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2. Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

Author

Bedague, D., Blanié, A., Casez, M., Chanques, G., Chaize, C., Dessertaine, G., Ferré, F., Gaide Chevronnay, L., Hébrard, A., Hespel, A., Jaber, S., de Jong, A., Lahjaouzi, A., Marino, M.R., Moury, P.H., Neau, A.C., Protar, D., Rhem, D., Rineau, E., Robin, S., Rossignol, E., Soucemarianadin, M., Veaceslav, S., Beloeil, H., Albaladejo, P., Sion, A., Durand, M., Martinez, V., Lasocki, S., Futier, E., Verzili, D., Minville, V., Fessenmeyer, C., Belbachir, A., Aubrun, F., Renault, A., and Bellissant, E.

Published
2019
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3. Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

Author

Beloeil, E, Albaladejo, A, Sion, A., Durand, A., Martinez, A., Lasocki, A, Futier, E., Verzili, A, Minville, A, Fessenmeyer, A, Belbachir, A., Aubrun, A, Renault, A., Bellissant, E., Beloeil, H., Albaladejo, P., Durand, M., Martinez, V., Lasocki, S., Verzili, D., Minville, V., Fessenmeyer, C., Aubrun, F., Bedague, D., Blanié, A., Casez, M., Chanques, Gérald, Chaize, C., Dessertaine, G., Ferré, F., Gaide Chevronnay, L., Hébrard, A., Hespel, A., Jaber, S., De JONG, A., Lahjaouzi, A., Marino, M., Moury, H., Neau, A., Protar, D., Rhem, D., Rineau, E., Robin, S., Rossignol, E., Soucemarianadin, M., Veaceslav, S., Université de Rennes (UR), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure de Lyon (ENS de Lyon), Université d'Angers (UA), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Intervention, innovation, imagerie, ingénierie en santé - UFC (I4S), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), lnPHRC 2011, French Minister of Health, Université de Rennes (UNIV-RENNES), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), École normale supérieure - Lyon (ENS Lyon), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), MORNET, Dominique, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Grenoble Alpes (UGA), Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Science et Ingénierie des Matériaux et Procédés (SIMaP), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut National Polytechnique de Grenoble (INPG)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Service d'anesthésie et réanimation chirurgicale, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Ketoprofen, ketoprofen, paracetamol, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Analgesic, Placebo, Drug Administration Schedule, law.invention, 03 medical and health sciences, 0302 clinical medicine, Nefopam, Double-Blind Method, Randomized controlled trial, 030202 anesthesiology, law, medicine, Humans, nefopam, Saline, ComputingMilieux_MISCELLANEOUS, Acetaminophen, Aged, Pain Measurement, Postoperative Care, Pain, Postoperative, business.industry, non-opioid analgesics, Analgesia, Patient-Controlled, morphine, postoperative analgesia, Analgesics, Non-Narcotic, Middle Aged, 3. Good health, Analgesics, Opioid, [SDV] Life Sciences [q-bio], Clinical trial, Treatment Outcome, opioid sparing, Anesthesiology and Pain Medicine, Anesthesia, Morphine, Drug Therapy, Combination, Female, business, medicine.drug
Abstract

International audience; Background: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. Methods: Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphine patient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery. Results: Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (interquartile range)] was significantly reduced in the PNK group [5 (1-11) mg] compared with either the C group [27 (11-42) mg; P

Published
2019

7. Airway microbiota signals anabolic and catabolic remodeling in the transplanted lung

Author

Mouraux, Stéphane, primary, Bernasconi, Eric, additional, Pattaroni, Céline, additional, Koutsokera, Angela, additional, Aubert, John-David, additional, Claustre, Johanna, additional, Pison, Christophe, additional, Royer, Pierre-Joseph, additional, Magnan, Antoine, additional, Kessler, Romain, additional, Benden, Christian, additional, Soccal, Paola M., additional, Marsland, Benjamin J., additional, Nicod, Laurent P., additional, Jougon, J., additional, Velly, J.-F., additional, Rozé, H., additional, Blanchard, E., additional, Dromer, C., additional, Antoine, M., additional, Cappello, M., additional, Ruiz, M., additional, Sokolow, Y., additional, Vanden Eynden, F., additional, Van Nooten, G., additional, Barvais, L., additional, Berré, J., additional, Brimioulle, S., additional, De Backer, D., additional, Créteur, J., additional, Engelman, E., additional, Huybrechts, I., additional, Ickx, B., additional, Preiser, T.J.C., additional, Tuna, T., additional, Van Obberghe, L., additional, Vancutsem, N., additional, Vincent, J.-L., additional, De Vuyst, P., additional, Etienne, I., additional, Féry, F., additional, Jacobs, F., additional, Knoop, C., additional, Vachiéry, J.L., additional, Van den Borne, P., additional, Wellemans, I., additional, Amand, G., additional, Collignon, L., additional, Giroux, M., additional, Angelescu, D., additional, Chavanon, O., additional, Hacini, R., additional, Pirvu, A., additional, Porcu, P., additional, Albaladejo, P., additional, Allègre, C., additional, Bataillard, A., additional, Bedague, D., additional, Briot, E., additional, Casez-Brasseur, M., additional, Colas, D., additional, Dessertaine, G., additional, Durand, M., additional, Francony, G., additional, Hebrard, A., additional, Marino, M.R., additional, Oummahan, B., additional, Protar, D., additional, Rehm, D., additional, Robin, S., additional, Rossi-Blancher, M., additional, Augier, C., additional, Bedouch, P., additional, Boignard, A., additional, Bouvaist, H., additional, Briault, A., additional, Camara, B., additional, Claustre, J., additional, Chanoine, S., additional, Dubuc, M., additional, Quétant, S., additional, Maurizi, J., additional, Pavèse, P., additional, Pison, C., additional, Saint-Raymond, C., additional, Wion, N., additional, Chérion, C., additional, Grima, R., additional, Jegaden, O., additional, Maury, J.-M., additional, Tronc, F., additional, Flamens, C., additional, Paulus, S., additional, Mornex, J.-F., additional, Philit, F., additional, Senechal, A., additional, Glérant, J.-C., additional, Turquier, S., additional, Gamondes, D., additional, Chalabresse, L., additional, Thivolet-Bejui, F., additional, Barnel, C., additional, Dubois, C., additional, Tiberghien, A., additional, Le Pimpec-Barthes, F., additional, Bel, A., additional, Mordant, P., additional, Achouh, P., additional, Boussaud, V., additional, Guillemain, R., additional, Méléard, D., additional, Bricourt, M.O., additional, Cholley, B., additional, Pezella, V., additional, Brioude, G., additional, D'Journo, X.B., additional, Doddoli, C., additional, Thomas, P., additional, Trousse, D., additional, Dizier, S., additional, Leone, M., additional, Papazian, L., additional, Bregeon, F., additional, Basire, A., additional, Coltey, B., additional, Dufeu, N., additional, Dutau, H., additional, Garcia, S., additional, Gaubert, J.Y., additional, Gomez, C., additional, Laroumagne, S., additional, Nieves, A., additional, Picard, L.C., additional, Reynaud-Gaubert, M., additional, Secq, V., additional, Mouton, G., additional, Baron, O., additional, Lacoste, P., additional, Perigaud, C., additional, Roussel, J.C., additional, Danner, I., additional, Haloun, A., additional, Magnan, A., additional, Tissot, A., additional, Lepoivre, T., additional, Treilhaud, M., additional, Botturi-Cavaillès, K., additional, Brouard, S., additional, Danger, R., additional, Loy, J., additional, Morisset, M., additional, Pain, M., additional, Pares, S., additional, Reboulleau, D., additional, Royer, P.-J., additional, Fabre, D., additional, Fadel, E., additional, Mercier, O., additional, Mussot, S., additional, Stephan, F., additional, Viard, P., additional, Cerrina, J., additional, Dorfmuller, P., additional, Ghigna, S.M., additional, Hervén, Ph., additional, Le Roy Ladurie, F., additional, Le Pavec, J., additional, Thomas de Montpreville, V., additional, Lamrani, L., additional, Castier, Y., additional, Cerceau, P., additional, Augustin, P., additional, Jean-Baptiste, S., additional, Boudinet, S., additional, Montravers, P., additional, Brugière, O., additional, Dauriat, G., additional, Jébrak, G., additional, Mal, H., additional, Marceau, A., additional, Métivier, A.-C., additional, Thabut, G., additional, Lhuillier, E., additional, Dupin, C., additional, Bunel, V., additional, Falcoz, P., additional, Massard, G., additional, Santelmo, N., additional, Ajob, G., additional, Collange, O., additional, Helms, O., additional, Hentz, J., additional, Roche, A., additional, Bakouboula, B., additional, Degot, T., additional, Dory, A., additional, Hirschi, S., additional, Ohlmann-Caillard, S., additional, Kessler, L., additional, Kessler, R., additional, Schuller, A., additional, Bennedif, K., additional, Vargas, S., additional, Stauder, J., additional, Ali-Azouaou, S., additional, Bonnette, P., additional, Chapelier, A., additional, Puyo, P., additional, Sage, E., additional, Bresson, J., additional, Caille, V., additional, Cerf, C., additional, Devaquet, J., additional, Dumans-Nizard, V., additional, Felten, M.-L., additional, Fischler, M., additional, Si Larbi, A.-G., additional, Leguen, M., additional, Ley, L., additional, Liu, N., additional, Trebbia, G., additional, De Miranda, S., additional, Douvry, B., additional, Gonin, F., additional, Grenet, D., additional, Hamid, A.M., additional, Neveu, H., additional, Parquin, F., additional, Picard, C., additional, Roux, A., additional, Stern, M., additional, Bouillioud, F., additional, Cahen, P., additional, Colombat, M., additional, Dautricourt, C., additional, Delahousse, M., additional, D'Urso, B., additional, Gravisse, J., additional, Guth, A., additional, Hillaire, S., additional, Honderlick, P., additional, Lequintrec, M., additional, Longchampt, E., additional, Mellot, F., additional, Scherrer, A., additional, Temagoult, L., additional, Tricot, L., additional, Vasse, M., additional, Veyrie, C., additional, Zemoura, L., additional, Berjaud, J., additional, Brouchet, L., additional, Dahan, M., additional, Mathe, F.O., additional, Benahoua, H., additional, DaCosta, M., additional, Serres, I., additional, Merlet-Dupuy, V., additional, Grigoli, M., additional, Didier, A., additional, Murris, M., additional, Crognier, L., additional, Fourcade, O., additional, Krueger, T., additional, Ris, H.B., additional, Gonzalez, M., additional, Jolliet, Ph., additional, Marcucci, C., additional, Chollet, M., additional, Gronchi, F., additional, Courbon, C., additional, Berutto, C., additional, Manuel, O., additional, Koutsokera, A., additional, Aubert, J.-D., additional, Nicod, L.P., additional, Mouraux, S., additional, Bernasconi, E., additional, Pattaroni, C., additional, Marsland, B.J., additional, Soccal, P.M., additional, Rochat, T., additional, Lücker, L.M., additional, Hillinger, S., additional, Inci, I., additional, Weder, W., additional, Schuepbach, R., additional, Zalunardo, M., additional, Benden, C., additional, Schuurmans, M.M., additional, Gaspert, A., additional, Holzmann, D., additional, Müller, N., additional, Schmid, C., additional, Vrugt, B., additional, Fritz, A., additional, Maier, D., additional, Deplanche, K., additional, Koubi, D., additional, Ernst, F., additional, Paprotka, T., additional, Schmitt, M., additional, Wahl, B., additional, Boissel, J.-P., additional, Olivera-Botello, G., additional, Trocmé, C., additional, Toussaint, B., additional, Bourgoin-Voillard, S., additional, Sève, M., additional, Benmerad, M., additional, Siroux, V., additional, Slama, R., additional, Auffray, C., additional, Charron, D., additional, Lefaudeux, D., additional, and Pellet, J., additional

Published
2018
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8. Blood CD9+B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Author

Brosseau, Carole, Danger, Richard, Durand, Maxim, Durand, Eugénie, Foureau, Aurore, Lacoste, Philippe, Tissot, Adrien, Roux, Antoine, Reynaud‐Gaubert, Martine, Kessler, Romain, Mussot, Sacha, Dromer, Claire, Brugière, Olivier, Mornex, Jean François, Guillemain, Romain, Claustre, Johanna, Magnan, Antoine, Brouard, Sophie, Jougon, J., Velly, J.‐F., Rozé, H., Blanchard, E., Antoine, M., Cappello, M., Ruiz, M., Sokolow, Y., Vanden Eynden, F, Van Nooten, G., Barvais, L., Berré, J., Brimioulle, S., De Backer, D., Créteur, J., Engelman, E, Huybrechts, I., Ickx, B., Preiser, T.J.C., Tuna, T., Van Obberghe, L., Vancutsem, N., Vincent, J.‐L., De Vuyst, P., Etienne, I., Féry, F., Jacobs, F., Knoop, C., Vachiéry, J.L., Van den Borne, P., Wellemans, I., Amand, G., Collignon, L., Giroux, M., Angelescu, D., Chavanon, O., Hacini, R., Martin, C., Pirvu, A., Porcu, P., Albaladejo, P., Allègre, C., Bataillard, A., Bedague, D., Briot, E., Casez‐Brasseur, M., Colas, D., Dessertaine, G., Francony, G., Hebrard, A., Marino, M.R., Protar, D., Rehm, D., Robin, S, Rossi‐Blancher, M., Augier, C., Bedouch, P., Boignard, A., Bouvaist, H., Briault, A., Camara, B., Chanoine, S., Dubuc, M., Quétant, S., Maurizi, J., Pavèse, P., Pison, C., Saint‐Raymond, C., Wion, N., Chérion, C., Grima, R., Jegaden, O., Maury, J.‐M., Tronc, F., Flamens, C., Paulus, S., Philit, F., Senechal, A., Glérant, J.‐C., Turquier, S., Gamondes, D., Chalabresse, L., Thivolet‐Bejui, F., Barnel, C., Dubois, C., Tiberghien, A., Pimpec‐Barthes, F., Bel, A., Mordant, P., Achouh, P., Boussaud, V., Méléard, D., Bricourt, M.O., Cholley, B., Pezella, V., Brioude, G., D'Journo, X.B., Doddoli, C., Thomas, P., Trousse, D., Dizier, S., Leone, M., Papazian, L., Bregeon, F., Coltey, B., Dufeu, N., Dutau, H., Garcia, S., Gaubert, J.Y., Gomez, C., Laroumagne, S., Mouton, G., Nieves, A., Picard, Ch., Rolain, J.M., Sampol, E., Secq, V., Perigaud, C., Roussel, J.C., Senage, T., Mugniot, A., Danner, I., Haloun, A., Abbes, S., Bry, C., Blanc, F.X., Lepoivre, T., Botturi‐Cavaillès, K., Loy, J., Bernard, M., Godard, E., Royer, P.‐J., Henrio, K., Dartevelle, Ph., Fabre, D., Fadel, E., Mercier, O., Stephan, F., Viard, P., Cerrina, J., Dorfmuller, P., Feuillet, S., Ghigna, M., Hervén, Ph., Le Roy Ladurie, F., Le Pavec, J., Thomas de Montpreville, V., Lamrani, L., Castier, Y., Mordant, P., Cerceau, P., Augustin, P., Jean‐Baptiste, S., Boudinet, S., Montravers, P., Dauriat, G., Jébrak, G., Mal, H., Marceau, A., Métivier, A.‐C., Thabut, G., Lhuillier, E., Dupin, C., Bunel, V., Falcoz, P., Massard, G., Santelmo, N., Ajob, G., Collange, O., Helms, O., Hentz, J., Roche, A., Bakouboula, B., Degot, T., Dory, A., Hirschi, S., Ohlmann‐Caillard, S., Kessler, L., Schuller, A., Bennedif, K., Vargas, S., Bonnette, P., Chapelier, A., Puyo, P., Sage, E., Bresson, J., Caille, V., Cerf, C., Devaquet, J., Dumans‐Nizard, V., Felten, M.L., Fischler, M., Si Larbi, A.G., Leguen, M., Ley, L., Liu, N., Trebbia, G., De Miranda, S., Douvry, B., Gonin, F., Grenet, D., Hamid, A.M., Neveu, H., Parquin, F., Picard, C., Stern, M., Bouillioud, F., Cahen, P., Colombat, M., Dautricourt, C., Delahousse, M., D'Urso, B., Gravisse, J., Guth, A., Hillaire, S., Honderlick, P., Lequintrec, M., Longchampt, E., Mellot, F., Scherrer, A., Temagoult, L., Tricot, L., Vasse, M., Veyrie, C., Zemoura, L., Dahan, M., Murris, M., Benahoua, H., Berjaud, J., Le Borgne Krams, A., Crognier, L., Brouchet, L., Mathe, O., Didier, A., Krueger, T., Ris, H.B., Gonzalez, M., Aubert, J.‐D., Nicod, L.P., Marsland, B.J., Berutto, T.C., Rochat, T., Soccal, P., Jolliet, Ph., Koutsokera, A., Marcucci, C., Manuel, O., Bernasconi, E., Chollet, M., Gronchi, F., Courbon, C., Hillinger, S., Inci, I., Kestenholz, P., Weder, W., Schuepbach, R., Zalunardo, M., Benden, C., Buergi, U., Huber, L.C., Isenring, B., Schuurmans, M.M., Gaspert, A., Holzmann, D., Müller, N., Schmid, C., Vrugt, B., Rechsteiner, T., Fritz, A., Maier, D., Deplanche, K., Koubi, D., Ernst, F., Paprotka, T., Schmitt, M., Wahl, B., Boissel, J.‐P., Olivera‐Botello, G., Trocmé, C., Toussaint, B., Bourgoin‐Voillard, S., Séve, M., Benmerad, M., Siroux, V., Slama, R., Auffray, C., Charron, D., Lefaudeux, D., and Pellet, J.

Abstract

Bronchiolitis obliterans syndrome is the main limitation for long‐term survival after lung transplantation. Some specific B cell populations are associated with long‐term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow‐up. CD24hiCD38hitransitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hiCD38hitransitional B cells specifically secrete IL‐10 and express CD9. Thus, patients with a total CD9+B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL‐10‐secreting CD24hiCD38hitransitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9‐expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long‐term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome–free survival. In lung transplant patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow‐up, IL‐10–secreting CD24hiCD38hi transitional B cells expressing CD9 are associated with better allograft outcome, suggesting CD9‐expressing B cells as a new predictive biomarker of bronchiolitis obliterans syndrome–free survival.

Published
2019
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10. T Cells Promote Bronchial Epithelial Cell Secretion of Matrix Metalloproteinase‐9 via a C‐C Chemokine Receptor Type 2 Pathway: Implications for Chronic Lung Allograft Dysfunction

Author

Pain, M., Royer, P.‐J., Loy, J., Girardeau, A., Tissot, A., Lacoste, P., Roux, A., Reynaud‐Gaubert, M., Kessler, R., Mussot, S., Dromer, C., Brugière, O., Mornex, J.‐F., Guillemain, R., Dahan, M., Knoop, C., Botturi, K., Pison, C., Danger, R., Brouard, S., Magnan, A., Jougon, J., Velly, J.‐F., Rozé, H., Blanchard, E., Antoine, M., Cappello, M., Souilamas, R., Ruiz, M., Sokolow, Y., Vanden Eynden, F., Van Nooten, G., Barvais, L., Berré, J., Brimioulle, S., De Backer, D., Créteur, J., Engelman, E., Huybrechts, I., Ickx, B., Preiser, T.J.C., Tuna, T., Van Obberghe, L., Vancutsem, N., Vincent, J.‐L., De Vuyst, P., Etienne, I., Féry, F., Jacobs, F., Vachiéry, J.L., Van den Borne, P., Wellemans, I., Amand, G., Collignon, L., Giroux, M., Arnaud‐Crozat, E., Bach, V., Brichon, P.‐Y., Chaffanjon, P., Chavanon, O., de Lambert, A., Fleury, J.P., Guigard, S., Hireche, K., Pirvu, A., Porcu, P., Hacini, R., Albaladejo, P., Allègre, C., Bataillard, A., Bedague, D., Briot, E., Casez‐Brasseur, M., Colas, D., Dessertaine, G., Durand, M., Francony, G., Hebrard, A., Marino, M.R., Oummahan, B., Protar, D., Rehm, D., Robin, S., Rossi‐Blancher, M., Bedouch, P., Boignard, A., Bouvaist, H., Briault, A., Camara, B., Chanoine, S., Dubuc, M., Lantuéjoul, S., Quétant, S., Maurizi, J., Pavèse, P., Saint‐Raymond, C., Wion, N., Chérion, C., Grima, R., Jegaden, O., Maury, J.‐M., Tronc, F., Flamens, C., Paulus, S., Philit, F., Senechal, A., Glérant, J.‐C., Turquier, S., Gamondes, D., Chalabresse, L., Thivolet‐Bejui, F., Barnel, C., Dubois, C., Tiberghien, A., Le Pimpec‐Barthes, F., Bel, A., Mordant, P., Achouh, P., Boussaud, V., Méléard, D., Bricourt, M.O., Cholley, B., Pezella, V., Adda, M., Badier, M., Bregeon, F., Coltey, B., D'Journo, X.B., Dizier, S., Doddoli, C., Dufeu, N., Dutau, H., Forel, J.M., Gaubert, J.Y., Gomez, C., Leone, M., Nieves, A., Orsini, B., Papazian, L., Picard, C., Roch, A., Rolain, J.M., Sampol, E., Secq, V., Thomas, P., Trousse, D., Yahyaoui, M., Baron, O., Perigaud, C., Roussel, J.C., Danner, I., Haloun, A., Lepoivre, T., Treilhaud, M., Botturi‐Cavaillès, K., Morisset, M., Pares, S., Reboulleau, D., Dartevelle, P., Fabre, D., Fadel, E., Mercier, O., Stephan, F., Viard, P., Cerrina, J., Dorfmuller, P., Feuillet, S., Ghigna, M., Hervén, P., Le Roy Ladurie, F., Le Pavec, J., Thomas de Montpreville, V., Lamrani, L., Castier, Y., Cerceau, P., Francis, F., Lesèche, G., Allou, N., Augustin, P., Boudinet, S., Desmard, M., Dufour, G., Montravers, P., Dauriat, G., Jébrak, G., Mal, H., Marceau, A., Métivier, A.‐C., Thabut, G., Ait Ilalne, B., Falcoz, P., Massard, G., Santelmo, N., Ajob, G., Collange, O., Helms, O., Hentz, J., Roche, A., Bakouboula, B., Degot, T., Dory, A., Hirschi, S., Ohlmann‐Caillard, S., Kessler, L., Schuller, A., Bennedif, K., Vargas, S., Bonnette, P., Chapelier, A., Puyo, P., Sage, E., Bresson, J., Caille, V., Cerf, C., Devaquet, J., Dumans‐Nizard, V., Felten, M.L., Fischler, M., Si Larbi, A.G., Leguen, M., Ley, L., Liu, N., Trebbia, G., De Miranda, S., Douvry, B., Gonin, F., Grenet, D., Hamid, A.M., Neveu, H., Parquin, F., Picard, C., Stern, M., Bouillioud, F., Cahen, P., Colombat, M., Dautricourt, C., Delahousse, M., D'Urso, B., Gravisse, J., Guth, A., Hillaire, S., Honderlick, P., Lequintrec, M., Longchampt, E., Mellot, F., Scherrer, A., Temagoult, L., Tricot, L., Vasse, M., Veyrie, C., Zemoura, L., Berjaud, J., Brouchet, L., Le Balle, F, Mathe, O., Benahoua, H., Didier, A., Goin, A.L., Murris, M., Crognier, L., and Fourcade, O.

Abstract

Chronic lung allograft dysfunction (CLAD) is the major limitation of long‐term survival after lung transplantation. CLADmanifests as bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS). Alloimmune reactions and epithelial‐to‐mesenchymal transition have been suggested in BOS. However, little is known regarding the role of allogenicity in epithelial cell differentiation. Primary human bronchial epithelial cells (BECs) were treated with activated T cells in the presence or absence of transforming growth factor (TGF)‐β. The expression of epithelial and mesenchymal markers was investigated. The secretion of inflammatory cytokines and matrix metalloproteinase (MMP)‐9 was measured in culture supernatants and in plasma from lung transplant recipients (LTRs): 49 stable, 29 with BOS,and 16 with RAS. We demonstrated that C‐C motif chemokine 2 secreted by T cells supports TGF‐β–induced MMP‐9 production by BECsafter binding to C‐C chemokine receptor type 2. Longitudinal investigation in LTRsrevealed a rise in plasma MMP‐9 before CLADonset. Multivariate analysis showed that plasma MMP‐9 was independently associated with BOS(odds ratio [OR] =6.19, p = 0.002) or RAS(OR= 3.9, p = 0.024) and predicted the occurrence of CLAD12 months before the functional diagnosis. Thus, immune cells support airway remodeling through the production of MMP‐9. Plasma MMP‐9 is a potential predictive biomarker of CLAD. The authors investigate the production of matrix metalloproteinase‐9 by primary bronchial epithelial cells after interaction with activated T cells and show that plasma matrix metalloproteinase‐9 can serve as a predictor of chronic lung allograft dysfunction 12 months before clinical diagnosis.

Published
2017
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12. Functional surgery for movement disorders: implications for anaesthesia

Author

Ollinet, C., Bedague, D., Carcey, J., Oddoux, M.-E., and Payen, J.-F.

Subjects
*MOVEMENT disorders, *NEUROLOGICAL nursing, *ANESTHESIA, *GLOBUS pallidus
Abstract

Functional surgery for movement disorders is a recent stereotactic neurosurgical operation, restricted yet to patients with advanced Parkinson’s disease or with generalized primary dystonia. One or two electrodes are implanted in the basal ganglia, namely in the globus pallidus pars interna or in the subthalamic nucleus, to realize a deep brain stimulation at high frequency. While this approach needs additional data to demonstrate clinical benefits, first results observed after short and long-term follow up are encouraging. Perioperative problems in patients with Parkinson’s disease are possible respiratory disorders, a postoperative miss in medication doses and potential drug interactions with anaesthesia. The objectives of anaesthesia will be to allow stereotactic neurosurgical procedure, to maintain the upper airway patency and to be quickly reversible. [Copyright &y& Elsevier]

Published
2004
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13. Pre-emptive veno-arterial ECMO in a giant compressive goiter-related difficult airway: A case report.

Author

Behouche A, Sebestyen A, Guillet L, Durand H, Chaffanjon P, and Bedague D

Subjects
Humans, Middle Aged, Goiter surgery, Goiter complications, Intubation, Intratracheal, Male, Female, Treatment Outcome, Extracorporeal Membrane Oxygenation methods
Abstract

A 64-year-old patient required emergency surgery with high risk of intubation failure, without any possibility to perform neither a direct transtracheal access nor VV-ECMO canulation. The patient was managed thanks to a VA-ECMO despite the absence of cardiac function impairment. This report describes perioperative challenges and management of this unconventional case with favorable outcome., (© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Published
2024
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14. Use of Aprotinin versus Tranexamic Acid in Cardiac Surgery Patients with High-Risk for Excessive Bleeding (APACHE) trial: a multicentre retrospective comparative non-randomized historical study.

Author

Gallo E, Gaudard P, Provenchère S, Souab F, Schwab A, Bedague D, de La Barre H, de Tymowski C, Saadi L, Rozec B, Cholley B, Scherrer B, Fellahi JL, and Ouattara A

Subjects
Humans, Antifibrinolytic Agents adverse effects, APACHE, Hemostatics adverse effects, Retrospective Studies, Aprotinin adverse effects, Blood Loss, Surgical prevention & control, Cardiac Surgical Procedures adverse effects, Tranexamic Acid adverse effects
Abstract

Objectives: Following the reintroduction of aprotinin into the European market, the French Society of Cardiovascular and Thoracic Anaesthesiologists recommended its prophylactic use at half-dose for high-risk cardiac surgery patients. We examined whether the use of aprotinin instead of tranexamic acid could significantly reduce severe perioperative bleeding., Methods: This multicentre, retrospective, historical study included cardiac surgery patients treated with aprotinin or tranexamic acid between December 2017 and September 2020. The primary efficacy end point was the severe or massive perioperative bleeding (class 3-4 of the universal definition of perioperative bleeding). The safety secondary end points included the occurrence of thromboembolic events and all-cause mortality within 30 days after surgery., Results: Among the 693 patients included in the study, 347 received aprotinin and 346 took tranexamic acid. The percentage of patients with severe or massive bleeding was similar in the 2 groups (42.1% vs 43.6%, Adjusted odds ratio [ORadj] = 0.87, 95% confidence interval: 0.62-1.23, P = 0.44), as was the perioperative need for blood products (81.0% vs 83.2%, ORadj = 0.75, 95% confidence interval: 0.48-1.17, P = 0.20). However, the median (Interquartile range) 12 h postoperative blood loss was significantly lower in the aprotinin group (383 ml [241-625] vs 450 ml [290-730], P < 0.01). Compared to tranexamic acid, the intraoperative use of aprotinin was associated with increased risk for thromboembolic events (adjusted Hazard ratio 2.30 [95% Cl: 1.06-5.30]; P = 0.04)., Conclusions: Given the modest reduction in blood loss at the expense of a significant increase in thromboembolic adverse events, aprotinin use in high-risk cardiac surgery patients should be based on a carefully considered benefit-risk assessment., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Published
2024
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15. Cangrelor for cardiopulmonary bypass in delayed-onset heparin-induced thrombocytopenia: a case report.

Author

Durost MB, Marlu R, Piliero N, Sebestyen A, and Bedague D

Abstract

Background: Anticoagulation for cardiopulmonary bypass (CPB) in cases of heparin-induced thrombocytopenia (HIT) is challenging as no convenient and proven alternative, such as heparin alone, exists. A "platelet anesthesia" concept using antiplatelet agent cangrelor with heparin has been successfully reported in this setting., Key Clinical Question: In cases of acute HIT, is CPB with cangrelor plus heparin effective and safe?., Clinical Approach: We report the case of a patient who developed, 2 weeks after patent foramen ovale (PFO) closure, a delayed-onset HIT complicated with carotid, popliteal, and PFO device thromboses that could not be controlled by argatroban anticoagulation and required urgent cardiac surgery. CPB for PFO occluder removal and popliteal thrombectomy were performed using cangrelor with heparin without complication. Neither a new thromboembolic event nor abnormal bleeding was noticed in the postoperative period., Conclusion: CPB using cangrelor with heparin seems to be an effective alternative for acute HIT., (© 2023 The Authors.)

Published
2023
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16. A randomized controlled trial of the intraoperative use of noninvasive ventilation versus supplemental oxygen by face mask for procedural sedation in an electrophysiology laboratory.

Author

Moury PH, Pasquier V, Greco F, Arvieux JL, Alves-Macedo S, Richard M, Casez-Brasseur M, Skaare K, Jacon P, Durand M, Bedague D, Jaber S, Bosson JL, and Albaladejo P

Subjects
Humans, Masks adverse effects, Apnea, Hypoxia epidemiology, Hypoxia etiology, Hypoxia prevention & control, Oxygen, Electrophysiology, Noninvasive Ventilation methods, Respiration Disorders, Respiratory Insufficiency therapy
Abstract

Purpose: The efficacy of noninvasive ventilation (NIV) during procedures that require sedation and analgesia has not been established. We evaluated whether NIV reduces the incidence of respiratory events., Methods: In this randomized controlled trial, we included 195 patients with an American Society of Anesthesiologists Physical Status of III or IV during electrophysiology laboratory procedures. We compared NIV with face mask oxygen therapy for patients under sedation. The primary outcome was the incidence of respiratory events determined by a computer-driven blinded analysis and defined by hypoxemia (peripheral oxygen saturation < 90%) or apnea/hypopnea (absence of breathing for 20 sec on capnography). Secondary outcomes included hemodynamic variables, sedation, patient safety (composite scores of major or minor adverse events), and adverse outcomes at day 7., Results: A respiratory event occurred in 89/98 (95%) patients in the NIV group and in 69/97 (73%) patients with face masks (risk ratio [RR], 1.29; 95% confidence interval [CI], 1.13 to 1.47; P < 0.001). Hypoxemia occurred in 40 (42%) patients in the NIV group and in 33 (34%) patients with face masks (RR, 1.21; 95% CI, 0.84 to 1.74; P = 0.30). Apnea/hypopnea occurred in 83 patients (92%) in the NIV group vs 65 patients (70%) with face masks (RR, 1.32; 95% CI, 1.14 to 1.53; P < 0.001). Hemodynamic variables, sedation, major or minor safety events, and patient outcomes were not different between the groups., Conclusions: Respiratory events were more frequent among patients receiving NIV without any safety or outcome impairment. These results do not support the routine use of NIV intraoperatively., Study Registration: ClinicalTrials.gov (NCT02779998); registered 4 November 2015., (© 2023. Canadian Anesthesiologists' Society.)

Published
2023
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17. Percutaneous FlowTriever Retrieval/Aspiration System for Impending Paradoxical Embolism: A New Tool?

Author

Piliero N, Guichard A, Bedague D, Sebestyen A, Saunier C, and Bouvaist H

Subjects
Humans, Treatment Outcome, Embolism, Paradoxical diagnostic imaging, Embolism, Paradoxical etiology, Foramen Ovale, Patent, Pulmonary Embolism
Abstract

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Published
2022
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18. Helpfulness of the liver disease scores in cardiac surgery for cirrhotic patients.

Author

Sebestyen A, Boutayeb A, Durand M, Martin C, Hilleret MN, Bedague D, Rhem D, and Chavanon O

Subjects
Humans, Liver Cirrhosis complications, Liver Cirrhosis diagnosis, Liver Cirrhosis surgery, Predictive Value of Tests, Prognosis, ROC Curve, Retrospective Studies, Severity of Illness Index, Cardiac Surgical Procedures adverse effects, End Stage Liver Disease
Abstract

Objectives: Liver cirrhosis is a well-known risk factor of mortality after cardiac surgery, but not considered in the widely used EuroSCOREII (ESII). The objective was to analyse the performance of the ESII, the Child-Pugh-Turcotte (CPT) and the Model of End-stage Liver Disease (MELD) scores to predict hospital mortality in cardiac surgery for cirrhotic patients and to analyse the survival according to the preoperative cirrhosis status., Methods: Preoperative and cirrhosis characteristics and postoperative outcomes were compared according to hospital mortality. The performance of the 3 scores was analysed by the area under the receiver-operating characteristics (AUC-ROC) by DeLong's method. The survival of the patients who were discharged was analysed by Kaplan-Meier curves according to the preoperative cirrhosis status., Results: Seventy-four patients were included. Observed hospital mortality was 12%, the predictive mortality by ESII was 3.9% ± 5.2%, and AUC-ROC was 0.67 [0.44-0.90]. Only the MELD score was discriminant (AUC-ROC 0.75 [0.57-0.93]). The observed hospital mortality increased by threefold over the ESII (12% versus 3.9%, p < 0.001), except the patients with MELD < 10 for whom hospital mortality was similar as ESII (3% versus 2.6%, p = 0.89). Long-term survival was higher for the MELD < 10 patients., Conclusions: The ESII did not predict hospital mortality after a cardiac surgery in cirrhotic patients and the MELD score should be considered for decision of cardiac intervention in cirrhotic patients., (© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Published
2022
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19. The Atrial Flow Regulator: A Novel Device for Left Ventricular Unloading in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support?

Author

Piliero N, Bedague D, Fournel E, Saunier C, and Bouvaist H

Subjects
Blood Flow Velocity, Device Removal, Heart-Assist Devices, Humans, Male, Middle Aged, Extracorporeal Membrane Oxygenation adverse effects, Heart Atria, Pulmonary Edema etiology, Septal Occluder Device, Shock, Cardiogenic therapy
Abstract

Severe pulmonary edema, secondary to left ventricular afterload increment, is a common problem occurring in patients receiving venoarterial extracorporeal membrane oxygenation. No consensus is currently available for its management, but several devices/procedures have been described, including an Impella device (Abiomed), balloon atrial septostomy, intraaortic balloon counterpulsation, or an additional venous cannula, as possible adjuncts. We report the feasibility and efficacy of the atrial flow regulator device (Occlutech) for left ventricular unloading in a 58-year-old patient receiving extracorporeal membrane oxygenation. However, the benefits of this device relative to simple balloon atrial septostomy need to be further investigated., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Published
2021
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20. Comparison of the additive, logistic european system for cardiac operative risk (EuroSCORE) with the EuroSCORE 2 to predict mortality in high-risk cardiac surgery.

Author

Guillet L, Moury PH, Bedague D, Durand M, Martin C, Payen JF, Chavanon O, and Albaladejo P

Subjects
Aged, Aged, 80 and over, Europe, Female, Humans, Male, Retrospective Studies, Cardiac Surgical Procedures mortality, Risk Assessment methods, Risk Assessment statistics & numerical data
Abstract

Background: The aim of this study was to compare the new EuroSCORE (ES) 2 prediction model in high-risk patients with the 2 other oldest additive ES (aES) and logistic ES (lES)., Methods: Consecutive adult patients undergoing all cardiac surgery except heart transplantation and left ventricular assist device were included. The 3 risk scores were collected before surgery. We defined 4 high-risk groups of patients, patients ≥80 years, combined cardiac surgery, surgery of the thoracic aorta, and emergency cardiac surgery, and 2 low-risk groups, valve surgery and coronary artery bypass surgery. The predicted value of each score has been assessed by the area under the receiver operating characteristics curve (AUC)., Results: The study had included 3301 patients. Thirty-day mortality was 3.9% (95% confidence interval (CI), 3.3 - 4.6%). The AUC of ES2 was 0.81 (0.77 - 0.84), 0.82 (0.78 - 0.85), 0.70 (0.64 - 0.76), 0.79 (0.74 - 0.83), 0.85 (0.83 - 0.87), and 0.88 (0.86 - 0.90) for octogenarians, thoracic aortic surgery, combined surgery, emergency surgery, coronary surgery, and valve surgery, respectively. These ES2 AUC values were higher than those obtained with the aES for octogenarians, and with the lES for octogenarians and valve surgery. The ES2 calibration was better than the aES and lES calibration for the whole population, and low-risk groups. The ES2 calibration was superior to aES and lES in high-risk groups, except for octogenarians and thoracic aortic surgery compared to lES., Conclusion: In high-risk cardiac surgery patients, ES2 only marginally improve the predicted 30-day mortality in comparison to other ES.

Published
2020
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21. Oesophageal Doppler to optimize intraoperative haemodynamics during prone position. A randomized controlled trial.

Author

Picard J, Bedague D, Bouzat P, Ollinet C, Albaladejo P, Bosson JL, and Payen JF

Subjects
Aged, Algorithms, Arterial Pressure, Blood Pressure, Female, Fluid Therapy, Humans, Hypotension epidemiology, Hypotension physiopathology, Intraoperative Complications epidemiology, Intraoperative Complications physiopathology, Male, Middle Aged, Prospective Studies, Spine surgery, Echocardiography, Doppler methods, Echocardiography, Transesophageal methods, Hemodynamics, Intraoperative Care standards, Prone Position
Abstract

Background: Intraoperative use of oesophageal Doppler (OD) was associated with improved postoperative outcomes through the optimization of perioperative fluid management. We studied the effect on haemodynamics of a goal-directed fluid management approach, guided by OD, during elective spine surgery in the prone position., Methods: Intraoperative fluid and vasopressor administration were directed according to one of two randomly chosen decision-making algorithms driven by either OD (OD group; n=33 patients) or standard parameters (standard group; n=34 patients). Both groups were monitored by OD, however haemodynamics management in the standard group was blinded to OD information. OD algorithm used corrected flow time as the primary variable to guide haemodynamics management. Mean arterial blood pressure (MAP) was maintained within 75% of the preoperative value for both groups. The primary outcome was the duration of intraoperative hypotensive episodes during prone position., Results: The proportion of procedure duration with MAP below the predefined threshold was greater in the Standard group than in the OD group: 34% (15-62) (median, interquartile range) versus 17% (5-35) of the observation period, respectively (P=0.01). They were also more frequent in the Standard group: 7 (3-11) per patient versus 3 (1-7) per patient (P<0.001). The requirement and dosing of ephedrine and infused colloids over the observation period did not significantly differ between the two groups. The OD parameters were comparable between the two groups during prone position., Conclusion: OD monitoring during spine surgery in prone position is feasible and may help physicians to reduce the duration of hypotensive episodes during this surgical procedure., (Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Published
2016
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22. Anaesthesiological support in a cardiac electrophysiology laboratory: a single-centre prospective observational study.

Author

Trouvé-Buisson T, Arvieux L, Bedague D, Casez-Brasseur M, Defaye P, Payen JF, and Albaladejo P

Subjects
Aged, Anesthesia methods, Cohort Studies, Death, Sudden, Cardiac etiology, Female, Heart Failure complications, Heart Failure therapy, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Treatment Outcome, Anesthesiology methods, Cardiac Electrophysiology methods, Defibrillators, Implantable adverse effects
Abstract

Background: Implantation of cardiovascular implantable electronic devices (CIEDs) has greatly increased during the last decade and anaesthetic management of these patients remains an open question., Objective: This study describes anaesthetic management and risk factors associated with complications occurring during these procedures., Design: A single-centre prospective observational study., Setting: Grenoble University Hospital, France, from May 2010 to October 2010., Patients: All patients admitted to the cardiac electrophysiology laboratory were included., Intervention: None., Main Outcome Measures: Clinical data, anaesthetic and medical characteristics as well as complications (respiratory or cardiovascular) and treatment were recorded by the anaesthetic nurse at the end of each procedure., Results: Two hundred and sixty-nine patients were included, 229 (85%) with an American Society of Anaesthesiologists (ASA) status of 3 or 4, 103 (38%) with a New York Heart Association (NYHA) functional class of 3 or 4 and 136 (51%) with a left ventricular ejection fraction of less than 40%. Two hundred and forty-seven (92%) of the patients underwent deep sedation and 12 (8%) general anaesthesia. Seventy-eight (29%) patients had at least one complication, among whom 21 (27%) had at least one considered as severe. Fifty (19%) of the patients had a respiratory complication and 46 (17%) a cardiovascular complication; the latter was more frequently severe (41 vs. 12%; P=0.001). Lead extraction [odds ratio (OR) 13.7, 95% confidence interval (CI) 3.5 to 53.3; P<0.001], NYHA status of 4 (OR 11.8, 95% CI 1.8 to 74.8; P<0.001), implantable cardioverter-defibrillator (ICD) testing by T-wave shock (OR 3.9, 95% CI 1.53 to 10.2; P=0.005) and length of procedure (OR 1.01, 95% CI 1.004 to 1.031; P=0.013) were identified as independent risk factors for cardiovascular complications., Conclusion: Patients requiring cardiovascular implantable electronic device (CIED) implantation were fragile with a high complication rate and a high rate of severe complications even with anaesthesiological support. These complications, as well as the need for deep sedation or general anaesthesia, clearly justify the involvement of a qualified anaesthesiologist.

Published
2013
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23. Evaluation of the effect of one large dose of erythropoietin against cardiac and cerebral ischemic injury occurring during cardiac surgery with cardiopulmonary bypass: a randomized double-blind placebo-controlled pilot study.

Author

Joyeux-Faure M, Durand M, Bedague D, Protar D, Incagnoli P, Paris A, Ribuot C, Levy P, and Chavanon O

Subjects
Aged, Biomarkers blood, Brain Ischemia blood, Brain Ischemia etiology, Cytokines blood, Cytoprotection drug effects, Data Interpretation, Statistical, Dose-Response Relationship, Drug, Double-Blind Method, Electrocardiography, Erythropoietin administration & dosage, Female, Humans, Male, Middle Aged, Myocardial Ischemia blood, Myocardial Ischemia etiology, Myocardial Reperfusion Injury blood, Myocardial Reperfusion Injury etiology, Myocardial Reperfusion Injury prevention & control, Nerve Growth Factors blood, Pilot Projects, Recombinant Proteins administration & dosage, Recombinant Proteins therapeutic use, Reperfusion Injury blood, Reperfusion Injury etiology, S100 Calcium Binding Protein beta Subunit, S100 Proteins blood, Treatment Outcome, Troponin T blood, Brain Ischemia prevention & control, Cardiopulmonary Bypass adverse effects, Erythropoietin therapeutic use, Myocardial Ischemia prevention & control, Reperfusion Injury prevention & control
Abstract

Cardiac surgery and cardiopulmonary bypass (CPB) induce ischemia-reperfusion and subsequent cellular injury with inflammatory reaction. Clinical and experimental studies suggest that recombinant human erythropoietin (EPO) independently of its erythropoietic effect may be used as a cytoprotective agent against ischemic injury. We tested the hypothesis that one large dose of EPO administered shortly before CPB prevents the elevation of cardiac and cerebral ischemic blood markers as well as the systemic inflammatory response induced by cardiac surgery with CBP through this randomized double-blind placebo-controlled pilot trial. Fifty patients scheduled for coronary artery bypass graft (CABG) surgery with CPB were randomly allocated to EPO or control groups. EPO (800 IU/kg intravenously) or placebo (saline) was administered before CPB. The primary end point was to study the effect of EPO administration on several blood markers of myocardial and cerebral ischemia in relation to CABG with CPB. In both groups, surgery increased plasma concentrations of cardiac (troponin T, NT-proBNP, and creatine kinase MB) and cerebral (S100β protein) markers ischemic as well as the pro-inflammatory marker interleukin-6. Compared with the placebo, EPO administration before CPB did not prevent an increase of all these markers following CPB. In conclusion, one large dose of EPO, given shortly before CPB, did not protect against cardiac and cerebral ischemia and inflammatory response occurring during CABG surgery with CPB. Although the long-term clinical implications remain unknown, the findings do not support use of EPO at this dose as a cytoprotective agent in patients undergoing cardiac surgery., (© 2011 The Authors Fundamental and Clinical Pharmacology © 2011 Société Française de Pharmacologie et de Thérapeutique.)

Published
2012
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