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1. The Anticipated Organ Donation Approach Increases the Number of Organ Donors

Author

Erwan d’Aranda, Valérie Arsonneau, and Didier Demory

Subjects
brain death, intensive care, organ donors, organ procurement, tissue donors, Anesthesiology, RD78.3-87.3
Abstract

Objective: Deficiency of organs for transplantation is a significant public health issue. French learned societies accept intensive care unit admission for patients with catastrophic neurological prognosis to optimize organs prior to probable brain death. We evaluated the implementation of a specific ethical care procedure for these patients. Methods: A descriptive before-after study was conducted, comparing the 2009-2012 period to the 2013-2016 period, during which this procedure was applied. Results: The number of patients increased from 145 to 186 (+28.3%) and the number of harvested organs increased from 323 to 485 (+50.1%). The anticipated organ donation approach was initiated 135 times. Of the 117 meetings with families, 83 (71%) consented to organ donation. Fifty-three (64%) patients were brain dead, and 49 (92%) of these patients had 194 organs harvested. Conclusion: The anticipated approach increased the number of donors and organs suitable for grafts. The application of a specific protocol for managing untreatable catastrophic neurological patients improved communication between hospital staff and families and respected patient autonomy by offering options for either organ donation or palliative care.

Published
2024
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2. Correlation between field triage criteria and the injury severity score of trauma patients in a French inclusive regional trauma system

Author

Arnaud Cassignol, Julien Marmin, Jean Cotte, Mickael Cardinale, Julien Bordes, Vanessa Pauly, François Kerbaul, Didier Demory, and Eric Meaudre

Subjects
Field triage, Vittel criteria, Algorithm, ISS, Mortality, Intensive care unit, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background In France, the pre-hospital field triage of trauma patients is currently based on the Vittel criteria algorithm. This algorithm was originally created in 2002 before the stratification of trauma centers and, at the national level, has not been revised since. This could be responsible for the overtriage of trauma patients in Level I Trauma Centers. The principal aim of this study was to evaluate the correlation between each Vittel field triage criterion and trauma patients’ Injury Severity Score. Methods Our Level I Trauma Center receives an average of 300 trauma patients per year. Demographic and physiological data, along with the entire trauma patient management process and Vittel field triage criteria, are recorded in a local trauma registry. The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are calculated after a complete assessment of the trauma victim during their in-hospital management. Results were concerned with the presence of an ISS of greater than 15, which defined a major trauma patient; mortality within 30 days; and admission to the intensive care unit. This study is a registry analysis from January 2013 to September 2017. Results Of the 1373 patients in the registry, 1151 were included in the analysis with a mean age of 43 years (± 19) and a median ISS of 13 (IQR = 5–22), where 887 (77%) were male. Nine of the 24 Vittel criteria were associated with an ISS > 15. In a multivariate analysis, no criterion related to kinetic elements was significantly correlated with an ISS > 15, mortality within 30 days, or admission to intensive care. Three algorithm categories were predictive of a major trauma patient (ISS > 15): physiological variables, pre-hospital resuscitation, and physical injuries, while kinetic elements were not. Conclusions Criteria related to physiological variables, pre-hospital resuscitation, and physical injuries are the most relevant to predicting the severity of a trauma patient’s condition. A revision of the VCA could potentially have beneficial effects on the over and undertriage phenomena, which constitute ongoing medical and financial concerns.

Published
2019
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3. Civilian prehospital transfusion – experiences from a French region

Author

Léa Goffinet, Pascal Mattei, Aurélien Renard, Sandrine Pons, Arnaud Cassignol, Julien Marmin, Didier Demory, and Julien Bordes

Subjects
Adult, Male, Emergency Medical Services, Resuscitation, medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Shock, Hemorrhagic, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Blood Transfusion, Aged, Retrospective Studies, business.industry, Mortality rate, Medical record, Glasgow Coma Scale, Retrospective cohort study, Hematology, General Medicine, Blood Coagulation Disorders, Middle Aged, Blood pressure, Emergency medicine, Wounds and Injuries, Female, France, Hypotension, Packed red blood cells, business, 030215 immunology
Abstract

BACKGROUND AND OBJECTIVES Haemorrhagic shock is a leading cause of avoidable mortality in prehospital care. For several years, our centre has followed a procedure of transfusing two units of packed red blood cells outside the hospital. Our study's aim was twofold: describe the patient characteristics of those receiving prehospital blood transfusions and analyse risk factors for the 7-day mortality rate. MATERIALS AND METHODS We performed a monocentric retrospective observational study. Demographic and physiological data were recovered from medical records. The primary outcome was mortality at seven days for all causes. All patients receiving prehospital blood transfusions between 2013 and 2018 were included. RESULTS Out of 116 eligible patients, 56 patients received transfusions. Trauma patients (n = 18) were younger than medical patients (n = 38) (P = 0·012), had lower systolic blood pressure (P = 0·001) and had higher haemoglobin levels (P = 0·016). Mortality was higher in the trauma group than the medical group (P = 0·015). In-hospital trauma patients received more fresh-frozen plasma and platelet concentrate than medical patients (P

Published
2020
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4. Curarisation prolongée et mémorisation après succinylcholine : déficit en butyrylcholinestérase

Author

Vincent Chauvin, Frédérique Blanc, Didier Demory, and Karine Guet

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, business.industry, Pseudocholinesterase deficiency, medicine, 030212 general & internal medicine, medicine.disease, business
Abstract

Resume La succinylcholine est un curare tres frequemment utilise et repute bien tolere. Cependant, son utilisation peut engendrer un bloc neuromusculaire prolonge de phase II en cas de deficit en pseudocholinesterase. Nous rapportons le cas d’une patiente de 61 ans ayant presente un retard de la reprise de la ventilation spontanee en fin d’intervention a l’arret de l’anesthesie generale, apres avoir ete exposee a la succinylcholine a l’induction. La ventilation mecanique a du etre poursuivie plus de six heures supplementaires. La patiente a egalement rapporte une parfaite memorisation de la periode qui a suivi l’arret des sedations. Le dosage de l’activite plasmatique en pseudocholinesterase a confirme le deficit fonctionnel de cette enzyme chez la patiente. Ce cas clinique est l’occasion de souligner l’interet de disposer d’un curametre en salle d’intervention au bloc operatoire. Nous rappelons aussi les grandes lignes de prise en charge d’un patient avec un deficit non connu en pseudocholinesterases, notamment l’information au patient et a la famille qui presente un caractere essentiel.

Published
2016
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5. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases

Author

Mourad Boufi, Eric Kipnis, Oriane Martinez, Alexandra Piton, Djillali Annane, Nicolas Bruder, Olivier Baldesi, Didier Demory, Matthieu Legrand, Jean-Michel Constantin, Claude Martin, Bernard Allaouchiche, Florent Wallet, Karim Asehnoune, Olivier Mimoz, Karine Baumstarck, Baptiste Hengy, Jean-Yves Lefrant, Charlotte Arbelot, Laurence Delapierre, Alexandre Ouattara, Bruno Levy, Carole Ichai, Simon Bourcier, Fanny Klasen, Elisa Richter, Thomas Rimmelé, Kamel Toufik, Carole Bechis, Marc Leone, Sigismond Lasocki, Emilie Friou, Pascal Augustin, Jugurtha Aliane, Olivier Collange, Etienne Brasdefer, Marie-Charlotte Vogler, Samir Jaber, Eric Peytel, Pierre-Marie Bertrand, 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), Service d’anesthésie et de réanimation, Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants (SPMC), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM), Service d’Anesthésie-Réanimation II Bordeaux, Services de soins intensifs, CHU Strasbourg, Département d’Anesthésie Réanimation Chirurgicale, CIT-IT Garches, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [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), Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de réanimation, CHU Saint-Antoine [AP-HP], Service de Réanimation Polyvalente, Centre Hospitalier Henri Duffaut (Avignon), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum Ulm - University Hospital of Ulm, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Lille (CHU de Lille), Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Agressions vasculaires et réponses tissulaires, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Retinoids, Development and Developmental Diseases (R2D2), Université d'Auvergne - Clermont-Ferrand I (UdA), Intensive Care Unit, Cannes general hospital, Cannes, Réanimation Polyvalente, Hôpital de la Timone [CHU - APHM] (TIMONE), Unité médicale de soins intensifs, Department of Medical Intensive Care and Hyperbaric Medicine, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service d’Anesthésiologie et Réanimation [H.I.A Laveran, Marseille], Hôpital d'instruction des armées Laveran [Marseille], Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Département d’Anesthésie et de Réanimation, Medical-surgical Intensive Care Unit, Service d’anesthésie réanimation, Aix-Marseille Université - Faculté de médecine (AMU MED), Aix Marseille Université (AMU), CHU Clermont-Ferrand, CHU Marseille, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Surgical Critical Care Unit, Department of Anesthesiology and Critical Care, Département d'anesthésie et de soins intensifs, and MORNET, Dominique

Subjects
medicine.medical_specialty, [SDV]Life Sciences [q-bio], health care facilities, manpower, and services, Recursive partitioning, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Severity of illness, medicine, Risk factor, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, business.industry, Mortality rate, 030208 emergency & critical care medicine, Retrospective cohort study, medicine.disease, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Mesenteric ischemia, Emergency medicine, business
Abstract

In the intensive care unit (ICU), the outcomes of patients with acute mesenteric ischemia (AMI) are poorly documented. This study aimed to determine the risk factors for death in ICU patients with AMI. A retrospective, observational, non-interventional, multicenter study was conducted in 43 ICUs of 38 public institutions in France. From January 2008 to December 2013, all adult patients with a diagnosis of AMI during their hospitalization in ICU were included in a database. The diagnosis was confirmed by at least one of three procedures (computed tomography scan, gastrointestinal endoscopy, or upon surgery). To determine factors associated with ICU death, we established a logistic regression model. Recursive partitioning analysis was applied to construct a decision tree regarding risk factors and their interactions most critical to determining outcomes. The death rate of the 780 included patients was 58 %. Being older, having a higher sequential organ failure assessment (SOFA) severity score at diagnosis, and a plasma lactate concentration over 2.7 mmol/l at diagnosis were independent risk factors of ICU mortality. In contrast, having a prior history of peripheral vascular disease or an initial surgical treatment were independent protective factors against ICU mortality. Using age and SOFA severity score, we established an ICU mortality score at diagnosis based on the cutoffs provided by recursive partitioning analysis. Probability of survival was statistically different (p

Published
2015
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6. Closed loop ventilation mode in Intensive Care Unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes

Author

Thomas Laubscher, Stephane-Yannis Donati, Gaëlle Corno, Didier Demory, Jean-Michel Arnal, Laurent Ducros, Jacques Durand-Gasselin, Dominik Novotni, Aude Garnero, and Gabrielle Quintana

Subjects
Male, medicine.medical_specialty, Sedation, medicine.medical_treatment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, Aged, Mechanical ventilation, business.industry, 030208 emergency & critical care medicine, Workload, Middle Aged, Respiration, Artificial, Intensive care unit, Clinical trial, Intensive Care Units, Anesthesiology and Pain Medicine, 030228 respiratory system, Emergency medicine, Ventilation (architecture), Arterial blood, Female, Blood Gas Analysis, medicine.symptom, business
Abstract

BACKGROUND There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. METHODS This randomized controlled trial compared the number of manual ventilator setting changes between a full closed loop ventilation and oxygenation mode (INTELLiVENT-ASV®) and conventional ventilation modes (volume assist control and pressure support) in Intensive Care Unit (ICU) patients. The secondary endpoints were to compare the number of arterial blood gas analysis, the sedation dose and the user acceptance. Sixty subjects with an expected duration of mechanical ventilation of at least 48 hours were randomized to be ventilated using INTELLiVENT-ASV® or conventional modes with a protocolized weaning. All manual ventilator setting changes were recorded continuously from inclusion to successful extubation or death. Arterial blood gases were performed upon decision of the clinician in charge. User acceptance score was assessed for nurses and physicians once daily using a Likert Scale. RESULTS The number of manual ventilator setting changes per 24 h-period per subject was lower in INTELLiVENT-ASV® as compared to conventional ventilation group (5 [4-7] versus 10 [7-17]) manuals settings per subject per day [P

Published
2018
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7. Antifungal therapy for patients with proven or suspected Candida peritonitis: Amarcand2, a prospective cohort study in French intensive care units

Author

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

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

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

Published
2017
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8. Does Admission During Morning Rounds Increase the Mortality of Patients in the Medical ICU?

Author

Antoine Roch, Magali Bisbal, Didier Demory, Vanessa Pauly, Jean-Michel Arnal, Christophe Guervilly, Marc Gainnier, Jean-Marie Forel, Fabrice Michel, and Laurent Papazian

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Hospital mortality, Critical Care and Intensive Care Medicine, Risk Assessment, Statistics, Nonparametric, Time, law.invention, Patient Admission, Risk Factors, law, Humans, Medicine, Hospital Mortality, APACHE, Aged, Proportional Hazards Models, Retrospective Studies, Chi-Square Distribution, business.industry, Proportional hazards model, Retrospective cohort study, Middle Aged, Intensive care unit, Icu admission, Intensive Care Units, Medical icu, Emergency medicine, Female, France, Cardiology and Cardiovascular Medicine, business, Morning Rounds, Chi-squared distribution
Abstract

Early optimization of treatment is crucial when admitting patients to the ICU and could depend on the organization of the medical team. The aim of this retrospective observational study was to determine whether admissions during morning rounds are independently associated with hospital mortality in a medical ICU.The 3,540 patients admitted from May 2000 to April 2010 to the medical ICU of Sainte Marguerite Hospital in Marseille, France, were divided into two groups based on the time of admission.The non-morning rounds group was admitted between 1:00 PM and 7:59 AM , and the morningrounds group was admitted between 8:00 AM and 12:59 PM . Hospital mortality (crude and adjusted)was compared between the two groups.The 583 patients (16.5%) admitted during morning rounds were older and sicker upon admission compared with those patients admitted during non-morning rounds. The crude hospital mortality was 35.2% (95% CI , 31.4-39.1) in the group of patients admitted during morning rounds and 28.0% (95% CI, 26.4-29.7) in the other group ( P.001). An admission during morning rounds was not independently associated with hospital death (adjusted hazard ratio, 1.10; 95% CI,0.94-1.28; P 5=.24).Being admitted to the medical ICU during morning rounds is not associated with a poorer outcome than afternoon and night admissions. The conditions of the patients admitted during morning rounds were more severe, which underlines the importance of the ICU team’s availability during this time. Further studies are needed to evaluate if the presence of a specific medical team overnight in the wards would be able to improve patients’ outcome by preventing delayed ICU admission.

Published
2012
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9. Right ventricular function during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome

Author

Jean-Marie Forel, Jérôme Allardet-Servent, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Didier Demory, Matthias Castanier, Antoine Roch, Karine Barreau-Baumstark, and Mélanie Adda

Subjects
medicine.medical_specialty, Ventricular function, business.industry, MEDLINE, Acute respiratory distress, Mean airway pressure, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, Randomized controlled trial, law, Emergency medicine, Respiration, medicine, Intensive care medicine, business, High frequency oscillatory ventilation
Abstract

Objective:To evaluate the effect of mean airway pressure under high-frequency oscillatory ventilation on right ventricular function.Design:Prospective randomized study.Setting:Intensive care unit of a tertiary care hospital.Patients:Sixteen consecutive patients within the first 48 hrs of mainly pulm

Published
2012
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10. Efficacité, tolérance et coût d’une sédation par sévoflurane en réanimation

Author

M. Sallée, I. Granier, Didier Demory, J.-M. Arnal, M. Bisbal, J. Durand-Gasselin, G. Corno, Stephane-Yannis Donati, and A. Passelac

Subjects
Anesthesiology and Pain Medicine, General Medicine
Abstract

Resume Objectifs Evaluer l’efficacite, la tolerance hemodynamique systemique et cerebrale, et le cout d’une sedation par sevoflurane apres echec du midazolam en reanimation. Type d’etude Etude prospective observationnelle monocentrique. Patients et methodes Les patients ventiles en echec de sedation profonde pendant quatre heures consecutives (score de Ramsay inferieur a 5 avec 10 mg/h de midazolam et 400 μg/h de fentanyl) etaient inclus. Une sedation par sevoflurane et fentanyl (200 μg/h) etait realisee pendant 48 heures. Le sevoflurane etait administre via un filtre evaporateur (AnaConDa™) avec un objectif de Ramsay superieur ou egal a cinq. Le score de Ramsay, la pression arterielle moyenne, la consommation de noradrenaline, la pression intracrânienne (PIC) et la pression de perfusion cerebrale (PPC) chez les patients traumatises crâniens etaient mesures. Les couts directs de la sedation et le cout indexe ont ete calcules. Les mesures a j0 (sedation intraveineuse), j1 et j2 (sedation inhalee) ont ete comparees . Resultats Vingt-cinq patients (âge = 51 [38–63], IGS II 43 [33–49]) ont ete inclus. Le score de Ramsay etait de 4 [4,5] a j0 et 6 [6] a j1 et j2 ( p p p p Conclusion Le sevoflurane represente une alternative efficace au midazolam chez les patients de reanimation en echec de sedation intraveineuse.

Published
2011
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11. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study

Author

Laurent, Zieleskiewicz, Laurent, Muller, Karim, Lakhal, Zoe, Meresse, Charlotte, Arbelot, Pierre-Marie, Bertrand, Belaid, Bouhemad, Bernard, Cholley, Didier, Demory, Serge, Duperret, Jacques, Duranteau, Christophe, Guervilly, Emmanuelle, Hammad, Carole, Ichai, Samir, Jaber, Olivier, Langeron, Jean-Yves, Lefrant, Yazine, Mahjoub, Eric, Maury, Eric, Meaudre, Fabrice, Michel, Michel, Muller, Cyril, Nafati, Sébastien, Perbet, Hervé, Quintard, Béatrice, Riu, Coralie, Vigne, Kathia, Chaumoitre, François, Antonini, Bernard, Allaouchiche, Claude, Martin, Jean-Michel, Constantin, Daniel, De Backer, Marc, Leone, Mathias, Castanier, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Pôle d'anesthésie-réanimation-urgences, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Intensive Care Unit, Cannes general hospital, Cannes, Université Bourgogne Franche-Comté [COMUE] (UBFC), 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), Service d'Anesthésie-Réanimation [CHU HEGP], 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), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, Département de Recherche en Ethique, Université Paris-Sud - Paris 11 (UP11), Service d'anesthésie et réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, 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), Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Unité Générale de Soins Intensifs, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de dermatologie [CHU d'Amiens-Picardie], CHU Amiens-Picardie, CHU Saint-Antoine [AP-HP], département d'anesthésie, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Service d'anesthésie et de réanimation, Institut de pharmacologie moléculaire et cellulaire (IPMC), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de Réanimation, Hospices Civils de Lyon (HCL)-Hôpital E. Herriot, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], Service des Soins Intensifs, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], CHU Toulouse [Toulouse], Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital Nord [CHU - APHM], Laboratoire d'Economie Appliquée de Grenoble ( GAEL ), Université Pierre Mendès France - Grenoble 2 ( UPMF ) -Institut National de la Recherche Agronomique ( INRA ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), CHU Pitié-Salpêtrière [APHP], Université Bourgogne Franche-Comté ( UBFC ), Service de réanimation médicale [HEGP], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Hôpital Sainte-Musse, Université Paris-Sud - Paris 11 ( UP11 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, 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 ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ) -Hôpital Universitaire Carémeau [Nîmes], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Hôpital d'Estaing, Institut de pharmacologie moléculaire et cellulaire ( IPMC ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE), Anthropologie bio-culturelle, Droit, Ethique et Santé ( ADES ), Aix Marseille Université ( AMU ) -EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique ( CNRS ), Hospices Civils de Lyon ( HCL ) -Hôpital E. Herriot, Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Erasme Hospital, Centre hospitalier universitaire de Nantes (CHU Nantes), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), and COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)

Subjects
medicine.medical_specialty, Point-of-Care Systems, Ultrasonic Therapy, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], education, MEDLINE, Critical Care and Intensive Care Medicine, law.invention, law, Intensive care, Anesthesiology, Medicine, Humans, Prospective Studies, Prospective cohort study, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, Point of care, Ultrasonography, [ SDV ] Life Sciences [q-bio], business.industry, Intensive care unit, 3. Good health, Transcranial Doppler, Intensive Care Units, Observational study, business
Abstract

To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU). POCUS is of growing importance in the ICU. Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown. Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified. Among 1954 patients hospitalized during the study period, 1073 (55 %) POCUS/day were performed in 709 (36 %) patients. POCUS served for diagnostic assessment in 932 (87 %) cases and procedural guidance in 141 (13 %) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16 % of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69 %, respectively. Ultrasound guidance was used in 54 and 15 % of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts. With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.

Published
2015
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12. Erratum to: Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases

Author

Marc Leone, Carole Bechis, Karine Baumstarck, Alexandre Ouattara, Olivier Collange, Pascal Augustin, Djillali Annane, Charlotte Arbelot, Karim Asehnoune, Olivier Baldési, Simon Bourcier, Laurence Delapierre, Didier Demory, Baptiste Hengy, Carole Ichai, Eric Kipnis, Etienne Brasdefer, Sigismond Lasocki, Matthieu Legrand, Olivier Mimoz, Thomas Rimmelé, Jugurtha Aliane, Pierre-Marie Bertrand, Nicolas Bruder, Fanny Klasen, Emilie Friou, Bruno Lévy, Oriane Martinez, Eric Peytel, Alexandra Piton, Elisa Richter, Toufik Kamel, Marie-Charlotte Vogler, Florent Wallet, Mourad Boufi, Bernard Allaouchiche, Jean-Michel Constantin, Claude Martin, Samir Jaber, Jean-Yves Lefrant, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Aix Marseille Université (AMU), Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], CHU Strasbourg, Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service médical des soins intensifs [CHU Raymond Poincaré], Hôpital Raymond Poincaré [AP-HP], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], 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), Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier du Pays d'Aix, Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Cochin [AP-HP], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Centre Hospitalier Henri Duffaut (Avignon), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service de Réanimation médico-chirurgicale [Nice], Hôpital Saint-Roch [Nice], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'anesthésie et réanimation chirurgicale, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Département d'Anesthésie Réanimation SMUR [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, Centre Hospitalier de Cannes, Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital Nord [CHU - APHM], PRES Université Nantes Angers Le Mans (UNAM), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital d'Instruction des Armées Laveran, Service de Santé des Armées, Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre Hospitalier Régional d'Orléans (CHRO), CHU Saint-Etienne, 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), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Herrada, Anthony, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Département d'Anesthésie-Réanimation [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)

Subjects
03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, 030228 respiratory system, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 3. Good health
Abstract

International audience

Published
2015
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13. Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome*

Author

Gilles Perrin, Valérie Marin, Marc Gainnier, Didier Demory, Antoine Roch, Laurent Papazian, Pierre Bongrand, Jean-Louis Blache, Pierre Michelet, and Jean-Marie Forel

Subjects
Male, medicine.medical_treatment, Inflammation, Critical Care and Intensive Care Medicine, Systemic inflammation, law.invention, Positive-Pressure Respiration, Double-Blind Method, Randomized controlled trial, law, Intensive care, medicine, Humans, Prospective Studies, Mechanical ventilation, Respiratory Distress Syndrome, Respiratory distress, business.industry, Respiratory disease, Middle Aged, medicine.disease, Neuromuscular Blocking Agents, Oxygen, Anesthesia, Cytokines, Female, medicine.symptom, business
Abstract

To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy.Multiple-center, prospective, controlled, and randomized trial.One medical and two medical-surgical intensive care units.A total of 36 patients with acute respiratory distress syndrome (Pao2/Fio2 ratio ofor =200 at a positive end-expiratory pressure ofor =5 cm H2O) were included within 48 hrs of acute respiratory distress syndrome onset.Patients were randomized to receive conventional therapy plus placebo (n = 18) or conventional therapy plus NMBAs (n = 18) for 48 hrs. Both groups were ventilated with a lung-protective strategy (tidal volume between 4 and 8 mL/kg ideal body weight, plateau pressure ofor =30 cm H2O).Bronchoalveolar lavages and blood samples were performed, before randomization and at 48 hrs, to determine the concentrations of tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, and IL-8. Pao2/Fio2 ratio was evaluated before randomization and at 24, 48, 72, 96, and 120 hrs. A decrease over time in IL-8 concentrations (p = .034) was observed in the pulmonary compartment of the NMBA group. At 48 hrs after randomization, pulmonary concentrations of IL-1beta (p = .005), IL-6 (p = .038), and IL-8 (p = .017) were lower in the NMBA group as compared with the control group. A decrease over time in IL-6 (p = .05) and IL-8 (p = .003) serum concentrations was observed in the NMBA group. At 48 hrs after randomization, serum concentrations of IL-1beta (p = .037) and IL-6 (p = .041) were lower in the NMBA group as compared with the control group. A sustained improvement in Pao2/Fio2 ratio was observed and was reinforced in the NMBA group (p.001).Early use of NMBAs decrease the proinflammatory response associated with acute respiratory distress syndrome and mechanical ventilation.

Published
2006
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14. Maladie de Crohn ou tuberculose digestive: complications liées à une erreur diagnostique

Author

Jean-Marie Forel, Bernard Consentino, Jean-Marie Sainty, Laurent Papazian, Didier Demory, Alexandra Guillin-Poujol, Fabrice Michel, and Marc Gainnier

Subjects
Gynecology, medicine.medical_specialty, business.industry, Medicine, General Medicine, business
Abstract

Resume Introduction Nous rapportons l’observation d’un patient atteint de tuberculose avec manifestations digestives mais traite initialement pour maladie de Crohn. Le traitement immunosuppresseur a conduit a une majoration et a une dissemination de l’atteinte tuberculeuse. Observation Un patient de 50 ans a ete hospitalise en reanimation pour detresse respiratoire dans le cadre d’une tuberculose disseminee. Apres une evolution respiratoire satisfaisante sous traitement anti-tuberculeux, un syndrome abdominal occlusif a revele une stenose ileale post-tuberculeuse. Commentaires Il est essentiel de differencier les 2 pathologies en raison des implications therapeutiques de la maladie de Crohn, pouvant amener a une explosion de la symptomatologie tuberculeuse. La prise en charge de cette derniere est medicale, avec une chirurgie reservee aux complications de type obstruction, fistulisation, perforations ou hemorragies.

Published
2006
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15. Comparison of prone positioning and high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome*

Author

Fabienne Bregeon, Jean-Michel Arnal, Marc Gainnier, Laurent Papazian, Antoine Roch, Jean-Marie Sainty, Jean-Marie Forel, Didier Demory, Valérie Marin, Pierre Bongrand, and Stéphane Donati

Subjects
Adult, Male, Supine position, medicine.medical_treatment, High-Frequency Ventilation, Respiratory physiology, Critical Care and Intensive Care Medicine, Intensive care, Prone Position, Supine Position, Humans, Medicine, Prospective Studies, Respiratory Distress Syndrome, Lung, Respiratory distress, Pulmonary Gas Exchange, business.industry, High-frequency ventilation, Respiratory disease, Middle Aged, respiratory system, medicine.disease, respiratory tract diseases, Prone position, medicine.anatomical_structure, Anesthesia, Respiratory Mechanics, Female, Blood Gas Analysis, Inflammation Mediators, business, Bronchoalveolar Lavage Fluid
Abstract

Both prone position and high-frequency oscillatory ventilation (HFOV) have the potential to facilitate lung recruitment, and their combined use could thus be synergetic on gas exchange. Keeping the lung open could also potentially be lung protective. The aim of this study was to compare physiologic and proinflammatory effects of HFOV, prone positioning, or their combination in severe acute respiratory distress syndrome (ARDS).: Prospective, comparative randomized study.A medical intensive care unit.Thirty-nine ARDS patients with a Pao2/Fio2 ratio150 mm Hg at positive end-expiratory pressureor =5 cm H2O.After 12 hrs on conventional lung-protective mechanical ventilation (tidal volume 6 mL/kg of ideal body weight, plateau pressure not exceeding the upper inflection point, and a maximum of 35 cm H2O; supine-CV), 39 patients were randomized to receive one of the following 12-hr periods: conventional lung-protective mechanical ventilation in prone position (prone-CV), HFOV in supine position (supine-HFOV), or HFOV in prone position (prone-HFOV).Prone-CV (from 138 +/- 58 mm Hg to 217 +/- 110 mm Hg, p.0001) and prone-HFOV (from 126 +/- 40 mm Hg to 227 +/- 64 mm Hg, p0.0001) improved the Pao2/Fio2 ratio whereas supine-HFOV did not alter the Pao2/Fio2 ratio (from 134 +/- 57 mm Hg to 138 +/- 48 mm Hg). The oxygenation index ({mean airway pressure x Fio2 x 100}/Pao2) decreased in the prone-CV and prone-HFOV groups and was lower than in the supine-HFOV group. Interleukin-8 increased significantly in the bronchoalveolar lavage fluid (BALF) in supine-HFOV and prone-HFOV groups compared with prone-CV and supine-CV. Neutrophil counts were higher in the supine-HFOV group than in the prone-CV group.Although HFOV in the supine position does not improve oxygenation or lung inflammation, the prone position increases oxygenation and reduces lung inflammation in ARDS patients. Prone-HFOV produced similar improvement in oxygenation like prone-CV but was associated with higher BALF indexes of inflammation. In contrast, supine-HFOV did not improve gas exchange and was associated with enhanced lung inflammation.

Published
2005
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16. Efficiency and safety of a noninvasive therapeutic hypothermia protocol in cardiac arrest

Author

Pierre Michelet, Didier Demory, Sophie de Bourmont, Gaëlle Corno, Jacques Durand-Gasselin, Jean-Michel Arnal, and Stéphane Donati

Subjects
Male, medicine.medical_treatment, Hemodynamics, Clinical Protocols, Hypothermia, Induced, medicine, Humans, In patient, Adverse effect, Saline, Surface cooling, Aged, Retrospective Studies, business.industry, Hypothermia, Middle Aged, medicine.disease, Hypokalemia, Heart Arrest, Treatment Outcome, Median time, Anesthesia, Emergency Medicine, Female, Medical emergency, medicine.symptom, business
Abstract

OBJECTIVES Therapeutic hypothermia (TH) is part of the treatment strategy for comatose survivors of cardiac arrest (CA). The aim of our study was to evaluate the efficiency and the safety of a noninvasive and affordable cooling procedure applied to all types of CA in an ICU. STUDY DESIGN This was a retrospective, observational, monocenter study. PATIENTS AND METHODS In all patients remaining unconscious after CA, irrespective of their initial cardiac rhythm, TH was induced with a rapid intravenous infusion of 30 ml/kg ice-cold (4°C) saline fluid associated with external surface cooling involving ice packs and wet sheets. The body temperature was maintained between 32 and 34°C during 24 h using external surface cooling only. The patients were then passively rewarmed. RESULTS Of 200 eligible patients, 145 were treated by TH; 104 patients completed the 24-h TH treatment. The primary cause of noninclusion or secondary exclusion was severe hemodynamic impairment. From induction, the median time to reach the target temperature was 167 min (47-300 min). During the protocol, 24 patients did not remain within the targeted temperature range. Adverse events included hypokalemia (44%), severe arrhythmia (13.8%), bleeding (4.8%), and seizure (1.4%). All patients presented hyperglycemia. The oxygen partial pressure to oxygen fractional concentration (PaO2/FiO2) ratio remained constant after initiation and throughout the procedure, even in patients with poor systolic function. CONCLUSION This noninvasive TH procedure seems efficient and safe in all patients remaining comatose after CA. Thanks to its simplicity, it could allow prehospital cooling to reach the target temperature more rapidly.

Published
2014

19. Safety and efficacy of a fully closed-loop control ventilation (IntelliVent-ASV®) in sedated ICU patients with acute respiratory failure: a prospective randomized crossover study

Author

Jacques Durand-Gasselin, Dominik Novotni, Didier Demory, Marc Wysocki, Gaëlle Corno, Ricardo Lopez, Jean-Michel Arnal, Isabelle Granier, and Stéphane Donati

Subjects
Male, ARDS, Safety Management, animal structures, Respiratory rate, medicine.medical_treatment, Respiratory physiology, Critical Care and Intensive Care Medicine, Plateau pressure, Outcome Assessment, Health Care, Medicine, Humans, Prospective Studies, Tidal volume, Aged, Monitoring, Physiologic, Mechanical ventilation, Aged, 80 and over, Respiratory Distress Syndrome, Cross-Over Studies, business.industry, Middle Aged, medicine.disease, Respiration, Artificial, Intensive Care Units, Anesthesia, embryonic structures, Breathing, Female, France, Deep Sedation, business, Respiratory minute volume
Abstract

IntelliVent-ASV® is a development of adaptive support ventilation (ASV) that automatically adjusts ventilation and oxygenation parameters. This study assessed the safety and efficacy of IntelliVent-ASV® in sedated intensive care unit (ICU) patients with acute respiratory failure. This prospective randomized crossover comparative study was conducted in a 12-bed ICU in a general hospital. Two periods of 2 h of ventilation in randomly applied ASV or IntelliVent-ASV® were compared in 50 sedated, passively ventilated patients. Tidal volume (V T), respiratory rate (RR), inspiratory pressure (P INSP), SpO2 and ETCO2 were continuously monitored and recorded breath by breath. Mean values over the 2-h period were calculated. Respiratory mechanics, plateau pressure (P PLAT) and blood gas exchanges were measured at the end of each period. There was no safety issue requiring premature interruption of IntelliVent-ASV®. Minute ventilation (MV) and V T decreased from 7.6 (6.5–9.5) to 6.8 (6.0–8.0) L/min (p

Published
2011

20. Prospective Randomized Cross-over Controlled Study Comparing Adaptive Support Ventilation (ASV) And A Fully Close Loop Control Solution (Intellivent®) In Adult ICU Patients With Acute Respiratory Failure

Author

Geon Durish, Didier Demory, Frederik Bruehschwein, Jean-Michel Arnal, Jacques Durand-Gasselin, Thomas Laubscher, Marc Wysocki, Dominik Novotni, and Ricardo Lopez

Subjects
Cross over, medicine.medical_specialty, Icu patients, business.industry, Loop control, Breathing, Adaptive support, Medicine, Acute respiratory failure, business, Intensive care medicine
Published
2010
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21. Automatic Calculation Of Respiratory Variations In Pulse Oximetry Plethysmographic Waveform Amplitude To Predict Fluid Responsiveness

Author

Dominik Novotni, Yannis Donati, Didier Demory, Jacques Durand-Gasselin, Marc Wysocki, and Jean-Michel Arnal

Subjects
Pulse oximetry, medicine.medical_specialty, Amplitude, medicine.diagnostic_test, business.industry, Internal medicine, Fluid responsiveness, medicine, Cardiology, Waveform, Plethysmograph, Respiratory system, business
Published
2010
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22. Sclérose latérale amyotrophique

Author

Didier Demory, Jean-Michel Arnal, and Stéphane Donati

Abstract

La sclerose laterale amyotrophique (SLA) est une degenerescence progressive des neurones moteurs de la corne anterieure. Les causes d’admission en reanimation sont d’ordre respiratoire le plus souvent (pneumopathie d’inhalation, bronchite...) chez un patient connu. Parfois la SLA est revelee en reanimation devant un echec de sevrage. Le diagnostic positif se fait par l’anamnese, l’examen clinique et l’electromyogramme. Le seul traitement etiologique valide a ce jour est le Riluzole. La prise en charge symptomatique est primordiale et repose sur une approche pluridisciplinaire. Le traitement symptomatique comprend le support ventilatoire a domicile par VNI ou tracheotomie en cas de forme bulbaire, les techniques d’aide a la toux et l’assistance nutritionnelle. La reflexion ethique doit etre menee tout au long de l’evolution de la maladie.

Published
2010
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23. Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score

Author

Didier Demory, Boris Jung, Bernard La Scola, Jérôme Allardet-Servent, Nathalie Embriaco, Jean-Marie Forel, François Roux, Samir Jaber, Laurent Papazian, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Marseille, Aix Marseille Université (AMU), Passerieux, Emilie, and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Calcitonin, Male, medicine.medical_specialty, Calcitonin Gene-Related Peptide, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Severity of Illness Index, Procalcitonin, law.invention, 03 medical and health sciences, 0302 clinical medicine, Blood serum, law, Intensive care, Internal medicine, medicine, Humans, Prospective Studies, Protein Precursors, Prospective cohort study, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, business.industry, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, respiratory system, Middle Aged, bacterial infections and mycoses, medicine.disease, Prognosis, respiratory tract diseases, 3. Good health, Anti-Bacterial Agents, Pneumonia, Intensive Care Units, Bronchoalveolar lavage, Gram staining, 030228 respiratory system, Female, business, Bronchoalveolar Lavage Fluid, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Biomarkers
Abstract

Early and adequate treatment of ventilator-associated pneumonia (VAP) is mandatory to improve the outcome. The aim of this study was to evaluate, in medical ICU patients, the respective and combined impact of the Clinical Pulmonary Infection Score (CPIS), broncho-alveolar lavage (BAL) gram staining, endotracheal aspirate and a biomarker (procalcitonin) for the early diagnosis of VAP.Prospective, observational studyA medical intensive care unit in a teaching hospital.Over an 8-month period, we prospectively included 57 patients suspected of having 86 episodes of VAP.The day of suspicion, a BAL as well as alveolar and serum procalcitonin determinations and evaluation of CPIS were performed.Of 86 BAL performed, 48 were considered positive (cutoff of 10(4) cfu ml(-1)). We found no differences in alveolar or serum procalcitonin between VAP and non-VAP patients. Including procalcitonin in the CPIS score did not increase its accuracy (55%) for the diagnosis of VAP. The best tests to predict VAP were modified CPIS (threshold at 6) combined with microbiological data. Indeed, both routinely twice weekly performed endotracheal aspiration at a threshold of 10(5) cfu ml(-1) and BAL gram staining improved pre-test diagnostic accuracy of VAP (77 and 66%, respectively).This study showed that alveolar procalcitonin performed by BAL does not help the clinician to identify VAP. It confirmed that serum procalcitonin is not an accurate marker of VAP. In contrast, microbiological resources available at the time of VAP suspicion (BAL gram staining, last available endotracheal aspirate) combined or not with CPIS are helpful in distinguishing VAP diagnosed by BAL from patients with a negative BAL.

Published
2008
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24. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients

Author

Isabelle Granier, Didier Demory, Marc Wysocki, Jean-Michel Arnal, Jacques Durand-Gasselin, Stéphane Donati, and Gaëlle Corno

Subjects
Pressure-volume curves, Male, medicine.medical_specialty, ARDS, Critical Care, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Positive-Pressure Respiration, Internal medicine, Intensive care, medicine, Pressure, Tidal Volume, Humans, Lung volumes, Prospective Studies, Positive end-expiratory pressure, Tidal volume, Aged, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Middle Aged, medicine.disease, Treatment Outcome, Volume (thermodynamics), Anesthesia, Cardiology, Linear Models, Respiratory Mechanics, Female, Blood Gas Analysis, business
Abstract

To assess the hysteresis of the pressure–volume curve (PV curve) as to estimate, easily and at the bedside, the recruitability of the lung in ARDS patients. Prospective study. Twelve medico-surgical ICU beds of a general hospital. Twenty-six patients within the first 24 h from meeting ARDS criteria. A Quasi-static inflation and deflation PV curve from 0 to 40 cmH2O and a 40 cmH2O recruitment maneuver (RM) maintained for 10 s were successively done with an interval of 30 min in between. Hysteresis of the PV curve (H PV) was calculated as the ratio of the area enclosed by the pressure volume loop divided by the predicted body weight (PBW). The volume increase during the RM (V RM) was measured by integration of the flow required to maintain the pressure at 40 cmH2O and divided by PBW, as an estimation of the volume recruited during the RM. A positive linear correlation was found between H PV and V RM (r = 0.81, P

Published
2007

25. High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation

Author

Laurent Papazian, Stéphane Donati, Didier Demory, Marc Gainnier, Jean-Marie Forel, Pierre Michelet, Fabienne Bregeon, and Jean-Michel Arnal

Subjects
Male, Supine position, Time Factors, Critical Care, medicine.medical_treatment, High-Frequency Ventilation, Mean airway pressure, Critical Care and Intensive Care Medicine, Hospitals, University, Intensive care, medicine, Prone Position, Supine Position, Tidal Volume, Humans, Lung volumes, Prospective Studies, Tidal volume, Aged, Mechanical ventilation, Analysis of Variance, Respiratory Distress Syndrome, business.industry, Pulmonary Gas Exchange, High-frequency ventilation, Middle Aged, Respiration, Artificial, Prone position, Treatment Outcome, Anesthesia, Female, France, Blood Gas Analysis, business, Tomography, X-Ray Computed
Abstract

Objective: The improvement in oxygenation with prone positioning is not persistent when patients with acute respiratory distress syndrome (ARDS) are turned supine. High-frequency oscillatory ventilation (HFOV) aims to maintain an open lung volume by the application of a constant mean airway pressure. The aim of this study was to show that HFOV is able to prevent the impairment in oxygenation when ARDS patients are turned back from the prone to the supine position. Design: Prospective, comparative randomized study. Setting: A medical intensive care unit. Patients: Forty-three ARDS patients with a PaO 2 /FiO 2 ratio

Published
2006

26. [Crohn disease and abdominal tuberculosis: complications related to a diagnostic error]

Author

Didier, Demory, Jean-Marie, Forel, Fabrice, Michel, Alexandra, Guillin-Poujol, Bernard, Consentino, Marc, Gainnier, Laurent, Papazian, and Jean-Marie, Sainty

Subjects
Male, Time Factors, Ileal Diseases, Antitubercular Agents, Colonoscopy, Middle Aged, Diagnosis, Differential, Radiography, Treatment Outcome, Crohn Disease, Tuberculosis, Gastrointestinal, Cecal Diseases, Humans, Drug Therapy, Combination, Diagnostic Errors, Tuberculosis, Pulmonary, Follow-Up Studies
Abstract

We report the case of a patient with abdominal tuberculosis initially treated as Crohn disease.A 50-year-old man, diagnosed with Crohn disease, was admitted to the intensive care unit for acute respiratory failure. After a new diagnosis of pulmonary and ileocecal tuberculosis and appropriate treatment for it, he improved.It is difficult - but essential - to differentiate intestinal tuberculosis and Crohn disease, for the immune suppression necessary to treat the latter can induce severe complications of the former. Management of intestinal tuberculosis is primarily medical, with surgery reserved for complications such as obstruction, fistulization, perforation, and bleeding.

Published
2006

27. Use of a fully closed-loop ventilation mode in long-term ventilated ICU patients: a prospective study

Author

Jean-Michel Arnal, Audrey Berric, M Wysocki, Didier Demory, Jacques Durand-Gasselin, Gaëlle Corno, Stéphane Donati, Laurent Ducros, and Aude Garnero

Subjects
medicine.medical_specialty, Icu patients, Respiratory rate, business.industry, Respiratory physiology, Oxygenation, Critical Care and Intensive Care Medicine, Ventilation mode, Emergency medicine, Poster Presentation, medicine, Breathing, Prospective cohort study, business, Respiratory minute volume
Abstract

IntelliVent-ASV® is a closed-loop ventilation mode that automatically adjusts ventilation and oxygenation settings in passive and active breathing patients. The minute volume is adjusted according to end-tidal CO2 (ETCO2) information in passive breathing patients (and respiratory rate in active breathing patients), and oxygenation is adjusted according to SpO2 information. This study reports the ventilation and oxygenation delivered by IntelliVent-ASV® in long-term ventilated ICU patients.

Published
2012

28. [Untitled]

Author

Antoine Roch, Jean-Marie Forel, Jean-Michel Arnal, Stéphane Donati, Laurent Papazian, Marc Gainnier, and Didier Demory

Subjects
business.industry, Anesthesia, Medicine, Hemodynamics, In patient, Acute respiratory distress, Oxygenation, Volume Curve, Critical Care and Intensive Care Medicine, business, Prospective cohort study, Affect (psychology), Tidal volume
Abstract

Introduction It is possible that taking a static pressure-volume (PV) measurement could durably affect oxygenation and thus interfere with early evaluation of a therapeutic intervention delivered just after that measurement. The aim of the present study was to investigate the effects over time of a single static PV measurement on gas exchange and haemodynamics; the PV measurements were taken using a super syringe and by using the constant flow method in patients with acute respiratory distress syndrome.

Published
2006
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29. High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation.

Author

Didier Demory

Subjects
*ADULT respiratory distress syndrome, *HIGH-frequency ventilation (Therapy), *PULMONARY manifestations of general diseases, *CRITICAL care medicine
Abstract

OBJECTIVE:: The improvement in oxygenation with prone positioning is not persistent when patients with acute respiratory distress syndrome (ARDS) are turned supine. High-frequency oscillatory ventilation (HFOV) aims to maintain an open lung volume by the application of a constant mean airway pressure. The aim of this study was to show that HFOV is able to prevent the impairment in oxygenation when ARDS patients are turned back from the prone to the supine position.DESIGN:: Prospective, comparative randomized study.SETTING:: A medical intensive care unit.PATIENTS:: Forty-three ARDS patients with a Pao2/Fio2 ratio <150 at positive end-expiratory pressure ≥5 cm H2O.INTERVENTIONS:: After an optimization period, the patients were assigned to one of three groups: a) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by a 12-hr period of conventional lung-protective mechanical ventilation in the supine position (CVprone-CVsupine); b) conventional lung-protective mechanical ventilation in the supine position (12 hrs) followed by HFOV in the supine position (12 hrs) (CVsupine-HFOVsupine); or c) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by HFOV in the supine position (CVprone-HFOVsupine group).MEASUREMENTS AND MAIN RESULTS:: Pao2/Fio2 ratio was higher at the end of the study period in the CVprone-HFOVsupine group than in the CVprone-CVsupine group (p < .02). Venous admixture at the end of the study period was lower in the CVprone-HFOVsupine group than in the two other groups.CONCLUSIONS:: HFOV maintained the improvement in oxygenation related to prone positioning when ARDS patients were returned to the supine position. [ABSTRACT FROM AUTHOR]

Published
2007
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30. Feasibility study on full closed-loop control ventilation (IntelliVent-ASV™) in ICU patients with acute respiratory failure: a prospective observational comparative study

Author

Aude Garnero, Laurent Ducros, Didier Demory, Stéphane Donati, Dominik Novonti, Samir Jaber, Jean-Michel Arnal, Gaëlle Corno, Jacques Durand-Gasselin, and Audrey Berric

Subjects
Male, medicine.medical_specialty, ARDS, Respiratory physiology, Critical Care and Intensive Care Medicine, Intermittent Positive-Pressure Ventilation, Tidal Volume, medicine, Humans, Prospective Studies, Intensive care medicine, Prospective cohort study, Tidal volume, Aged, COPD, Lung, business.industry, Research, Oxygenation, Middle Aged, medicine.disease, Intensive Care Units, medicine.anatomical_structure, Anesthesia, Acute Disease, Breathing, Feasibility Studies, Female, Respiratory Insufficiency, business
Abstract

Introduction IntelliVent-ASV™ is a full closed-loop ventilation mode that automatically adjusts ventilation and oxygenation parameters in both passive and active patients. This feasibility study compared oxygenation and ventilation settings automatically selected by IntelliVent-ASV™ among three predefined lung conditions (normal lung, acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD)) in active and passive patients. The feasibility of IntelliVent-ASV™ use was assessed based on the number of safety events, the need to switch to conventional mode for any medical reason, and sensor failure. Method This prospective observational comparative study included 100 consecutive patients who were invasively ventilated for less than 24 hours at the time of inclusion with an expected duration of ventilation of more than 12 hours. Patients were ventilated using IntelliVent-ASV™ from inclusion to extubation. Settings, automatically selected by the ventilator, delivered ventilation, respiratory mechanics, and gas exchanges were recorded once a day. Results Regarding feasibility, all patients were ventilated using IntelliVent-ASV™ (392 days in total). No safety issues occurred and there was never a need to switch to an alternative ventilation mode. The fully automated ventilation was used for 95% of the total ventilation time. IntelliVent-ASV™ selected different settings according to lung condition in passive and active patients. In passive patients, tidal volume (VT), predicted body weight (PBW) was significantly different between normal lung (n = 45), ARDS (n = 16) and COPD patients (n = 19) (8.1 (7.3 to 8.9) mL/kg; 7.5 (6.9 to 7.9) mL/kg; 9.9 (8.3 to 11.1) mL/kg, respectively; P 0.05). In passive ARDS patients, FiO2 and positive end-expiratory pressure (PEEP) were statistically higher than passive normal lung (35 (33 to 47)% versus 30 (30 to 31)% and 11 (8 to 13) cmH2O versus 5 (5 to 6) cmH2O, respectively; P< 0.05). Conclusions IntelliVent-ASV™ was safely used in unselected ventilated ICU patients with different lung conditions. Automatically selected oxygenation and ventilation settings were different according to the lung condition, especially in passive patients. Trial Registration ClinicalTrials.gov: NCT01489085

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