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1. Simpaticomiméticos: farmacología e indicaciones terapéuticas en reanimación

Author

B Ragonnet, Marc Leone, and Claude Martin

Subjects
business.industry, Philosophy, Medicine, business, Humanities
Abstract

Los agentes simpaticomimeticos son potentes medicamentos vasopresores o inotropos positivos. Algunas catecolaminas son de origen natural (adrenalina, noradrenalina, dopamina), mientras que otras son sinteticas (dobutamina, dopexamina, isoproterenol). Otros agentes no tienen la estructura quimica de las catecolaminas, pero actuan en sus mismos receptores para producir sus mismos efectos farmacologicos (fenilefrina, efedrina, etc.). Los agentes simpaticomimeticos son la piedra angular, junto con la expansion de la volemia, del tratamiento de la insuficiencia cardiocirculatoria. En las formas graves de shock hemorragico, la adrenalina y la noradrenalina son adyuvantes indispensables para evitar el fallecimiento por neutralizacion de la bomba cardiaca. En el shock cardiogenico, la dopamina, la dobutamina y la noradrenalina se escogen en funcion del nivel de presion arterial. En el shock septico, la noradrenalina asociada o no a la dobutamina es el agente de eleccion. No existen indicaciones para prescribir la dopamina a dosis dopaminergicas (

Published
2015

2. Farmacologia dei simpaticomimetici: indicazioni terapeutiche in rianimazione

Author

Marc Leone, B Ragonnet, and Claude Martin

Subjects
Philosophy, Humanities
Abstract

Gli agenti simpaticomimetici sono farmaci vasopressori o inotropi positivi. Alcune catecolamine sono di origine naturale (adrenalina, noradrenalina, dopamina) e altre di origine sintetica (dobutamina, dopexamina, isoproterenolo). Altri agenti non hanno la struttura chimica delle catecolamine ma agiscono sugli stessi recettori per dare i loro effetti farmacologici (fenilefrina, efedrina). Gli agenti simpaticomimetici sono una delle basi, con l’espansione volemica, del trattamento dei distress cardiocircolatori. In presenza di uno stato di shock settico o emorragico, la noradrenalina e la catecolamina da prescrivere in prima intenzione. L’adrenalina e, dal canto suo, sempre la pietra angolare del trattamento degli stati di shock anafilattico. La dobutamina conserva un posto importante quando l’inotropismo cardiaco e alterato, benche la sua innocuita resti controversa. Non esiste alcuna indicazione a prescrivere dopamina in rianimazione.

Published
2015

3. Antifungal therapy for patients with proven or suspected Candida peritonitis: Amarcand2, a prospective cohort study in French intensive care units

Author

Alexandre Ouattara, Lionel Lamhaut, Olivier Leroy, F. Thevenot, B. Goubaux, Franck Petitpas, Elie Azoulay, Cédric Bretonnière, P. Geffe, Jean-Marie Forel, Joel Cousson, G. Brunin, F. Bellec, Yves Cohen, A. Kherchache, C. Sejourne, R. Grenot, Bruno Mégarbane, A.L. Foucher-Lezla, Philippe Karoubi, M.C. Barthet, E. Duroy, Jean-Michel Constantin, S. Brua, F. Lebreton, Philippe Mateu, Anne Charlotte Tellier, Jean-Paul Mira, Didier Guillemot, T. Lepoivre, D. Guelon, Didier Demory, A.M. Guerin-Robardey, Elie Zogheib, D. Hayl-Slayman, Bernard Allaouchiche, Gilles Blasco, Pierre-François Perrigault, Bruno Levy, D. du Cheyron, Alain Lepape, J. F. Timsit, Nicolas Bruder, Michel Durand, N. Van Grunderbeek, Jean-Pierre Gangneux, H. Houissa, J.F. Vincent, E. Diconne, O. Lortholary, B Ragonnet, Christophe Lemaire, E. Brocas, Olivier Baldesi, E. Delpierre, Sébastien Bailly, J. Ruiz, Philippe Montravers, Hervé Dupont, Anne-Sylvie Dumenil, Olivier Lesieur, Agnès Bonadona, P. Cabaret, Philippe Gaudard, Ambroise Montcriol, P. Ichai, Z. Schmitt, C. Bensoussan, P. Gouin, Laurent Argaud, C. Dubost, Florent Baudin, Sami Hraiech, Christophe Guervilly, Pierre-Emmanuel Charles, Fabien Lambiotte, S. Gette, N. Ammenouche, M. Adda, Jean-Marie Tonnelier, D. Samba, Russel Chabanne, Pierre-Joachim Mahe, B. Page, P. Mahul, Dorothée Carpentier, Philippe Seguin, C. Badetti, J. Gally, Jean-Charles Cartier, Christophe Girault, S. Fratea, G. Angel, Olivier Bastien, Raphaël Cinotti, Charles-Edouard Luyt, Soizic Gergaud, Boris Jung, G. Grossmith, F. Saliba, Antoine Roquilly, C. Cheval, J.Y. Lefrant, A. Launoy, A. Aait Hssain, Gilles Hilbert, Sandrine Wiramus, Pierre-Edouard Bollaert, Hervé Quintard, Gaëtan Plantefève, Jean-Christophe Navellou, M. Kaidomar, A. Quinart, Charles Cerf, J.C. Merle, Y. Mootien, Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université Paris Diderot - Paris 7 (UPD7), Hôpital Cochin [AP-HP], Université Paris Descartes - Paris 5 (UPD5), Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris], Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Hôpital Chatiliez, Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CHU Clermont-Ferrand, CHU Amiens-Picardie, Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Université Paris Diderot - Paris 7 ( UPD7 ), CHU Cochin [AP-HP], Université Paris Descartes - Paris 5 ( UPD5 ), Centre d'infectiologie Necker-Pasteur, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire ( CNRMA ), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses ( B2PHI ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris], and Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)

Subjects
0301 basic medicine, Comorbidity, Severity of Illness Index, 0302 clinical medicine, Critically ill patients, Risk Factors, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Peritonitis score, Odds Ratio, Prospective Studies, 030212 general & internal medicine, Simplified Acute Physiology Score, Prospective cohort study, Candida, biology, Candidiasis, General Medicine, Middle Aged, 3. Good health, Invasive candidiasis, Intensive Care Units, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Treatment Outcome, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, SAPS II, France, medicine.drug, Microbiology (medical), medicine.medical_specialty, Echinocandin, 030106 microbiology, Peritonitis, Empiric antifungal therapy, 03 medical and health sciences, Candida score, Internal medicine, Intensive care, medicine, Humans, Targeted antifungal therapy, Antifungal agents, Aged, Candida glabrata, business.industry, biology.organism_classification, medicine.disease, Surgery, Candida peritonitis, ROC Curve, business, Fluconazole
Abstract

International audience; OBJECTIVE:The clinical characteristics and prognosis of patients treated for Candida peritonitis (CP) were compared according to the type of systemic antifungal therapy (SAT), empiric (EAF) or targeted (TAF) therapies, and the final diagnosis of infection.METHODS:Patients in intensive care units (ICU) treated for CP were selected among the AmarCAND2 cohort, to compare patients receiving EAF for unconfirmed suspicion of CP (EAF/nonCP), to those with suspected secondarily confirmed CP (EAF/CP), or with primarily proven CP receiving TAF.RESULTS:In all, 279 patients were evaluated (43.4% EAF/nonCP, 29.7% EAF/CP and 25.8% TAF patients). At SAT initiation, the severity of illness was similar among EAF/nonCP and EAF/CP patients, lower among TAF patients (median Simplified Acute Physiology Score II (SAPS II) 49 and 51 versus 35, respectively; p 0.001). Candida albicans was involved in 67%, Candida glabrata in 15.6%. All strains were susceptible to echinocandin; 84% to fluconazole. Echinocandin was administered to 51.2% EAF/nonCP, 49% EAF/CP and 40% TAF patients. At day 28, 72%, 76% and 75% of EAF/nonCP, EAF/CP and TAF patients, respectively, were alive. An increased mortality was observed in patients with a Sequential Organ Failure Assessment (SOFA) score

Published
2017

4. Pré-éclampsie sévère et hémorragie post-partum: apport de l’échographie « corps entier »

Author

Maxime Tourret, Cécile Chau, Laurent Zieleskiewicz, B Ragonnet, Marc Leone, Fabien Craighero, Claire Contargyris, Candice Pierrou, and Claude Martin

Subjects
Gynecology, medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Anesthesia, medicine, General Medicine, Ultrasonography, business
Abstract

Objectif La prise en charge des patientes pre-eclamptiques severes est un defi pour les equipes travaillant en secteur obstetrical. Nous montrons ici que l’echographie de plusieurs organes du corps realisee au lit d’une patiente a apporte des informations necessaires a la prise en charge, sans necessite de la transferer en service de radiologie ni d’avoir recours a des intervenants exterieurs.

Published
2013

5. Selective digestive decontamination and empirical antimicrobial therapy of late–onset ventilator–associated pneumonia in trauma patients

Author

Julien Textoris, Marc Leone, Frédéric Garcin, François Antonini, B Ragonnet, and Claude Martin

Subjects
musculoskeletal diseases, medicine.medical_specialty, business.industry, Ventilator-associated pneumonia, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Retrospective cohort study, Late onset, General Medicine, Pneumonia, lcsh:RC86-88.9, medicine.disease, University hospital, Antimicrobial, Digestive decontamination, Intensive care unit, Trauma, law.invention, Antimicrobial therapy, law, Internal medicine, Selective digestive decontamination, medicine, Intensive care medicine, business
Abstract

Objective To assess the appropriateness of empirical antimicrobial therapy in trauma patients treated with selective digestive decontamination (SDD) who developed ventilator-associated pneumonia (VAP). Methods Retrospective study comparing 199 trauma patients receiving SDD and 99 non-trauma patients not receiving SDD hospitalized in a polyvalent intensive care unit (ICU) of a university hospital. Results Early-onset VAP were recorded in 76 (35%) patients. Late-onset VAP occurred in 86 (72%) trauma patients receiving SDD and 56 (56%) non-trauma patients not receiving SDD ( P = 0.02). The empirical antimicrobial therapy was appropriate in 108 (91%) trauma patients receiving SDD and 82 (83%) non-trauma patients not receiving SDD ( P = 0.1). In the patients who developed late-onset VAP, the empirical antimicrobial therapy was appropriate in 77 (90%) trauma patients receiving SDD and 49 (88%) non-trauma patients not receiving SDD ( P = 0.9). De-escalation was performed in 52 (44%) trauma patients receiving SDD and 37 (37%) non-trauma patients not receiving SDD ( P = 0.4). Recurrences were observed in 26 (22%) trauma patients receiving SDD and 18 (18%) non-trauma patients not receiving SDD ( P = 0.6). These episodes were due to easy-to-treat pathogens in 75 (63%) trauma patients and 33 (33%) non-trauma patients ( P = 0.01). Conclusions SDD is not associated with a rise in the rate of inappropriateness of the empirical antimicrobial therapy in trauma patients developing late-onset VAP.

Published
2012

6. Practices of end-of-life decisions in 66 southern French ICUs 4years after an official legal framework: A 1-day audit

Author

Samir Jaber, Pierre Bouzat, Bernard Allaouchiche, B Ragonnet, Jean-Yves Lefrant, J. Morel, Emmanuel Futier, Thomas Rimmelé, Nicolas Molinari, Arnaud Friggeri, Stein Silva, Jean-Michel Constantin, Olivier Desebbe, Carole Ichai, Boris Jung, Marc Leone, Jean Christophe Orban, Claire Roger, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hémostase, Inflammation et sepsis (EA 4609), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Réanimation Médico-Chirurgicale, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service d'anesthésiologie et de soins intensifs, Hospices Civils de Lyon (HCL)-Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Hospices Civils de Lyon, Service d’Anesthésie Réanimation, ANTE-INSERM U836, équipe 5, Neuroimagerie fonctionnelle et perfusion cérébrale, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, Service d’Anesthésie et de Réanimation, Service de Réanimation, Hospices Civils de Lyon (HCL)-Hôpital E. Herriot, Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), MORNET, Dominique, Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Hémostase, Inflammation et sepsis, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-VetAgro Sup ( VAS ), Institut Montpelliérain Alexander Grothendieck ( IMAG ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Hospices Civils de Lyon ( HCL ) -Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon ( HCL ), Grenoble Institut des Neurosciences ( GIN ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Michallon-Hôpital Michallon, Hospices Civils de Lyon ( HCL ) -Hôpital E. Herriot, CHU Nice-Hôpital St Roch, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes ( URMITE ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), and Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS )

Subjects
Male, medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], Clinical Decision-Making, withdrawing, Legislation, end-of-life, Audit, Critical Care and Intensive Care Medicine, 03 medical and health sciences, family communication, 0302 clinical medicine, Intensive care, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, Aged, withholding, Withholding Treatment, Clinical Audit, [ SDV ] Life Sciences [q-bio], business.industry, Medical record, 030208 emergency & critical care medicine, General Medicine, Middle Aged, humanities, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, Anesthesiology and Pain Medicine, SAPS II, Family medicine, Life support, Observational study, Female, France, Guideline Adherence, business, Advance Directives
Abstract

International audience; Since the implementation of two French laws in 2002 and 2005 and the implementation of guidelines about End-of-Life (EoL) decisions, few studies concerning EoL practices in French intensive care units (ICUs) have been reported. This study was aimed at assessing compliance with recommendations and current legislation concerning EoL decisions. Prospective observational study based on 1-day audit conducted from January to May 2009 in 66 southern French ICUs. Six hundred and twenty-five patients were included (median age: 63 [52-76] years, median SAPS II: 46 [34-58]). The written designation of a surrogate decision-maker was reported for 87 (15%) patients. Advance directives were completed for only 4% of patients. The EoL decision-making process consisted in a multidisciplinary approach for 99 (47%) patients and was recorded in the medical chart for 63 (64%) cases. Families were informed about medical decisions in 58% of cases. This proportion was higher (87%) if a decision to forego life-sustaining therapy was made. EoL decisions consisted of withholding treatments for 72 (94%) patients and withdrawal of treatments for 5 (6%) patients. In the multivariate stepwise logistic regression, four variables were independently associated with a decision to forego life support: preexisting dependence on others (P

Published
2015

7. [Jagged edge]

Author

M, Leone, B, Ragonnet, and V, Moutardier

Subjects
Humans, Wounds, Penetrating, Abdominal Injuries
Published
2013

8. Occult pulmonary embolism in intensive care unit patients undergoing chest computed tomography scan: incidence and effect on outcomes

Author

Claude Martin, Kathia Chaumoitre, Sandrine Wiramus, B Ragonnet, Elodie Arnoult, Emmanuelle Hammad, Marc Leone, Fabien Craighero, and Julien Textoris

Subjects
Adult, Male, medicine.medical_specialty, Critical Care, law.invention, Cohort Studies, law, Risk Factors, medicine, Humans, Hospital Mortality, Aged, Retrospective Studies, business.industry, Mortality rate, Incidence (epidemiology), Retrospective cohort study, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, Occult, Respiration, Artificial, Pulmonary embolism, Anesthesiology and Pain Medicine, Treatment Outcome, Embolism, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Tomography, X-Ray Computed, Case Management, Cohort study
Abstract

Objective To determine the incidence of occult pulmonary embolism (PE) and the associated morbidity in an intensive care unit (ICU). Design Retrospective study. Setting Fifteen-bed ICU of a university hospital. Participants Two hundred patients who underwent chest computed tomography (CT) scans with administration of contrast. Interventions The patients were classified into 3 groups: (1) Occult PE if the chest CT scan was not taken, specifically for elucidating the diagnosis of PE, but it confirmed this diagnosis; (2) non-occult PE if the chest CT scan was taken to elucidate a suspected diagnosis of PE and confirmed this diagnosis; and (3) the chest CT scan did not confirm this diagnosis. The analysis was conducted to identify the effect of a diagnosis of occult PE on the outcomes of patients. Measurements and Main Results Among the 200 patients who underwent chest CT scan, 27 (13%) patients had PE, in whom 18 (9%) were classified as occult PE and 9 (4.5%) as non-occult PE. The duration of ICU stay was increased in patients with PE, as compared with the controls (23 [18-48] days v 17 [10-20] days v 14 [7-29] days; p = 0.02 for occult PE, non-occult PE, and controls, respectively). No difference was observed in mortality rate among the 3 groups. Conclusion Occult PE was found in 9% of the cohort. This emphasized the need for developing diagnostic strategies in high-risk patients. Future studies should aim at assessing interventions for preventing this event.

Published
2012

9. [Respect the wishes of our elderly]

Author

M, Leone and B, Ragonnet

Subjects
Aged, 80 and over, Resuscitation, Right to Die, Humans, Patient Preference, Aged
Published
2012

10. Quel vasopresseur utiliser au cours du choc septique?

Author

M Leone, B Ragonnet, Sandrine Wiramus, and C Martin

Abstract

L’hemodynamique est l’etude des lois qui reglent l’ecoulement et le debit du sang dans les vaisseaux. Elle est basee sur la loi d’Ohm qui specifie qu’un courant (flux sanguin) egale la difference de voltage (pression de perfusion) divisee par la resistance (au flux). Au niveau des vaisseaux, la pression de perfusion est la difference de pression entre deux points donnes du vaisseau. Au niveau d’un organe, la pression de perfusion exprime generalement la difference entre les pressions arterielles et veineuses. Le flux sanguin est donc sous la dependance de la pression de perfusion et est restreint par la resistance des vaisseaux. La resistance du vaisseau est sous la dependance du radius, de la longueur du vaisseau et de la viscosite du sang. En pratique, la resistance des arterioles a un effet majeur sur le flux sanguin.

Published
2011

11. À double tranchant

Author

V. Moutardier, B. Ragonnet, and Marc Leone

Subjects
chemistry.chemical_compound, Anesthesiology and Pain Medicine, chemistry, business.industry, Shock (circulatory), Anesthesia, Medicine, General Medicine, medicine.symptom, Penetrant (biochemical), business
Published
2013

12. Respectons les désirs de nos anciens

Author

B. Ragonnet and M. Leone

Subjects
Anesthesiology and Pain Medicine, business.industry, Medicine, General Medicine, Decision-making, business, Data science
Published
2012

14. Télomères et cotélomères d'intérêt biologique et biomedical—II. Synthese de télomères galactosylés fluorescents marqueurs potentiels des lectines membranaires

Author

B. Ragonnet, A.A. Pavia, and B. Pucci

Subjects
Polymers and Plastics, Chemistry, Telomerization, Organic Chemistry, Materials Chemistry, General Physics and Astronomy, Molecular biology
Abstract

Resume Nous rapportons la synthese d'un nouveau type de sonde fluorescente utilisable pour le marquage de lectines membranaires et/ou pour l'etude de l'endocytose de substances saccharidiques. Il s'agit de molecules comportant plusieurs residus saccharidiques fixes a un support hydrocarbone inerte par l'intermediaire de bras ecarteurs de nature peptidique. Le squelette hydrocarbone est egalement porteur d'un marqueur de fluorescence. Le compose decrit dans ce travail est obtenu par telomerisation radicalaire d'une entite polymerisable, l'acryloylglycine sur laquelle est fixe un residu galactose. La telomerisation a lieu en presence d'un initiateur de radicaux libres (ici, l'α,α′-azobis(isobutyronitrile), AIBN) et d'un agent telogene (un derive de l'acide thioglycolique) qui est derivatise pour recevoir apres telomerisation la molecule de fluoresceine. Les tests preliminaires montrent que le compose presente une bonne affinite pour des cellules connues pour posseder des recepteurs membranaires specifiques du galactose.

Published
1988

18. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use

Author

Xavier Bobbia, Laurent Muller, Hervé Quintard, Nicolas Molinari, B Ragonnet, Lana Zoric, Marc Leone, Guillaume Louart, Jean Yves Lefrant, Mehdi Toumi, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie (MISTEA), Institut National de la Recherche Agronomique (INRA)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Aix Marseille Université (AMU), Centre Hospitalier Universitaire de Nice (CHU Nice), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Male, medicine.medical_specialty, Fluid responsiveness, Vena Cava, Inferior, Respiratory physiology, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, [INFO]Computer Science [cs], cardiovascular diseases, Respiratory system, Acute circulatory failure, [MATH]Mathematics [math], business.industry, Research, Shock, Stroke Volume, 030208 emergency & critical care medicine, Stroke volume, Surgery, medicine.vein, Shock (circulatory), Respiratory Mechanics, cardiovascular system, Cardiology, Breathing, Fluid Therapy, Female, medicine.symptom, business, Blood Flow Velocity
Abstract

International audience; INTRODUCTION: To investigate whether respiratory variation of inferior vena cava diameter (cIVC) predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure (ACF). METHODS: Forty patients with ACF and spontaneous breathing were included. Response to fluid challenge was defined as a 15% increase of subaortic velocity time index (VTI) measured by transthoracic echocardiography. Inferior vena cava diameters were recorded by a subcostal view using M Mode. The cIVC was calculated as follows: (Dmax - Dmin/Dmax) × 100 and then receiver operating characteristic (ROC) curves were generated for cIVC, baseline VTI, E wave velocity, E/A and E/Ea ratios. RESULTS: Among 40 included patients, 20 (50%) were responders (R). The causes of ACF were sepsis (n = 24), haemorrhage (n = 11), and dehydration (n = 5). The area under the ROC curve for cIVC was 0.77 (95% CI: 0.60-0.88). The best cutoff value was 40% (Se = 70%, Sp = 80%). The AUC of the ROC curves for baseline E wave velocity, VTI, E/A ratio, E/Ea ratio were 0.83 (95% CI: 0.68-0.93), 0.78 (95% CI: 0.61-0.88), 0.76 (95% CI: 0.59-0.89), 0.58 (95% CI: 0.41-0.75), respectively. The differences between AUC the ROC curves for cIVC and baseline E wave velocity, baseline VTI, baseline E/A ratio, and baseline E/Ea ratio were not statistically different (p = 0.46, p = 0.99, p = 1.00, p = 0.26, respectively). CONCLUSION: In spontaneously breathing patients with ACF, high cIVC values (>40%) are usually associated with fluid responsiveness while low values (< 40%) do not exclude fluid responsiveness.

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19. Practices of end-of-life decisions in 66 southern French ICUs 4 years after an official legal framework: A 1-day audit.

Author

Roger C, Morel J, Molinari N, Orban JC, Jung B, Futier E, Desebbe O, Friggeri A, Silva S, Bouzat P, Ragonnet B, Allaouchiche B, Constantin JM, Ichai C, Jaber S, Leone M, Lefrant JY, and Rimmelé T

Subjects
Aged, Clinical Audit, Female, France, Guideline Adherence, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Time Factors, Advance Directives legislation & jurisprudence, Clinical Decision-Making
Abstract

Objective: Since the implementation of two French laws in 2002 and 2005 and the implementation of guidelines about End-of-Life (EoL) decisions, few studies concerning EoL practices in French intensive care units (ICUs) have been reported. This study was aimed at assessing compliance with recommendations and current legislation concerning EoL decisions., Method: Prospective observational study based on 1-day audit conducted from January to May 2009 in 66 southern French ICUs., Results: Six hundred and twenty-five patients were included (median age: 63 [52-76] years, median SAPS II: 46 [34-58]). The written designation of a surrogate decision-maker was reported for 87 (15%) patients. Advance directives were completed for only 4% of patients. The EoL decision-making process consisted in a multidisciplinary approach for 99 (47%) patients and was recorded in the medical chart for 63 (64%) cases. Families were informed about medical decisions in 58% of cases. This proportion was higher (87%) if a decision to forego life-sustaining therapy was made. EoL decisions consisted of withholding treatments for 72 (94%) patients and withdrawal of treatments for 5 (6%) patients. In the multivariate stepwise logistic regression, four variables were independently associated with a decision to forego life support: preexisting dependence on others (P<0.0001), advance directives (P=0.01), age (P=0.008) and the SAPS 2 score (P=0.009)., Conclusion: The major finding of the present study is the existence of a gap between the widely approved EoL recommendations made by scientific societies and the daily practice of southern French ICUs. Even if EoL decisions are mostly shared with relatives, their written documentation in medical charts remains insufficient. Concerning EoL practices, the withdrawal of treatment remains an uncommon decision., (Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Published
2015
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20. [Role of whole-body ultrasound in severe pre-eclampsia and post-partum hemorrhage].

Author

Zieleskiewicz L, Pierrou C, Ragonnet B, Tourret M, Chau C, Craighero F, Contargyris C, Martin C, and Leone M

Subjects
Adult, Catheterization, Central Venous instrumentation, Cesarean Section, Echocardiography, Transesophageal methods, Factor VIIa therapeutic use, Female, HELLP Syndrome diagnostic imaging, Hematoma diagnostic imaging, Humans, Hysterectomy, Patient Care Planning, Pregnancy, Pulmonary Edema diagnostic imaging, Pulmonary Edema therapy, Shock, Hemorrhagic therapy, Ultrasonography, Doppler, Pulsed, Ultrasonography, Interventional methods, Uterine Hemorrhage diagnostic imaging, Point-of-Care Systems, Postpartum Hemorrhage diagnostic imaging, Pre-Eclampsia diagnostic imaging, Whole Body Imaging methods
Abstract

Purpose: Management of severe pre-eclamptic patients is a challenge for the staff on obstetrical wards. We demonstrate that ultrasound applied to several organs performed at a patient's bedside gave the information required for the patient's management, without the need to transfer her to the radiology department or to call external consultants., Clinical Features: A 29-yr-old severely pre-eclamptic patient with HELLP syndrome (hemolysis, cytolysis, thrombopenia) presented, in the post-partum period, with an occult uterine hemorrhage diagnosed with bedside abdominal/pelvic ultrasound. Ultrasound was also used to insert a central venous catheter. After undergoing a hysterectomy to control hemorrhage and receiving activated factor VII, the patient recovered uneventfully. Hemodynamic management was optimized non-invasively using pulmonary and cardiac ultrasound, when the patient developed hemorrhagic shock followed by pulmonary edema. Volume replacement was guided by cardiac ultrasound findings, and we were able to detect incipient interstitial pulmonary edema and follow its course using pulmonary ultrasound., Conclusion: Practitioners must be aware of the role of whole-body ultrasound in the diagnosis and treatment of complex, multi-organ conditions such as pre-eclampsia. Moreover, ultrasound helps in the management of global hemodynamics. The training of anesthesiologists in a variety of ultrasound techniques should be encouraged.

Published
2013
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21. Occult pulmonary embolism in intensive care unit patients undergoing chest computed tomography scan: incidence and effect on outcomes.

Author

Arnoult E, Wiramus S, Textoris J, Craighero F, Ragonnet B, Hammad E, Chaumoître K, Martin C, and Leone M

Subjects
Adult, Aged, Case Management, Cohort Studies, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Pulmonary Embolism epidemiology, Respiration, Artificial, Retrospective Studies, Risk Factors, Treatment Outcome, Critical Care methods, Pulmonary Embolism etiology, Pulmonary Embolism therapy, Tomography, X-Ray Computed adverse effects, Tomography, X-Ray Computed methods
Abstract

Objective: To determine the incidence of occult pulmonary embolism (PE) and the associated morbidity in an intensive care unit (ICU)., Design: Retrospective study., Setting: Fifteen-bed ICU of a university hospital., Participants: Two hundred patients who underwent chest computed tomography (CT) scans with administration of contrast., Interventions: The patients were classified into 3 groups: (1) Occult PE if the chest CT scan was not taken, specifically for elucidating the diagnosis of PE, but it confirmed this diagnosis; (2) non-occult PE if the chest CT scan was taken to elucidate a suspected diagnosis of PE and confirmed this diagnosis; and (3) the chest CT scan did not confirm this diagnosis. The analysis was conducted to identify the effect of a diagnosis of occult PE on the outcomes of patients., Measurements and Main Results: Among the 200 patients who underwent chest CT scan, 27 (13%) patients had PE, in whom 18 (9%) were classified as occult PE and 9 (4.5%) as non-occult PE. The duration of ICU stay was increased in patients with PE, as compared with the controls (23 [18-48] days v 17 [10-20] days v 14 [7-29] days; p = 0.02 for occult PE, non-occult PE, and controls, respectively). No difference was observed in mortality rate among the 3 groups., Conclusion: Occult PE was found in 9% of the cohort. This emphasized the need for developing diagnostic strategies in high-risk patients. Future studies should aim at assessing interventions for preventing this event., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Published
2013
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22. [Jagged edge].

Author

Leone M, Ragonnet B, and Moutardier V

Subjects
Humans, Abdominal Injuries therapy, Wounds, Penetrating therapy
Published
2013
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23. Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units.

Author

Leone M, Ragonnet B, Alonso S, Allaouchiche B, Constantin JM, Jaber S, Martin C, Fabbro-Peray P, and Lefrant JY

Subjects
Adult, Evidence-Based Medicine, Female, France, Humans, Male, Medical Audit, Delivery of Health Care standards, Guideline Adherence statistics & numerical data, Intensive Care Units, Practice Guidelines as Topic
Abstract

Objective: Clinical guidelines should provide a framework for managing patients hospitalized in intensive care units. Little is known about guideline compliance in real-life practice. To evaluate compliance rates for a large bundle of intensive care unit practice guidelines and determine factors associated with noncompliance to these guidelines., Design, Setting, and Patients: A bundle of 13 clinical guidelines was elaborated by a group of senior physicians. Four external consultants validated the process. Then, a 1-day audit was performed at 66 participating adult intensive care units in 39 institutions by a group of 64 junior investigators supervised by senior intensivists. At the bedside, investigators collected data from 625 patients hospitalized in those units., Interventions and Measurements: The eligibility and compliance rates were determined for each clinical recommendation. The rate of full compliance to each eligible clinical guideline was calculated. Mortality data were requested 28 days after the completion of the audit., Main Results: The eligibility rate ranged from 11% (sepsis bundle) to 80% (identified closest relative). The median compliance rate was 75% (60-100), ranging from 24% (sedation monitoring) to 96% (identified closest relative and bacteriological sampling before initiating antibiotics). Our results showed that only 24% (20-27) of patients in our cohort received fully compliant care. The 28-day survival probability was .77 (.73-.80)., Conclusions: At the bedside, clinical guidelines are fully applied in 24% of patients. Our study underlines the need to both improve the process of implementation and become cognizant of excessive proliferation of clinical guidelines.

Published
2012
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24. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use.

Author

Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, Quintard H, Leone M, Zoric L, and Lefrant JY

Subjects
Acute Disease, Aged, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Shock therapy, Blood Flow Velocity physiology, Fluid Therapy methods, Respiratory Mechanics physiology, Shock physiopathology, Stroke Volume physiology, Vena Cava, Inferior physiology
Abstract

Introduction: To investigate whether respiratory variation of inferior vena cava diameter (cIVC) predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure (ACF)., Methods: Forty patients with ACF and spontaneous breathing were included. Response to fluid challenge was defined as a 15% increase of subaortic velocity time index (VTI) measured by transthoracic echocardiography. Inferior vena cava diameters were recorded by a subcostal view using M Mode. The cIVC was calculated as follows: (Dmax - Dmin/Dmax) × 100 and then receiver operating characteristic (ROC) curves were generated for cIVC, baseline VTI, E wave velocity, E/A and E/Ea ratios., Results: Among 40 included patients, 20 (50%) were responders (R). The causes of ACF were sepsis (n = 24), haemorrhage (n = 11), and dehydration (n = 5). The area under the ROC curve for cIVC was 0.77 (95% CI: 0.60-0.88). The best cutoff value was 40% (Se = 70%, Sp = 80%). The AUC of the ROC curves for baseline E wave velocity, VTI, E/A ratio, E/Ea ratio were 0.83 (95% CI: 0.68-0.93), 0.78 (95% CI: 0.61-0.88), 0.76 (95% CI: 0.59-0.89), 0.58 (95% CI: 0.41-0.75), respectively. The differences between AUC the ROC curves for cIVC and baseline E wave velocity, baseline VTI, baseline E/A ratio, and baseline E/Ea ratio were not statistically different (p = 0.46, p = 0.99, p = 1.00, p = 0.26, respectively)., Conclusion: In spontaneously breathing patients with ACF, high cIVC values (>40%) are usually associated with fluid responsiveness while low values (< 40%) do not exclude fluid responsiveness.

Published
2012
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