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1. Quality of life of patients with hip fracture was better during the COVID-19 period than before, an ancillary study from the HiFIT multicenter study

Author

Sigismond Lasocki, Xavier Capdevila, Benjamin Bijok, Maria Lahlou-Casulli, Vincent Collange, Nicolas Grillot, Thibault Loupec, Emmanuel Rineau, Maxime Léger, the HiFIT Investigators, CHU Angers, Guillaume BOUHOURS, Sigismond LASOCKI, Adeline LEBAIL, Maxime LEGER, Elsa PAROT-SCHINKEL, Emmanuel RINEAU, Louis RONY, Bruno VIELLE, CHU – Hôpital Lapeyronie Montpellier, Xavier CAPDEVILLA, Thibault LOUPEC, Benjamin MOUNET, Fabien SWISSER, HIA Clermont-Tonnerre, Marc Danguy des Deserts, CHU Nantes, Raphael Cinotti, Karim Asehnoune, Antoine Roquilly, CHU de Rennes, Hélène Beloeil, Lyon Villeurbanne Medipôle, Sébastien PARENT, Ramsay Sante, Bertrand DELANNOY, Olivier Desebbe, CHD Vendée, Alexis Duchalais, CHU Poitiers, Bertrand DRUGEON, Jérémy GUENEZAN, CHU Grenoble Alpes, Pierre BOUZAT, Sabine DREVET, Gaetan GAVAZZI, Jules GREZE, CHRU Lille, Benjamin BIJOK, Delphine GARRIGUE, and Jean-Stéphane DAVID

Subjects
COVID-19, hip fracture, older adult, quality of life, EQ5D, Public aspects of medicine, RA1-1270
Abstract

BackgroundThe COVID-19 pandemic had a global impact on people life, notably because of lockdown periods. This could particularly affected patients suffering from hip fracture, who could have been more isolated during these periods. We aim at evaluating the impact of the COVID-19 period (including lockdown periods) on quality of life (QOL) in older adult patients 90 days after a surgery for a hip fracture.Subject and methodsAncillary study of the prospective randomized controlled HiFIT study. We compared the QOL measured at 90 days after a hip fracture surgery using the EuroQOL-5 dimensions 3 levels (EQ-5D), the Perceived Quality of life (PQOL) and the Instrumental Activities of Daily Living (IADL) in patients included in the Hifit study before and during the COVID-19 pandemic.ResultsThe characteristics of the 161 patients included before and of the 213 included during the COVID period (including 122 (57%) during COVID with containment periods and 91 (43%) during COVID without containment periods) were similar (mean age 84 ± 10 years; 282 (75%) women). The majority (81%) of the patients alive at 90 days had returned to their previous place of residence in both periods. During the COVID period, EQ-5D showed better patient pain/discomfort and anxiety/depression levels. The PQOL happiness was not different, with around 81% of the patient being “happy” or “very happy” during the two periods and the IADL was also similar during the two periods. In the multivariate analysis odd ratios of having poorer outcomes were increased before COVID for pain/discomfort (OR 2.38, 95%CI [1.41–4.15], p = 0.001), anxiety (OR 1.89 [1.12–3.21], p = 0.017) and mobility (1.69 [1.02–2.86], p = 0.044).ConclusionPatient’s quality of life measured using different scales was not altered during the COVID period compared to before COVID, 90 days after a hip fracture. Surprisingly, the Pain/Discomfort and Anxiety dimensions of the EQ-5D questionnaires were even better during the COVID period.Clinical trial registration:https://clinicaltrials.gov/ (NCT02972294).

Published
2024
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2. Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort studyResearch in context

Author

Marc Garnier, Jean-Michel Constantin, Raphaël Cinotti, Chafia Daoui, Dimitri Margetis, Grégory Destruhaut, Cédric Cirenei, Eric Noll, Christophe Quesnel, Agnes Lecinq, Sigismond Lasocki, Hélène Charbonneau, Stanislas Abrard, Cyril Quemeneur, Bruno Pastene, Nathanaël Lapidus, Marc Leone, El Mahdi Hafiani, Olivier Imauven, Emmanuel Rineau, Maxime Léger, Marc Danguy des Deserts, Johan Schmitt, Philippe Aries, Aurélie Gouel, Julia Voulgaropoulos, Laura Soldan, Romain Deransy, Quentin Laurent, Etienne Gayat, Franck Verdonk, Sabrina Chaouche, Amélie Cambriel, Vincent Degos, Julie Dupont, Laura Daoud, Romain Salettes, Malory Favreau, Julien Pottecher, Sophie Diemunsch, Cyril Bidon, Clémence Roy, Laëtitia Ottolenghi, Damien Edouard, Agnès Lecinq, Frédéric Mercier, Delphine Garrigue, Elsa Jozefowicz, Marie Pariès, Fabien Espitalier, Charlène Piat, Richard Descamps, Maëlle Duchesne, Stéphanie Sigaut, Laurie-Anne Thion, Julie Renard, Elsa Brocas, Besma Zbidi, Mohamed Fki, Guillaume Dufour, Mario Bucciero, Charles-Edouard Rochon, Céline Delerue, Virginie Trehel-Tursis, Julien Raft, Olivier Rangeard, Claire Thiriet, Kevin Lagarde, Angélina Pollet, Félix Pelen, Anaïs Caillard, Philippe Penven, Olivier Huet, Floriane Puel, Xavier Pichon, Laetitia Ligneres, Pauline Bleuze, Stéphanie Deryckere, Lionel Velly, Pierre Simeone, Hery Andrianjatovo, Youri Chipouline, Mouna Boolad, Denis Frasca, Quentin Plouviez, Benoit Plaud, Eric Roland, Delphine Cheron-Leroy, Samy Figueiredo, Antonia Blanié, Olivier Joannes-Boyau, Simon Monziols, Jean-Jacques Robin, Matthieu Biais, Hugues De Courson, Cécile Degryse, Marie Do-Khac, Marie-Pierre Bonnet, Aurélien Mazeraud, Jean Bardon, Eléonore Bouchereau, Karine Bezulier, Ségolène Mrozek, Nicolas Mayeur, and Sandrine Lopez

Subjects
COVID-19, Anaesthesia, Surgery, Perioperative risk, Respiratory complications, Postoperative pneumonia, Medicine (General), R5-920
Abstract

Summary: Background: Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. Methods: We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. Findings: Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48–2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02–15.8]; p = 0.04). Interpretation: In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. Funding: The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).

Published
2023
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3. Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry

Author

Josefine S. Baekgaard, Paer-Selim Abback, Marouane Boubaya, Jean-Denis Moyer, Delphine Garrigue, Mathieu Raux, Benoit Champigneulle, Guillaume Dubreuil, Julien Pottecher, Philippe Laitselart, Fleur Laloum, Coralie Bloch-Queyrat, Frédéric Adnet, Catherine Paugam-Burtz, and Traumabase® Study Group

Subjects
Hyperoxemia, Hyperoxia, Trauma, Critical care, Oxygen, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Hyperoxemia has been associated with increased mortality in critically ill patients, but little is known about its effect in trauma patients. The objective of this study was to assess the association between early hyperoxemia and in-hospital mortality after severe trauma. We hypothesized that a PaO2 ≥ 150 mmHg on admission was associated with increased in-hospital mortality. Methods Using data issued from a multicenter prospective trauma registry in France, we included trauma patients managed by the emergency medical services between May 2016 and March 2019 and admitted to a level I trauma center. Early hyperoxemia was defined as an arterial oxygen tension (PaO2) above 150 mmHg measured on hospital admission. In-hospital mortality was compared between normoxemic (150 > PaO2 ≥ 60 mmHg) and hyperoxemic patients using a propensity-score model with predetermined variables (gender, age, prehospital heart rate and systolic blood pressure, temperature, hemoglobin and arterial lactate, use of mechanical ventilation, presence of traumatic brain injury (TBI), initial Glasgow Coma Scale score, Injury Severity Score (ISS), American Society of Anesthesiologists physical health class > I, and presence of hemorrhagic shock). Results A total of 5912 patients were analyzed. The median age was 39 [26–55] years and 78% were male. More than half (53%) of the patients had an ISS above 15, and 32% had traumatic brain injury. On univariate analysis, the in-hospital mortality was higher in hyperoxemic patients compared to normoxemic patients (12% versus 9%, p

Published
2020
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4. Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring

Author

Sophie Susen, Charles Ambroise Tacquard, Alexandre Godon, Alexandre Mansour, Delphine Garrigue, Philippe Nguyen, Anne Godier, Sophie Testa, Jerrold H. Levy, Pierre Albaladejo, Yves Gruel, and on behalf of GIHP and GFHT

Subjects
COVID-19, Thrombosis, Obesity, Anticoagulant, Heparin, Coagulation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract COVID-19 is an infection induced by the SARS-CoV-2 coronavirus, and severe forms can lead to acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) management. Severe forms are associated with coagulation changes, mainly characterized by an increase in D-dimer and fibrinogen levels, with a higher risk of thrombosis, particularly pulmonary embolism. The impact of obesity in severe COVID-19 has also been highlighted. In this context, standard doses of low molecular weight heparin (LMWH) may be inadequate in ICU patients, with obesity, major inflammation, and hypercoagulability. We therefore urgently developed proposals on the prevention of thromboembolism and monitoring of hemostasis in hospitalized patients with COVID-19. Four levels of thromboembolic risk were defined according to the severity of COVID-19 reflected by oxygen requirement and treatment, the body mass index, and other risk factors. Monitoring of hemostasis (including fibrinogen and D-dimer levels) every 48 h is proposed. Standard doses of LMWH (e.g., enoxaparin 4000 IU/24 h SC) are proposed in case of intermediate thrombotic risk (BMI 120 kg), or unfractionated heparin (UFH) if renal insufficiency (200 IU/kg/24 h, IV), is proposed. The thrombotic risk was defined as very high in obese patients with ARDS and added risk factors for thromboembolism, and also in case of extracorporeal membrane oxygenation (ECMO), unexplained catheter thrombosis, dialysis filter thrombosis, or marked inflammatory syndrome and/or hypercoagulability (e.g., fibrinogen > 8 g/l and/or D-dimers > 3 μg/ml). In ICU patients, it is sometimes difficult to confirm a diagnosis of thrombosis, and curative anticoagulant treatment may also be discussed on a probabilistic basis. In all these situations, therapeutic doses of LMWH, or UFH in case of renal insufficiency with monitoring of anti-Xa activity, are proposed. In conclusion, intensification of heparin treatment should be considered in the context of COVID-19 on the basis of clinical and biological criteria of severity, especially in severely ill ventilated patients, for whom the diagnosis of pulmonary embolism cannot be easily confirmed.

Published
2020
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5. Study protocol for a multicentre, 2×2 factorial, randomised, controlled trial evaluating the interest of intravenous iron and tranexamic acid to reduce blood transfusion in hip fracture patients (the HiFIT study)

Author

Bertrand Drugeon, Olivier Mimoz, Karim Asehnoune, Antoine Roquilly, Sigismond Lasocki, Hélène Beloeil, Olivier Desebbe, Pierre Bouzat, Bruno Vielle, Thibault Loupec, Elsa Parot-Schinkel, Marc Danguy des Déserts, Maria Lahlou-Casulli, Vincent Collange, Alexis Duchalais, Delphine Garrigue, Benjamin Mounet, Franck Hamard, Jean-Stéphane David, Maxime Leger, Emmanuel Rineau, Guillaume Bouhours, Adeline Lebail, Emmanuel Samson, Xavier Capdevilla, Fabien Swisser, Marc Danguy Des Deserts, Sébastien Parent, Gaetan Gavazzi, and Benjamin Bijok

Subjects
Medicine
Abstract

Introduction Blood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce the transfusion rate in these patients.Methods and analysis The HiFIT study is a multicentre, 2×2 factorial, randomised, double-blinded, controlled trial evaluating the effect of iron isomaltoside (IIM) (20 mg/kg) vs placebo and of TXA (intravenously at inclusion and topically during surgery) versus placebo on transfusion rate during hospitalisation, in patients undergoing emergency surgery for HF and having a preoperative haemoglobin between 95 and 130 g/L. 780 patients are expected. The primary endpoint is the proportion of patients receiving an allogenic blood transfusion of packed red blood cells from the day of surgery until hospital discharge (or until D30 if patient is still hospitalised). Enrolment started on March 2017 in 11 French hospitals. The study was stopped between July 2017 and August 2018 (because of investigation of serious AEs with IIM in Spain) and slowed down since March 2020 (COVID-19 crisis). The expected date of final follow-up is May 2022. Analyses of the intent-to-treat and per-protocol populations are planned.Ethics and dissemination The HiFIT trial protocol has been approved by the Ethics Committee of Comité de Protection des Personnes Ouest II and the French authorities (ANSM). It will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. The HiFIT trial will be the largest study evaluating iron and TXA in patients with HF.Trial registration number clinicalTrials.gov identifier: NCT02972294; EudraCT Number 2016-003087-40.

Published
2021
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6. Specification and Evaluation of Plasticizer Migration Simulants for Human Blood Products: A Delphi Study

Author

Aurélie Thelliez, Grégory Hénard, Bruno Delorme, Sonia Chatellier, Cécile Danel, Laurent Ducoroy, Annabelle Dupont, Delphine Garrigue, Stéphanie Genay, Jean-François Goossens, Laurence Goossens, Coralie Havet, Jean-Daniel Hecq, Caroline Maeght, Isabelle Mendel, Tomé Najdovski, Pascal Odou, Guillaume Saint-Lorant, Alexandre Ung, Marie Lecoeur, and Bertrand Décaudin

Subjects
labile blood product, migration, plasticizer, simulant, Microbiology, QR1-502
Abstract

Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the plasticizers are not chemically bonded to the PVC, they can be released into labile blood products (LBPs) during storage. Ideally, LBPs would be used in laboratory studies of plasticizer migration from the medical device. However, short supply (i.e., limited stocks of human blood in collection centres) has prompted the development of specific simulants for each type of LBP in the evaluation of new transfusion devices. We performed a Delphi study with a multidisciplinary panel of 24 experts. In the first (qualitative) phase, the panel developed consensus definitions of the specification criteria to be met by each migration simulant. Next, we reviewed the literature on techniques for simulating the migration of plasticizers into LBPs. A questionnaire was elaborated and sent out to the experts, and the replies were synthesized in order to obtain a consensus. The qualitative study established specifications for each biological matrix (whole blood, red blood cell concentrate, plasma, and platelet concentrate) and defined the criteria required for a suitable LBP simulant. Ten criteria were suggested: physical and chemical characteristics, opacity, form, stability, composition, ability to mimic a particular clinical situation, ease and safety of use, a simulant–plastic interaction correlated with blood, and compatibility with analytical methods. The questionnaire data revealed a consensus on the use of natural products (such as pig’s blood) to mimic the four LBPs. Opinions diverged with regard to synthetic products. However, an isotonic solution and a rheological property modifier were considered to be of value in the design of synthetic simulants. Consensus reached by the Delphi group could be used as a database for the development of simulants used to assess the migration of plasticizers from PVC bags into LBPs.

Published
2021
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8. Prévention du risque thromboembolique veineux et surveillance de l’hémostase chez les patients hospitalisés pour COVID-19 : propositions réactualisées (avril 2021). Groupe d’intérêt en hémostase périopératoire (GIHP) et groupe d’étude sur l’hémostase et la thrombose (GFHT)

Author

Sophie Susen, Dominique Lasne, Jerrold H. Levy, Alexandre Mansour, Sophie Testa, Philippe Nguyen, Anne Godier, Yves Gruel, Delphine Garrigue, le Gfht, pour le Gihp, Alexandre Godon, Charles Tacquard, and Pierre Albaladejo

Subjects
Propositions, Anticoagulation, Anesthesiology and Pain Medicine, Risque hémorragique, Maladie thromboembolique veineuse, COVID-19, Risque thrombotique, Thromboprophylaxie
Abstract

Resume Contexte La COVID-19 est associee a un risque thromboembolique veineux eleve, en particulier chez les patients severes. Depuis les premieres propositions GIHP/GFHT publiees en avril 2020, de nouvelles connaissances sont apparues. L’objet du present travail etait de reactualiser ces propositions. Methodes Un groupe de travail a defini sept questions et effectue une revue critique de la litterature. Les propositions ont ete formulees apres consensus entre les membres du groupe de travail et les autres membres du GIHP/GFHT. Resultats Chez les patients hospitalises non severes et certains patients ambulatoires a risque, nous suggerons l’administration d’une thromboprophylaxie a dose standard. Chez les patients severes, nous suggerons une thromboprophylaxie a dose intermediaire ou therapeutique selon le taux de D-dimeres et son evolution. Sept a dix jours apres l’admission, nous suggerons de revenir a une dose standard pour reduire le risque hemorragique. Chez les patients presentant un tres haut risque thrombotique, ayant recu une thromboprophylaxie a dose therapeutique, nous suggerons un depistage systematique de la thrombose avant la desescalade. Nous suggerons d’ajuster l’anticoagulation au poids des patients. Nous suggerons un monitorage regulier des parametres d’hemostase, incluant les D-dimeres, chez les patients severes. Nous suggerons un monitorage de l’anticoagulation a dose intermediaire et therapeutique par l’activite anti-Xa. Conclusion Les propositions reactualisees suivent une approche standard de la thromboprophylaxie, visant a diminuer l’incidence des evenements thromboemboliques veineux symptomatiques. Chez les patients severes, nous proposons une strategie sequentielle tenant compte de la relation temporelle entre le risque thrombotique et le risque hemorragique.

Published
2021

9. La chirurgie urgente a-t-elle besoin d’une filière dédiée ?

Author

Delphine Garrigue Huet, Benoît Tavernier, and Delphine Lepercq

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030208 emergency & critical care medicine, 030230 surgery
Abstract

Resume La chirurgie urgente est par definition une chirurgie non programmee. Qu’elle soit d’origine traumatique ou non, son incidence est en augmentation. La chirurgie d’urgence, comparativement a la chirurgie reglee, est un facteur de risque independant de mortalite et de morbidite. Elle peut etre compliquee par des retards de prise en charge, qui sont favorises par les difficultes d’acces aux plateaux techniques et par l’indisponibilite des personnels. Pourtant, aucune organisation specifique pour la chirurgie d’urgence n’est recommandee en France. Trois types de filieres sont decrits pour la prise en charge des urgences chirurgicales : 1) un plateau operatoire d’urgence avec une ou plusieurs salle(s) dediee(s) multi-specialites ; 2) une (ou des) salle(s) d’operation dediee(s) au sein d’un plateau chirurgical (specialise ou non) ; 3) aucune salle d’operation dediee, avec integration des patients urgents aux flux de chirurgie programmee. L’utilisation d’une classification des urgences chirurgicales, partagee par l’ensemble des acteurs de soin, et la mise en place d’une filiere dediee ont permis une diminution du retard ainsi que des complications et de la mortalite des patients. Le terme « dedie » signifie que cette filiere se compose d’une equipe medicale et paramedicale, chargee exclusivement de prendre en charge les operations urgentes dans des blocs operatoires specifiques. L’instauration d’une filiere dediee entraine un changement structurel des systemes de sante et permet une optimisation du temps de soin en diminuant le delai entre les operations. Cette organisation peut se superposer a celle mise en place dans les reseaux de traumatologie d’Acute care surgery. Ce type de filiere est recommande au Royaume-Uni, mais pas en France.

Published
2021

10. Comprehensive analysis of coagulation factor delivery strategies in a cohort of trauma patients

Author

Florian Roquet, Anne Godier, Delphine Garrigue-Huet, Jean-Luc Hanouz, Fanny Vardon-Bounes, Vincent Legros, Romain Pirracchio, Sylvain Ausset, Jacques Duranteau, Bernard Vigué, and Sophie Rym Hamada

Subjects
Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Abstract

The 5All adult patients, admitted directly to participating centers between 2011 and 2019, were extracted from a trauma registry. Two subpopulations were studied: severe hemorrhage (SH) and massive transfusion (MT) groups.A total of 19,396 patients were included, among whom 8.4% (1630) experienced SH and 3% (579) received MT. Within the first 24 hours, 10% received fresh frozen plasma (FFP), rising to 93% and 99% in the subgroups of patients experiencing SH and MT respectively. Only, 8% received fibrinogen concentrate (FC), increasing to 75% and 92% in subgroups SH and MT respectively. Co-administration of FFP and FC became the dominant strategy with 68% of patients at 6 h and 72% at 24 h in SH subgroup. In unadjusted data, mortality was systematically lower in groups that complied with recommendations, a lower mortality than expected was mostly observed in contrast to non-compliant subgroups. The per-patient compliance to studied recommendations was 21% and 22% in SH and MT subgroups.The main hemostatic strategy for major bleeding combined the administration of both FFP and FC, favoring an early additional supply of fibrinogen. Compliance with the recommendations was low in SH and MT subgroups.

Published
2022

11. Association of Organizational Pathways With the Delay of Emergency Surgery

Author

Delphine Lepercq, Tobias Gauss, Anne Godier, Julie Bellet, Guillaume Bouhours, Pierre Bouzat, Emeline Cailliau, Fabrice Cook, Jean-Stéphane David, Fatou Drame, Marvin Gauthier, Antoine Lamblin, Julien Pottecher, Benoit Tavernier, and Delphine Garrigue-Huet

Subjects
General Medicine
Abstract

ImportanceDelayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date.ObjectiveTo examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France.Design, Setting, and ParticipantsThis prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded.ExposuresEmergency surgery.Main Outcomes and MeasuresThe main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1.ResultsA total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P Conclusions and RelevanceIn this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.

Published
2023

12. Intrahospital Trauma Flowcharts - cognitive aids for intrahospital trauma management from the French Society of Anaesthesia and Intensive Care Medicine and the French Society of Emergency Medicine

Author

Tobias Gauss, Hervé Quintard, Benjamin Bijok, Guillaume Bouhours, Thomas Clavier, Fabrice Cook, Hugues de Courson, Jean-Stéphane David, Caroline Duracher-Gout, Delphine Garrigue, Thomas Geeraerts, Sophie Hamada, Olivier Joannes-Boyau, Romain Jouffroy, Antoine Lamblin, Olivier Langeron, Pierre Lanot, Sigismond Lasocki, Marc Leone, Sébastien Mirek, Laurent Muller, Pierre Pasquier, Bertrand Prunet, Sébastien Perbet, Mathieu Raux, Justin Richards, Claire Roger, Antoine Roquilly, Emmanuel Weiss, Pierre Bouzat, Julien Pottecher, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Anesthesiology and Pain Medicine, Traumatic Brain Injury, Resuscitation, Cognitive aid, Shock, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Guideline, Damage Control, Critical Care and Intensive Care Medicine, Trauma
Published
2022

13. Prothrombin Time ratio can predict mortality in severe pediatric trauma: Study in a French trauma center level 1

Author

Romain Momal, Audrey Hochart, Benjamin Bijok, Delphine Garrigue-Huet, Elodie Drumez, and Sophie Susen

Subjects
Male, Pediatrics, medicine.medical_specialty, Adolescent, Population, Likelihood ratios in diagnostic testing, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, Predictive Value of Tests, Interquartile range, medicine, Coagulopathy, Humans, Mortality, Child, education, Retrospective Studies, education.field_of_study, Predictive marker, business.industry, Trauma center, Infant, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Triage, Child, Preschool, Prothrombin Time, Emergency Medicine, Wounds and Injuries, Female, France, business, Pediatric trauma
Abstract

Injury results in more deaths in children than all other causes combined, but there is little data regarding the association of early coagulopathy on outcomes in pediatric patients with traumatic injuries. The aim of this study was to determine the optimal cut-off value for the Prothrombin Time ratio (PTr) and to show the diagnostic characteristics of the PTr to predict mortality.We retrospectively included during 4 years all patients less than 16 years old referred to our trauma center for traumatic injury with ISS ≥9.A total of 272 children were included. Mean age was 9.4 ± 4.8 years and median ISS was 17 [interquartile range, 12 to 26]. Day 28 mortality was 6.7%. The optimal cut-off value in our population for predicting day 28 mortality was 1.24. Using this value, the sensitivity of PTr was 84%, specificity was 82%, positive likelihood ratio was 4.7, and negative likelihood ratio was 0.19. Early mortality (i.e., mortality at 24 h) was also well-predicted (1.0% versus 16.4%, p .0001), as the need for massive transfuion. Similarly, patients with PTr ≥1.24 at admission presented with a higher rate of severe thoracic and abdominal trauma, higher ISS, higher likelihood of admission to an intensive care unit, longer hospitalization, and higher rate of significant procedure (e.g., surgery or embolization).Trauma-induced coagulopathy defined only by a PTr ≥1.24 could be used as a severity predictive marker and as a sensitive, specific, quick, and easy to use tool for admission triage of pediatric patients.

Published
2020

14. Effect of fibrinogen concentrate administration on early mortality in traumatic hemorrhagic shock: A propensity score analysis

Author

Eric Meaudre, Tobias Gauss, Romain Pirracchio, Jacques Duranteau, Alexandra Rouquette, Fabrice Cook, Mathieu Boutonnet, Paer Selim Abback, Sophie Hamada, Frédéric Lesache, Mohammed Nadjib Benlaldj, Jocelyn Beauchesne, Julien Pottecher, Josse Julie, Marc Leone, and Delphine Garrigue

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Delphi Technique, Shock, Hemorrhagic, Critical Care and Intensive Care Medicine, Fibrinogen, Hemostatics, Time-to-Treatment, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Shock, Traumatic, Hospital Mortality, Prospective Studies, Registries, Young adult, Propensity Score, Prospective cohort study, business.industry, Confounding, Absolute risk reduction, 030208 emergency & critical care medicine, Middle Aged, Confidence interval, 3. Good health, Treatment Outcome, Shock (circulatory), Propensity score matching, Female, Surgery, medicine.symptom, Erythrocyte Transfusion, business, medicine.drug
Abstract

Background Fibrinogen concentrate is widely used in traumatic hemorrhagic shock despite weak evidence in the literature. The aim of the study was to evaluate the effect of fibrinogen concentrate administration within the first 6 hours on 24-hour all-cause mortality in traumatic hemorrhagic shock using a causal inference approach. Methods Observational study from a French multicenter prospective trauma registry was performed. Hemorrhagic shock was defined as transfusion of four or more red blood cell units within the first 6 hours after admission. The confounding variables for the outcome (24-hour all-cause mortality) and treatment allocation (fibrinogen concentrate administration within the first 6 hours) were chosen by a Delphi method. The propensity score was specified with a data-adaptive algorithm and a doubly-robust approach with inverse proportionality of treatment weighting allowed to compute the average treatment effect. Sensitivity analyses were performed. Results Of 14,336 patients in the registry during the study period, 1,027 in hemorrhagic shock were analyzed (758 receiving fibrinogen concentrate within 6 hours and 269 not receiving fibrinogen concentrate). The average treatment effect, expressed as a risk difference, was -0.031 (95% confidence interval, -0.084 to 0.021). All sensitivity analysis confirmed the results. Conclusions Fibrinogen concentrate administration within the first 6 hours of a traumatic hemorrhagic shock did not decrease 24-hour all-cause mortality. Level of evidence Prognostic, level III.

Published
2020

15. Withholding and withdrawal of life-sustaining therapy in 8569 trauma patients: A multicentre, analytical registry study

Author

Malik Haddam, Laura Kubacsi, Sophie Hamada, Anatole Harrois, Arthur James, Olivier Langeron, Mathieu Boutonnet, Mathilde Holleville, Delphine Garrigue, Marion Leclercq, Jean-Luc Hanouz, Julien Pottecher, Gérard Audibert, Mickael Cardinale, Hélène Vinour, Laurent Zieleskiewicz, Noemie Resseguier, and Marc Leone

Subjects
Male, Intensive Care Units, Anesthesiology and Pain Medicine, Withholding Treatment, Humans, Registries, Middle Aged, Aged, Retrospective Studies
Abstract

This study aimed to determine the prevalence of withholding or withdrawal of life-sustaining therapy (WLST) decisions in trauma ICU patients, using a large registry. We hypothesised that this prevalence is similar to that of the general population admitted to an ICU. As secondary aims, it sought to describe the trauma patients for whom the decision was made for WLST and the factors associated with this decision.This observational study assessed data from 14 French centres listed in the TraumaBaseTM registry. All trauma patients hospitalised for more than 48 h were pro-spectively included.Data from 8569 trauma patients, obtained from January 2016 to December 2018, were included in this study. A WLST decision was made in 6% of all cases. In the WLST group, 67% of the patients were older men (age: 62 versus 36, P 0.001); more often they had a prior medical history and higher median severity scores than the patients in the no WLST decision group; SAPS II 58 (46 to 69) versus 21 (13 to 35) and ISS 26 (22 to 24) versus 12 (5 to 22), P 0.001. Neurological status was strongly associated with WLST decisions. The geographic area of the ICUs affected the rate of the WLST decisions. The ICU mortality was 11% (n = 907) of which 47% (n = 422) were preceded by WLST decisions. Fourteen percent of WLST orders were not associated to the death.Among 8569 patients, medical history, trauma severity criteria, notably neurological status and geographical areas were associated with WLST. These regional differences deserve to be investigated in future studies.

Published
2022

16. Four-factor prothrombin complex concentrate to reduce allogenic blood product transfusion in patients with major trauma, the PROCOAG trial: study protocol for a randomized multicenter double-blind superiority study

Author

Jean-François Payen, Jacques Duranteau, Paër-Sélim Abback, Jean-Stéphane David, Pierre Bouzat, Jonathan Charbit, Delphine Garrigue, Bruno Riou, Albrice Levrat, Karim Asehnoune, Jean-Luc Bosson, Guillaume Marcotte, Julien Pottecher, and Marc Leone

Subjects
Medicine (General), Resuscitation, Medicine (miscellaneous), Context (language use), Factor IX, Study Protocol, R5-920, Blood product, Intensive care, Medicine, Severe trauma, Humans, Multicenter Studies as Topic, Pharmacology (medical), Blood Transfusion, Prospective Studies, Randomized Controlled Trials as Topic, business.industry, Prothrombin complex concentrate, Glasgow Outcome Scale, Major trauma, Trauma center, Massive transfusion, medicine.disease, Blood Coagulation Factors, Acute traumatic coagulopathy, Anesthesia, business, medicine.drug
Abstract

BackgroundOptimal management of severe trauma patients with active hemorrhage relies on adequate initial resuscitation. Early administration of coagulation factors improves post-traumatic coagulation disorders, and four-factor prothrombin complex concentrate (PCC) might be useful in this context. Our main hypothesis is that four-factor PCC in addition to a massive transfusion protocol decreases blood product consumption at day 1 in severe trauma patients with major bleeding.MethodsThis is a prospective, randomized, multicenter, double-blind, parallel, controlled superiority trial. Eligible patients are trauma patients with major bleeding admitted to a French level-I trauma center. Patients randomized in the treatment arm receive 1 mL/kg (25 IU/ml of Factor IX/Kg) four-factor PCC within 1-h post-admission while patients randomized in the controlled group receive 1 mL/kg of saline solution 0.9% as a placebo. Treatments are given as soon as possible using syringe pumps (120 mL/h). The primary endpoint is the amount of blood products transfused in the first 24 h post-admission (including red blood cells, frozen fresh plasma, and platelets). The secondary endpoints are the amount of each blood product transfused in the first 24 h, time to achieve prothrombin time ratio < 1.5, time to hemostasis, number of thrombo-embolic events at 28 days, mortality at 24 h and 28 days, number of intensive care unit-free days, number of ventilator-free days, number of hospital-free days within the first 28 days, hospitalization status at day 28, Glasgow outcome scale extended for patients with brain lesions on initial cerebral imaging, and cost of each strategy at days 8 and 28. Inclusions have started in December 2017 and are expected to be complete by June 2021.DiscussionIf PCC reduces total blood consumption at day 1 after severe trauma, this therapy, in adjunction to a classic massive transfusion protocol, may be used empirically on admission in patients at risk of massive transfusion to enhance coagulation. Moreover, this treatment may decrease blood product-related complications and may improve clinical outcomes after post-traumatic hemorrhage.Trial registrationClinicalTrials.govNCT03218722. Registered on July 14, 2017

Published
2021

17. Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Author

Alexandre Godon, Charles Ambroise Tacquard, Alexandre Mansour, Delphine Garrigue, Philippe Nguyen, Dominique Lasne, Sophie Testa, Jerrold H. Levy, Pierre Albaladejo, Yves Gruel, Sophie Susen, Anne Godier, P. Albaladejo, N. Blais, F. Bonhomme, A. Borel-Derlon, A. Cohen, J.-P. Collet, E. de Maistre, P. Fontana, D. Garrigue Huet, A. Godier, Y. Gruel, A. Godon, B. Ickx, S. Laporte, D. Lasne, J. Llau, G. Le Gal, T. Lecompte, S. Lessire, J.H. Levy, D. Longrois, S. Madi-Jebara, A. Mansour, M. Mazighi, P. Mismetti, P.E. Morange, S. Motte, F. Mullier, N. Nathan, P. Nguyen, G. Pernod, N. Rosencher, S. Roullet, P.M. Roy, S. Schlumberger, P. Sié, A. Steib, S. Susen, C.A. Tacquard, S. Testa, A. Vincentelli, P. Zufferey, E Boissier, B Dumont, C James, V. Siguret, BrainTech Laboratory [CHU Grenoble Alpes - Inserm U1205] (Brain Tech Lab ), CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Service d'Anesthésie-Réanimation [Strasbourg], Nouvel Hôpital Civil [Strasbourg], CHU Strasbourg-CHU Strasbourg, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Reims (CHU Reims), Hémostase, Inflammation, Thrombose (HITH - U1176 Inserm - CHU Bicêtre), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Université Paris-Saclay, Istituti Ospitalieri di Cremona, Duke University [Durham], CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Lille, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire (CHU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Hôpitaux Universitaires de Genève (HUG), Université de Genève = University of Geneva (UNIGE), CHU UCL Namur, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Cité (UPCité), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Biologie Intégrative du Tissu Osseux (LBTO), Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), F-Crin Innovte [CHU Saint-Etienne], Service d’Hématologie Biologique [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Roche, and Sanofi

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, [SDV]Life Sciences [q-bio], COVID-19, Retrospective cohort study, General Medicine, Perioperative, Critical Care and Intensive Care Medicine, medicine.disease, Thrombosis, Article, Anticoagulation, Thrombotic risk, Anesthesiology and Pain Medicine, Intensive care, Bleeding risk, Epidemiology, Medicine, In patient, business, Intensive care medicine, Thromboprophylaxis, Venous thromboembolism
Abstract

In April 2020, in response to the high thrombotic risk associated with COVID-19, the GIHP and GFHT published proposals for the prevention of venous thromboembolism (VTE) and haemostasis monitoring in patients with COVID-19 [1]. In February 2021, six authors from the proposals (CT, AM, AlG, AnG, SS, YG, PA) decided to update them. This update was justified by several points: - The epidemiology of thrombotic complications has been described. - Different anticoagulation regimens have been reported, and retrospective studies have suggested that higher-than-standard prophylactic anticoagulation may be beneficial. - Initially underestimated, bleeding complications have emerged as a limitation of increased-dose anticoagulation and occur later than thrombotic events. - The first results of large-scale randomised controlled studies on increased doses of anticoagulation have been published. - Immunomodulatory therapies (corticosteroids, interleukin-6 receptor antagonists) are now widely used, but their effect on the thrombotic risk is unknown. - Despite improved survival, thrombotic complications remain a concern [2].

Published
2021

18. Prise en charge des traumatisés pelviens graves à la phase précoce (24 premières heures)

Author

Pascal Incagnoli, Alain Puidupin, Sylvain Ausset, Jean-Paul Beregi, Jacques Bessereau, Xavier Bobbia, Julien Brun, Élodie Brunel, Clément Buléon, Jacques Choukroun, Xavier Combes, Jean Stéphane David, François-Régis Desfemme, Delphine Garrigue, Jean Luc Hanouz, Éric Kipnis, Isabelle Plénier, Frédéric Rongieras, and Benoît Vivien

Subjects
Anesthesiology and Pain Medicine
Published
2019

19. Gestion des agents antiplaquettaires en cas de procédure invasive non programmée ou d’hémorragie. Propositions du Groupe d’intérêt en hémostase périopératoire (GIHP) et du Groupe français d’études sur l’hémostase et la thrombose (GFHT) en collaboration avec la Société française d’anesthésie et de réanimation (SFAR)

Author

Normand Blais, François Mullier, Dan Longrois, Nathalie Nathan, Serge Motte, S. Laporte, Juan V. Llau, Yves Gruel, Stéphanie Roullet, J. Guay, J.-L. Bosson, Philippe Nguyen, P. van Der Linden, Dominique Lasne, Annick Steib, P.E. Morange, Anne Godier, Pierre Albaladejo, Sophie Susen, Brigitte Ickx, Jerrold H. Levy, G. Pernod, Emmanuel Marret, Samia Madi-Jebara, Guy Meyer, Yves Ozier, David Faraoni, Fanny Bonhomme, E. van Belle, Jean-François Schved, Mikael Mazighi, André Vincentelli, Patrick Mismetti, J.L. Mas, P.M. Roy, Emmanuel de Maistre, Jean-Philippe Collet, Sylvie Schlumberger, Y. Huet, Pierre Fontana, Charles Marc Samama, Delphine Garrigue, J.Y. Borg, Nadia Rosencher, S. Belisle, Jean-François Hardy, Thomas Lecompte, P. Sié, D. Garrigue Huet, P. Zufferey, A. Borel-Derlon, A. Cohen, S. Lessire, G. Le Gal, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service d'anesthésiologie, and UCL - (MGD) Laboratoire de biologie clinique

Subjects
03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Agent antiplaquettaireChirurgieHémorragieThromboseAnesthésie locorégionale, 030202 anesthesiology, 030204 cardiovascular system & hematology
Abstract

Le Groupe d’intérêt en hémostase périopératoire (GIHP) et le Groupe français d’études sur l’hémostase et la thrombose (GFHT), en collaboration avec la Société française d’anesthésie et de réanimation (SFAR) ont fait des propositions de gestion des agents antiplaquettaires (AAP) pour une procédure invasive programmée. Ces propositions ont été discutées et validées par vote ; toutes sauf une ont fait l’objet d’un accord fort. La gestion des AAP dépend de leur indication et de la procédure considérée. Le risque hémorragique lié à la procédure invasive peut être divisé en bas, intermédiaire ou élevé, selon la possibilité ou non de réaliser la procédure sous traitement (sous respectivement bithérapie antiplaquettaire, aspirine en monothérapie ou aucun AAP). Si une interruption des AAP est indiquée avant la procédure, une dernière prise d’aspirine, clopidogrel, ticagrélor et prasugrel 3, 5, 5 et 7 jours avant la procédure est proposée. Le risque thrombotique associé à l’interruption des AAP doit être évalué en fonction de l’indication des AAP. Il est plus élevé chez les patients traités par bithérapie pour un stent coronaire que chez ceux traités par monothérapie pour une prévention cardiovasculaire, un antécédent d’accident vasculaire cérébral ischémique ou une artériopathie oblitérante des membres inférieurs. Ces propositions concernent aussi le rôle potentiel des tests fonctionnels plaquettaires, la gestion des AAP pour l’anesthésie locorégionale, centrale et périphérique, et pour la chirurgie cardiaque coronaire.

Published
2019

20. National early warning score to predict intensive care unit transfer and mortality in COVID‐19 in a French cohort

Author

Jacques Desbordes, Arnaud Scherpereel, Elodie Drumez, Lille Covid-team, Cécile Yelnik, Amélie Bruandet, Delphine Garrigue, Ady Assaf, Marc Lambert, Emmanuel Faure, Anne Goffard, Karine Faure, Mohammad Ryadh Pokeerbux, Julien Labreuche, Charles Garabedian, and Julien Poissy

Subjects
Adult, Male, medicine.medical_specialty, education, 030204 cardiovascular system & hematology, Risk Assessment, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, law, Intensive care, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Aged, Retrospective Studies, Original Paper, business.industry, SARS-CoV-2, COVID-19, Retrospective cohort study, General Medicine, Odds ratio, Early warning score, Intensive care unit, Original Papers, Intensive Care Units, Infectious Diseases, Early Warning Score, Emergency medicine, Cohort, Female, business, Cohort study
Abstract

Background No risk stratification tool has been validated in hospitalised patients with coronavirus disease 2019 (COVID‐19), despite a high rate of intensive care requirement and in‐hospital mortality. We aimed to determine whether the National Early Warning Score (NEWS) at admission can accurately predict in‐hospital mortality and ICU transfer. Methods This was a retrospective cohort study from January 24 to April 16, 2020, at Lille University Hospital. All consecutive adult patients with laboratory‐confirmed COVID‐19 who were initially admitted to non‐ICU wards were included. The primary outcome was a composite criterion consisting of ICU transfer or in‐hospital mortality. We evaluated the prognostic performance of NEWS by calculating the area under (AUC) the receiver operating characteristic curve, the optimal threshold value of NEWS, and its association with the primary outcome. Results Of the 202 COVID‐19 patients, the median age was 65 (interquartile range 52‐78), 38.6% were women and 136 had at least one comorbidity. The median NEWS was 4 (2‐6). A total of 65 patients were transferred to the ICU or died in the hospital. Compared with patients with favourable outcome, these patients were significantly older, had more comorbidities and higher NEWS. The AUC for NEWS was 0.68 (0.60‐0.77) and the best cutoff value was 6. Adjusted odds ratio for NEWS ≥ 6 as an independent predictor was 3.78 (1.94‐7.09). Conclusions In hospitalised COVID‐19 patients, NEWS was an independent predictor of ICU transfer and in‐hospital death. In daily practice, NEWS ≥ 6 at admission may help to identify patients who are at risk to deteriorate.

Published
2021

21. Vascular Endothelial Damage in the Pathogenesis of Organ Injury in Severe COVID-19

Author

Antoine Rauch, Guillaume Lefèvre, Alain Duhamel, Anne Bauters, Eric Kipnis, Natacha Rousse, Senna Staessens, Pauline Varlet, Sophie Susen, Annabelle Dupont, Julien Labreuche, Bart Staels, Morgan Caplan, Flavien Vincent, Julien Poissy, Marc Lambert, Mickael Rosa, Mouhamed Moussa, Simon F. De Meyer, Julien Goutay, Karine Faure, Fanny Lassalle, Delphine Corseaux, Delphine Garrigue, Emmanuelle Jeanpierre, and Peter J. Lenting

Subjects
0301 basic medicine, Male, Pathology, medicine.medical_specialty, Endothelium, Critical Care, Multiple Organ Failure, 030204 cardiovascular system & hematology, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Tissue factor pathway inhibitor, medicine, Humans, Complement Activation, Liver injury, business.industry, SARS-CoV-2, Microcirculation, COVID-19, Thrombosis, Neutrophil extracellular traps, Immune dysregulation, Liver Failure, Acute, Middle Aged, medicine.disease, Complement system, Nucleosomes, 030104 developmental biology, medicine.anatomical_structure, Respiratory failure, Cytokines, Tumor necrosis factor alpha, Female, Endothelium, Vascular, Cardiology and Cardiovascular Medicine, business, Respiratory Insufficiency, Biomarkers
Abstract

Objective: Whether endotheliopathy only mirrors coronavirus disease 2019 (COVID-19) severity or plays an intrinsic role in microvascular thrombosis and organ failure remains unanswered. We assessed whether markers of endothelial damage and immune dysregulation were associated with organ failure, thrombus formation, and death. Approach and Results: Markers of endothelial damage (VWF:Ag [von Willebrand factor antigen], PAI-1 [plasminogen activator inhibitor-1], syndecan-1, TFPI [tissue factor pathway inhibitor], and soluble thrombomodulin), complement activation (C5a and C5b-9), cytokines (IL [interleukin]-6, TNF [tumor necrosis factor]-α, and IL-2R), and neutrophil extracellular traps (cell-free DNA, nucleosomes, and myeloperoxidase-DNA) were measured at intensive care unit admission in 82 patients with COVID-19. We also analyzed the histological composition of thrombi collected in critically ill living patients successfully weaned from extracorporeal membrane oxygenation. Beside respiratory failure, VWF:Ag, PAI-1, TFPI, and syndecan-1 were independently associated with liver injury and multiorgan failure development, underlining the direct role of endotheliopathy in organ failure. Nucleosomes were also associated with liver injury, multiorgan failure, and death which occurred in 38%, 60%, and 27% of patients, respectively. Moreover, dysregulated immune response including cytokines, complement, and neutrophil extracellular traps was associated with markers of endothelial damage, respiratory failure, and liver injury. COVID-19 thrombi retrieved from extracorporeal membrane oxygenation circuitry contained accumulation of neutrophils, VWF, and significantly higher amount of neutrophil extracellular traps when compared with non-COVID-19 thrombi. Conclusions: We provide new associative data supporting that endotheliopathy and dysregulated immune responses are involved in respiratory and liver failure through microvascular damage in patients with severe COVID-19.

Published
2021

22. Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia

Author

Charles Tacquard, Alexandre Mansour, Alexandre Godon, Julien Godet, Julien Poissy, Delphine Garrigue, Eric Kipnis, Sophie Rym Hamada, Paul Michel Mertes, Annick Steib, Mathilde Ulliel-Roche, Bélaïd Bouhemad, Maxime Nguyen, Florian Reizine, Isabelle Gouin-Thibault, Marie Charlotte Besse, Nived Collercandy, Stefan Mankikian, Jerrold H. Levy, Yves Gruel, Pierre Albaladejo, Sophie Susen, Anne Godier, P. Albaladejo, N. Blais, F. Bonhomme, A. Borel-Derlon, A. Cohen, J.-P. Collet, E. de Maistre, P. Fontana, D. Garrigue Huet, A. Godier, Y. Gruel, A. Godon, B. Ickx, S. Laporte, D. Lasne, J. Llau, G. Le Gal, T. Lecompte, S. Lessire, J.H. Levy, D. Longrois, S. Madi-Jebara, A. Mansour, M. Mazighi, P. Mismetti, P.E. Morange, S. Motte, F. Mullier, N. Nathan, P. Nguyen, G. Pernod, N. Rosencher, S. Roullet, P.M. Roy, S. Schlumberger, P. Sié, A. Steib, S. Susen, C.A. Tacquard, S. Testa, A. Vincentelli, P. Zufferey, CHU Strasbourg, CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Centre Hospitalier Universitaire [Grenoble] (CHU), Unité de Glycobiologie Structurale et Fonctionnelle (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Duke University [Durham], University Hospital of Strasbourg (Hopitaux Universitaires de Strasbourg-Direction de la Recherche Clinique et des Innovations), Université de Rennes (UR), Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent

Subjects
BMI, body mass index, [SDV]Life Sciences [q-bio], VTE, venous thromboembolism, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Interquartile range, 030212 general & internal medicine, anticoagulation, Original Research, Incidence (epidemiology), Hazard ratio, INR, international normalized ratio, Vitamin K antagonist, IPTW, inverse probability treatment weighting, ICU, intensive care unit, 3. Good health, Pulmonary embolism, [SDV] Life Sciences [q-bio], Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.drug_class, Critical Illness, Low molecular weight heparin, HPA, high dose prophylactic anticoagulation, 03 medical and health sciences, Internal medicine, medicine, Humans, CRRT, continuous renal replacement therapy, UFH, unfractionated heparin, APTT, activated partial thromboplastin time, Blood Coagulation, thrombosis, DOAC, direct oral anticoagulant, business.industry, SARS-CoV-2, Anticoagulants, COVID-19, Retrospective cohort study, VKA, vitamin K antagonist, medicine.disease, bleeding, HR, hazard ratio, LMWH, low molecular weight heparin, OR, odds ratio, 030228 respiratory system, COPD, chronic obstructive pulmonary disease, TC, thrombotic complication, business, ECMO, extracorporeal membrane oxygenation
Abstract

International audience; BACKGROUND: Because of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent. RESEARCH QUESTION: What is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC? STUDY DESIGN AND METHODS: All consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight. RESULTS: Of 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75). INTERPRETATION: High-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results.

Published
2021

23. Coagulation biomarkers are independent predictors of increased oxygen requirements in COVID‐19

Author

Julien Goutay, Emmanuelle Jeanpierre, Julien Poissy, Antoine Rauch, Marc Lambert, Sophie Susen, Morgan Caplan, Karine Faure, Leslie Charbonnier, Alain Duhamel, Fanny Lassalle, Julien Labreuche, Eric Kipnis, Aurelien Rohn, Annabelle Dupont, Peter J. Lenting, Delphine Garrigue, Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires (RNMCD - U1011), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Hémostase, Inflammation, Thrombose (HITH - U1176 Inserm - CHU Bicêtre), Université Paris-Sud - Paris 11 (UP11)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Glycobiologie Structurale et Fonctionnelle (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), ANR-16-IDEX-0004,ULNE,ULNE(2016), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Université de Lille, LillOA, ULNE - - ULNE2016 - ANR-16-IDEX-0004 - IDEX - VALID, and Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD)

Subjects
Male, [SDV]Life Sciences [q-bio], Comorbidity, 030204 cardiovascular system & hematology, Fibrinogen, Gastroenterology, Body Mass Index, 0302 clinical medicine, Patient Admission, Risk Factors, hemic and lymphatic diseases, Prevalence, Medicine, Platelet, Prospective Studies, Letter to the Editor, 2. Zero hunger, biology, Age Factors, Venous Thromboembolism, Hematology, Middle Aged, Thrombosis, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Coagulation, Female, Original Article, France, medicine.drug, circulatory and respiratory physiology, medicine.medical_specialty, SARS‐CoV2, Risk Assessment, Letter to the Editors, 03 medical and health sciences, Sex Factors, Von Willebrand factor, Internal medicine, Diabetes mellitus, von Willebrand Factor, Humans, Blood Coagulation, Factor VIII, business.industry, Oxygen Inhalation Therapy, Anticoagulants, COVID-19, Original Articles, medicine.disease, Oxygen, SARS-CoV2, biology.protein, Metabolic syndrome, business, Body mass index, Biomarkers
Abstract

International audience; Background :Hypercoagulability seems to contribute to SARS-CoV-2 pneumonia pathogenesis. However, age and metabolic syndrome are potential confounders when assessing the value of coagulation biomarkers’ prediction of COVID-19 outcomes. We assessed whether coagulation biomarkers, including factor VIII (FVIII) and von Willebrand factor (VWF) levels, measured at time of admission, were predictive of COVID-19 adverse outcomes irrespective of age and major comorbidities associated with metabolic syndrome.Methods :Blood was sampled at admission in 243 adult COVID-19 patients for analysis of coagulation biomarkers including FVIII and VWF on platelet-poor plasma. The association between baseline C-reactive protein (CRP), activated partial thromboplastin time ratio, prothrombin time ratio, D-dimers, fibrinogen, FVIII, VWF antigen (VWF:Ag), and FVIII/VWF:Ag ratio levels and adverse outcomes (increased oxygen requirements, thrombosis, and death at day 30) was assessed by regression analysis after adjustment on age, sex, body mass index (BMI), diabetes, and hypertension.Results :In univariable regression analysis increased CRP (subdistribution hazard ratio [SHR], 1.68; 95% confidence interval [CI], 1.26-2.23), increased fibrinogen (SHR, 1.32; 95% CI, 1.04-1.68), and decreased FVIII/VWF:Ag ratio (SHR, 0.70; 95% CI, 0.52-0.96) levels at admission were significantly associated with the risk of increased oxygen requirement during follow-up. Leucocytes (SHR, 1.36; 95% CI, 1.04-1.76), platelets (SHR,1.71; 95% CI, 1.11-2.62), D-dimers (SHR, 2.48; 95% CI, 1.66-3.78), and FVIII (SHR, 1.78; 95% CI, 1.17-2.68) were associated with early onset of thrombosis after admission. After adjustment for age, sex, BMI, hypertension, and diabetes, these associations were not modified.Conclusion :Coagulation biomarkers are early and independent predictors of increased oxygen requirement in COVID-19 patients.

Published
2020

24. Early management of severe abdominal trauma

Author

Catherine Arvieux, Julien Pottecher, Bertrand Prunet, Guillaume Valdenaire, Tobias Gauss, Christophe Tresallet, Pierre Bouzat, Bruno Simonnet, Xavier Bobbia, Barbara Villoing, Paul Balandraud, Jean-Stéphane David, Jean-Alexandre Long, Jonhatan Charbit, Emmanuel Weiss, Delphine Garrigue, Julien Vaux, Laurent Zieleskiewicz, Damien Viglino, Karim Tazarourte, Cédric Gil-Jardiné, Julien Frandon, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, medicine.medical_treatment, Population, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, IETO, Laparotomy, medicine, Focused assessment with sonography for trauma, 030212 general & internal medicine, education, education.field_of_study, medicine.diagnostic_test, business.industry, General surgery, 030208 emergency & critical care medicine, Interventional radiology, General Medicine, Guideline, Evidence-based medicine, medicine.disease, 3. Good health, Anesthesiology and Pain Medicine, Abdominal trauma, Damage control surgery, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Objective To develop French guidelines on the management of patients with severe abdominal trauma. Design A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Societe francaise d’anesthesie et de reanimation, SFAR), the French Society of Emergency Medicine (Societe francaise de medecine d’urgence, SFMU), the French Society of Urology (Societe francaise d’urologie, SFU) and from the French Association of Surgery (Association francaise de chirurgie, AFC), the Val-de-Grâce School (Ecole du Val-De-Grâce, EVG) and the Federation for Interventional Radiology (Federation de radiologie interventionnelle, FRI-SFR) was convened. Declaration of all conflicts of interest (COI) policy by all participants was mandatory throughout the development of the guidelines. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for assessment of the available level of evidence with particular emphasis to avoid formulating strong recommendations in the absence of high level. Some recommendations were left ungraded. Methods The guidelines are divided in diagnostic and, therapeutic strategy and early surveillance. All questions were formulated according to Population, Intervention, Comparison, and Outcomes (PICO) format. The panel focused on three questions for diagnostic strategy: (1) What is the diagnostic performance of clinical signs to suggest abdominal injury in trauma patients? (2) Suspecting abdominal trauma, what is the diagnostic performance of prehospital FAST (Focused Abdominal Sonography for Trauma) to rule in abdominal injury and guide the prehospital triage of the patient? and (3) When suspecting abdominal trauma, does carrying out a contrast enhanced thoraco-abdominal CT scan allow identification of abdominal injuries and reduction of mortality? Four questions dealt with therapeutic strategy: (1) After severe abdominal trauma, does immediate laparotomy reduce morbidity and mortality? (2) Does a “damage control surgery” strategy decrease morbidity and mortality in patients with a severe abdominal trauma? (3) Does a laparoscopic approach in patients with abdominal trauma decrease mortality or morbidity? and (4) Does non-operative management of patients with abdominal trauma without bleeding reduce mortality and morbidity? Finally, one question was formulated regarding the early monitoring of these patients: In case of severe abdominal trauma, which kind of initial monitoring does allow to reduce the morbi-mortality? The analysis of the literature and the recommendations were conducted following the GRADE® methodology. Results The SFAR/SFMU Guideline panel provided 15 statements on early management of severe abdominal trauma. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), six have a low level of evidence (Grade 2±) and four are expert judgments. Finally, no recommendation was provided for one question. Conclusions Substantial agreement exists among experts regarding many strong recommendations for the best early management of severe abdominal trauma.

Published
2020

26. Guidelines for the acute care of severe limb trauma patients

Author

Cédric Gil-Jardiné, Jonathan Charbit, Olivier Barbier, Hugues Lefort, Stéphane Travers, Bertrand Prunet, Julien Pottecher, Sophie Rym Hamada, Hervé Quintard, Pierre Pasquier, Philippe Adam, T. Gauss, Delphine Garrigue, Pierre Bouzat, Karim Tazarourte, Anatole Harrois, Lionel Velly, M. Galinski, Yannick Georg, Claire Roger, Romain Kedzierewicz, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Société Française d’Anesthésie et de Réanimation, and Société Française de Médecine d'Urgence

Subjects
Damage control, medicine.medical_specialty, Referral, Physical examination, Guidelines, Critical Care and Intensive Care Medicine, Rhabdomyolysis, 03 medical and health sciences, 0302 clinical medicine, Acute care, Fracture fixation, medicine, Medical history, 030212 general & internal medicine, Grading (education), Intensive care medicine, Modalities, medicine.diagnostic_test, business.industry, Fat embolism syndrome, 030208 emergency & critical care medicine, General Medicine, Evidence-based medicine, Severe limb trauma patient, Tourniquet, 3. Good health, Anesthesiology and Pain Medicine, Compartment syndrome, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Goal To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. Design A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. Methods The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient's prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. Results The experts' synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/−) and 12 had a low level of evidence (GRADE 2+/−). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. Conclusions There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.

Published
2021

27. Specification and Evaluation of Plasticizer Migration Simulants for Human Blood Products: A Delphi Study

Author

Pascal Odou, Aurélie Thelliez, Annabelle Dupont, Jean-François Goossens, Caroline Maeght, Bertrand Décaudin, Cécile Danel, Stéphanie Genay, Marie Lecoeur, Guillaume Saint-Lorant, Laurence Goossens, Laurent Ducoroy, Gregory Henard, Bruno Delorme, Alexandre Ung, Jean-Daniel Hecq, Tomé Najdovski, Coralie Havet, Delphine Garrigue, Isabelle Mendel, and Sonia Chatellier

Subjects
Blood Platelets, Erythrocytes, Delphi Technique, Surface Properties, Computer science, Delphi method, 02 engineering and technology, 030204 cardiovascular system & hematology, migration, Microbiology, Biochemistry, Article, Plasma, 03 medical and health sciences, 0302 clinical medicine, Plasticizers, Surveys and Questionnaires, Materials Testing, Isotonic, Humans, Blood Transfusion, Platelet concentrate, Polyvinyl Chloride, Process engineering, Molecular Biology, Whole blood, Blood Cells, Human blood, Viscosity, business.industry, Plasticizer, simulant, Hematology, Hydrogen-Ion Concentration, plasticizer, 021001 nanoscience & nanotechnology, QR1-502, Questionnaire data, labile blood product, Blood Preservation, Compatibility (mechanics), Blood Banks, Interdisciplinary Communication, 0210 nano-technology, business
Abstract

Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the plasticizers are not chemically bonded to the PVC, they can be released into labile blood products (LBPs) during storage. Ideally, LBPs would be used in laboratory studies of plasticizer migration from the medical device. However, short supply (i.e., limited stocks of human blood in collection centres) has prompted the development of specific simulants for each type of LBP in the evaluation of new transfusion devices. We performed a Delphi study with a multidisciplinary panel of 24 experts. In the first (qualitative) phase, the panel developed consensus definitions of the specification criteria to be met by each migration simulant. Next, we reviewed the literature on techniques for simulating the migration of plasticizers into LBPs. A questionnaire was elaborated and sent out to the experts, and the replies were synthesized in order to obtain a consensus. The qualitative study established specifications for each biological matrix (whole blood, red blood cell concentrate, plasma, and platelet concentrate) and defined the criteria required for a suitable LBP simulant. Ten criteria were suggested: physical and chemical characteristics, opacity, form, stability, composition, ability to mimic a particular clinical situation, ease and safety of use, a simulant–plastic interaction correlated with blood, and compatibility with analytical methods. The questionnaire data revealed a consensus on the use of natural products (such as pig’s blood) to mimic the four LBPs. Opinions diverged with regard to synthetic products. However, an isotonic solution and a rheological property modifier were considered to be of value in the design of synthetic simulants. Consensus reached by the Delphi group could be used as a database for the development of simulants used to assess the migration of plasticizers from PVC bags into LBPs.

Published
2021

28. Massive bleeding in the operating room

Author

Anne Godier, Sophie Susen, and Delphine Garrigue

Subjects
medicine.medical_specialty, business.industry, Massive bleeding, medicine, Hematology, business, Surgery
Published
2017

29. Erratum to 'Early management of severe pelvic injury (first 24 hours)' [Anaesth Crit Care Pain Med 38 (2019) 199–207. https://doi.org/10.1016/j.accpm.2018.12.003]

Author

Pascal Incagnoli, Alain Puidupin, Sylvain Ausset, Jean-Paul Beregi, Jacques Bessereau, Xavier Bobbia, Julien Brun, Elodie Brunel, Clément Buléon, Jacques Choukroun, Xavier Combes, Jean Stéphane David, François-Régis Desfemmes, Delphine Garrigue, Jean-Luc Hanouz, Isabelle Plénier, Fréderic Rongieras, Benoit Vivien, Tobias Gauss, Anatole Harrois, Pierre Bouzat, and Eric Kipnis

Subjects
Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Published
2019

30. Routine use of viscoelastic tests for severe trauma management: The bright side

Author

Delphine Garrigue, Bertrand Prunet, and Julien Pottecher

Subjects
business.industry, Fibrinolysis, General Medicine, Blood Coagulation Disorders, Critical Care and Intensive Care Medicine, Blood Viscosity, Elasticity, Thrombelastography, Anesthesiology and Pain Medicine, Severe trauma, Anesthesia, Medicine, Humans, Wounds and Injuries, Blood Coagulation Tests, business, Blood Coagulation, Trauma induced coagulopathy, Randomized Controlled Trials as Topic
Published
2019

31. Early management of severe pelvic injury (first 24 hours)

Author

Pascal Incagnoli, Fréderic Rongieras, Tobias Gauss, Clément Buléon, Delphine Garrigue, Jean-Luc Hanouz, Jacques Choukroun, Eric Kipnis, Isabelle Plenier, Anatole Harrois, François Régis Desfemmes, Jean Stephane David, Xavier Combes, Pierre Bouzat, Elodie Brunel, Sylvain Ausset, Xavier Bobbia, Benoît Vivien, Jacques Bessereau, Julien Brun, Jean Paul Beregi, Alain Puidupin, Service d'anesthésie-réanimation, Hospices Civils de Lyon, centre hospitalier Lyon Sud, Direction centrale du service de santé des armées, École du Val de Grâce (EVDG), Service de Santé des Armées, Service de radiologie et d'imagerie médicale, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Assistance publique des Hôpitaux de Marseille, SAMU 13, pôle RUSH, CHU de la Timone, Division anesthésie-réanimation douleur urgences, Pôle anesthésie-réanimation, Grenoble Alpes Trauma Centre, Service d'anesthésie-réanimation, hôpital Purpan, CHU Toulouse [Toulouse], Service Réanimation médico-chirurgicale [CH Le Mans], Centre Hospitalier Le Mans (CH Le Mans), Hôpital Bellepierre, SAMU 974, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Service de chirurgie urologique, Hôpital d'instruction des Armées du Val de Grace, Service d'accueil des urgences vitales chirurgicales, CHRU de Lille, Service de chirurgie de l'urgence, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique des Hôpitaux Paris, hôpital Beaujon, servie d'anesthésie-réanimation, réanimation chirurgicale, Hôpitaux Universitaires Paris Nord Val de Seine, Service d'anesthésie-réanimation, reanimation chirurgicale, Assistance publique des Hôpitaux Paris, CHU de Bicêtre, Pôle d'anesthésie-réanimation, and CHRU de Lille, réanimation chirurgicale

Subjects
medicine.medical_specialty, Critical Care, Population, Critical Care and Intensive Care Medicine, Pelvis, Fractures, Bone, 03 medical and health sciences, BIOMECANIQUE, [SPI]Engineering Sciences [physics], 0302 clinical medicine, PELVIC TRAUMA, PREHOSPITAL SETTING, Health care, Humans, Medicine, Anesthesia, TRAUMA NETWORK, education, 030222 orthopedics, education.field_of_study, Trauma Severity Indices, business.industry, General surgery, ARTERIAL EMBOLIZATION, SEVERITY CRITERIA, [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], 030208 emergency & critical care medicine, General Medicine, Guideline, Evidence-based medicine, medicine.disease, 3. Good health, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Pelvic fracture, Wounds and Injuries, Abdomen, Professional association, business, Trauma surgery
Abstract

Objective Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients. To date, in France, there are no guidelines issued by healthcare authorities or professional societies that address this subject. Design A consensus committee of 22 experts from the French Society of Anaesthesia and Intensive Care Medicine (Societe Francaise d’Anesthesie et de Reanimation; SFAR) and the French Society of Emergency Medicine (Societe Francaise de Medecine d’Urgence; SFMU) in collaboration with the French Society of Radiology (Societe Francaise de Radiologie; SFR), French Defence Health Service (Service de Sante des Armees; SSA), French Society of Urology (Association Francaise d’Urologie; AFU), the French Society of Orthopaedic and Trauma Surgery (Societe Francaise de Chirurgie Orthopedique et Traumatologique; SOCFCOT), and the French Society of Digestive Surgery (Societe Francaise de Chirurgie digestive; SFCD) was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently from any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Methods Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE® methodology. Results The SFAR Guideline panel provided 22 statements on prehospital and hospital management of the unstable patient with pelvic fracture. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, 11 have a high level of evidence (Grade 1 ± ), 11 have a low level of evidence (Grade 2 ± ). Conclusions Substantial agreement exists among experts regarding many strong recommendations for management of the unstable patient with pelvic fracture.

Published
2019

32. Strategic proposal for a national trauma system in France

Author

Delphine Garrigue, Guillaume de Saint Maurice, Jérôme Tonetti, Marc Leone, Benjamin Bijok, Jean François Payen, Groupe d’intérêt en traumatologie grave, Thomas Geeraerts, Romain Pirracchio, Isabelle Plenier, Sandrine Barbois, Julio Abba, Catherine Paugam-Burtz, Jonathan Charbit, Sébastien Perbet, Catherine Arvieux, Julien Picard, Abdel Nadji, Bruno Riou, Paul Balandraud, Sébastien Mirek, Sylvain Rigal, Pierre-Francois Wey, Frédéric Thony, Dominique Savary, Hicham Kobeiter, Thierry Secheresse, Jacques Duranteau, Xavier Bobbia, François-Xavier Ageron, Pierre Bouzat, Jean-Stéphane David, Karim Tazarourte, Pierre Albaladejo, Julien Ghelfi, Anatole Harrois, Albrice Levrat, Sophie Hamada, Julien Pottecher, Christophe Tresallet, Fabrice Cook, Julien Frandon, Tobias Gauss, Clinic of Abdominal, Thoracic and Vascular Surgery, Laveran Military Hospital, Marseille, France, parent, Biotop, Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), CHU Grenoble, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes (UGA), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Soins Intensifs [Mondor], Hôpital Henri Mondor, Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Microcirculation, bioénergétique, inflammation et insuffisance circulatoire aiguë (URCT), Université Paris-Sud - Paris 11 (UP11)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC), Fédération des Urgences - SAMU 59, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Unité Générale de Soins Intensifs, Hôpital d'Estaing, Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Laboratoire de Recherche sur les Apprentissages en Contexte (LaRAC), Centre d’enseignement par simulation (CEnSIM), Urgences Médicales, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Service de chirurgie générale d'endocrinologie [CHU Pitié–Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Institut franco-allemand de recherches de Saint-Louis (ISL), DGA-Matériaux et nanosciences d'Alsace, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpitaux Universitaires Paris Nord Val de Seine, Académie de Médecine Militaire Française [Ecole du Val-de-Grâce, Paris], Ecole du Val-de-Grâce [Paris, France], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Lille, Hôpital Lapeyronie [Montpellier] (CHU), Université de Montpellier (UM), CHU Henri Mondor, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Université Paris-Saclay, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpitaux Universitaires Paris Sud, Toulouse Neuro Imaging Center (ToNIC), 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)-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Nord [CHU - APHM], Université Paris Diderot - Paris 7 (UPD7), CHU Clermont-Ferrand, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), CHU Strasbourg, Hôpital de Hautepierre [Strasbourg], Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Service de Chirurgie Générale, Viscérale et Endocrinienne [CHU Pitié-Sapêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire International de Neuroimagerie et Modélisation (Linem), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université de Montréal (UdeM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital d'Instruction des Armées Desgenettes, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Paris 13 (UP13)-Université Paris-Sud - Paris 11 (UP11)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Université de Strasbourg (UNISTRA), and Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
National Health Programs, education, Strategy, Certification, Guidelines, Critical Care and Intensive Care Medicine, Trauma, [SHS]Humanities and Social Sciences, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, 030202 anesthesiology, Trauma Trauma system Guidelines Strategy Organisation, Medicine, Humans, Road map, Registries, Implementation, Data collection, Education, Medical, business.industry, Major trauma, Rehabilitation, 030208 emergency & critical care medicine, Trauma system, General Medicine, medicine.disease, Triage, Anesthesiology and Pain Medicine, Organisation, Scale (social sciences), Wounds and Injuries, Medical emergency, France, business, Trauma surgery, Delivery of Health Care
Abstract

International audience; In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years.

Published
2018

33. Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

Author

Nicolas, Deye, Alain, Cariou, Patrick, Girardie, Nicolas, Pichon, Bruno, Megarbane, Philippe, Midez, Jean-Marie, Tonnelier, Thierry, Boulain, Hervé, Outin, Arnaud, Delahaye, Aurélie, Cravoisy, Alain, Mercat, Pascal, Blanc, Charles, Santré, Hervé, Quintard, François, Brivet, Julien, Charpentier, Delphine, Garrigue, Bruno, Francois, Jean-Pierre, Quenot, François, Vincent, Pierre-Yves, Gueugniaud, Jean-Paul, Mira, Pierre, Carli, Eric, Vicaut, Frédéric J, Baud, and J J, Portal

Subjects
Male, medicine.medical_treatment, Targeted temperature management, Return of spontaneous circulation, Extracorporeal, Body Temperature, law.invention, Randomized controlled trial, Hypothermia, Induced, law, Physiology (medical), Coagulopathy, Humans, Medicine, Single-Blind Method, Prospective Studies, Aged, business.industry, Endovascular Procedures, Disease Management, Middle Aged, medicine.disease, Survival Rate, Catheter, Life support, Anesthesia, Female, Hemodialysis, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest, Follow-Up Studies
Abstract

Background— Targeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling. Methods and Results— Inclusion criteria were the following: age of 18 to 79 years, out-of-hospital cardiac arrest related to a presumed cardiac cause, time to return of spontaneous circulation P =0.107). Improvement in favorable outcome at day 90 in favor of the endovascular group did not reach significance (odds ratio, 1.51; 95% confidence interval, 0.96–2.35; P =0.07). Time to target temperature (33°C) was significantly shorter and target hypothermia was more strictly maintained in the endovascular than in the surface group ( P P =0.009). Conclusion— Despite better hypothermia induction and maintenance, endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00392639.

Published
2015

34. Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations?

Author

Fanny Bonhomme, Dominique Lasne, David Faraoni, Stéphanie Roullet, Emmanuel de Maistre, Gihp, Brigitte Ickx, Sophie Susen, Normand Blais, A. Godier, and Delphine Garrigue

Subjects
Adult, Male, medicine.medical_specialty, Population, Hemorrhage, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Haemophilia, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Thromboelastography, medicine, Severe trauma, Humans, Cardiac Surgical Procedures, Intensive care medicine, education, Child, Blood Coagulation, Societies, Medical, education.field_of_study, Liver transplantation, Perioperative medicine, Viscoelastic tests, medicine.diagnostic_test, business.industry, Thromboelastometry, Postpartum Hemorrhage, Généralités, General Medicine, Perioperative, Cardiac surgery, medicine.disease, Thrombosis, Hemostasis, Surgical, Liver Transplantation, Thrombelastography, Transplantation, Anesthesiology and Pain Medicine, Wounds and Injuries, Female, France, Emergencies, business, Algorithms
Abstract

Purpose: Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine. Methods: A review of the literature. Principal findings: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. Conclusion: VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2017

35. French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial

Author

Anne Bauters, Eric Kipnis, Sophie Susen, Eric Resch, François Machuron, Camille Paris, Benoit Tavernier, Delphine Garrigue, A. Sailliol, Pascale Renom, Julien Labreuche, Alain Duhamel, Patrick Goldstein, Anne Godier, and A. Glacet

Subjects
Adult, Male, Randomization, Resuscitation, 030204 cardiovascular system & hematology, Fibrinogen, Hemostatics, law.invention, 03 medical and health sciences, Plasma, 0302 clinical medicine, Randomized controlled trial, Blood product, law, Clinical endpoint, Coagulopathy, Medicine, Humans, Blood Transfusion, Blood Coagulation, business.industry, 030208 emergency & critical care medicine, Hematology, Blood Coagulation Disorders, Middle Aged, medicine.disease, Confidence interval, Freeze Drying, Anesthesia, Emergency Medicine, Wounds and Injuries, Female, Fresh frozen plasma, France, business, medicine.drug
Abstract

Essentials An immediate supply of plasma in case of trauma-induced coagulopathy is required. The Traucc trial compared French Lyophilised Plasma (FLyP) and Fresh Frozen Plasma (FFP). FLyP achieved higher fibrinogen concentrations compared with FFP. FLyP led to a more rapid coagulopathy improvement than FFP. Summary Background Guidelines recommend beginning hemostatic resuscitation immediately in trauma patients. We aimed to investigate if French lyophilized plasma (FLyP) was more effective than fresh frozen plasma (FFP) for the initial management of trauma-induced coagulopathy. Methods In an open-label, phase 3, randomized trial (NCT02750150), we enrolled adult trauma patients requiring an emergency pack of 4 plasma units within 6 h of injury. We randomly assigned patients to receive 4-FLyP units or 4-FFP units. The primary endpoint was fibrinogen concentration at 45 min after randomization. Secondary outcomes included time to transfusion, changes in hemostatic parameters at different time-points, blood product requirements and 30-day in-hospital mortality. Results Forty-eight patients were randomized (FLyP, n = 24; FFP, n = 24). FLyP reduced the time from randomization to transfusion of first plasma unit compared with FFP (median[IQR],14[5-30] vs. 77[64-90] min). FLyP achieved a higher fibrinogen concentration 45 min after randomization compared with FFP (baseline-adjusted mean difference, 0.29 g L-1 ; 95% confidence interval [CI], 0.08-0.49) and a greater improvement in prothrombin time ratio, factor V and factor II. The between-group differences in coagulation parameters remained significant at 6 h. FLyP reduced fibrinogen concentrate requirements. Thirty-day in-hospital mortality rate was 22% with FLyP and 29% with FFP. Conclusion FLyP led to a more rapid, pronounced and extended increase in fibrinogen concentrations and coagulopathy improvement compared with FFP in the initial management of trauma patients. FLyP represents an attractive option for trauma management, especially when facing logistical issues such as combat casualties or mass casualties related to terror attacks or disasters.

Published
2017

36. Chest trauma: First 48 hours management

Author

Sébastien Pierre, Xavier Benoit D’Journo, Marc Freysz, Valérie Monnin Bares, Pierre Bouzat, Christian Laplace, Jean Stephane David, Mathieu Boutonnet, Fatima Rayeh-Pelardy, Marc Leone, Thibault Desmettre, Michel Galinski, G. Boddaert, Raphaelle Duponq, Mathieu Biais, Mathieu Raux, Delphine Garrigue, Didier Honnart, Fanny Vardon, Laurent Ducros, Pierre Michelet, Karim Tazarourte, Dominique Savary, Neuro-imagerie fonctionnelle et métabolique ( ANTE-INSERM U836, équipe 5 ), 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 ), Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de gériatrie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Urgences Médicales, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Fédération des Urgences - SAMU 59, Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Aix Marseille Université ( AMU ), Département de Médecine d'Urgence - Centre Régional Universitaire des Urgences (CRUU) (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], 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 ), Chirurgie thoracique et cardio-vasculaire, Hôpital d'instruction des Armées Percy, Service des maladies infectieuses, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), 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), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Aix Marseille Université (AMU), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), 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, 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), 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), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Médecine Gériatrique [CHU Pitié-Salpêtrière], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
medicine.medical_specialty, Critical Care, Thoracic Injuries, Referral, Delphi method, Guidelines as Topic, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Health services, 0302 clinical medicine, Blunt, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Trauma management, Intensive care, medicine, Humans, In patient, 030212 general & internal medicine, Intensive care medicine, business.industry, High mortality, 030208 emergency & critical care medicine, General Medicine, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Anesthesiology and Pain Medicine, Practice Guidelines as Topic, Emergency medicine, business, Case Management
Abstract

International audience; Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time, there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both prehospital an in hospital settings, for the first 48 hours. The ``Societe francaise d'anesthesie reanimation'' and the ``Societe francaise de mdecine d'urgence'' worked together on the 7 following questions: (1) criteria defining severity and for appropriate hospital referral; (2) diagnosis strategy in both pre- and in-hospital settings; (3) indications and guidelines for ventilatory support; (4) management of analgesia; (5) indications and guidelines for chest tube placement; (6) surgical and endovascular repair indications in blunt chest trauma; (7) definition, medical and surgical specificity of penetrating chest trauma. For each question, prespecified ``crucial'' (and sometimes also ``important'') outcomes were identified by the panel of experts because it mattered for patients. We rated evidence across studies for these specific clinical outcomes. After a systematic Grade (R) approach, we defined 60 recommendations. Each recommendation has been evaluated by all the experts according to the DELPHI method. (C) 2017 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Published
2017

37. WITHDRAWN: Chest Trauma: First 48 hours management

Author

Michel Galinski, Pierre Michelet, Mathieu Raux, Pierre Bouzat, Jean Stephane David, Delphine Garrigue, Karim Tazarourte, Thibault Desmettre, and Laurent Ducros

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, Text mining, business.industry, General surgery, Medicine, General Medicine, Critical Care and Intensive Care Medicine, business, Surgery
Abstract

The Publisher regrets that this article is an accidental duplication of an article that has already been published inAbbreviated Journal Title, volume (year) first page - last page, http://dx.doi.org/10.1016/j.accpm.2017.01.003 . The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Published
2017

38. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Author

Walid Habre, Nicola Disma, Katalin Virag, Karin Becke, Tom G Hansen, Martin Jöhr, Brigitte Leva, Neil S Morton, Petronella M Vermeulen, Marzena Zielinska, Krisztina Boda, Francis Veyckemans, Walter Klimscha, Regina Konecny, Robert Luntzer, Ulrike Morawk-Wintersperger, Franz Neiger, Lydia Rustemeyer, Christian Breschan, Denise Frey, Manuela Platzer, Reinhard Germann, Joachim Oeding, Birgit Stoegermüller, Bernhard Ziegler, Philipp Brotatsch, Anton Gutmann, Gerlinde Mausser, Brigitte Messerer, Wolfgang Toller, Maria Vittinghoff, Gregor Zangl, Natascha Seidel-Ahyai, Christoph Hochhold, Ruth Kroess, Peter Paal, Steven Cnudde, Patricia Coucke, Birgit Loveniers, John Mitchell, David Kahn, Thierry Pirotte, Caroline Pregardien, Marc Coppens, Stefan De Hert, Björn Heyse, Martine Neckebroek, Aliaksandra Parashchanka, Jurgen Van Limmen, Nancy Van Den Eynde, Caroline Vanpeteghem, Piet Wyffels, Michaël Lalot, Jean-Paul Lechat, France Stevens, Sari Casaer, Françoise De Groote, Françoise De Pooter, Andrée De Villé, Marc Gerin, Natalia Magasich, Cristel Sanchez Torres, Denise Van Deenen, Johan Berghmans, Dirk Himpe, Eva Roofthooft, Ellen Joukes, Carine Smitz, Veronique Van Reeth, Christel Huygens, Julie Lauweryns, Karen De Smet, Nadia Najafi, Jan Poelaert, Anne Van de Velde, Veerle Van Mossevelde, Ivan Bekavac, Diana Butkovic, Dubravka Heli Litvic, Ivana Kerovec Soric, Hrvoje Maretic, Djurdjica Moscatello, Ljiljana Popovic, Slobodan Micici, Ivana Stuck Tus, Lada Kalagac Fabris, Tatjana Simurina, Nina Sulen, Gordana Kesic-Valpotic, Dajana Djapic, Jirí Žurek, Lucie Jureckova, Iveta Mackova, Monika Skacel, Stanislava Weinlichova, Jan Divák, Michal Frelich, René Urbanec, Vera Biskupova, Vladimir Mixa, Jana Pavlickova, Arash Afshari, Morten Bøttger, Marguerite B. Ellekvist, Mathias Johansen, Birgitte Ingeborg Madsen, Jens Christian Nilsson, Birgitte MB Schousboe, Nicola G. Clausen, Tom G. Hansen, Nick Phaff Steen, Mari-Liis Ilmoja, Virge Tonise, Juri Karjagin, Reet Kikas, Mika Isohanni, Anniina Lyly, Annika Takala, Johanna Happo, Kai Kiviluoma, Kati Martikainen, Riku Aantaa, Tuula Manner, Sanna Vilo, Catherine Amory, Hugues Ludot, Patricia Lambotte, René Busche, Olivier Jacqmarcq, Corinne Lejus, Julien Corouge, Christian Erb, Delphine Garrigue, Patricia Gillet, Anne Laffargue, Veronique Lambelin, Hélène Le Freche, Daliana Peresbota, Pierre Richart, Jerome Berton, Catherine Chapotte, Laurent Colbus, Thierry Lehousse, Jean Monrigal, Catherine Baujard, Philippe Roulleau, Giuseppe Staiti, Hélène Batoz, Maryline Bordes, Anne Didier, Yann Hamonic, Sylvaine Lagarde, Karine Nouette-Gaulain, François Semjen, Brigitte Zaghet, Jacky Dekens, Axelle Delcuze, Hervé Dupont, Aurélien Legrand, Celine Raffoflandreur, Noémie Audren, Blandine Camus, Marielle Cartal, Chantal Chazelet, Isabelle Davin, Marion Guillier, Luc Desjeux, Claire Larcher, Elodie Grein, Mickeal Leclercq, Roxana Levitchi, Lilica Rosu, Dominique Simon, Aurélien Zang, Anne Migeon, Anne-Charlotte Gagey, Nathalie Bourdaud, Anne-Charlotte Carre, Frédéric Duflo, Jean-Claude Riche, Philippe Robert, Emilie Druot, Olivier Maupain, Gilles Orliaguet, Lucie Sabau, Hanna Taright, Lynn Uhrig, Juliette Verchere-Montmayeur, Lise Debrabant, Clotaire Pilla, Alexandre Podvin, Benjamin Roth, Souhayl Dahmani, Florence Julien-Marsollier, Nada Sabourdin, Bogdan Alexandri, Gilles Brezac, Francois de la Brière, Catherine Hayem, Elizabeth Lhubat, Jean Paul Mission, Charlotte Rémond, Christophe Dadure, Maud Maniora, Anais Marie, Philippe Pirat, Anne-Charlotte Saour, Chrystelle Sola, Claude Ecoffey, Eric Wodey, Christian Adam, Thomas Standl, Ehrenfried Schindler, Tomohiro Yamamoto, Michael Brackhahn, Christoph Bernhard Eich, Holger Guericke, Petra Kindermann, Michael Laschat, Cornel Schink, Frank Wappler, Claudia Hoehne, Natalia Skordou, Johanna Ulrici, Martin Jetzek-Zader, Peter Kienbaum, Tanja Meyer-Treschan, Olaf Picker, Maximilian S. Schaefer, Golo Mielke, Sabine Baethge, Axel Ramminger, Martin Bauer, Matthias Bollinger, José Hinz, Michael Quintel, Sebastian G. Russo, Michael Bauer, Dfominik Geil, Andreas Kortgen, Niels-Peter Preussler, Ulrich Hofmann, Manfred Raber, Doris Reindl, Karin Oppenrieder, Bettina Schierlinger, Jens Roth, Wolfgang Funk, Thomas Fischer, Christian Gernoth, Christina Wiefelspütz, Hauke Volger, Nicole Zederer, Anja Diers, Matthias Huber, Clemens Schorer, Andreas Weyland, Konrad Schwarzkopf, Catharina Grau, Winfried Roth, Rolf Holy, Thomas Mader, Laura Peter, Hauke Supthut, Thomas Kuehhirt, Alexander Milde, Fritz Fiedler, Carsten Isselhorst, Ulrich Grundmann, Alexander Pattar, Jennifer Reinert, Birgit Ehm, Katrin Fritzsche, Ralf Gaebler, Patrick Meybohm, Maximilian Hein, Ines Guzman, Johanna Jokinen, Peter Kranke, Ulrich Goebel, Sarah Harris, Christoph Eisner, Miriam Ochsenreiter, Michael Schoeler, Elke Thil, Richard Ellerkmann, Andreas Hoeft, Claudia Neumann, Stefan Weber, Julia Keilhauer, Jan Kloessing, Michael Schramm, Uwe Trieschmann, Kristina Knauss, Barbara Sinner, Johannes Steinmann, Herbert Koessler, Evagelia Kalliardou, Anna Malisiova, Adelais Tsiotou, Pelagia Chloropoulou, Mpratzou Chrysi, Despoina Iordanidou, Merkourios Ntavlis, Krisztina B Boda, Christilynn Guerin, Janice Irwin, Claire Magner, Solmaz Nakhjavani, Brendan O'Hare, Deborah Galvin, Yosry Jamil, Carlos Lesmes, Yuri Barak, Haran Fisher, Ludmyla Kachko, Jacob Katz, Dmitry Kirilov, Michael Levinzon, Yair Manevich, Konstantin Nekrasov, Elia Peled, Elena Sanko, Dmitri Schmain, Olga Sheinkin, Eliahu Simhi, Alex Tarabikin, Evelina Trabkin, Irena Yagudaev, Yelena Zeitlin, Igor Zunser, Elisabetta Cerutti, Maria Maddalena Schellino, Silvia Valzan, Rosa Lucia Pinciroli, Luciano Bortone, Giorgia Cerati, Fabiana Salici, Leonardo Bussolin, Giuliana Rizzo, Francesca Rossetti, Laura Marchesini, Simonetta Tesoro, Brita De Lorenzo, Fabio Guarracino, Beate Kuppers, Marinella Astuto, Sofia Pitino, Rita Scalisi, Lucia Scordo, Sandra D'Alessandro, Luigi Dei Giudici, Ivano Farinelli, Giuseppe Lofino, Giuliano Marchetti, Sergio Giuseppe Picardo, Simone Reali, Alessandro Vittori, Francesco Antonio Idone, Maria Sammartino, Fabio Sbaraglia, Cinzia Barbera, Michela Bevilacqua, Valeria Cento, Svetlana Kotzeva, Leila Mameli, Giovanni Montobbio, Leandro Passariello, Cinzia Punzo, Rosanna Sileo, Rosanna Viacava, Claudia Volpe, Clelia Zanaboni, Edoardo Calderini, Daniele Genco, Simona Neri, Davide Ottolina, Anna Camporesi, Francesca Izzo, Ida Salvo, Andrea Wolfler, Andrea Sanna, Angela Sciascia, Paolo Stoia, Annamaria Guddo, Maria Lapi, Giorgio Ivani, Annalisa Longobardo, Valeria Mossetti, Dino Pedrotti, Maurizia Grazzini, Luisa Meneghini, Salvatore Metrangolo, Stefania Michelon, Carmelo Minardi, Costanza Tognon, Nicola Zadra, Ilaria Busi, Magda Khotcholava, Bruno Guido Locatelli, Valter Sonzogni, Giusi Starita, Nicole Almenrader, Caterina Aurilio, Pasquale Sansone, Raffaella Albarello, Paolo Bracci, Mariateresa Cecini, Maria Cristina Mondardini, Lorena Pasini, Milo Vason, Gianluca Zani, Roberto Zoppellari, Laura Pistidda, Andrea Cortegiani, Santi Maurizio Raineri, Antigona Hasani, Medita Hashimi, Agris Ancupans, Arta Barzdina, Zane Straume, Anda Zundane, Mikhail Chlopin, Dalia Gestautaite, Laura Lukosiene, Evelina Paliokaite, Ilona Razlevice, Inesa Armoniene, Aurelija Bernotiene, Vidunas Daugelavicius, Ilona Dockiene, Lina Gaidelyte, Nijole Saviciene, Jolita Krikstaponiene, Dominika Sidlovskaite-Baltake, Vladyslav Stasevski, Agne Vaitoskaite, David Gatt, Stephanie Mifsud, Simone Zammit, Celia Allison, Hamid Aslami, Susanne Eberl, Mireille F M van Stijn, Markus F Stevens, Kees Punt, Rob van Osch, Arthur Bauwman, Harm Scholten, Vesna Svircevic, Veronique Adriaens, Maaike Dirckx, Jaap Dogger, Ilse Dons-Sinke, Andreas Machotta, Xavier Moors, Mandana Rad, Lonneke Staals, Anouk van der Knijff - van Dortmont, Caroline van der Marel, Anne Sieben, Tim van der Zwan, Marianne Veldhuizen, David Alders, Wolfgang Buhre, Nicole Engel, Carine Vossen, Ravin Mahadewsing, Patrick Meijer, Volker Gerling, Roelof van der Schatte Olivier, Thea van Doorn, Kristy Vons Mark Hendriks, Sandra Lako, Gert jan Scheffer, Luc Tielens, Marieke Voet, Anthony Absalom, Margot Bergsma, Vera Spanjer, Rob Spanjersberg, Yvette van de Riet, Martin Volkers, Jurgen C. de Graaff, Geranne A.J. Hopman, Teus H. Kappen, J. Hannie, A.M. Megens, Sandra C. Numan, Anton N.J. Schouten, Nigel M. Turner, Désirée B.M. Van Der Werff, Renee T.M. Wensing, Erik Ephraim, Claire Nolte, Tore Reikvam, Ole Fredrik Lund, Lene Skaaden, Kari Marthe Ballovarre, Wenche Bakken Boerke, Guro Grindheim, Pal H H Lindenskov, Anne Beate Solas, Sjur Sponheim, Kyrre Ullensvang, Oddbjorn Viken, Inger Marie Drage, Kasper Gymoese Berthelsen, Bjørn Anders Kroken, Unni Bergland, Miroslaw Pryzmont, Mariola Talalaj, Malgorzata Wasiluk, Dorota Zalewska, Maria Damps, Jadzia Siemek-Mitela, Pawel Wieczorek, Magdalena Juzwa, Jowita Rosada-Kurasinska, Alicja Bartkowska-Sniatkowska, Maciej Cettler, Renata Kopycinska, Iwona Rudewicz, Jaek Sobczyk, Dariusz Wojciechowski, Artur Baranowski, Ewa Basiewicz, Magdalena Mierzewska-Schmidt, Wlodzimierz Retka, Piotr Sawicki, Magdalena Checinska, Magdalena Zurawska, Teresa Leal, Catia Mascarenhas, António Pedro Pina, Maria Joao Susano, Antonio Moniz, Maria Teresa Rocha, Carolina Calvao Santos, M Domingas Patuleia, Ricardo Pereira, Helena Roxo, Rosa Amaral, Isabel Guedes, Cristina Gomes, Marta Gonçalves, Helena Salgado, Maria Santos, Sara Rodrigues, Angela Sa, Elvira Machado, Sandra Pé d'Arca, Manuel Seabra, Ligia Mihaela Gheorghe, Constantin Ivascu, Lucia Moraru-Draghici, Mirela Suvejan, Remus Babici, Kovacs Eniko, Cristiana Hogea, Dubau Mihaela, Daraban Nicoleta, Danut Barbunc, Alina Maria Nistor, Violeta Stefan, Gabriela Catalina Ionescu, Irina Davidescu, Alina Teodora Nastase, Florin Dumitru Rusu, Victoria Badarau, Iulia Cindea, Melania Moscaliuc, Dana Olteanu, Luxita Petrescu, Daniela Ceuca, Irena Galinescu, Rodica Badeti, Alin Capusan, Cosmina Cucui-Cozma, Barbura Popescu, Luminita Cimpeanu, Mihaela-Petronela Birliba, Magdalena Miulescu, Stefania Balamat, Adriana Gurita, Luminita Ilie, Gabriel Mocioiu, Darina Pick, Rodica Sirghie, Radu Tabacaru, Irinel Trante, Lucian Horhota, Daniela Bandrabur, Tudor Ciobanu, Veaceslav Cuciuc, Valentin Munteanu, Valentin Olaru, Corneliu Paiu, Anca Savu, Oana Trifan, Anca Elena Malos, Anton Glazunov, Alexander Ivanov, Evgeny Poduskov, Alexander Popov, Igor Guskov, Alexander Lugovoy, Vladislav Nechaev, Alexey Ovezov, Mikhail Basov, Vladimir Kochkin, Vladimir Lazarev, Dmitri Chizhov, Ivan Ostreikov, Konstantin Tolasov, Ivana Budic, Vesna Marjanovic, Biljana Draskovic, Marina Pandurov, Jovana Simin, Vladimir Dolinaj, Dusanka Janjevic, Ana Mandras, Maja Mircetic, Sladjana Petrovic, Vlatka Rebac, Bojana Slavkovic, Vesna Stevanovic, Ana Velcev, Mirjana Knezevic, Irina Milojevic, Selena Puric, Irena Simic, Marija Stevic, Vladimir Stranjanac, Dusica Simic, Barbora Cabanova, Miloslav Hanula, Andry Grynyuk, Jelena Berger, Uros Cerne, Andraz Nastran, Dejan Pirc, Rok Popic, Spela Stupnik, Paloma Rubio, Cristina del Río, Pilar Benito, Gema Pino, Ignacio Gutierrez, Andrea Gutierrez Valcarcel, Irene León Carsi, Anibal Perez Garcia, Sílvia López Galera, Joan Marco Valls, Laura Ricol Lainez, Andrea Vallejo Tarrat, David Artes, Ester Banus, Luca Chirichiello, Leidy De Abreu, Belen De Josemaria, M Helena Gaitan, Antonio Garces, Juan J Lazaro, Ferran Manen Berga, Dolors Molies, Enric Monclus, Montserrat Navaro, Carmen Pamies, Marina Perelló, Mar Prat, Laura Ribo, M Angeles Sanz, Silvia Serrano, Eva Sola Ruiz, Blanca Anuncia Escontrela Rodríguez, Andrea Maria Gago Martinez, Alberto Martínez Ruiz, Fausto De La Cruz Benito, Gustavo Gabilondo Garcia, Ever Martinez Maldonado, Bryant Noriega, Lara Oller Duque, Alberto Olmos Mendez, Antonio Perez- Ferrer, Francisco Reinoso Barbero, Ismael Acevedo Bambaren, Fernando Domínguez, Teresa Franco, Anabel Jiménez, Alicia Melero, Montserrat Feliu, Irene García, Núria Montferrer, Francisca Munar, Cristina Muro, Rosario Nuño, Remel Perera, Erika Schmucker, Glenda Börjesson, Lars Gillberg, Albert Castellheim, Kerstin Sandström, Annette Bauer, Torbjörn Roos, Lars Hedlund, Yann Boegli, Mirko Dolci, Carine Marcucci, Isabelle Spahr-Schopfer, Michel Pellegrini, Malte Book, Loreen Errass, Christine Riggenbach, Mattias Casutt, Martin Hölzle, Thomas Hurni, Jacqueline Mauch, Luciano Anselmi, Irene Anselmi, Alfred Jacomet, Markus Oberhauser, Stephanie Wossner, Angelika Zettl, Thomas Erb, Tomasz Mackiewicz, Helena Simitzes, Yetkin Ozer, Arzu Takil, Zekeriyya Alanoglu, Onat Bermede, K.Sanem Cakar Turhan, Neslihan Alkis, Cigdem Yildirim Guclu, Basak Ceyda Meco, Zehra Hatipoglu, Dilek Ozcengiz, Zekine Begec, Huseyin Ilksen Toprak, Pinar Kendigelen, Ayse Cigdem Tütüncü, Meltem Savran Karadeniz, Tulay Seyhan Ozkan, Nuket Sivrikoz, Mustafa Kemal Arslantas, Ayse Hizal, Gülbin Tore Altun, Tumay Umuroglu, Sibel Baris, Zuleyha Kazak Bengisun, Galyna Goncharenko, Maksym Khrapak, Tetyana Klymenko, Vitaliy Pavlenko, Dmytro Prysiazhniuk, Olga Rudio, Mykhailo Varyvoda, Sergii Vodianytskyi, Ivanna Boryshkevych, Iryna Kyselova, Nikolay Trikash, Andrew Albokrinov, Valentina Perova-Sharonova, Vitaliy Sklyar, Denis Surkov, Amr Abdelaal, Nicola Barber, Sarah Checuti, Leisha Godsiff, Lynch Johanne, Joanna Simpson, Helen Underhill, Rishi Diwan, Nivedita Kelgeri, Nuria Masip, Radha Ravi, Steve Roberts, Annagrazia Cillis, Ritchie Marcus, Federica Merella, David Love, Paolo Baraggia, Victoria Bird, Joseph Hussey, Peter Alderson, Karen Bartholomew, Michael Moncreiff, Sarah Davidson, Alison Hare, Ami Kotecha, Corina Lee, Ganga Liyanage, Shivali Patel, Amee Samani, Mark Abou-Samra, Matthew Boyd, Laurence Hullatt, David Levy, Mark Pauling, Sarah-Jane Sharman, Natalie Smith, John Rutherford, Alison Cavalier, Christie Locke, Frederic Sage, Smita Bapat, Jacinda Hammerschlag, Ioannis Ioannou, Stephanie King, Rachel Pegg, Vishal Salota, Jonathan Sketcher, Muthu Thadsad, Deborah Zeitlin, Ewan Jack, Colin Lang, Samira Ahmed, Reema Ayyash, Francoise Bari, Sarah J Bell, Claire Elizabeth Biercamp, Sandra Briggs, Maria Gabriella Elena Clement, Mark Dalton, Mohamed Ali Eissa Eid, Monica Gandhi, Idse Harmen Herrema, Ranj Khaffaf, Savio Jeng Min Law, Joanna McClintock, Nicholas Ireland, Mohammed Majid Saleem, Fiona Smith, Marc Cohen, Clover-Ann Lee, Lizanne O'Donahue, Alex Powell, Ellen Rawlinson, Aarjan Snoek, Katja Weiss, Hugo Wellesley, Michael Crawford, Mostafa Abdel-Hafiz, Alexandra Day, Balaji Rajamani, Rita Saha, Dave Wright, Lew-Chin Chee, Stephanie Bew, Rachel Homer, Nalini Malarkkan, Juliet Wolfe Barry, Pradeep Angadi, Brid Cagney, Eric De Melo, Elsa Dekker, Emma Helm, Gareth Jones, Kawshala Peiris, William Russell, Patricia Slater, Puja Sodhi, Mike Browning, Trudie Phillips, Rachel Van Hecke, Vimty Muir, Piyush Singh, Tereza Soskova, Craig Cumming, Pamela Farquharson, Karen Pearson, Neil Shaw, Jonathan Whiteside, Emma Whyte, Gordon Byers, Kay Davies, Thomas Engelhardt, Isabella Faliszewski, Graham Johnston, Nils Kaufmann, Zuzana Kusnirikova, Graham Wilson, Peter Carachi, Andrew Makin, Brian Foster, Dariusz Lipczynski, Rebecca Mawer, William Rutherford, David Rogerson, Sarah Rushman, Christopher Taylor, William Tomlinson, Philippa Dix, Tom Woodward, Graham Bell, David Boyle, Marianne Cloherty, Julia Cullen, Pauline Cullen, Ross Fairgrieve, Robert Ghent, Russell Glasgow, Elena Gordeeva, Alison Harden, Sarah Hivey, Kevin Jerome, Lesley McKee, Neil Morton, Vicky Pribul, John Sinclair, Maria Steiner, Heather Steward, Lorraine Sweeney, Wendy Thomson, Jeanette Whiteside, Andrew Dalton, Mark Ross, Carolyn Smith, Claire Allen, Nicola Anders, Victoria Barlow, Mike Bassett, Leanne Darwin, Rachel Davison, Jacques Diacono, Amy Hobbs, Adel Hutchinson, Bernadette Lomas, Hannah Lonsdale, Leila Nasser, Vimmi Oshan, Pradip Patel, Christopher Raistrick, Victoria Scott-Warren, Laura Talbot, Carolynn Wai, Sophie Childs, Matthew Dickinson, Tom Bloomfield, Sweyn Garrioch, Karen Watson, James Gaynor, Richard Harrison, Juliette Lee, Elizabeth Blythe, Teresa Dorman, Ayman Eissa, James Ellwood, Ingrid Gooch, Robert Hearn, Vanessa Hodgetts, Robert John, Christine Kirton, Nadia Ladak, Judith Morgan, Nina Plant, Elizabeth Shepherd, Judith Short, Charles Stack, Simon Steel, Matthew Taylor, Deborah Thomas, Catharine Wilson, Elaine Wilson-Smith, Carol L. Bradbury, Nageena Hussain, Antonia Mayell, Ahmed Mesbah, Arif Qureshi, Chandra Vaidyanath, Tim Geary, Chris Hawksworth, Tamaraichelvi Parasuraman, Nicole Perry, Indrani Banerjee, Katharine Barr, Patrick Butler, Jack Davies, Lisa Flewin, Richard Gande, James Montague, James Plumb, Thomas Pratt, Paul Sutherland, Hannah Vail, Andrew Wilkins, Catherine Hunter, Susan Russell, Alun Thomas, Mark Mifsud, Dominic Strachan, Benoit Plichon, Pierre Harlet, Anesthesiology, APH - Quality of Care, Graduate School, Other Research, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ANS - Neuroinfection & -inflammation, ACS - Heart failure & arrhythmias, ACS - Diabetes & metabolism, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), APRICOT Grp European Soc Anaesthes, Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G, Jöhr, Martin, Leva, Brigitte, Morton, Neil S, Vermeulen, Petronella M, Zielinska, Marzena, Boda, Krisztina, Veyckemans, Franci, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermüller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Hert, Stefan, Heyse, Björn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michaël, Lechat, Jean Paul, Stevens, France, Casaer, Sari, De Groote, Françoise, De Pooter, Françoise, De Villé, Andrée, Gerin, Marc, Magasich, Natalia, Sanchez Torres, Cristel, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Heli Litvic, Dubravka, Kerovec Soric, Ivana, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micici, Slobodan, Stuck Tus, Ivana, Kalagac Fabris, Lada, Simurina, Tatjana, Sulen, Nina, Kesic Valpotic, Gordana, Djapic, Dajana, Žurek, Jirí, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divák, Jan, Frelich, Michal, Urbanec, René, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bøttger, Morten, Ellekvist, Marguerite B., Johansen, Mathia, Ingeborg Madsen, Birgitte, Christian Nilsson, Jen, Schousboe, Birgitte MB, Clausen, Nicola G., Hansen, Tom G., Phaff Steen, Nick, Ilmoja, Mari Lii, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugue, Lambotte, Patricia, Busche, René, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Hélène, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Hélène, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette Gaulain, Karine, Semjen, Françoi, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Hervé, Legrand, Aurélien, Raffoflandreur, Celine, Audren, Noémie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurélien, Migeon, Anne, Gagey, Anne Charlotte, Bourdaud, Nathalie, Carre, Anne Charlotte, Duflo, Frédéric, Riche, Jean Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gille, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gille, de la Brière, Francoi, Hayem, Catherine, Lhubat, Elizabeth, Paul Mission, Jean, Rémond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anai, Pirat, Philippe, Saour, Anne Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thoma, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Bernhard Eich, Christoph, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek Zader, Martin, Kienbaum, Peter, Meyer Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthia, Hinz, José, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andrea, Preussler, Niels Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Dori, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jen, Funk, Wolfgang, Fischer, Thoma, Gernoth, Christian, Wiefelspütz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthia, Schorer, Clemen, Weyland, Andrea, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thoma, Peter, Laura, Supthut, Hauke, Kuehhirt, Thoma, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ine, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andrea, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johanne, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelai, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourio, Boda, Krisztina B, Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlo, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, Zunser, Igor, Cerutti, Elisabetta, Maddalena Schellino, Maria, Valzan, Silvia, Lucia Pinciroli, Rosa, Bortone, Luciano, Cerati, Giorgia, Salici, Fabiana, Bussolin, Leonardo, Rizzo, Giuliana, Rossetti, Francesca, Marchesini, Laura, Tesoro, Simonetta, De Lorenzo, Brita, Guarracino, Fabio, Kuppers, Beate, Astuto, Marinella, Pitino, Sofia, Scalisi, Rita, Scordo, Lucia, D'Alessandro, Sandra, Dei Giudici, Luigi, Farinelli, Ivano, Lofino, Giuseppe, Marchetti, Giuliano, Giuseppe Picardo, Sergio, Reali, Simone, Vittori, Alessandro, Antonio Idone, Francesco, Sammartino, Maria, Sbaraglia, Fabio, Barbera, Cinzia, Bevilacqua, Michela, Cento, Valeria, Kotzeva, Svetlana, Mameli, Leila, Montobbio, Giovanni, Passariello, Leandro, Punzo, Cinzia, Sileo, Rosanna, Viacava, Rosanna, Volpe, Claudia, Zanaboni, Clelia, Calderini, Edoardo, Genco, Daniele, Neri, Simona, Ottolina, Davide, Camporesi, Anna, Izzo, Francesca, Salvo, Ida, Wolfler, Andrea, Sanna, Andrea, Sciascia, Angela, Stoia, Paolo, Guddo, Annamaria, Lapi, Maria, Ivani, Giorgio, Longobardo, Annalisa, Mossetti, Valeria, Pedrotti, Dino, Grazzini, Maurizia, Meneghini, Luisa, Metrangolo, Salvatore, Michelon, Stefania, Minardi, Carmelo, Tognon, Costanza, Zadra, Nicola, Busi, Ilaria, Khotcholava, Magda, Guido Locatelli, Bruno, Sonzogni, Valter, Starita, Giusi, Almenrader, Nicole, Aurilio, Caterina, Sansone, Pasquale, Albarello, Raffaella, Bracci, Paolo, Cecini, Mariateresa, Cristina Mondardini, Maria, Pasini, Lorena, Vason, Milo, Zani, Gianluca, Zoppellari, Roberto, Pistidda, Laura, Cortegiani, Andrea, Maurizio Raineri, Santi, Hasani, Antigona, Hashimi, Medita, Ancupans, Agri, Barzdina, Arta, Straume, Zane, Zundane, Anda, Chlopin, Mikhail, Gestautaite, Dalia, Lukosiene, Laura, Paliokaite, Evelina, Razlevice, Ilona, Armoniene, Inesa, Bernotiene, Aurelija, Daugelavicius, Viduna, Dockiene, Ilona, Gaidelyte, Lina, Saviciene, Nijole, Krikstaponiene, Jolita, Sidlovskaite Baltake, Dominika, Stasevski, Vladyslav, Vaitoskaite, Agne, Gatt, David, Mifsud, Stephanie, Zammit, Simone, Allison, Celia, Aslami, Hamid, Eberl, Susanne, van Stijn, Mireille F. M, Stevens, Markus F, Punt, Kee, van Osch, Rob, Bauwman, Arthur, Scholten, Harm, Svircevic, Vesna, Adriaens, Veronique, Dirckx, Maaike, Dogger, Jaap, Dons Sinke, Ilse, Machotta, Andrea, Moors, Xavier, Rad, Mandana, Staals, Lonneke, Van, der Knijff, van der Marel, Caroline, Sieben, Anne, van der Zwan, Tim, Veldhuizen, Marianne, Alders, David, Buhre, Wolfgang, Engel, Nicole, Vossen, Carine, Mahadewsing, Ravin, Meijer, Patrick, Gerling, Volker, van der Schatte Olivier, Roelof, van Doorn, Thea, Vons Mark Hendriks, Kristy, Lako, Sandra, jan Scheffer, Gert, Tielens, Luc, Voet, Marieke, Absalom, Anthony, Bergsma, Margot, Spanjer, Vera, Spanjersberg, Rob, van de Riet, Yvette, Volkers, Martin, de Graaff, Jurgen C., Hopman, Geranne A. J., Kappen, Teus H., Hannie, J., Megens, A. M., Numan, Sandra C., Schouten, Anton N. J., Turner, Nigel M., Van Der Werff, Désirée B. M., Wensing, Renee T. M., Ephraim, Erik, Nolte, Claire, Reikvam, Tore, Fredrik Lund, Ole, Skaaden, Lene, Marthe Ballovarre, Kari, Bakken Boerke, Wenche, Grindheim, Guro, Lindenskov, Pal H. H, Beate Solas, Anne, Sponheim, Sjur, Ullensvang, Kyrre, Viken, Oddbjorn, Marie Drage, Inger, Gymoese Berthelsen, Kasper, Anders Kroken, Bjørn, Bergland, Unni, Pryzmont, Miroslaw, Talalaj, Mariola, Wasiluk, Malgorzata, Zalewska, Dorota, Damps, Maria, Siemek Mitela, Jadzia, Wieczorek, Pawel, Juzwa, Magdalena, Rosada Kurasinska, Jowita, Bartkowska Sniatkowska, Alicja, Cettler, Maciej, Kopycinska, Renata, Rudewicz, Iwona, Sobczyk, Jaek, Wojciechowski, Dariusz, Baranowski, Artur, Basiewicz, Ewa, Mierzewska Schmidt, Magdalena, Retka, Wlodzimierz, Sawicki, Piotr, Checinska, Magdalena, Zurawska, Magdalena, Leal, Teresa, Mascarenhas, Catia, Pedro Pina, António, Joao Susano, Maria, Moniz, Antonio, Teresa Rocha, Maria, Calvao Santos, Carolina, Domingas Patuleia, M., Pereira, Ricardo, Roxo, Helena, Amaral, Rosa, Guedes, Isabel, Gomes, Cristina, Gonçalves, Marta, Salgado, Helena, Santos, Maria, Rodrigues, Sara, Sa, Angela, Machado, Elvira, Pé d'Arca, Sandra, Seabra, Manuel, Mihaela Gheorghe, Ligia, Ivascu, Constantin, Moraru Draghici, Lucia, Suvejan, Mirela, Babici, Remu, Eniko, Kovac, Hogea, Cristiana, Mihaela, Dubau, Nicoleta, Daraban, Barbunc, Danut, Maria Nistor, Alina, Stefan, Violeta, Catalina Ionescu, Gabriela, Davidescu, Irina, Teodora Nastase, Alina, Dumitru Rusu, Florin, Badarau, Victoria, Cindea, Iulia, Moscaliuc, Melania, Olteanu, Dana, Petrescu, Luxita, Ceuca, Daniela, Galinescu, Irena, Badeti, Rodica, Capusan, Alin, Cucui Cozma, Cosmina, Popescu, Barbura, Cimpeanu, Luminita, Birliba, Mihaela Petronela, Miulescu, Magdalena, Balamat, Stefania, Gurita, Adriana, Ilie, Luminita, Mocioiu, Gabriel, Pick, Darina, Sirghie, Rodica, Tabacaru, Radu, Trante, Irinel, Horhota, Lucian, Bandrabur, Daniela, Ciobanu, Tudor, Cuciuc, Veaceslav, Munteanu, Valentin, Olaru, Valentin, Paiu, Corneliu, Savu, Anca, Trifan, Oana, Elena Malos, Anca, Glazunov, Anton, Ivanov, Alexander, Poduskov, Evgeny, Popov, Alexander, Guskov, Igor, Lugovoy, Alexander, Nechaev, Vladislav, Ovezov, Alexey, Basov, Mikhail, Kochkin, Vladimir, Lazarev, Vladimir, Chizhov, Dmitri, Ostreikov, Ivan, Tolasov, Konstantin, Budic, Ivana, Marjanovic, Vesna, Draskovic, Biljana, Pandurov, Marina, Simin, Jovana, Dolinaj, Vladimir, Janjevic, Dusanka, Mandras, Ana, Mircetic, Maja, Petrovic, Sladjana, Rebac, Vlatka, Slavkovic, Bojana, Stevanovic, Vesna, Velcev, Ana, Knezevic, Mirjana, Milojevic, Irina, Puric, Selena, Simic, Irena, Stevic, Marija, Stranjanac, Vladimir, Simic, Dusica, Cabanova, Barbora, Hanula, Miloslav, Grynyuk, Andry, Berger, Jelena, Cerne, Uro, Nastran, Andraz, Pirc, Dejan, Popic, Rok, Stupnik, Spela, Rubio, Paloma, del Río, Cristina, Benito, Pilar, Pino, Gema, Gutierrez, Ignacio, Gutierrez Valcarcel, Andrea, León Carsi, Irene, Perez Garcia, Anibal, López Galera, Sílvia, Marco Valls, Joan, Ricol Lainez, Laura, Vallejo Tarrat, Andrea, Artes, David, Banus, Ester, Chirichiello, Luca, De Abreu, Leidy, De Josemaria, Belen, Helena Gaitan, M., Garces, Antonio, Lazaro, Juan J, Manen Berga, Ferran, Molies, Dolor, Monclus, Enric, Navaro, Montserrat, Pamies, Carmen, Perelló, Marina, Prat, Mar, Ribo, Laura, Angeles Sanz, M., Serrano, Silvia, Sola Ruiz, Eva, Anuncia Escontrela Rodríguez, Blanca, Maria Gago Martinez, Andrea, Martínez Ruiz, Alberto, De La Cruz Benito, Fausto, Gabilondo Garcia, Gustavo, Martinez Maldonado, Ever, Noriega, Bryant, Oller Duque, Lara, Olmos Mendez, Alberto, Perez Ferrer, Antonio, Reinoso Barbero, Francisco, Acevedo Bambaren, Ismael, Domínguez, Fernando, Franco, Teresa, Jiménez, Anabel, Melero, Alicia, Feliu, Montserrat, García, Irene, Montferrer, Núria, Munar, Francisca, Muro, Cristina, Nuño, Rosario, Perera, Remel, Schmucker, Erika, Börjesson, Glenda, Gillberg, Lar, Castellheim, Albert, Sandström, Kerstin, Bauer, Annette, Roos, Torbjörn, Hedlund, Lar, Boegli, Yann, Dolci, Mirko, Marcucci, Carine, Spahr Schopfer, Isabelle, Pellegrini, Michel, Book, Malte, Errass, Loreen, Riggenbach, Christine, Casutt, Mattia, Hölzle, Martin, Hurni, Thoma, Mauch, Jacqueline, Anselmi, Luciano, Anselmi, Irene, Jacomet, Alfred, Oberhauser, Marku, Wossner, Stephanie, Zettl, Angelika, Erb, Thoma, Mackiewicz, Tomasz, Simitzes, Helena, Ozer, Yetkin, Takil, Arzu, Alanoglu, Zekeriyya, Bermede, Onat, Cakar Turhan, K. Sanem, Alkis, Neslihan, Yildirim Guclu, Cigdem, Ceyda Meco, Basak, Hatipoglu, Zehra, Ozcengiz, Dilek, Begec, Zekine, Ilksen Toprak, Huseyin, Kendigelen, Pinar, Cigdem Tütüncü, Ayse, Karadeniz, Meltem Savran, Seyhan Ozkan, Tulay, Sivrikoz, Nuket, Kemal Arslantas, Mustafa, Hizal, Ayse, Tore Altun, Gülbin, Umuroglu, Tumay, Baris, Sibel, Kazak Bengisun, Zuleyha, Goncharenko, Galyna, Khrapak, Maksym, Klymenko, Tetyana, Pavlenko, Vitaliy, Prysiazhniuk, Dmytro, Rudio, Olga, Varyvoda, Mykhailo, Vodianytskyi, Sergii, Boryshkevych, Ivanna, Kyselova, Iryna, Trikash, Nikolay, Albokrinov, Andrew, Perova Sharonova, Valentina, Sklyar, Vitaliy, Surkov, Deni, Abdelaal, Amr, Barber, Nicola, Checuti, Sarah, Godsiff, Leisha, Johanne, Lynch, Simpson, Joanna, Underhill, Helen, Diwan, Rishi, Kelgeri, Nivedita, Masip, Nuria, Ravi, Radha, Roberts, Steve, Cillis, Annagrazia, Marcus, Ritchie, Merella, Federica, Love, David, Baraggia, Paolo, Bird, Victoria, Hussey, Joseph, Alderson, Peter, Bartholomew, Karen, Moncreiff, Michael, Davidson, Sarah, Hare, Alison, Kotecha, Ami, Lee, Corina, Liyanage, Ganga, Patel, Shivali, Samani, Amee, Abou Samra, Mark, Boyd, Matthew, Hullatt, Laurence, Levy, David, Pauling, Mark, Sharman, Sarah Jane, Smith, Natalie, Rutherford, John, Cavalier, Alison, Locke, Christie, Sage, Frederic, Bapat, Smita, Hammerschlag, Jacinda, Ioannou, Ioanni, King, Stephanie, Pegg, Rachel, Salota, Vishal, Sketcher, Jonathan, Thadsad, Muthu, Zeitlin, Deborah, Jack, Ewan, Lang, Colin, Ahmed, Samira, Ayyash, Reema, Bari, Francoise, Bell, Sarah J, Elizabeth Biercamp, Claire, Briggs, Sandra, Gabriella Elena Clement, Maria, Dalton, Mark, Ali Eissa Eid, Mohamed, Gandhi, Monica, Harmen Herrema, Idse, Khaffaf, Ranj, Jeng Min Law, Savio, Mcclintock, Joanna, Ireland, Nichola, Majid Saleem, Mohammed, Smith, Fiona, Cohen, Marc, Lee, Clover Ann, O'Donahue, Lizanne, Powell, Alex, Rawlinson, Ellen, Snoek, Aarjan, Weiss, Katja, Wellesley, Hugo, Crawford, Michael, Abdel Hafiz, Mostafa, Day, Alexandra, Rajamani, Balaji, Saha, Rita, Wright, Dave, Chee, Lew Chin, Bew, Stephanie, Homer, Rachel, Malarkkan, Nalini, Wolfe Barry, Juliet, Angadi, Pradeep, Cagney, Brid, De Melo, Eric, Dekker, Elsa, Helm, Emma, Jones, Gareth, Peiris, Kawshala, Russell, William, Slater, Patricia, Sodhi, Puja, Browning, Mike, Phillips, Trudie, Van Hecke, Rachel, Muir, Vimty, Singh, Piyush, Soskova, Tereza, Cumming, Craig, Farquharson, Pamela, Pearson, Karen, Shaw, Neil, Whiteside, Jonathan, Whyte, Emma, Byers, Gordon, Davies, Kay, Engelhardt, Thoma, Faliszewski, Isabella, Johnston, Graham, Kaufmann, Nil, Kusnirikova, Zuzana, Wilson, Graham, Carachi, Peter, Makin, Andrew, Foster, Brian, Lipczynski, Dariusz, Mawer, Rebecca, Rutherford, William, Rogerson, David, Rushman, Sarah, Taylor, Christopher, Tomlinson, William, Dix, Philippa, Woodward, Tom, Bell, Graham, Boyle, David, Cloherty, Marianne, Cullen, Julia, Cullen, Pauline, Fairgrieve, Ro, Ghent, Robert, Glasgow, Russell, Gordeeva, Elena, Harden, Alison, Hivey, Sarah, Jerome, Kevin, Mckee, Lesley, Morton, Neil, Pribul, Vicky, Sinclair, John, Steiner, Maria, Steward, Heather, Sweeney, Lorraine, Thomson, Wendy, Whiteside, Jeanette, Dalton, Andrew, Ross, Mark, Smith, Carolyn, Allen, Claire, Anders, Nicola, Barlow, Victoria, Bassett, Mike, Darwin, Leanne, Davison, Rachel, Diacono, Jacque, Hobbs, Amy, Hutchinson, Adel, Lomas, Bernadette, Lonsdale, Hannah, Nasser, Leila, Oshan, Vimmi, Patel, Pradip, Raistrick, Christopher, Scott Warren, Victoria, Talbot, Laura, Wai, Carolynn, Childs, Sophie, Dickinson, Matthew, Bloomfield, Tom, Garrioch, Sweyn, Watson, Karen, Gaynor, Jame, Harrison, Richard, Lee, Juliette, Blythe, Elizabeth, Dorman, Teresa, Eissa, Ayman, Ellwood, Jame, Gooch, Ingrid, Hearn, Robert, Hodgetts, Vanessa, John, Robert, Kirton, Christine, Ladak, Nadia, Morgan, Judith, Plant, Nina, Shepherd, Elizabeth, Short, Judith, Stack, Charle, Steel, Simon, Taylor, Matthew, Thomas, Deborah, Wilson, Catharine, Wilson Smith, Elaine, Bradbury, Carol L., Hussain, Nageena, Mayell, Antonia, Mesbah, Ahmed, Qureshi, Arif, Vaidyanath, Chandra, Geary, Tim, Hawksworth, Chri, Parasuraman, Tamaraichelvi, Perry, Nicole, Banerjee, Indrani, Barr, Katharine, Butler, Patrick, Davies, Jack, Flewin, Lisa, Gande, Richard, Montague, Jame, Plumb, Jame, Pratt, Thoma, Sutherland, Paul, Vail, Hannah, Wilkins, Andrew, Hunter, Catherine, Russell, Susan, Thomas, Alun, Mifsud, Mark, Strachan, Dominic, Plichon, Benoit, Harlet, Pierre, Child and Adolescent Psychiatry / Psychology, Morawk-Wintersperger, Ulrike, Seidel-Ahyai, Natascha, Lechat, Jean-Paul, Kesic-Valpotic, Gordana, Ilmoja, Mari-Lii, Nouette-Gaulain, Karine, Gagey, Anne-Charlotte, Carre, Anne-Charlotte, Riche, Jean-Claude, Verchere-Montmayeur, Juliette, Julien-Marsollier, Florence, Saour, Anne-Charlotte, Jetzek-Zader, Martin, Meyer-Treschan, Tanja, Preussler, Niels-Peter, Sidlovskaite-Baltake, Dominika, van Stijn, Mireille F M, Dons-Sinke, Ilse, van der Knijff - van Dortmont, Anouk, Hopman, Geranne A.J., Megens, A.M., Schouten, Anton N.J., Van Der Werff, Désirée B.M., Wensing, Renee T.M., Lindenskov, Pal H H, Siemek-Mitela, Jadzia, Rosada-Kurasinska, Jowita, Bartkowska-Sniatkowska, Alicja, Mierzewska-Schmidt, Magdalena, Moraru-Draghici, Lucia, Cucui-Cozma, Cosmina, Birliba, Mihaela-Petronela, Perez- Ferrer, Antonio, Spahr-Schopfer, Isabelle, Cakar Turhan, K.Sanem, Perova-Sharonova, Valentina, Abou-Samra, Mark, Sharman, Sarah-Jane, McClintock, Joanna, Lee, Clover-Ann, Abdel-Hafiz, Mostafa, Chee, Lew-Chin, McKee, Lesley, Scott-Warren, Victoria, and Wilson-Smith, Elaine

Subjects
Male, Pediatrics, Health Status, OPERATING-ROOM, Respiratory Tract Diseases, CHILDREN, 0302 clinical medicine, REGIONAL ANESTHESIA, Postoperative Complications, 030202 anesthesiology, CARDIAC-ARREST, Medicine, General anaesthesia, Prospective Studies, Prospective cohort study, Child, Intraoperative Complications, COMPLICATIONS, ddc:617, Incidence (epidemiology), Mortality rate, musculoskeletal, neural, and ocular physiology, Incidence, Age Factors, Hospitals, Europe, Cardiovascular Diseases, Child, Preschool, RESPIRATORY ADVERSE EVENTS, Female, Clinical Competence, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, macromolecular substances, Anesthesia, General, Drug Hypersensitivity, 03 medical and health sciences, MORBIDITY, Journal Article, Humans, business.industry, Infant, Newborn, Infant, 030208 emergency & critical care medicine, Perioperative, nervous system, PROSPECTIVE COHORT, Relative risk, RISK-FACTORS, Observational study, Human medicine, Nervous System Diseases, business, SYSTEM
Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p

Published
2017

39. Response to Letter Regarding Article, 'Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study'

Author

Alain Cariou, Nicolas Deye, Hervé Quintard, Julien Charpentier, Nicolas Pichon, Patrick Girardie, Arnaud Delahaye, Bruno François, Charles Santre, Aurélie Cravoisy, Jean-Pierre Quenot, Hervé Outin, Frédéric J. Baud, Pascal Blanc, Bruno Mégarbane, Eric Vicaut, François Vincent, Thierry Boulain, Philippe Midez, Pierre Carli, Pierre-Yves Gueugniaud, Alain Mercat, Jean-Paul Mira, François G. Brivet, Jean-Marie Tonnelier, and Delphine Garrigue

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Core temperature, Targeted temperature management, Out of hospital cardiac arrest, Body Temperature, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Hypothermia, Induced, law, Physiology (medical), medicine, Humans, Intensive care medicine, business.industry, Endovascular Procedures, Disease Management, 030208 emergency & critical care medicine, Workload, Thermoregulation, Hypothermia, Intensive care unit, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract

We thank Dr Yan Kang and colleagues for their comments assuming that endovascular cooling may theoretically present more advantages than surface cooling. We agree with this assertion as we consider that automated devices control like endovascular cooling allow significant shortening in time-to-target temperature, better controlled maintenance and rewarming phases, and improvement in intensive care unit nurses’ workload as described in our trial.1 However, as reported in several studies, it is not clear whether reaching the targeted temperature more quickly may result in a better prognosis in post–cardiac arrest patients. Although demonstrated by most of animal studies,2 several clinical studies failed to prove any relationship between time-to-target temperature and final outcome.3 In contrast, studies even observed that the lower the time-to-target temperature, the worse the prognosis could be, suggesting that the more the brain is damaged, the more the thermoregulation is impaired leading to lower core temperature on admission.4 This …

Published
2016

40. Prise en charge actuelle du traumatisé grave en France : premier bilan de l’étude FIRST (French Intensive care Recorded in Severe Trauma)

Author

Bruno Riou, F. Rayeh, Claude Jacquot, Jacques Duranteau, Claude Martin, Claire Bonithon-Kopp, Delphine Garrigue, Jean-Michel Yeguiayan, Marc Freysz, and Christine Binquet

Subjects
medicine.medical_specialty, business.industry, Intensive care, Anesthesiology, Emergency Medicine, medicine, Mobile intensive care unit, Medical emergency, medicine.disease, business
Abstract

Objectif Decrire la prise en charge des traumatises graves fermes dans les hopitaux universitaires francais.

Published
2012

41. Étude multicentrique française HemTrO : prise en charge de la coagulopathie aigue du traumatisé au cours des 6 premières heures

Author

Sophie Susen, Pierre Albaladejo, Carole Ichai, Jean-Stéphane David, Annick Steib, Marc Leone, Anne Godier, and Delphine Garrigue

Subjects
Anesthesiology and Pain Medicine
Abstract

Introduction Les recommandations de prise en charge de la coagulopathie aigue du traumatise (CAT) ont recemment evolue [1] . L’objectif etait d’evaluer les modalites de traitement transfusionnel et hemostatique mis en œuvre en France. Materiel et methodes Etude prospective multicentrique observationnelle (CCTIRS et CNIL) realisee dans 18 centres francais de traumatologie amenes a prendre en charge les traumatises severes. Etaient inclus 10 traumatises consecutifs par centre necessitant une transfusion ≥ 5 concentres de globules rouges (CGR) dans les 6 h suivant l’arrivee. Le type de traumatisme, les donnees cliniques et biologiques et les modalites de prise en charge de la CAT (CGR, plasma (PFC), plaquettes, acide tranexamique (ATX), concentres de fibrinogene (Fib), concentre de complexe prothombinique (CCP) et rFVIIa) ont ete releves du prehospitalier jusqu’a la 6 e heure apres l’admission. Les resultats sont exprimes en mediane et interquartiles. Resultats Les 18 centres ont inclus 163 patients (70 % d’hommes), âges de 42[27–58] ans. Les traumatismes etaient severes avec un ISS median de 34[27–50] (95 % d’ISS > 15), et principalement fermes (78,5 %). En prehospitalier, sont notes 15,5 % d’arret cardiaque, 65 % d’intubation, 45 % de catecholamines. Le delai avant l’arrivee a l’hopital etait de 114[75–143] min. Le Tableau 1 synthetise le traitement de la CAT jusqu’a la 6 e heure. Chaque traitement etait marque d’un effet centre. Les patients ont recu 4[2-6] CGR (dont des CGR O − dans 75 % des cas) et 3[2-4] PFC a H1, et 9[6–12] CGR et 7[4–10] PFC a H6. Le ratio PFC:CGR est passe de 0[0–0,7] a H1 a 0,8[0,6–1] a H6. La mortalite hospitaliere etait de 32 % dont 9 % a H6, attribuee a l’hemorragie dans 75 % des cas. La concentration en fibrinogene [Fib] a l’arrivee etait de 1,2[0,8–1,7] ; 57,1 %, 75,5 % et 89 % des [Fib] etaient respectivement −1 . L’administration prehospitaliere d’ATX n’etait pas correlee a [Fib] a l’arrivee. La [Fib] etait un facteur predictif de mortalite a H24. Aucun patient n’a recu de Fib en prehospitalier ; 42 % en ont recu la 1 re h avec une dose mediane de 3[1,5–3]g. L’administration a l’arrivee dependait du centre ; 54 % des patients ayant une [Fib] 1,5 en ont recu. Les patients traites avaient une mortalite a H24 plus elevee ( p re h chez les patients traites par Fib [+0,4(0–0,9] vs 0[−0,6–0,4]g.L −1 , p −1 dans 52 % des cas. A 48 h, tous les patients ayant un dosage avaient une [Fib] > 2 g.L −1 . Discussion Les pratiques ont evolue mais ne sont pas toujours conformes aux recommandations, avec des effets centres : les ratio PFC:CGR sont bas la 1 re h, la transfusion plaquettaire concerne

Published
2015

42. Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

Author

Delphine Garrigue, Marc Freysz, Jean-Michel Yeguiayan, Claire Bonithon-Kopp, Anabelle Yap, Claude Jacquot, Christine Binquet, Bruno Riou, Claude Martin, Département de médecine d'urgence / SAMU - SMUR - CESU 21 (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Fédération des Urgences - SAMU 59, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Pôle Anesthésie Réanimation, CHU Grenoble, Centre de Traumatologie et Département d'Anesthésie Réanimation, Université de la Méditerranée - Aix-Marseille 2-Centre Hospitalier Universitaire Nord, Lipides - Nutrition - Cancer (U866) (LNC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Accueil des Urgences [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Pierre et Marie Curie - Paris 6 (UPMC), This study was supported by the Programme Hospitalier de Recherche Clinique 2003 of the French Ministry of Health (National PHRC), the Société Française d'Anesthésie Réanimation (SFAR), and the Centre Hospitalier Universitaire of Dijon., Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques ( CIC-EC ), Université de Bourgogne ( UB ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Accueil des Urgences, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], BMC, Ed., Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)

Subjects
Adult, Male, medicine.medical_specialty, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], [SHS.INFO]Humanities and Social Sciences/Library and information sciences, Critical Care and Intensive Care Medicine, Wounds, Nonpenetrating, [SHS.INFO] Humanities and Social Sciences/Library and information sciences, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Intensive care, [ SHS.INFO ] Humanities and Social Sciences/Library and information sciences, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Young adult, Mortality, Prospective cohort study, Trauma Severity Indices, blunt trauma, [ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], business.industry, Mortality rate, Research, Disease Management, 030208 emergency & critical care medicine, Middle Aged, 3. Good health, Surgery, Blunt trauma, Propensity score matching, Injury Severity Score, Female, business, Tomography, X-Ray Computed, Cohort study
Abstract

International audience; IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.ResultsIn total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups.ConclusionsDiagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

Published
2012

43. The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients

Author

Jean-Michel Yeguiayan, Benoît Vivien, Sébastien Mirek, Bruno Riou, Claire Bonithon-Kopp, Delphine Garrigue, Marc Freysz, and Yannick Le Manach

Subjects
Adult, Male, Emergency Medical Services, Movement, Poison control, Logistic regression, Injury Severity Score, Medicine, Humans, Glasgow Coma Scale, Prospective Studies, Receiver operating characteristic, business.industry, General Medicine, Odds ratio, Revised Trauma Score, medicine.disease, Triage, Logistic Models, ROC Curve, Anesthesia, Emergency Medicine, Wounds and Injuries, Female, Medical emergency, business
Abstract

Purpose We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS) conveys most of the predictive information of triage scores (Triage Revised Trauma Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma patients. Method We conducted a multicenter prospective observational study and evaluated 1690 trauma patients in 14 centers. We compared the GCS, T-RTS, MGAP, and Trauma Related Injury Severity Score (reference standard) using the full GCS or its motor component only using logistic regression model, area under the receiver operating characteristic curve, and reclassification technique. Results Although some changes were noted for the GCS itself and the Trauma Related Injury Severity Score, no significant change was observed using the motor component only for T-RTS and MGAP when considering (1) the odds ratio of variables included in the logistic model as well as their discrimination and calibration characteristics, (2) the area under the receiver operating characteristic curve (0.827 ± 0.014 vs 0.831 ± 0.014, P = .31 and 0.863 ± 0.011 vs 0.859 ± 0.012, P = .23, respectively), and (3) the reclassification technique. Although the mortality rate remained less than the predetermined threshold of 5% in the low-risk stratum, it slightly increased for MGAP (from 1.9% to 3.9%, P = .048). Conclusion The use of the motor component only of the GCS did not change the global performance of triage scores in trauma patients. However, because a subtle increase in mortality rate was observed in the low-risk stratum for MGAP, replacing the GCS by its motor component may not be recommended in every situation.

Published
2011

44. Intra-cerebral haemorrhages: are there any differences in baseline characteristics and intra-hospital mortality between hospitaland population-based registries?

Author

Didier Leys, Charlotte Cordonnier, Matthieu P. Rutgers, Frédéric Dumont, Marta Pasquini, Maurice Giroud, Yannick Béjot, Jean-Paul Lejeune, Hilde Hénon, Xavier Leclerc, and Delphine Garrigue

Subjects
Male, medicine.medical_specialty, Neurology, Population, Hypercholesterolemia, Disease, Comorbidity, Cohort Studies, Age Distribution, Epidemiology, medicine, Humans, cardiovascular diseases, Hospital Mortality, Registries, education, Stroke, Selection Bias, Neuroradiology, Aged, Cerebral Hemorrhage, Aged, 80 and over, education.field_of_study, business.industry, Vascular disease, Patient Selection, Middle Aged, medicine.disease, nervous system diseases, Surgery, Natural history, Alcoholism, Emergency medicine, Female, Neurology (clinical), France, business, Emergency Service, Hospital
Abstract

A better understanding of the natural history of intracerebral haemorrhages (ICH) with cohorts representing the whole spectrum of the disease is necessary to improve treatment. Our aim was to identify potential differences in baseline characteristics and short-term outcomes of patients with non-traumatic ICH, included in a hospital- and in a population-based stroke registry. We compared 373 patients recruited in a university hospital and the last 373 ICH patients included in a population-based registry. Both cohorts included consecutive patients with non-traumatic parenchymal haemorrhages. In the hospital cohort, we collected data from all patients admitted in the emergency room, irrespective of the clinical severity and of the specialist in charge of the patient.In the hospital cohort, patients were younger and more often alcoholic, but these differences may be explained by the younger age and a higher prevalence of alcoholism in this area. Patients also had more frequently hypercholesterolemia, and were more often under antiplatelet therapy. Both cohorts did not differ for intra-hospital casefatality rate.The characteristics of patients included in the hospital cohort were very close to those of patients from a population-based registry, and the differences observed are likely to be explained by differences in the characteristics of the populations in the two areas and different periods of recruitment. Recruiting patients in emergency rooms, and not in stroke units, neurological, or neurosurgical departments, has enabled us to build a cohort of ICH patients representative of the whole spectrum of the disease, with minimised recruitment bias and maximised precision of the variables collected. This cohort may, therefore, provide reliable information on the natural history of ICH.

Published
2007

45. Audit clinique ciblé sur la prise en charge des 24 premières heures d’un patient en choc hémorragique d’origine traumatique

Author

Benoît Tavernier, Morgane Bacus, Eric Kipnis, Anne Guidat, Sophie Susen, and Delphine Garrigue

Subjects
Anesthesiology and Pain Medicine
Abstract

Introduction L’hemorragie par traumatisme est la premiere cause de deces evitable chez le jeune en France. Pour ameliorer la qualite et la securite des soins, un audit clinique cible, utilisant l’echelle de conformite de la Haute Autorite de sante et base sur les recommandations europeennes mises a jour en 2013 [1] a ete realise. Materiel et methodes Etude observationnelle, retrospective, non interventionnelle, realisee de mai 2010 a octobre 2014 (CNIL). Les dossiers audites etaient les patients victimes d’un traumatisme, ayant recu 6 culots de globules rouges ou plus au cours des 24 premieres heures de prise en charge. La pratique observee etait comparee a la pratique attendue, selon un referentiel cree a partir des 37 recommandations traduites puis regroupees en 20 criteres. Chacun des criteres etait classe dans 1 des 5 items qui correspondaient aux differents temps et objectifs de la prise en charge decrits dans les recommandations de 2013 : – reanimation initiale et prevention du saignement ; – diagnostic et monitorage ; – oxygenation, remplissage, lutte contre l’hypothermie ; – controle rapide du saignement ; – gestion du saignement et de la coagulopathie. Pour chaque critere des limites de conformite (conforme/non conforme/non applicable) ont ete discutees par des experts et validees par le medecin coordinateur a la gestion des risques associes aux soins. Ils etaient classes selon un niveau de maturite (1 a 4) decrit par l’HAS [2] . Les resultats sont exprimes en nombre ou %, en moyenne (ecart-type) ou mediane [1 er quartile;3 e quartile]. Test statistique de Kruskal–Wallis. p Resultats Ainsi, 121 dossiers ont ete audites. L’âge etait de 42 (± 16) ans, 66 % etaient des hommes. L’ISS etait de 34 [19;45], la mortalite a H24 etait de 18 % et a j30 de 32 %. Le delai entre l’arrivee et la realisation d’un body-scanner etait de 30 [21;47] min et de 168 [106;222] min entre l’arrivee et le geste d’hemostase. Sept criteres avaient un niveau de maturite maitrise et optimise (niveaux 3 et 4, conformes dans plus de 80 % des dossiers), 10 avaient un niveau de maturite defini (niveau 2, conformes dans 45 a 80 % des cas) et 2 avaient un niveau de base (niveau 1, conformes dans moins de 45 % des cas). Les patients vivants a H24 et j30 avaient un nombre de criteres conformes superieur aux patients decedes, respectivement : 11[10;13] vs 9,5[8;11]; p = 0,0005 a H24 et 11 [10;13] vs 10 [8;11], p Discussion La grille d’audit mise au point pour les besoins de ce travail a permis une evaluation objective et exhaustive des pratiques de prise en charge initiale du choc hemorragique traumatique dans notre hopital. Elle pourrait etre utilisee par toute structure souhaitant evaluer ses pratiques dans ce domaine. Des protocoles de prise en charge bases sur les recommandations francaises de 2014 seront proposes afin d’ameliorer nos pratiques [3] et un nouvel audit sera realise.

Published
2015

46. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

Author

Christine Binquet, Marc Freysz, Claude Jacquot, Fatima Rayeh, Jean Michel Yeguiayan, Claire Bonithon-Kopp, Delphine Garrigue, Claude Martin, Jacques Duranteau, Bruno Riou, Service d'Anesthésie et Réanimation (hôpital général, CHU Dijon), Hôpital général (CHU Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Fédération des Urgences - SAMU59, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service d'anesthésie et réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Centre de traumatologie et Département d'Anesthésie Réanimation, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital nord, Service d'Anesthésie Réanimation Chirurgicale [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service d'Accueil des Urgences [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), This study was supported by the Programme Hospitalier de Recherche Clinique 2003 of the French Ministry of Health (National PHRC), the Société Française d'Anesthésie Réanimation (SFAR) and the Centre Hospitalier Universitaire de Dijon., The FIRST (French Intensive Care Recorded In Severe Trauma) Study Group, Université de la Méditerranée - Aix-Marseille 2-Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Assistance Publique - Hôpitaux de Marseille (APHM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Anesthésie et Réanimation, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques ( CIC-EC ), Université de Bourgogne ( UB ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Albert Michallon, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille ( APHM ) -Hôpital nord, CHU de Poitiers, Service d'Accueil des Urgences, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], and BMC, Ed.

Subjects
Male, Emergency Medical Services, Time Factors, MESH : Aged, MESH : Prospective Studies, Poison control, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Injury Severity Score, Patient Admission, Emergency medical services, [ SHS.INFO ] Humanities and Social Sciences/Library and information sciences, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Prospective cohort study, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Mortality rate, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Patient Admission, MESH : Adult, Middle Aged, 3. Good health, MESH : Wounds and Injuries, Intensive Care Units, Treatment Outcome, Blunt trauma, MESH: Young Adult, MESH: Emergency Medical Services, MESH : Injury Severity Score, France, MESH: Firefighters, MESH : Intensive Care Units, Cohort study, MESH : Time Factors, Adult, medicine.medical_specialty, Adolescent, MESH : Male, [SHS.INFO]Humanities and Social Sciences/Library and information sciences, MESH: Injury Severity Score, MESH : Young Adult, MESH : Treatment Outcome, [SHS.INFO] Humanities and Social Sciences/Library and information sciences, MESH : Hospital Mortality, 03 medical and health sciences, Young Adult, Intensive care, MESH : Adolescent, medicine, Humans, MESH : Emergency Medical Services, MESH : Middle Aged, MESH: Hospital Mortality, Intensive care medicine, MESH : France, Aged, MESH: Adolescent, MESH: Humans, business.industry, MESH: Patient Admission, Research, MESH : Humans, MESH: Time Factors, 030208 emergency & critical care medicine, MESH: Adult, MESH: Male, MESH: Prospective Studies, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Wounds and Injuries, Firefighters, Emergency medicine, Wounds and Injuries, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Firefighters, business
Abstract

International audience; INTRODUCTION: Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. METHODS: The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. RESULTS: Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. CONCLUSIONS: This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.

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47. Endotheliopathy Is Induced by Plasma From Critically Ill Patients and Associated With Organ Failure in Severe COVID-19

Author

Rauch, Antoine, Dupont, Annabelle, GOUTAY, Julien, Caplan, Morgan, Staessens, Senna, Moussa, Mouhamed, Jeanpierre, Emmanuelle, Corseaux, Delphine, Lefevre, Guillaume, Lassalle, Fanny, Faure, Karine, Lambert, Marc, Duhamel, Alain, Labreuche, Julien, Garrigue, Delphine, De Meyer, Simon F., Staels, Bart, Van Belle, Eric, Vincent, Flavien, Kipnis, Eric, Lenting, Peter J., Poissy, Julien, Susen, Sophie, Research Network (LICORNE), For the Lille COVID, Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Université Catholique de Louvain = Catholic University of Louvain (UCL), Unité de Glycobiologie Structurale et Fonctionnelle UMR 8576 (UGSF), Université de Lille-Institut National de la Recherche Agronomique (INRA)-Centre National de la Recherche Scientifique (CNRS), This study was supported by the French government through the Program Investissement d’Avenir (I-SITE ULNE/ANR-16-IDEX-0004 ULNE)., Members of the LICORNE Scientific Committee: Dominique Deplanque (Clinical Investigation Center, CHU Lille, France) Karine Faure (Department of Infectious Diseases, CHU Lille, France) Guillaume Lefevre (Department of Immunology, CHU Lille, France) Enagnon Kazali Alidjinou (Department of Virology, CHU Lille, France) Régis Bordet (Department of Medical Pharmacology, CHU Lille, France) Marie-Charlotte Chopin (Department of Infectious Diseases, CHU Lille, France) Ilka Engelmann (Department of Virology, CHU Lille, France) Delphine Garrigue (Department of Emergency, CHU Lille, France) Anne Goffard (Department of Virology, CHU Lille, France) Eric Kipnis (Department of Anesthesia and Critical Care, CHU Lille, France) Myriam Labalette (Department of Immunology, CHU Lille, France) Marc Lambert (Department of Internal Medicine, CHU Lille, France) David Launay (Department of Internal Medicine, CHU Lille, France) Daniel Mathieu (Department of Intensive Care, CHU Lille, France) Claude-Alain Maurage (Department of Anatomopathology, CHU Lille, France) Julien Poissy (Department of Intensive Care, CHU Lille, France) Boualem Sendid (Department of Parasitology, CHU Lille, France) Sophie Susen (Department of Hematology, CHU Lille, France), ANR-16-IDEX-0004,ULNE,ULNE(2016), Université de Lille, LillOA, ULNE - - ULNE2016 - ANR-16-IDEX-0004 - IDEX - VALID, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), and Université de Lille-Centre National de la Recherche Scientifique (CNRS)

Subjects
renal failure, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Severity of Illness Index, Plasma, chemistry.chemical_compound, 0302 clinical medicine, Cytotoxic T cell, 030212 general & internal medicine, Cells, Cultured, ComputingMilieux_MISCELLANEOUS, endotheliopathy, biology, Interleukin, 3. Good health, Endothelial stem cell, [SDV] Life Sciences [q-bio], cell death, endothelial cell, Tumor necrosis factor alpha, Coronavirus Infections, Cardiology and Cardiovascular Medicine, Cell-Free Nucleic Acids, liver injury, medicine.medical_specialty, Cell Survival, Critical Illness, Multiple Organ Failure, Pneumonia, Viral, Aspartate transaminase, Proinflammatory cytokine, Betacoronavirus, 03 medical and health sciences, Immune system, Physiology (medical), Lactate dehydrogenase, Internal medicine, Correspondence, Research Letter, medicine, Humans, Pandemics, SARS-CoV-2, Interleukin-6, business.industry, respiratory failure, COVID-19, Endothelial Cells, Endocrinology, chemistry, Microvessels, biology.protein, Syndecan-1, business
Abstract

This article assessed whether plasma collected from patients with COVID-19 at different disease stages could trigger endothelial damage in vitro by using cultured human pulmonary microvascular endothelial cells (HPMVEC) This study also further investigated the association of plasma-induced cytotoxicity with levels of circulating biomarkers related to organ dysfunction (Pao2 [partial pressure of oxygen in arterial blood]/Fio2 [fraction of inspired oxygen], widely used as an indicator of oxygenation requirements, lactate dehydrogenase, creatinine, and aspartate transaminase), endothelial damage (von Willebrand factor antigen;ADAMTS13;plasminogen activator inhibitor-1;syndecan-1), tissue injury (cell-free DNA, a damage-associated molecular patterns marker), and levels of circulating cytokines related to the activation of innate (interleukin [IL]-6 and tumor necrosis factor-a) and adaptative immune cell responses (soluble IL-2 receptor) Inclusion criteria were individuals aged 18 years or older with a positive SARS-CoV-2 real-time reverse-transcriptase polymerase chain reaction on nasal or tracheal samples This data shed new light on the pathophysiology of COVID-19 by demonstrating the direct and rapid cytotoxic effect of plasma collected from critically ill patients on vascular endothelial cells This rapid effect (1 hour after plasma exposure) excludes a direct cytopathic effect of SARS-CoV-2 infection, as the progression of viral infection and visible cytopathogenic effects are in general only apparent 12 to 24 hours after infection 5 A higher cytotoxic effect of plasma on endothelial cells was associated with a more pronounced hypoxemia and organ dysfunction as reflected by the correlation with Pao2/FiO2, lactate dehydrogenase, creatinine, and aspartate transaminase This cytotoxic effect also correlated with circulating markers of endothelial damage, indicating that this in vitro functional assay reflects microvascular endothelial damage in vivo Different pathways could be involved in endothelial cell injury during the course of COVID-19, i e , complement activation, cellular hypoxia, platelets, and direct cytotoxicity of cytokines such as IL-6, IL-1beta, and tumor necrosis factor-a The study observed a relationship between this cytotoxic effect and the level of proinflammatory cytokines, suggesting that cytotoxicity could be related to overproduction of proinflammatory cytokines

Published
2020

48. Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network.

Author

Godier A, Lasne D, Pernod G, Blais N, Bonhomme F, Bounes F, Bourguignon A, Cohen A, de Maistre E, Fontana P, Galanaud JP, Huet DG, Godon A, Gouin-Thibault I, Jebara S, Laporte S, Lecompte T, Longrois D, H Levy J, Le Gal G, Gruel Y, Mansour A, Martin AC, Mazighi M, Morange PE, Motte S, Mullier F, Nguyen P, Rosencher N, Roullet S, Roy PM, Schved JF, Sevestre MA, Sié P, Susen S, Tacquard C, Vincentelli A, Zufferey P, Mismetti P, and Albaladejo P

Abstract

Background: Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE., Objective: A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011., Methods: The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed., Results: 78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts., Conclusions: These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs., (Copyright © 2024. Published by Elsevier Masson SAS.)

Published
2024
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