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1. Frequency of screening and SBT Technique Trial—North American Weaning Collaboration (FAST-NAWC): an update to the protocol and statistical analysis plan

Author

Burns, Karen E. A., Lafrienier-Roula, Myriam, Hill, Nicholas S., Cook, Deborah J., Seely, Andrew J. E., Rochwerg, Bram, Mayette, Michael, D’Aragon, Frederick, Devlin, John W., Dodek, Peter, Tanios, Maged, Gouskos, Audrey, Turgeon, Alexis F., Aslanian, Pierre, Sia, Ying Tung, Beitler, Jeremy R., Hyzy, Robert, Criner, Gerard J., Kassis, Elias Baedorf, Tsang, Jennifer L. Y., Meade, Maureen O., Liebler, Janice M., Wong, Jessica T. Y., and Thorpe, Kevin E.

Published
2023
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2. 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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3. 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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9. 7 versus 14 days of antibiotic treatment for critically ill patients with bloodstream infection: a pilot randomized clinical trial

Author

Daneman, Nick, Rishu, Asgar H., Pinto, Ruxandra, Aslanian, Pierre, Bagshaw, Sean M., Carignan, Alex, Charbonney, Emmanuel, Coburn, Bryan, Cook, Deborah J., Detsky, Michael E., Dodek, Peter, Hall, Richard, Kumar, Anand, Lamontagne, Francois, Lauzier, Francois, Marshall, John C., Martin, Claudio M., McIntyre, Lauralyn, Muscedere, John, Reynolds, Steven, Sligl, Wendy, Stelfox, Henry T., Wilcox, M. Elizabeth, Fowler, Robert A., and on behalf of the Canadian Critical Care Trials Group

Published
2018
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11. Management of Acute Respiratory Distress Syndrome and Refractory Hypoxemia. A Multicenter Observational Study

Author

Duan, Erick H., Adhikari, Neill K. J., DʼAragon, Frederick, Cook, Deborah J., Mehta, Sangeeta, Alhazzani, Waleed, Goligher, Ewan, Charbonney, Emmanuel, Arabi, Yaseen M., Karachi, Tim, Turgeon, Alexis F., Hand, Lori, Zhou, Qi, Austin, Peggy, Friedrich, Jan, Lamontagne, Francois, Lauzier, François, Patel, Rakesh, Muscedere, John, Hall, Richard, Aslanian, Pierre, Piraino, Thomas, Albert, Martin, Bagshaw, Sean M., Jacka, Mike, Wood, Gordon, Henderson, William, Dorscheid, Delbert, Ferguson, Niall D., and Meade, Maureen O.

Published
2017
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12. Non-invasive detection of a femoral-to-radial arterial pressure gradient in intensive care patients with vasoactive agents

Author

Jacquet-Lagrèze, Matthias, primary, Claveau, David, additional, Cousineau, Julie, additional, Liu, Kun Peng, additional, Guimond, Jean-Gilles, additional, Aslanian, Pierre, additional, Lamarche, Yoan, additional, Albert, Martin, additional, Charbonney, Emmanuel, additional, Hammoud, Ali, additional, Kontar, Loay, additional, and Denault, André, additional

Published
2021
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13. Additional file 1 of An international tool to measure perceived stressors in intensive care units: the PS-ICU scale

Author

Laurent, Alexandra, Fournier, Alicia, Lheureux, Florent, Delgado, Maria Cruz Martin, Bocci, Maria G., Prestifilippo, Alessia, Aslanian, Pierre, Henriques, Julie, Paget-Bailly, Sophie, Jean-Michel Constantin, Besch, Guillaume, Quenot, Jean-Pierre, Anota, Amelie, Belaid Bouhemad, and Capellier, Gilles

Abstract

Additional file 1: Table S1. Qualitative results of Phase 1. Table S2. Suppressed and discuted items during Phase 2. Table S3. Comparisons between different methods of extraction (principal component, principal axis and maximum likelihood) and rotation techniques (Oblimin and Varimax) with six-factor structure and without items 22, 14, 43, 47. Table S4. Difficulties and fit statistics for the PS-ICU items from Item Response Theory models. Table S5. Mean comparisons (ANOVAs) according to between-subjects (occupation and gender) and within-subjects (stress factors) variables. Box 1. Details of statistical analysis. Box 2. PS-ICU scale English, French, Spanish and Italian versions.

Published
2021
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14. Construction of a stress scale specific to intensive care units: the PS-ICU scale

Author

Fournier, Alicia, Martin Delgado, Maria Cruz, Bocci, Maria Grazia, Prestifilippo, Alessia, Anota, Amélie, Aslanian, Pierre, Besch, Guillaume, Constantin, Jean-Michel, Quenot, Jean-Pierre, Bouhemad, Belaïd, Capellier, Gilles, Laurent, Alexandra, Laboratoire de psychologie : dynamiques relationnelles et processus identitaires [Dijon] (PSY-DREPI), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (MSHE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hospital Universitario de Torrejón, Fondazione 'Policlinico Universitario A. Gemelli' [Rome], Chercheur indépendant, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Maison des Sciences de l'Homme de Dijon (MSH Dijon (MSHD)), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), the French Intensive Care Society International Congress, Stress et Santé mentale des soignants en réanimation : de l’outil d’évaluation aux dispositifs d’accompagnement psychologique, Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (UAR 3124) (MSHE), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)

Subjects
[SHS.PSY]Humanities and Social Sciences/Psychology
Abstract

International audience; Rationale: The intensive care units (ICU) are fertile ground for the emergence of professional stressors. Assessed by individuals as situations that weaken or are beyond their resources, work-related stressors impact the mental and physical health of workers and the quality and safety of care. Currently, many tools are used to assess caregiver stress in ICU, but do not consider the specificity of this work. The objective of this international and multicentric study was to develop a perceived stress scale specific to ICU.Patients and methods: Interviews were conducted with 166 caregivers (84 nurses and 81 physicians) in four countries (France, Italy, Spain, Canada). These interviews were recorded, transcribed and then a thematic analysis was carried out to identify stress factors. A first version of the scale was pre-tested with 70 caregivers (30 physicians and 40 nurses) in the same countries. Finally, we carried out qualitative and quantitative analyses select the most relevant items.Results: We identified 99 stressors specific to the ICU that were grouped into eight main themes: stress in relation to 1) the patient, 2) the task to be performed, 3) the institutional context, 4) the team, 5) the organization of the unit, 6) the personal dimensions, 7) the patient’s family, 8) the working conditions. Following the pre-test, 50 items were selected to constitute the PS-ICU scale.Conclusion: Our results highlight specific items related to vital risk/emergency management and ethically and morally problematic situations. These dimensions will be discussed and compared against existing scales (e.g., JCQ). The PS-ICU scale will allow to better identify and measure stressors in ICU. This scale will contribute to the development of targeted actions in terms of prevention, training and support for professionals. The creation of an internationally validated tool will make it possible to develop comparative studies on cultural and organizational factors.

Published
2020
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15. Development of a scale of perceived stressors specific to ICU: the PS-ICU scale

Author

Fournier, Alicia, Laurent, Alexandra, Anota, Amélie, Lheureux, Florent, Martin Delgado, Maria Cruz, Bocci, Maria Grazia, Prestifilippo, Alessia, Aslanian, Pierre, Capellier, Gilles, Laboratoire de psychologie : dynamiques relationnelles et processus identitaires [Dijon] (PSY-DREPI), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (MSHE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Maison des Sciences de l'Homme de Dijon (MSH Dijon (MSHD)), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire de Psychologie - UFC (EA 3188) (PSYCHO), Université de Franche-Comté (UFC), Hospital Universitario de Torrejón, Fondazione 'Policlinico Universitario A. Gemelli' [Rome], Chercheur indépendant, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), European Health Psychology Society, Stress et Santé mentale des soignants en réanimation : de l’outil d’évaluation aux dispositifs d’accompagnement psychologique, Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (UAR 3124) (MSHE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Psychologie - UFC (UR 3188) (PSYCHO), and Maison des Sciences de l'Homme, MSH Dijon

Subjects
[SHS.PSY] Humanities and Social Sciences/Psychology, Suffering at work, Unité de soins intensifs, Stressors, Intensive Care Unit, Souffrance au travail, [SHS.PSY]Humanities and Social Sciences/Psychology, marqueurs, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2019

16. Identification of stress factors in intensive care units: Is a specific stress scale necessary?

Author

Fournier, Alicia, Laurent, Alexandra, Lheureux, Florent, Martin Delgado, Maria Cruz, Bocci, Maria Grazia, Prestifilippo, Alessia, Anota, Amélie, Aslanian, Pierre, Capellier, Gilles, Maison des Sciences de l'Homme, MSH Dijon, Laboratoire de psychologie : dynamiques relationnelles et processus identitaires [Dijon] (PSY-DREPI), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (UAR 3124) (MSHE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Maison des Sciences de l'Homme de Dijon (MSH Dijon (MSHD)), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Psychologie - UFC (UR 3188) (PSYCHO), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hospital Universitario de Torrejón, Fondazione 'Policlinico Universitario A. Gemelli' [Rome], Chercheur indépendant, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), European Health Psychology Society, Stress et Santé mentale des soignants en réanimation : de l’outil d’évaluation aux dispositifs d’accompagnement psychologique, Maison des Sciences de l'Homme et de l'Environnement Claude Nicolas Ledoux (MSHE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Laboratoire de Psychologie - UFC (EA 3188) (PSYCHO)

Subjects
Suffering at work, [SHS.PSY] Humanities and Social Sciences/Psychology, Stressors, [SHS.PSY]Humanities and Social Sciences/Psychology, Souffrance au travail, marqueurs
Abstract

International audience; Background: Intensive care units (ICUs) are a health environment particularly affected by suffering at work. These units treat patients with serious medical conditions with an immediate life-threatening risk in an emergency situation. As a result, caregivers are confronted intensively and repeatedly with an extreme clinic. Currently, many tools used to assess caregiver stress are not as close as possible to the professional experience and do not take into account the subjective perception of stressors. The objective of this qualitative study is to rely directly on the way professionals perceive their work, and to identify the specificity of stress factors in ICU. Methods: We conducted individual clinical interviews with 166 intensive care providers (84 nurses and 81 physicians) in four countries (France, Italy, Spain, Canada). During the interview, they were asked to express their work experiences. The interviews were recorded, and then fully transcribed, and analysed using interpretative phenomenological analysis. Findings: The qualitative analysis identified 99 stressors divided into eight main stress source themes. The identification of these stress factors highlights stress dimensions that seem more specific to ICU such as dealing with ethical and moral-related situations, risk management issues. Discussion: All dimensions of stress are not well represented in the stress scales most commonly used in ICU (e.g. JCQ, ERI, NSS, NWI). This study shows us the need to develop a stress tool specific to ICU.

Published
2019

17. Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy: The SCARLET Randomized Clinical Trial

Author

Vincent, Jean-Louis, Francois, Bruno, Zabolotskikh, Igor, Daga, Mradul Kumar, Lascarrou, Jean-Baptiste, Kirov, Mikhail Y., Pettila, Ville, Wittebole, Xavier, Meziani, Ferhat, Mercier, Emmanuelle, Lobo, Suzana M., Barie, Philip S., Crowther, Mark, Esmon, Charles T., Fareed, Jawed, Gando, Satoshi, Gorelick, Kenneth J., Levi, Marcel, Mira, Jean-Paul, Opal, Steven M., Parrillo, Joseph, Russell, James A., Saito, Hidehiko, Tsuruta, Kazuhisa, Sakai, Takumi, Fineberg, David, Bertuzzi, Romina, Bellomo, Rinaldo, Chapman, Marianne, Ernest, David, Fletcher, Jason, French, Craig, Gowardman, John, Shehabi, Yahya, Venkatesh, Bala, Walsham, James, Vij, Sanjiv, Chochrad, Didier, Creteur, Jacques, Devriendt, Jacques, Dive, Alain-Michel, Dugernier, Thierry, Foret, Frederic, Hoste, Eric, Jorens, Philippe, Simon, Marc, Spapen, Herbert, Dias, Fernando, Freire, Antonio, Lobo, Suzana Margarth, Simeonov, Georgi, Stefanov, Chavdar, Aslanian, Pierre, Berthiaume, Luc, Martin, Claudio, Chittock, Dean, Dhar, Anil, Doig, Christopher, Jones, Gwynne, Hall, Richard, Boyd, John, Shin, Phil, Wood, Gordon, Zarychanski, Ryan, Quinteros, Guillermo Agamenon, Gasparovic, Vladimir, Husedzinovic, Ino, Balik, Martin, Burget, Ivo, Dlouhy, Pavel, Pachl, Jan, Karlsson, Sari, Laru-Sompa, Raili, Parviainen, Ilkka, Ruokone, Esko, Skrifvars, Markus, Bohe, Julien, Dellamonica, Jean, Duguet, Alexandre, Durand-Gasselin, Jacques, Fiancette, Maud, Joannes-Boyau, Olivier, Lefrant, Jean-Yves, Mercat, Alain, Nseir, Saad, Quenot, Jean-Pierre, Reignier, Jean, Schwebel, Carole, Marx, Gernot, Zacharowski, Kai, Armaganidis, Apostolos, Komnos, Apostolos, Fejer, Csaba, Appajigol, Jayaprakash, Behera, Sarat Kumar, ChandraShekhar, Shivprasad, Chowdhury, Sanmay, D'costa, Pradeep Micheal, Gupta, Hari Shankar Shivkumar, Iyer, Shivakumar, Khan, Zafer A., Mehta, Minesh, Murthy, Sudharshan, Sahu, Sambit, Tewari, Reshma, Bar-Lavie, Yaron, Bregman, Gennady, Cohen, Jonathan, Eden, Arie, Einav-Bromiker, Sharon, Jakobson, Daniel, Nimrod, Adi, Beishuizen, Albertus, Gerritsen, Richard, Pickkers, Peter, Rozendaal, Wim, Schoonderbeek, F. J., Spoelstra-de Man, Angelique, van Zanten, Arthur R. H., Zijlstra, Jan G., Freebairn, Ross, Henderson, Seton, McArthur, Colin, Young, Paul, Mayorga, Manuel Jesus, Agafina, Alina S., Bubnova, Natalia, Gritsan, Alexey, Kameneva, Evgenia, Katasonov, Sergey P., Khasanova, Nina M., Kruberg, Lilly, Kulabukhov, Vladimir V., Lebedinskii, Konstantin, Spesivtsev, Yuri A., Rankovic, Zarko, Hong, Sang Bum, Kim, Min-Ja, Suh, Gee Young, Yoo, Chul-Gyu, Raventos, Antonio Artigas, Ferrer, Ricard, Vazquez, Rita Galeiras, Hernandez, Marianela, Piacentini, Enrique, Rodriguez Oviedo, Alejandro Hugo, Garcia, Miguel Sanchez, Chan, Ming-Cheng, Cheng, Kuo-Chen, Yu, Chong-Jen, Eddleston, Jane, Smith, Fang Gao, MacNaughton, Peter, Welters, Ingeborg, Allen, Karen, Bochicchio, Grant, Carlson, Richard, Eaton, Stephanie, Fink, Ryan, Gianatiempo, Carmine, Kapoor, Rajat, Kinasewitz, Gary, Koura, Firas, Krell, Kenneth, Martin, Niels, Nepal, Santosh, Pastores, Stephen M., Peltan, Ithan, Pullman, John, Seibert, Allan, Smith, Jason, Tennenberg, Steven, Wilhelm, Andrew, Zeno, Brian, Allton, Pam, Carruthers, David, Matsuki, Osamu, Kayanoki, Toshihiko, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (MGD) Services des soins intensifs, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Diabetes & metabolism, UCL - (SLuc) Service de soins intensifs, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and SCARLET Trial Grp

Subjects
Male, medicine.medical_specialty, Thrombomodulin, COAGULATION, PROTEIN, Placebo, 01 natural sciences, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Intensive care, Cause of Death, Sepsis, medicine, Clinical endpoint, Coagulopathy, Humans, 030212 general & internal medicine, International Normalized Ratio, Treatment Failure, 0101 mathematics, Infusions, Intravenous, Original Investigation, Aged, business.industry, Mortality rate, 010102 general mathematics, Anticoagulants, General Medicine, Disseminated Intravascular Coagulation, Blood Coagulation Disorders, Middle Aged, medicine.disease, Recombinant Proteins, 3. Good health, Injections, Intravenous, Female, Human medicine, business, Packed red blood cells
Abstract

IMPORTANCE Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy.OBJECTIVE To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy.DESIGN, SETTING, AND PARTICIPANTS The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 x 10(9)/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019.INTERVENTIONS Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06mg/kg/d [maximum, 6mg/d]; n=-395) or matching placebo (n=-405) once daily for 6 days.MAIN OUTCOME AND MEASURES The primary end pointwas 28-day all-cause mortality.RESULTS Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P=-.32). The absolute risk difference was 2.55%(95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group.CONCLUSIONS AND RELEVANCE Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01598831

Published
2019
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23. Stratégies de prise en charge liquidienne restrictive et pronostics en transplantation hépatique : une revue systématique.

Author

Carrier, François Martin, Chassé, Michaël, Wang, Han Ting, Aslanian, Pierre, Iorio, Stéfanie, Bilodeau, Marc, and Turgeon, Alexis F.

Subjects
PREVENTION of surgical complications, FLUID therapy, SYSTEMATIC reviews, SURGICAL complications, LIVER transplantation, ACUTE kidney failure
Abstract

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2020
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27. Additional file 1: of 7 versus 14Â days of antibiotic treatment for critically ill patients with bloodstream infection: a pilot randomized clinical trial

Author

Daneman, Nick, Asgar Rishu, Pinto, Ruxandra, Aslanian, Pierre, Bagshaw, Sean, Carignan, Alex, Charbonney, Emmanuel, Coburn, Bryan, Cook, Deborah, Detsky, Michael, Dodek, Peter, Hall, Richard, Kumar, Anand, Francois Lamontagne, Francois Lauzier, Marshall, John, Martin, Claudio, Lauralyn McIntyre, Muscedere, John, Reynolds, Steven, Sligl, Wendy, Stelfox, Henry, M. Wilcox, and Fowler, Robert

Subjects
3. Good health
Abstract

CONSORT 2010 Checklist of information to include when reporting a pilot or feasibility trial*. (DOC 226 kb)

28. Additional file 1: of 7 versus 14Â days of antibiotic treatment for critically ill patients with bloodstream infection: a pilot randomized clinical trial

Author

Daneman, Nick, Asgar Rishu, Pinto, Ruxandra, Aslanian, Pierre, Bagshaw, Sean, Carignan, Alex, Charbonney, Emmanuel, Coburn, Bryan, Cook, Deborah, Detsky, Michael, Dodek, Peter, Hall, Richard, Kumar, Anand, Francois Lamontagne, Francois Lauzier, Marshall, John, Martin, Claudio, Lauralyn McIntyre, Muscedere, John, Reynolds, Steven, Sligl, Wendy, Stelfox, Henry, M. Wilcox, and Fowler, Robert

Subjects
3. Good health
Abstract

CONSORT 2010 Checklist of information to include when reporting a pilot or feasibility trial*. (DOC 226 kb)

29. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.

Author

Daneman N, Rishu A, Pinto R, Rogers BA, Shehabi Y, Parke R, Cook D, Arabi Y, Muscedere J, Reynolds S, Hall R, Dwivedi DB, McArthur C, McGuinness S, Yahav D, Coburn B, Geagea A, Das P, Shin P, Detsky M, Morris A, Fralick M, Powis JE, Kandel C, Sligl W, Bagshaw SM, Singhal N, Belley-Cote E, Whitlock R, Khwaja K, Morpeth S, Kazemi A, Williams A, MacFadden DR, McIntyre L, Tsang J, Lamontagne F, Carignan A, Marshall J, Friedrich JO, Cirone R, Downing M, Graham C, Davis J, Duan E, Neary J, Evans G, Alraddadi B, Al Johani S, Martin C, Elsayed S, Ball I, Lauzier F, Turgeon A, Stelfox HT, Conly J, McDonald EG, Lee TC, Sullivan R, Grant J, Kagan I, Young P, Lawrence C, O'Callaghan K, Eustace M, Choong K, Aslanian P, Buehner U, Havey T, Binnie A, Prazak J, Reeve B, Litton E, Lother S, Kumar A, Zarychanski R, Hoffman T, Paterson D, Daley P, Commons RJ, Charbonney E, Naud JF, Roberts S, Tiruvoipati R, Gupta S, Wood G, Shum O, Miyakis S, Dodek P, Kwok C, and Fowler RA

Abstract

Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain., Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days. Antibiotic selection, dosing, and route were at the discretion of the treating team. We excluded patients with severe immunosuppression, foci requiring prolonged treatment, single cultures with possible contaminants, or cultures yielding Staphylococcus aureus . The primary outcome was death from any cause by 90 days after diagnosis of the bloodstream infection, with a noninferiority margin of 4 percentage points., Results: Across 74 hospitals in seven countries, 3608 patients underwent randomization and were included in the intention-to-treat analysis; 1814 patients were assigned to 7 days of antibiotic treatment, and 1794 to 14 days. At enrollment, 55.0% of patients were in the ICU and 45.0% were on hospital wards. Infections were acquired in the community (75.4%), hospital wards (13.4%) and ICUs (11.2%). Bacteremia most commonly originated from the urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%). By 90 days, 261 patients (14.5%) receiving antibiotics for 7 days had died and 286 patients (16.1%) receiving antibiotics for 14 days had died (difference, -1.6 percentage points [95.7% confidence interval {CI}, -4.0 to 0.8]), which showed the noninferiority of the shorter treatment duration. Patients were treated for longer than the assigned duration in 23.1% of the patients in the 7-day group and in 10.7% of the patients in the 14-day group. A per-protocol analysis also showed noninferiority (difference, -2.0 percentage points [95% CI, -4.5 to 0.6]). These findings were generally consistent across secondary clinical outcomes and across prespecified subgroups defined according to patient, pathogen, and syndrome characteristics., Conclusions: Among hospitalized patients with bloodstream infection, antibiotic treatment for 7 days was noninferior to treatment for 14 days. (Funded by the Canadian Institutes of Health Research and others; BALANCE ClinicalTrials.gov number, NCT03005145.)., (Copyright © 2024 Massachusetts Medical Society.)

Published
2024
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30. Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial.

Author

Burns KEA, Wong J, Rizvi L, Lafreniere-Roula M, Thorpe K, Devlin JW, Cook DJ, Seely A, Dodek PM, Tanios M, Piraino T, Gouskos A, Kiedrowski KC, Kay P, Mitchell S, Merner GW, Mayette M, D'Aragon F, Lamontagne F, Rochwerg B, Turgeon A, Sia YT, Charbonney E, Aslanian P, Criner GJ, Hyzy RC, Beitler JR, Kassis EB, Kutsogiannis DJ, Meade MO, Liebler J, Iyer-Kumar S, Tsang J, Cirone R, Shanholtz C, and Hill NS

Abstract

Importance: The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown., Objective: To compare the effects of screening frequency (once-daily screening vs more frequent screening) and SBT technique (pressure-supported SBT with a pressure support level that was >0-≤8 cm H2O and a positive end-expiratory pressure [PEEP] level that was >0-≤5 cm H2O vs T-piece SBT) on the time to successful extubation., Design, Setting, and Participants: Randomized clinical trial with a 2 × 2 factorial design including critically ill adults who were receiving invasive mechanical ventilation for at least 24 hours, who were capable of initiating spontaneous breaths or triggering ventilators, and who were receiving a fractional concentration of inspired oxygen that was 70% or less and a PEEP level of 12 cm H2O or less. Recruitment was between January 2018 and February 2022 at 23 intensive care units in North America; last follow-up occurred October 18, 2022., Interventions: Participants were enrolled early to enable protocolized screening (more frequent vs once daily) to identify the earliest that patients met criteria to undergo pressure-supported or T-piece SBT lasting 30 to 120 minutes., Main Outcome and Measures: Time to successful extubation (time when unsupported, spontaneous breathing began and was sustained for ≥48 hours after extubation)., Results: Of 797 patients (198 in the once-daily screening and pressure-supported SBT group, 204 in once-daily screening and T-piece SBT, 195 in more frequent screening and pressure-supported SBT, and 200 in more frequent screening and T-piece SBT), the mean age was 62.4 (SD, 18.4) years and 472 (59.2%) were men. There were no statistically significant differences by screening frequency (hazard ratio [HR], 0.88 [95% CI, 0.76-1.03]; P = .12) or by SBT technique (HR, 1.06 [95% CI, 0.91-1.23]; P = .45). The median time to successful extubation was 2.0 days (95% CI, 1.7-2.7) for once-daily screening and pressure-supported SBT, 3.1 days (95% CI, 2.7-4.8) for once-daily screening and T-piece SBT, 3.9 days (95% CI, 2.9-4.7) for more frequent screening and pressure-supported SBT, and 2.9 days (95% CI, 2.0-3.1) for more frequent screening and T-piece SBT. An unexpected interaction between screening frequency and SBT technique required pairwise contrasts that revealed more frequent screening (vs once-daily screening) and pressure-supported SBT increased the time to successful extubation (HR, 0.70 [95% CI, 0.50-0.96]; P = .02). Once-daily screening and pressure-supported SBT (vs T-piece SBT) did not reduce the time to successful extubation (HR, 1.30 [95% CI, 0.98-1.70]; P = .08)., Conclusions and Relevance: Among critically ill adults who received invasive mechanical ventilation for more than 24 hours, screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBT) did not change the time to successful extubation. However, an unexpected and statistically significant interaction was identified; protocolized more frequent screening combined with pressure-supported SBTs increased the time to first successful extubation., Trial Registration: ClinicalTrials.gov Identifiers: NCT02399267 and NCT02969226.

Published
2024
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31. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial.

Author

Johnstone J, Meade M, Lauzier F, Marshall J, Duan E, Dionne J, Arabi YM, Heels-Ansdell D, Thabane L, Lamarche D, Surette M, Zytaruk N, Mehta S, Dodek P, McIntyre L, English S, Rochwerg B, Karachi T, Henderson W, Wood G, Ovakim D, Herridge M, Granton J, Wilcox ME, Goffi A, Stelfox HT, Niven D, Muscedere J, Lamontagne F, D'Aragon F, St-Arnaud C, Ball I, Nagpal D, Girard M, Aslanian P, Charbonney E, Williamson D, Sligl W, Friedrich J, Adhikari NK, Marquis F, Archambault P, Khwaja K, Kristof A, Kutsogiannis J, Zarychanski R, Paunovic B, Reeve B, Lellouche F, Hosek P, Tsang J, Binnie A, Trop S, Loubani O, Hall R, Cirone R, Reynolds S, Lysecki P, Golan E, Cartin-Ceba R, Taylor R, and Cook D

Subjects
Aged, Anti-Bacterial Agents adverse effects, Bacterial Infections prevention & control, Diarrhea prevention & control, Female, Humans, Intensive Care Units, Male, Middle Aged, Treatment Failure, Anti-Bacterial Agents therapeutic use, Lacticaseibacillus rhamnosus, Pneumonia, Ventilator-Associated prevention & control, Probiotics therapeutic use, Respiration, Artificial adverse effects
Abstract

Importance: Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections have also been reported., Objective: To evaluate the effect of Lactobacillus rhamnosus GG on preventing VAP, additional infections, and other clinically important outcomes in the intensive care unit (ICU)., Design, Setting, and Participants: Randomized placebo-controlled trial in 44 ICUs in Canada, the United States, and Saudi Arabia enrolling adults predicted to require mechanical ventilation for at least 72 hours. A total of 2653 patients were enrolled from October 2013 to March 2019 (final follow-up, October 2020)., Interventions: Enteral L rhamnosus GG (1 × 1010 colony-forming units) (n = 1321) or placebo (n = 1332) twice daily in the ICU., Main Outcomes and Measures: The primary outcome was VAP determined by duplicate blinded central adjudication. Secondary outcomes were other ICU-acquired infections including Clostridioides difficile infection, diarrhea, antimicrobial use, ICU and hospital length of stay, and mortality., Results: Among 2653 randomized patients (mean age, 59.8 years [SD], 16.5 years), 2650 (99.9%) completed the trial (mean age, 59.8 years [SD], 16.5 years; 1063 women [40.1%.] with a mean Acute Physiology and Chronic Health Evaluation II score of 22.0 (SD, 7.8) and received the study product for a median of 9 days (IQR, 5-15 days). VAP developed among 289 of 1318 patients (21.9%) receiving probiotics vs 284 of 1332 controls (21.3%; hazard ratio [HR], 1.03 (95% CI, 0.87-1.22; P = .73, absolute difference, 0.6%, 95% CI, -2.5% to 3.7%). None of the 20 prespecified secondary outcomes, including other ICU-acquired infections, diarrhea, antimicrobial use, mortality, or length of stay showed a significant difference. Fifteen patients (1.1%) receiving probiotics vs 1 (0.1%) in the control group experienced the adverse event of L rhamnosus in a sterile site or the sole or predominant organism in a nonsterile site (odds ratio, 14.02; 95% CI, 1.79-109.58; P < .001)., Conclusions and Relevance: Among critically ill patients requiring mechanical ventilation, administration of the probiotic L rhamnosus GG compared with placebo, resulted in no significant difference in the development of ventilator-associated pneumonia. These findings do not support the use of L rhamnosus GG in critically ill patients., Trial Registration: ClinicalTrials.gov Identifier: NCT02462590.

Published
2021
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