marcela, Baharlo, Behrad, Carungcong, Jaime, Costa, Patricia, Martins, Laura, Kapoor, Ritoo, Hazelton, Tracy, Moon, Angela, Musselwhite, Janine, Shelley, Ben, McCall, Philip, Ostermann, Marlies, Arbane, Gill, Bociek, Aneta, Marotti, Martina, Lim, Rosario, Campos, Sara, Grau Novellas, Neus, Cennamo, Armando, Slack, Andrew, Wyncoll, Duncan, Camporota, Luigi, Sparkes, Simon, Tilley, Rosalinde, Rattray, Austin, Moreland, Gayle, Duffy, Jane, McGonigal, Elizabeth, Hopkins, Philip, Finney, Clare, Smith, John, Noble, Harriet, Watson, Hayley, Harris, Claire-Louise, Clarey, Emma, Corcoran, Eleanor, Beck, James, Howcroft, Clare, Youngs, Nora, Wilby, Elizabeth, Ogg, Bethan, Wolverson, Adam, Lee, Sandra, Butler, Susie, Okubanjo, Maryanne, Hindle, Julia, Welters, Ingeborg, Williams, Karen, Johnson, Emily, Patrick-Heselton, Julie, Shaw, David, Waugh, Victoria, Stewart, Richard, Mwaura, Esther, Wren, Lynn, Mew, Louise, Sutherland, Sara-Beth, Adderley, Jane, Ruddy, Jim, Harkins, Margaret, Kaye, Callum, Scott, Teresa, Mitchell, Wendy, Anderson, Felicity, Willox, Fiona, Jagannathan, Vijay, Clark, Michele, Purv, Sarah, Sharman, Andrew, Meredith, Megan, Ryan, Lucy, Conner, Louise, Peters, Cecilia, Harvey, Dan, Roshdy, Ashraf, Collins, Amy, Sim, Malcolm, Henderson, Steven, Chee, Nigel, Pitts, Sally, Bowman, Katie, Dilawershah, Maria, Vamplew, Luke, Howe, Elizabeth, Rogers, Paula, Hernandez, Clara, Prendergast, Clara, Benton, Jane, Rosenberg, Alex, Forni, Lui G., Grant, Alice, Carvelli, Paula, Raithatha, Ajay, Bird, Sarah, Richardson, Max, Needham, Matthew, Hirst, Claire, Ball, Jonathan, Leaver, Susannah, Howlett, Luisa, Castro Delgado, Carlos, Farnell-Ward, Sarah, Farrah, Helen, Gray, Geraldine, Joseph, Gipsy, Robinson, Francesca, Tridente, Ascanio, Harrop, Clare, Shuker, Karen, McLaughlan, Derek, Ramsey, Judith, Meehan, Sharon, Oliver Rose, Bernd, Reece-Anthony, Rosie, Gurung, Babita, Whitehouse, Tony, Snelson, Catherine, Veenith, Tonny, Johnston, Andy, Cooper, Lauren, Carrera, Ron, Ellis, Karen, Fellows, Emma, Harkett, Samanth, Bergin, Colin, Spruce, Elaine, Despy, Liesl, Goundry, Stephanie, Dooley, Natalie, Mason, Tracy, Clark, Amy, Dignam, Gemma, Ward, Geraldine, Attwood, Ben, Parsons, Penny, Mason, Sophie, Margarson, Michael, Lord, Jenny, McGlone, Philip, Hodgson, Luke E., Chadbourn, Indra, Gomez, Raquel, Margalef, Jordi, Pretorius, Rinus, Hamshere, Alexandra, Carter, Joseph, Cahill, Hazel, Grainger, Lia, Howard, Kate, Forshaw, Greg, Guy, Zoe, Kashani, Kianoush B., Albright, Robert C., Amsbaugh, Amy, Stoltenberg, Anita, Niven, Alexander S., Lynch, Matthew, O’Mara, AnnMarie, Naeem, Syed, Sharif, Sairah, McKenney Goulart, Joyce, Lynch, Matthew, O’Mara, AnnMarie, Naeem, Syed, Sharif, Sairah, McKenney Goulart, Joyce, Tolwani, Ashita, Lyas, Claretha, Latta, Laura, Bihorac, Azra, Hashemighouchani, Haleh, Efron, Philip, Ruppert, Matthew, Cupka, Julie, Kiley, Sean, Carson, Joshua, White, Peggy, Omalay, George, Brown, Sherry, Velez, Laura, Marceron, Alina, Neyra, Javier A., Carlos Aycinena, Juan, Elias, Madona, Ortiz-Soriano, Victor M., Hauschild, Caroline, and Dorfman, Robert

Published
2024
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19. Dual titration of minute ventilation and sweep gas flow to control carbon dioxide variations in patients on venovenous extracorporeal membrane oxygenation

Author

Paul Masi, François Bagate, Samuel Tuffet, Mariantonietta Piscitelli, Thierry Folliguet, Keyvan Razazi, Nicolas De Prost, Guillaume Carteaux, and Armand Mekontso Dessap

Subjects
Extracorporeal membrane oxygenation, Carbon dioxide control, Titration sweep gas flow, Titration minute ventilation, Ultra-protective ventilation, Intracranial bleeding, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The implantation of venovenous extracorporeal membrane oxygenation (VV-ECMO) support to manage severe acute respiratory distress syndrome generates large variations in carbon dioxide partial pressure (PaCO2) that are associated with intracranial bleeding. We assessed the feasibility and efficacy of a pragmatic protocol for progressive dual titration of sweep gas flow and minute ventilation after VV-ECMO implantation in order to limit significant PaCO2 variations. Patients and methods A protocol for dual titration of sweep gas flow and minute ventilation following VV-ECMO implantation was implemented in our unit in September 2020. In this single-centre retrospective before-after study, we included patients who required VV-ECMO from March, 2020 to May, 2021, which corresponds to two time periods: from March to August, 2020 (control group) and from September, 2020 to May, 2021 (protocol group). The primary endpoint was the mean absolute change in PaCO2 in consecutive arterial blood gases samples drawn over the first 12 h following VV-ECMO implantation. Secondary endpoints included large (> 25 mmHg) initial variations in PaCO2, intracranial bleedings and mortality in both groups. Results Fifty-one patients required VV-ECMO in our unit during the study period, including 24 in the control group and 27 in the protocol group. The protocol was proved feasible. The 12-h mean absolute change in PaCO2 was significantly lower in patients of the protocol group as compared with their counterparts (7 mmHg [6–12] vs. 12 mmHg [6–24], p = 0.007). Patients of the protocol group experienced less large initial variations in PaCO2 immediately after ECMO implantation (7% vs. 29%, p = 0.04) and less intracranial bleeding (4% vs. 25%, p = 0.04). Mortality was similar in both groups (35% vs. 46%, p = 0.42). Conclusion Implementation of our protocol for dual titration of minute ventilation and sweep gas flow was feasible and associated with less initial PaCO2 variation than usual care. It was also associated with less intracranial bleeding.

Published
2023
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21. SARS-CoV-2 variants and mutational patterns: relationship with risk of ventilator-associated pneumonia in critically ill COVID-19 patients in the era of dexamethasone

Author

Keyvan Razazi, Anissa Martins Bexiga, Romain Arrestier, Bastien Peiffer, Guillaume Voiriot, Charles-Edouard Luyt, Tomas Urbina, Julien Mayaux, Tài Pham, Damien Roux, Raphael Bellaiche, Zakaria AIt Hamou, Stéphane Gaudry, Elie Azoulay, Armand Mekontso Dessap, Christophe Rodriguez, Jean-Michel Pawlotsky, Slim Fourati, and Nicolas de Prost

Subjects
Medicine, Science
Abstract

Abstract We aimed to explore the relationships between specific viral mutations/mutational patterns and ventilator-associated pneumonia (VAP) occurrence in COVID-19 patients admitted in intensive care units between October 1, 2020, and May 30, 2021. Full-length SARS-CoV-2 genomes were sequenced by means of next-generation sequencing. In this prospective multicentre cohort study, 259 patients were included. 222 patients (47%) had been infected with pre-existing ancestral variants, 116 (45%) with variant α, and 21 (8%) with other variants. 153 patients (59%) developed at least one VAP. There was no significant relationship between VAP occurrence and a specific SARS CoV-2 lineage/sublineage or mutational pattern.

Published
2023
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22. Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Author

Simon Bourcier, Maxime Coutrot, Alexis Ferré, Nicolas Van Grunderbeeck, Julien Charpentier, Sami Hraiech, Elie Azoulay, Saad Nseir, Nadia Aissaoui, Jonathan Messika, Pierre Fillatre, Romain Persichini, Serge Carreira, Alexandre Lautrette, Clément Delmas, Nicolas Terzi, Bruno Mégarbane, Jean-Baptiste Lascarrou, Keyvan Razazi, Xavier Repessé, Claire Pichereau, Damien Contou, Aurélien Frérou, François Barbier, Stephan Ehrmann, Etienne de Montmollin, Benjamin Sztrymf, Elise Morawiec, Naïke Bigé, Danielle Reuter, David Schnell, Olivier Ellrodt, Jean Dellamonica, Alain Combes, and Matthieu Schmidt

Subjects
Hypothyroidism, Myxedema, Coma, Cardiogenic shock, Critical care, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients. Methods We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure. Results Eighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75–24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47–84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27–18.6)] as being independently associated with in-ICU mortality. Conclusions SH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.

Published
2023
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23. The authors reply

Author

Angriman, Federico, Muttalib, Fiona, Lamontagne, François, Adhikari, Neill K. J., Chassé, Michaël, Aslanian, Pierre, Bélisle, Sylvain, Cailhier, Jean-François, Martin Carrier, François, Charbonney, Emmanuel, Denault, André, Girard, Martin, Guimond, Jean-Gilles, Halwagi, Antoine, Hébert, Paul, Kolan, Christophe, Ouellet, Caroline, Robillard, Nicholas, Benettaib, Fatna, Boumahni, Dounia, Lebrasseur, Martine, Salamé, Maya, Cantin, Marie-Ève, Archambault, Patrick, Drouin, Christine, Duquet-Deblois, Estel, Noël-Hunter, Monia, Dubé, Jean-Nicolas, Bériault, Marie-Josée, Chacon, Marco, Claveau, David, Naud, Jean-François, Rodrigue, Élise, Tapss, Danielle, Toupin, Guylaine, Ting Wang, Han, Brosseau, Marc, Laufer, Brian, Marquis, François, Toupin, Francis, Tassy, Danaë, Cheung, Vincent, Toun, Sam-Ang, Lamontagne, François, D’Aragon, Frédérick, Bérard, Dominique, Grondin-Beaudoin, Brian, Leclair, Marc-André, Lesur, Olivier, Mayette, Michaël, Poulin, Yannick, Quiroz Martinez, Hector, St-Arnaud, Charles, Carbonneau, Elaine, Bélisle, Julie, Bouchard, Marie-Pier, Côté, Line, Ladouceur, Marylène, Marchand, Joannie, Naisby, Alexandra, Robert-Petit, Louise, Thibault, Marie-Ève, Charbonney, Emmanuel, Albert, Martin, Bernard, Francis, Cavayas, Alexandros, Serri, Karim, Williamson, David, Williams, Virginie, Lainer Palacios, Julia, Lauzier, François, Francoeur, Charles, Leblanc, Guillaume, St-Onge, Maude, Turgeon, Alexis, Bellemare, David, Boulanger, Marie-Claude, Cloutier, Eve, Guilbault, Gabrielle, Thibeault, Frédérique, Belley-Côté, Emilie, Fox-Robichaud, Alison, Meade, Maureen, Whitlock, Richard, Hand, Lori, Hayward, Leah, Mullen, Courtney, Savija, Nevena, Lellouche, François, Simon, Mathieu, Tung Sia, Ying, Lizotte, Patricia, Rochwerg, Bram, Millen, Tina, Maslove, David, Gordon Boyd, J., Drover, John, Muscedere, John, Sibley, Stephanie, Boyd, Tracy, Hunt, Miranda, Mele, Tina, Bentall, Tracey, ElKhatib, Chadia, Shahin, Jason, Khwaja, Kosar, Campisi, Josie, Alam, Norine, Rahgoshai, Raham, Mehta, Sangeeta, Detsky, Michael, Shah, Sumesh, Kohli, Sonny, Cui, Fulan, Khera, Vikas, McConachie, David, Rehsia, Sachdeep, Bharti, Dalisha, Perez, Adic, James Kutsogiannis, Demetrios, Chowdhury, Raiyan, Davidow, Jon, Johnston, Curtis, Kim, Michael, Macala, Kimberley, Marcushamer, Sam, Markland, Darren, Matheson, Doug, Parker, Arabesque, Paton-Gay, Damian, Hewer, Tayne, Thompson, Patrica, Cook, Deborah, Al-Hazzani, Waleed, Duan, Erick, Ligori, Tania, Soth, Mark, Clarke, France, Copland, Mary, Matic, Karlo, Adhikari, Neill KJ, Amaral, Andre, Cuthbertson, Brian H, Fowler, Robert A, Piquette, Dominique, Scales, Damon C, Tillmann, Bourke, Wunsch, Hannah, Marinoff, Nicole, Kamra, Maneesha, Kaur, Navjot, Murali, Deeptha, Sabananthan, Thivya, Sugumaran, Thuva, Seely, Andrew, English, Shane, Meggison, Hilary, Microys, Sherissa, Millington, Scott, Sarti, Aimee, Haines, Jessica, Miezitis, Sydney, Porteous, Rebecca, Watpool, Irene, Del Sorbo, Lorenzo, Fan, Eddy, Granton, John, Abdelhady, Hesham, Romagnuolo, Tina, Rewa, Oleksa, Bagshaw, Sean, Meier, Michael, Sligl, Wendy, Baig, Nadia, Wood, Gordon, Ovakim, Daniel, Auld, Fiona, Carney, Gayle, Parfett, Deborah, Leblanc, Rémi, Poirier, Matthieu, Theriault, Theophile, Williston, Maryse, Caissie Collette, Jackie, Carriere, Melanie, Daigle, Melissa, Gaudet, Bernise, Morin, Karine, Ouellette-Bernier, Lola, Poitras, Julie, Robichaud, Melanie, Rockburn, Joanne, Mekontso Dessap, Armand, Arrestier, Romain, Bagate, François, Bendib, Ines, Benelli, Brice, Berti, Enora, Bertier, Astrid, Cavaleiro, Pedro, de Prost, Nicolas, Gendreau, Segolene, Hartman, Otto, Haudebourg, Anne-Fleur, Lopinto, Julien, Masi, Paul, Michaud, Gaël, Razazi, Keyvan, Tuffet, Samuel, Alves, Aline, Nait Chabane, Luiza, Ouali, Fariza, Ouedraogo, Rachida, Annane, Djillali, Abdeladim, Lilia, Bounab, Rania, Heming, Nicholas, Maxime, Virginie, Moine, Pierre, Bossard, Isabelle, Jourdier, Segolene, Mahiou, Siline, Tessa, Hayette, McGuinness, Shay, Ball, Jonathan, Hennessy, Immanuel, Hogan, Maurice, Butler, Magdalena, Cowdrey, Keri-Anne, Gilder, Eileen, Parke, Rachael, Ryan, Samantha, Woollett, Melissa, Van Der Poll, Andrew, Benson-Cooper, Kerry, Chen, Jonathan, Freeman, Kirk, Harley, David, Harvey, Dave, Hourigan, Craig, Julian, Kylie, Lo, Stephen, McArthur, Colin, Miller, Stuart, Pointer, Chris, Anthony Smith, Rex, Tincknell, Laura, McConnochie, Rachael, Simmonds, Catherine, Shaw, Geoffrey, Betteridge, Toby, Burke, Brandon, Closey, David, Crombie, Rosalind, Davidson, Neil, Henderson, Louise, Henderson, Seton, Hitchings, Louise, Knight, David, Quigley, Christine, Ritzema Carter, Jay, Roberts, Jessica, Townend, Katherine, Doyle, Tara, Mehrtens, Jan, Morgan, Stacey, Morris, Anna, Van Der Heyden, Kymbalee, Twardowski, Pawel, Dvoracek, Martin, Renner, Markus, Silverman, David, Smith, Myles, Monica Stephens, Katherine, Albert Waibel, Hansjörg, Wiebe, Stefan, Woolley, Mark, Eden, Amie, France, Dawn, Buehner, Ulrike, Erin Williams, Katallah Kramer, Browne, Troy, Callender, Owen, Chen, Jonathan, Farrell, Susanne, Higson, Vicky, Jackson, David, Keet, Owen, Goodson, Jennifer, Martynoga, Robert, Byrne, Kelly, Butler, Amelia, Trask, Kara, Mans, Gay, Termaat, Jonathan, Young, Paul, Barnes, Colin, Barry, Ben, Grayson, Kim, Moore, James, Psirides, Alex, Sturland, Shawn, Tietjens, Kate, Ure, Bob, Walker, Laurence, Wright, Jason, Aguilar-Dano, April, Delaney, Kirsha, Lawrence, Cassie, Lesona, Mildred, Millington, Alexandra, Navarra, Leanlove, Olatunji, Shaanti, Sol Cruz, Raulle, Sol Cruz, Rhoze, Young, Chelsea, Day, Andrew, Cook, Deborah J, Guyatt, Gordon H, Sprague, Sheila, Cohen, Dian, Heyland, Daren K, Lamontagne, François, Masse, Marie-Hélène, Ménard, Julie, Adhikari, Neill KJ, Pinto, Ruxandra, Kanji, Salmaan, Battista, Marie-Claude, Annane, Djillali, Tirupakuzhi Vijayaraghavan, Bharath Kumar, McGuinness, Shay, Parke, Rachael, and Arabi, Yaseen

Published
2023
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24. One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation

Author

Sonneville, Romain, Mazighi, Mikael, Collet, Magalie, Gayat, Etienne, Degos, Vincent, Duranteau, Jacques, Grégoire, Charles, Sharshar, Tarek, Naim, Giulia, Cortier, David, Jost, Paul-Henri, Foucrier, Arnaud, Bagate, François, de Montmollin, Etienne, Papin, Gregory, Magalhaes, Eric, Guidet, Bertrand, Ben Hadj Salem, Omar, Benghanem, Sarah, le Guennec, Loïc, Delpierre, Eric, Legriel, Stephane, Megarbane, Bruno, Toumert, Karim, Tran, Marc, Geri, Guillaume, Monchi, Mehran, Bodiguel, Eric, Mariotte, Eric, Demoule, Alexandre, Zarka, Jonathan, Diehl, Jean-Luc, Roux, Damien, Barré, Eric, Tanaka, Sebastien, Osman, David, Pasquier, Pierre, Lamara, Fariza, Crassard, Isabelle, Boursin, Perrine, Ruckly, Stéphane, Staiquly, Quentin, Timsit, Jean-François, Woimant, France, Ader, Tiare, Bout, Hélène, Bresson, Damien, Combes, Alain, Chrisment, Anne, Crozier, Sophie, da Silva, Daniel, Decavele, Maxens, Dres, Martin, Faugeras, Frédéric, Fournier, Marie-Céline, Gauss, Tobias, Gernez, Coralie, Hurel, Dominique, Jamme, Matthieu, Josse, Laurence, Jurcisin, Igor, Kerhuel, Lionel, Lamy, Catherine, Lancelot, Aymeric, Lapergue, Bertrand, Lenclud, Christophe, Lermuzeaux, Mathilde, Malissin, Isabelle, Maldjian, Alain, Marin, Nathalie, Martin, Jérôme, Martinez, Thibault, Dessap, Armand Mekontso, Outin, Hervé, Pichereau, Claire, Pissot, Matthieu, Razazi, Keyvan, Reuter, Danielle, Richard, Christian, Schimpf, Caroline, Servan, Jérôme, Thion, Laurie-Anne, Traki, Widad, Vassel, Philippe, Vigué, Bernard, and Zafimahazo, Daniel

Published
2023
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26. Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study

Author

Roman Mounier, Ronan Le Guen, Paul-Louis Woerther, Mathieu Nacher, Clément Bonnefon, Nicolas Mongardon, Olivier Langeron, Eric Levesque, Séverine Couffin, Stéphanie Houcke, Michel Wolff, Ariane Roujansky, Caroline Schimpf, Armand Mekontso Dessap, Fabrice Cook, Keyvan Razazi, and Hatem Kallel

Subjects
AmpC-producing Enterobacterales, AmpC β-lactamases, Third-generation cephalosporins, Infection, ICU, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background β-lactams are the main antibiotics used against wild-type AmpC-producing Enterobacterales (wtAE). However, they may fail or select AmpC-overproducing mutants. Our aim was to assess factors associated with clinical failure of β-lactams in the treatment of wtAE infection. Methods From September 2017 to December 2020, we prospectively included all consecutive patients treated by definitive β-lactams therapy for wtAE infection in four university ICUs. Clinical failure was defined as inadequate response to antimicrobial therapy leading to death or to the switch for a broader-spectrum antibiotic. Results 177 patients were included and 29.4% progressed to clinical failure. E. cloacae was the most prevalent species (42.4%) and ventilator-associated pneumonia (VAP) was the most frequent wtAE infection (69.5%). Cefepime and cefotaxime were used as definitive antibiotic treatment in 42.9% and 27.7% of patients, respectively. Occurrence of AmpC-overproduction was documented in 5.6% of patients and was associated with clinical failure (p = 0.004). In multivariate analysis, VAP (p

Published
2022
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27. Evaluation of tribological behavior of PEO composite coating containing SiO2 particles on 7075 aluminum alloy

Author

Mohammad Razazi Boroujeni, Zahraa Salah Hadi Aljassar, and Farhad Azimifar

Subjects
coating, plasma electrolyte oxidation, composite, wear, friction, Materials of engineering and construction. Mechanics of materials, TA401-492
Abstract

AbstractIntroduction: Electrolytic plasma oxidation coatings are one of the most important materials used to deal with the wear of aluminum parts due to their compact, sticky and hard nature. In recent years, improving the surface properties of these coatings with the help of adding reinforcement particles has attracted the attention of researchersMethods In this study, plasma electrolytic oxidation (PEO) process was applied in two modes, normal and composite, to coat aluminum 7075. To produce the composite coating, the same electrolyte as the normal mode was used with the addition of 12 grams per liter of silicon oxide particles. Characterization of coatings was done with the help of SEM, X-ray diffraction analysis, energy dispersive spectrometer (EDS) analysis, roughness measurement and hardness measurement. The tribological behavior of coatings was investigated with the help of pin-on-disk test and the analysis of the wear mechanism of the samples was done with the help of SEM images and EDS analysis of wear surfaces.Findings: Both coatings had a pancake structure with craters. Also, the drainage channels that lead to the porosity of the coatings were less created on the surface of the composite coating. The normal coating was an oxide coating with an amorphous/crystalline nature, but the composite coating had silicon oxide and mullite crystalline phases in addition to these two phases. The lowest weight loss (highest wear resistance) and friction coefficient were obtained for the composite coating. wear mechanism was also observed delamination wear and oxidation wear for substrate, abrasion, adhesive and oxidation wear for PEO coating, and fine scratch mechanisms and adhesive mechanism with very little effect for composite coating.

Published
2022
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29. Driving pressure-guided ventilation decreases the mechanical power compared to predicted body weight-guided ventilation in the Acute Respiratory Distress Syndrome

Author

Anne-Fleur Haudebourg, Samuel Tuffet, François Perier, Keyvan Razazi, Nicolas de Prost, Armand Mekontso Dessap, and Guillaume Carteaux

Subjects
Acute respiratory distress syndrome, Mechanical ventilation, Protective ventilation, Tidal volume, Driving pressure, Ventilator-induced lung injury, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Whether targeting the driving pressure (∆P) when adjusting the tidal volume in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS) may decrease the risk of ventilator-induced lung injury remains a matter of research. In this study, we assessed the effect of a ∆P-guided ventilation on the mechanical power. Methods We prospectively included adult patients with moderate-to-severe ARDS. Positive end expiratory pressure was set by the attending physician and kept constant during the study. Tidal volume was first adjusted to target 6 ml/kg of predicted body weight (PBW-guided ventilation) and subsequently modified within a range from 4 to 10 ml/kg PBW to target a ∆P between 12 and 14 cm H2O. The respiratory rate was then re-adjusted within a range from 12 to 40 breaths/min until EtCO2 returned to its baseline value (∆P-guided ventilation). Mechanical power was computed at each step. Results Fifty-one patients were included between December 2019 and May 2021. ∆P-guided ventilation was feasible in all but one patient. The ∆P during PBW-guided ventilation was already within the target range of ∆P-guided ventilation in five (10%) patients, above in nine (18%) and below in 36 (72%). The change from PBW- to ∆P-guided ventilation was thus accompanied by an overall increase in tidal volume from 6.1 mL/kg PBW [5.9–6.2] to 7.7 ml/kg PBW [6.2–8.7], while respiratory rate was decreased from 29 breaths/min [26–32] to 21 breaths/min [16–28] (p

Published
2022
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30. Corporeal rehabilitation to manage acute stress in critically ill patients

Author

Irma Bourgeon-Ghittori, Maryline Couette, Sylvie Marini, Rachida Ouedraogo, Aline Alves, Keyvan Razazi, Damien Carras, Ann-Cecile Pallud, Nancy Kentish-Barnes, and Armand Mekontso Dessap

Subjects
Intensive care, Stress, Corporeal, Rehabilitation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Intensive care unit (ICU) patients often endure discomfort and distress brought about by their medical environment and the subjective experience of their stay. Distress, pain, and loss of control are important predictors of future neuropsychiatric disorders. Depression, anxiety, and post-traumatic stress are common after discharge. We aimed at mitigating acute stress and discomfort via a novel intervention based on body image rehabilitation and rehabilitation of senses performed following a holistic approach guided by positive communication (corporeal rehabilitation care, CRC). Results We conducted a prospective observational study on 297 consecutively enrolled patients participating in at least one CRC session. Benefits of CRC were assessed on both subjective analogical scales of stress, pain, and well-being criteria, and objective clinical measures of dyspnea, respiratory rate, and systolic arterial pressure, just after CRC and long after (a median of 72 min later) to estimate its remote effect. Results showed that CRC had a positive effect on all overt measures of distress (acute stress, pain, discomfort) just after CRC and remotely. This beneficial effect was also observed on dyspnea and respiratory rate. Results also showed that best CRC responders had higher baseline values of stress and heart rate and lower baseline values of well-being score, indicating that the care targeted the population most at risk of developing psychological sequelae. Interestingly, a positive CRC response was associated with a better survival even after adjustment for physiologic severity, indicating a potential to identify patients prompt to better respond to other therapeutics and/or rehabilitation. Conclusion This study demonstrated the feasibility of an innovative holistic patient-centered care approach and its short-term positive effects on critical parameters that are considered risk factors for post-intensive care syndrome. Further studies are warranted to study long-term benefits for patients, and overall benefits for relatives as well as ICU staff.

Published
2022
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31. IV Vitamin C in Adults With Sepsis: A Bayesian Reanalysis of a Randomized Controlled Trial*

Author

Angriman, Federico, Muttalib, Fiona, Lamontagne, François, Adhikari, Neill K. J., Chassé, Michaël, Aslanian, Pierre, Bélisle, Sylvain, Cailhier, Jean-François, Carrier, François Martin, Charbonney, Emmanuel, Denault, André, Girard, Martin, Guimond, Jean-Gilles, Halwagi, Antoine, Hébert, Paul, Kolan, Christophe, Ouellet, Caroline, Robillard, Nicholas, Benettaib, Fatna, Boumahni, Dounia, Lebrasseur, Martine, Salamé, Maya, Cantin, Marie-Ève, Archambault, Patrick, Drouin, Christine, Dubé, Jean-Nicolas, Bériault, Marie-Josée, Chacon, Marco, Claveau, David, Naud, Jean-François, Rodrigue, Élise, Ting Wang, Han, Brosseau, Marc, Laufer, Brian, Marquis, François, Toupin, Francis, Lamontagne, François, D’Aragon, Frédérick, Bérard, Dominique, Grondin-Beaudoin, Brian, Leclair, Marc-André, Lesur, Olivier, Mayette, Michaël, Poulin, Yannick, Quiroz Martinez, Hector, St-Arnaud, Charles, Charbonney, Emmanuel, Albert, Martin, Bernard, Francis, Cavayas, Alexandros, Serri, Karim, Williamson, David, Duquet-Deblois, Estel, Noël-Hunter, Monia, Tapss, Danielle, Toupin, Guylaine, Tassy, Danaë, Cheung, Vincent, Toun, Sam-Ang, Carbonneau, Elaine, Bélisle, Julie, Bouchard, Marie-Pier, Côté, Line, Ladouceur, Marylène, Marchand, Joannie, Naisby, Alexandra, Robert-Petit, Louise, Thibault, Marie-Ève, Williams, Virginie, Lainer Palacios, Julia, Charbonney, Emmanuel, Albert, Martin, Bernard, Francis, Cavayas, Alexandros, Serri, Karim, Williamson, David, Lauzier, François, Francoeur, Charles, Leblanc, Guillaume, St-Onge, Maude, Turgeon, Alexis, Belley-Côté, Emilie, Fox-Robichaud, Alison, Meade, Maureen, Whitlock, Richard, Lellouche, François, Simon, Mathieu, Tung Sia, Ying, Rochwerg, Bram, Maslove, David, Gordon Boyd, J., Drover, John, Muscedere, John, Sibley, Stephanie, Mele, Tina, Shahin, Jason, Khwaja, Kosar, Mehta, Sangeeta, Detsky, Michael, Kohli, Sonny, Cui, Fulan, Khera, Vikas, McConachie, David, Rehsia, Sachdeep, James Kutsogiannis, Demetrios, Chowdhury, Raiyan, Davidow, Jon, Johnston, Curtis, Kim, Michael, Macala, Kimberley, Marcushamer, Sam, Markland, Darren, Matheson, Doug, Parker, Arabesque, Paton-Gay, Damian, Cook, Deborah, Al-Hazzani, Waleed, Duan, Erick, Ligori, Tania, Soth, Mark, Adhikari, Neill KJ, Amaral, Andre, Cuthbertson, Brian H, Fowler, Robert A, Piquette, Dominique, Scales, Damon C, Tillmann, Bourke, Wunsch, Hannah, Seely, Andrew, English, Shane, Meggison, Hilary, Microys, Sherissa, Millington, Scott, Sarti, Aimee, Del Sorbo, Lorenzo, Fan, Eddy, Granton, John, Rewa, Oleksa, Bagshaw, Sean, Meier, Michael, Sligl, Wendy, Wood, Gordon, Ovakim, Daniel, Leblanc, Rémi, Poirier, Matthieu, Theriault, Theophile, Williston, Maryse, Bellemare, David, Boulanger, Marie-Claude, Cloutier, Eve, Guilbault, Gabrielle, Thibeault, Frédérique, Hand, Lori, Hayward, Leah, Mullen, Courtney, Savija, Nevena, Lizotte, Patricia, Millen, Tina, Boyd, Tracy, Hunt, Miranda, Bentall, Tracey, ElKhatib, Chadia, Campisi, Josie, Alam, Norine, Rahgoshai, Raham, Shah, Sumesh, Bharti, Dalisha, Perez, Adic, Hewer, Tayne, Thompson, Patrica, Clarke, France, Copland, Mary, Matic, Karlo, Marinoff, Nicole, Kamra, Maneesha, Kaur, Navjot, Murali, Deeptha, Sabananthan, Thivya, Sugumaran, Thuva, Haines, Jessica, Miezitis, Sydney, Porteous, Rebecca, Watpool, Irene, Abdelhady, Hesham, Romagnuolo, Tina, Baig, Nadia, Auld, Fiona, Carney, Gayle, Parfett, Deborah, Caissie Collette, Jackie, Carriere, Melanie, Daigle, Melissa, Gaudet, Bernise, Morin, Karine, Ouellette-Bernier, Lola, Poitras, Julie, Robichaud, Melanie, Rockburn, Joanne, Mekontso Dessap, Armand, Arrestier, Romain, Bagate, François, Bendib, Ines, Benelli, Brice, Berti, Enora, Bertier, Astrid, Cavaleiro, Pedro, de Prost, Nicolas, Gendreau, Segolene, Hartman, Otto, Haudebourg, Anne-Fleur, Lopinto, Julien, Masi, Paul, Michaud, Gaël, Razazi, Keyvan, Tuffet, Samuel, Annane, Djillali, Abdeladim, Lilia, Bounab, Rania, Heming, Nicholas, Maxime, Virginie, Moine, Pierre, Alves, Aline, Nait Chabane, Luiza, Ouali, Fariza, Ouedraogo, Rachida, Bossard, Isabelle, Jourdier, Segolene, Mahiou, Siline, Tessa, Hayette, McGuinness, Shay, Ball, Jonathan, Hennessy, Immanuel, Hogan, Maurice, Van Der Poll, Andrew, Benson-Cooper, Kerry, Chen, Jonathan, Freeman, Kirk, Harley, David, Harvey, Dave, Hourigan, Craig, Julian, Kylie, Lo, Stephen, McArthur, Colin, Miller, Stuart, Pointer, Chris, Anthony Smith, Rex, Tincknell, Laura, Shaw, Geoffrey, Betteridge, Toby, Burke, Brandon, Closey, David, Crombie, Rosalind, Davidson, Neil, Henderson, Louise, Henderson, Seton, Hitchings, Louise, Knight, David, Quigley, Christine, Ritzema Carter, Jay, Roberts, Jessica, Townend, Katherine, Twardowski, Pawel, Dvoracek, Martin, Renner, Markus, Silverman, David, Smith, Myles, Monica Stephens, Katherine, Albert Waibel, Hansjörg, Wiebe, Stefan, Woolley, Mark, Buehner, Ulrike, Kramer, Katallah, Browne, Troy, Callender, Owen, Chen, Jonathan, Farrell, Susanne, Higson, Vicky, Jackson, David, Keet, Owen, Martynoga, Robert, Byrne, Kelly, Young, Paul, Barnes, Colin, Barry, Ben, Grayson, Kim, Moore, James, Psirides, Alex, Sturland, Shawn, Tietjens, Kate, Ure, Bob, Walker, Laurence, Wright, Jason, Butler, Magdalena, Cowdrey, Keri-Anne, Gilder, Eileen, Parke, Rachael, Ryan, Samantha, Woollett, Melissa, McConnochie, Rachael, Simmonds, Catherine, Doyle, Tara, Mehrtens, Jan, Morgan, Stacey, Morris, Anna, Van Der Heyden, Kymbalee, Eden, Amie, France, Dawn, Williams, Erin, Goodson, Jennifer, Butler, Amelia, Trask, Kara, Mans, Gay, Termaat, Jonathan, Aguilar-Dano, April, Delaney, Kirsha, Lawrence, Cassie, Lesona, Mildred, Millington, Alexandra, Navarra, Leanlove, Olatunji, Shaanti, Cruz, Raulle Sol, Cruz, Rhoze Sol, Young, Chelsea, Day, Andrew, Cook, Deborah J, Guyatt, Gordon H, Sprague, Sheila, Cohen, Dian, Heyland, Daren K, Lamontagne, François, Masse, Marie-Hélène, Ménard, Julie, Adhikari, Neill KJ, Pinto, Ruxandra, Kanji, Salmaan, Battista, Marie-Claude, Annane, Djillali, Vijayaraghavan, Bharath Kumar Tirupakuzhi, McGuinness, Shay, Parke, Rachael, and Arabi, Yaseen

Published
2023
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35. Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study

Author

Mounier, Roman, Le Guen, Ronan, Woerther, Paul-Louis, Nacher, Mathieu, Bonnefon, Clément, Mongardon, Nicolas, Langeron, Olivier, Levesque, Eric, Couffin, Séverine, Houcke, Stéphanie, Wolff, Michel, Roujansky, Ariane, Schimpf, Caroline, Mekontso Dessap, Armand, Cook, Fabrice, Razazi, Keyvan, and Kallel, Hatem

Published
2022
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37. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study

Author

Massart, Nicolas, Maxime, Virginie, Fillatre, Pierre, Razazi, Keyvan, Ferré, Alexis, Moine, Pierre, Legay, Francois, Voiriot, Guillaume, Amara, Marlene, Santi, Francesca, Nseir, Saad, Marque-Juillet, Stephanie, Bounab, Rania, Barbarot, Nicolas, Bruneel, Fabrice, and Luyt, Charles-Edouard

Published
2022
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38. Neurologic outcome of VZV encephalitis one year after ICU admission: a multicenter cohort study

Author

Adrien Mirouse, Romain Sonneville, Keyvan Razazi, Sybille Merceron, Laurent Argaud, Naïke Bigé, Stanislas Faguer, Pierre Perez, Guillaume Géri, Claude Guérin, Anne-Sophie Moreau, Laurent Papazian, René Robert, François Barbier, Frédérique Ganster, Julien Mayaux, Elie Azoulay, and Emmanuel Canet

Subjects
Varicella-zoster virus, Encephalitis, Virus, Intensive care unit, Long-term prognosis, Acute brain injury, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Varicella-zoster virus (VZV) is one of the main viruses responsible of acute encephalitis. However, data on the prognosis and neurologic outcome of critically ill patients with VZV encephalitis are limited. We aimed to describe the clinical features of VZV encephalitis in the ICU and to identify factors associated with a favorable neurologic outcome. We performed a multicenter cohort study of patients with VZV encephalitis admitted in 18 ICUs in France between 2000 and 2017. Factors associated with a favorable neurologic outcome, defined by a modified Rankin Score (mRS) of 0–2 1 year after ICU admission, were identified by multivariable regression analysis. Results Fifty-five patients (29 (53%) men, median age 53 (interquartile range 36–66)) were included, of whom 43 (78%) were immunocompromised. ICU admission occurred 1 (0–3) day after the onset of neurological symptoms. Median Glasgow Coma Score at ICU admission was 12 (7–14). Cerebrospinal fluid examination displayed a median leukocyte count of 68 (13–129)/mm3, and a median protein level of 1.37 (0.77–3.67) g/L. CT scan and MRI revealed brain lesions in 30% and 66% of the cases, respectively. Invasive mechanical ventilation was implemented in 46 (84%) patients for a median duration of 13 (3–30) days. Fourteen (25%) patients died in the ICU. One year after ICU admission, 20 (36%) patients had a favorable neurologic outcome (mRS 0–2), 12 (22%) had significant disability (mRS 3–5), and 18 (33%) were deceased (lost to follow-up n = 5, 9%). On multivariable analysis, age (OR 0.92 per year, (0.88–0.97), p = 0.01), and invasive mechanical ventilation (OR 0.09 CI 95% (0.01–0.84), p = 0.03) reduced the likelihood of favorable neurologic outcome. Conclusion One in every three critically ill patients with VZV encephalitis had a favorable neurologic outcome 1 year after ICU admission. Older age and invasive mechanical ventilation were associated with a higher risk of disability and death.

Published
2022
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40. Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Author

Nicolas Massart, Virginie Maxime, Pierre Fillatre, Keyvan Razazi, Alexis Ferré, Pierre Moine, Francois Legay, Guillaume Voiriot, Marlene Amara, Francesca Santi, Saad Nseir, Stephanie Marque-Juillet, Rania Bounab, Nicolas Barbarot, Fabrice Bruneel, Charles-Edouard Luyt, and the COVID ICU Bacteremia Study Group on behalf of the COVID-ICU Investigators

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients. Patients and methods We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching. Results Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05–1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population. Conclusion COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.

Published
2021
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44. Nationwide retrospective study of critically ill adults with sickle cell disease in France

Author

Maïté Agbakou, Armand Mekontso-Dessap, Morgane Pere, Guillaume Voiriot, Muriel Picard, Jérémy Bourenne, Stephan Ehrmann, Emmanuel Canet, Alexandre Boyer, Saad Nseir, Fabienne Tamion, Arnaud W. Thille, Laurent Argaud, Emmanuel Pontis, Jean-Pierre Quenot, Francis Schneider, Arnaud Hot, Gilles Capellier, Cécile Aubron, Keyvan Razazi, Agathe Masseau, Noëlle Brule, Jean Reignier, and Jean-Baptiste Lascarrou

Subjects
Medicine, Science
Abstract

Abstract Little is known about patients with sickle cell disease (SCD) who require intensive care unit (ICU) admission. The goals of this study were to assess outcomes in patients admitted to the ICU for acute complications of SCD and to identify factors associated with adverse outcomes. This multicenter retrospective study included consecutive adults with SCD admitted to one of 17 participating ICUs. An adverse outcome was defined as death or a need for life-sustaining therapies (non-invasive or invasive ventilation, vasoactive drugs, renal replacement therapy, and/or extracorporeal membrane oxygenation). Factors associated with adverse outcomes were identified by mixed multivariable logistic regression. We included 488 patients admitted in 2015–2017. The main reasons for ICU admission were acute chest syndrome (47.5%) and severely painful vaso-occlusive event (21.3%). Sixteen (3.3%) patients died in the ICU, mainly of multi-organ failure following a painful vaso-occlusive event or sepsis. An adverse outcome occurred in 81 (16.6%; 95% confidence interval [95% CI], 13.3%–19.9%) patients. Independent factors associated with adverse outcomes were low mean arterial blood pressure (adjusted odds ratio [aOR], 0.98; 95% CI 0.95–0.99; p = 0.027), faster respiratory rate (aOR, 1.09; 95% CI 1.05–1.14; p

Published
2021
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45. Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study

Author

Vincent Labbé, Stephane Ederhy, Nathanael Lapidus, Jérémie Joffre, Keyvan Razazi, Laurent Laine, Oumar Sy, Sebastian Voicu, Frank Chemouni, Nadia Aissaoui, Roland Smonig, Denis Doyen, Fabrice Carrat, Guillaume Voiriot, Armand Mekontso-Dessap, Ariel Cohen, Muriel Fartoukh, and for the FAST Study Group

Subjects
Atrial fibrillation, Transesophageal echocardiography, Stroke, Bleeding, Sepsis, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Echocardiographic parameters have been poorly investigated for estimating cardiovascular risk in patients with sepsis and new-onset atrial fibrillation. We aim to assess the prevalence of transesophageal echocardiographic abnormalities and their relationship with cardiovascular events in mechanically ventilated patients with sepsis and new-onset atrial fibrillation. Methods In this prospective multicenter pilot study, left atrial/left atrial appendage (LA/LAA) dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were assessed using an initial transesophageal echocardiographic study, which was repeated after 48–72 h to detect LA/LAA thrombus formation. The study outcome was a composite of cardiovascular events at day 28, including arterial thromboembolic events (ischemic stroke, non-cerebrovascular arterial thromboembolism, LA/LAA thrombus), major bleeding, and all-cause death. Results The study population comprised 94 patients (septic shock 63%; 35% women; median age 69 years). LA/LAA dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were detected in 17 (19%), 22 (24%), and 27 (29%) patients, respectively. At day 28, the incidence of cardiovascular events was 46% (95% confidence interval [CI]: 35 to 56). Arterial thromboembolic events and major bleeding occurred in 7 (7%) patients (5 ischemic strokes, 1 non-cerebrovascular arterial thromboembolism, 2 left atrial appendage thrombi) and 18 (19%) patients, respectively. At day 28, 27 patients (29%) died. Septic shock (hazard ratio [HR]: 2.36; 95% CI 1.06 to 5.29) and left ventricular systolic dysfunction (HR: 2.06; 95% CI 1.05 to 4.05) were independently associated with cardiovascular events. Conclusions Transesophageal echocardiographic abnormalities are common in mechanically ventilated patients with sepsis and new-onset atrial fibrillation, but only left ventricular systolic dysfunction was associated with cardiovascular events at day 28.

Published
2021
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46. Refractory ineffective triggering during pressure support ventilation: effect of proportional assist ventilation with load-adjustable gain factors

Author

Anne-Fleur Haudebourg, Tommaso Maraffi, Samuel Tuffet, François Perier, Nicolas de Prost, Keyvan Razazi, Armand Mekontso Dessap, and Guillaume Carteaux

Subjects
Mechanical ventilation, Patient, Ventilator asynchrony, Ineffective triggering, Proportional assist ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Ineffective triggering is frequent during pressure support ventilation (PSV) and may persist despite ventilator adjustment, leading to refractory asynchrony. We aimed to assess the effect of proportional assist ventilation with load-adjustable gain factors (PAV+) on the occurrence of refractory ineffective triggering. Design Observational assessment followed by prospective cross-over physiological study. Setting Academic medical ICU. Patients Ineffective triggering was detected during PSV by a twice-daily inspection of the ventilator’s screen. The impact of pressure support level (PSL) adjustments on the occurrence of asynchrony was recorded. Patients experiencing refractory ineffective triggering, defined as persisting asynchrony at the lowest tolerated PSL, were included in the physiological study. Interventions Physiological study: Flow, airway, and esophageal pressures were continuously recorded during 10 min under PSV with the lowest tolerated PSL, and then under PAV+ with the gain adjusted to target a muscle pressure between 5 and 10 cmH2O. Measurements Primary endpoint was the comparison of asynchrony index between PSV and PAV+ after PSL and gain adjustments. Results Among 36 patients identified having ineffective triggering under PSV, 21 (58%) exhibited refractory ineffective triggering. The lowest tolerated PSL was higher in patients with refractory asynchrony as compared to patients with non-refractory ineffective triggering. Twelve out of the 21 patients with refractory ineffective triggering were included in the physiological study. The median lowest tolerated PSL was 17 cmH2O [12–18] with a PEEP of 7 cmH2O [5–8] and FiO2 of 40% [39–42]. The median gain during PAV+ was 73% [65–80]. The asynchrony index was significantly lower during PAV+ than PSV (2.7% [1.0–5.4] vs. 22.7% [10.3–40.1], p

Published
2021
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48. Cardiac and vascular effects of low-dose steroids during the early phase of septic shock: An echocardiographic study

Author

François Bagate, Alexandre Coppens, Paul Masi, Nicolas de Prost, Guillaume Carteaux, Keyvan Razazi, and Armand Mekontso Dessap

Subjects
low-dose steroid therapy, hydrocortisone, fludrocortisone, septic shock, echocardiography, global longitudinal strain, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundLow-dose steroids are known to increase arterial pressure during septic shock through restoration of vasopressor response to norepinephrine. However, their effects on cardiac performance and ventriculo-arterial coupling (VAC) have never been scrutinized during human septic shock. The aim of this study was to perform a comprehensive description of the cardiovascular effects of low-dose steroids using modern echocardiographic tools (including speckle tracking imaging).MethodsThis prospective study was conducted in the intensive care unit (ICU) of a university hospital in France. Consecutive adult patients admitted for septic shock and requiring low-dose steroid therapy were prospectively enrolled within 24 h of septic shock onset. We recorded hemodynamic and echocardiographic data to explore left ventricle (LV) contractility, loading conditions and VAC just before the initiation of low-dose steroids (50 mg intravenous hydrocortisone plus 50 μg enteral fludrocortisone) and 2–4 h after.ResultsFifty patients [65 (55–73) years; 33 men] were enrolled. Arterial pressure, heart rate, almost all LV afterload parameters, and most cardiac contractility parameters significantly improved after steroids. VAC improved with steroid therapy and less patients had uncoupled VAC (> 1.36) after (24%) than before (44%) treatment.ConclusionIn this comprehensive echocardiographic study, we confirmed an improvement of LV afterload after initiation of low-dose steroids. We also observed an increase in LV contractility with improved cardiovascular efficiency (less uncoupling with decreased VAC).

Published
2022
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49. Hemodynamic effects and tolerance of dobutamine for myocardial dysfunction during septic shock: An observational multicenter prospective echocardiographic study

Author

Keyvan Razazi, Vincent Labbé, Laurent Laine, Alexandre Bedet, Guillaume Carteaux, Nicolas de Prost, Florence Boissier, Francois Bagate, and Armand Mekontso Dessap

Subjects
septic shock, myocardial depression, dobutamine, mortality, echocardiography, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundThe role of dobutamine during septic shock resuscitation is still controversial.MethodsThe aim of this prospective multicentre study was to comprehensively characterize the hemodynamic response of septic shock patients with systolic myocardial dysfunction to incremental doses of dobutamine (0, 5, 10, and 15 μg/kg/min).ResultsThirty two patients were included in three centers. Dobutamine significantly increased contractility indices of both ventricles [crude and afterload-adjusted left ventricular (LV) ejection fraction, global LV longitudinal peak systolic strain, tissue Doppler peak systolic wave at mitral and tricuspid lateral annulus, and tricuspid annular plane excursion) as well as global function indices (stroke volume and cardiac index) and diastolic function (increased e' and decreased E/e' ratio at lateral mitral annulus). Dobutamine also induced a significant decrease in arterial pressure and cardiac afterload indices (effective arterial elastance, systemic vascular resistance and diastolic shock index). Oxygen transport, oxygen consumption and carbon dioxide production all increased with dobutamine, without change in the respiratory quotient or lactate. Dobutamine was discontinued for poor tolerance in a majority of patients (n = 21, 66%) at any dose and half of patients (n = 15, 47%) at low-dose (5 μg/kg/min). Poor tolerance to low-dose dobutamine was more frequent in case of acidosis, was associated with lower vasopressor-free days and survival at day-14.ConclusionIn patients with septic myocardial dysfunction, dobutamine induced an overall improvement of echocardiographic parameters of diastolic and systolic function, but was poorly tolerated in nearly two thirds of patients, with worsening vasoplegia. Patients with severe acidosis seemed to have a worse response to dobutamine.

Published
2022
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50. Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-Hôpitaux de Paris clinical data warehouse: a pilot study

Author

Muriel Fartoukh, Guillaume Voiriot, Laurent Guérin, Jean Damien Ricard, Alain Combes, Morgane Faure, Sarah Benghanem, Etienne de Montmollin, Yacine Tandjaoui-Lambiotte, Antoine Vieillard-Baron, Eric Maury, Jean-Luc Diehl, Keyvan Razazi, Virginie Lemiale, Pierre Trouiller, Benjamin Planquette, Laurent Savale, Nicholas Heming, Jonathan Marey, AP-HP Clinical Data Warehouse, Fabrice Carrat, Nathanael Lapidus, and The EPIcuFLU_APHP Group

Subjects
Epidemic, Influenza, Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse, Critical care, Prognosis, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Purpose At the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation. Materials, patients and methods We aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on medical adult critical care units of the AP-HP, and outcome of patients during the flu season 2017–2018. This exploratory multi-site epidemiological study comprised all consecutive adult stays (n = 320) in 18 medical intensive care units (ICU) or intermediate care wards (ICW) for probable or confirmed Influenza virus infection during the 2017–2018 flu season. Results Patients admitted to ICU/ICW had low vaccination coverage (21%), required life support in 60% of cases, stayed in the ICU for a median of 8 days, and had high 28-day mortality rate (19.7%; 95% confidence interval 15.5–24.5). Early prognostic factors included age, core temperature, the acute organ failures score, and the early administration of antiviral therapy. Conclusions Data directly extracted from the electronic medical records stored in the data warehouse provide detailed clinical, care pathway and prognosis information. The real-time availability should enable to detect and assess the burden of the most severe cases. By a firmer and more acute monitoring and adjustment of care and patient management, hospitals could generate more ICU/ICW capacities, sensitize their emergency department and contribute to the recommendations from health authorities. This pilot study is of particular relevance in the context of emerging epidemics of severe acute respiratory diseases.

Published
2021
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