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1. Cerebral Vasospasm After Subarachnoid Hemorrhage: Respective Short-Term Effects of Induced Arterial Hypertension and its Combination With IV Milrinone: A Proof-of-Concept Study Using Transcranial Doppler Ultrasound

Author

Karim Lakhal, MD, Marion H. Fresco, MD, Antoine Hivert, MD, Bertrand Rozec, MD, PhD, and Julien Cadiet, MD

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (Vmean). In patients treated for cerebral vasospasm, we aimed to assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler. DESIGN:. Observational proof-of-concept prospective study. SETTING:. ICU in a French tertiary care center. PATIENTS:. Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure [MBP] of 100–120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Vmean was measured at vasospasm diagnosis (TDIAGNOSIS), after the induction of hypertension (THTN), and 1 (THTN+MILRINONE_H1) and 12 hours after the adjunction of IV milrinone (THTN+MILRINONE_H12). Thirteen patients were included. Median Vmean was significantly lower (p < 0.01) at THTN+MILRINONE_H1 (99 [interquartile range (IQR) 89; 134] cm.s−1) and THTN+MILRINONE_H12 (85 [IQR 73–127] cm/s) than at TDIAGNOSIS (136 [IQR 115–164] cm/s) and THTN (148 [IQR 115–183] cm/s), whereas TDIAGNOSIS and THTN did not significantly differ. In all patients but one, Vmean at THTN+MILRINONE_H1 was lower than its value at TDIAGNOSIS (p = 0.0005). Vmean-to-MBP and Vmean-to-cardiac output (CO) ratios (an assessment of Vmean regardless of the level of MBP [n = 13] or CO [n = 7], respectively) were, respectively, similar at TDIAGNOSIS and THTN but were significantly lower after the adjunction of milrinone (p < 0.01). CONCLUSIONS:. The induction of arterial hypertension was not associated with a significant decrease in Vmean, whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.

Published
2023
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2. Early recognition of cardiac surgery-associated acute kidney injury: lack of added value of TIMP2 IGFBP7 over short-term changes in creatinine (an observational pilot study)

Author

Karim Lakhal, Edith Bigot-Corbel, Emilie Sacchetto, Floris Chabrun, Thomas Senage, Lucile Figueres, Maxime Leroy, Arnaud Legrand, and Bertrand Rozec

Subjects
Acute kidney injury [MeSH], Insulin-like growth factor binding proteins/urine* [MeSH], Tissue inhibitor of Metalloproteinase-2/urine* [MeSH], Tissue inhibitor of Metalloproteinase-2 [MeSH], Creatinine/blood [MeSH], Lipocalins/metabolism* [MeSH], Anesthesiology, RD78.3-87.3
Abstract

Abstract Background For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesized that, in the context of perioperative haemodilution, lack of postoperative decrease in pCr would be of honourable performance for the detection of CS-AKI. We therefore aimed at comparing these biomarkers and their kinetics (primary objective). As secondary objectives, we assessed plasma neutrophil gelatinase-associated lipocalin (pNGAL), cystatin C (pCysC) and urea (pUrea). We also determined the ability of these biomarkers to early discriminate persistent from transient CS-AKI. Methods Patients over 75 years-old undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in this prospective observational study. Biomarkers were measured before/after CPB and at the sixth postoperative hour (H6). Results In 65 patients, CS-AKI occurred in 27 (42%). ∆pCr from post-CPB to H6 (∆pCrpostCPB-H6): outperformed TIMP2 IGFBP7 at H6 and its intra- or postoperative changes: area under the receiver operating characteristic curve (AUCROC) of 0.84 [95%CI:0.73–0.92] vs. ≤0.67 [95%CI:0.54–0.78], p ≤ 0.03. The AUCROC of pNGAL, pCysC and pUrea did not exceed 0.72 [95%CI:0.59–0.83]. Indexing biomarkers levels for blood or urine dilution did not improve their performance. Combining TIMP2 IGFBP7 and ∆pCrpostCPB-H6 was of no evident added value over considering ∆pCrpostCPB-H6 alone. For the early recognition of persistent CS-AKI, no biomarker outperformed ∆pCrpostCPB-H6 (AUCROC = 0.69 [95%CI:0.48–0.85]). Conclusions In this hypothesis-generating study mostly testing early detection of mild CS-AKI, there was no evident added value of the tested modern biomarkers over early minimal postoperative changes in pCr: despite the common perioperative hemodilution in the setting of cardiac surgery, if pCr failed to decline within the 6 h after CPB, the development of CS-AKI was likely. Confirmatory studies with more severe forms of CS-AKI are required.

Published
2021
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3. Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review

Author

Karim Lakhal, Stephan Ehrmann, and Vincent Robert-Edan

Subjects
Contrast media (MeSH: D003287), Intensive care units (MeSH D007362), Drug-related side effects and adverse reactions (MeSH D064420), Tomography scanners, X-ray computed (MeSH: D015898), Percutaneous coronary interventions (MeSH: D062645), Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.

Published
2020
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4. Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study

Author

Florian Guillotin, Cécile Poulain, Benjamin Gaborit, Marwan Bouras, Raphaël Cinotti, Karim Lakhal, Mickael Vourc’h, Bertrand Rozec, Karim Asehnoune, Marie-Anne Vibet, Valéry-Pierre Riche, Sophie-Anne Gibaud, Lise Crémet, and Antoine Roquilly

Subjects
pneumonia, biomolecular diagnosis, empiric treatment, intensive care unit, hospital-acquired pneumonia, Microbiology, QR1-502
Abstract

ObjectivesTo investigate the potential impact of the syndromic multiplex FilmArray® Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP).MethodsRespiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio.ResultsThe predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p

Published
2022
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5. The Artificial Kidney Initiation in Kidney Injury 2 (AKIKI2): study protocol for a randomized controlled trial

Author

Stéphane Gaudry, David Hajage, Laurent Martin-Lefevre, Guillaume Louis, Sébastien Moschietto, Dimitri Titeca-Beauport, Béatrice La Combe, Bertrand Pons, Nicolas de Prost, Sébastien Besset, Alain Combes, Adrien Robine, Marion Beuzelin, Julio Badie, Guillaume Chevrel, Jean Reignier, Julien Bohé, Elisabeth Coupez, Nicolas Chudeau, Saber Barbar, Christophe Vinsonneau, Jean-Marie Forel, Didier Thevenin, Eric Boulet, Karim Lakhal, Nadia Aissaoui, Steven Grange, Marc Leone, Guillaume Lacave, Saad Nseir, Florent Poirson, Julien Mayaux, Karim Asehnoune, Guillaume Geri, Kada Klouche, Guillaume Thiery, Laurent Argaud, Jean-Damien Ricard, Jean-Pierre Quenot, and Didier Dreyfuss

Subjects
Acute kidney injury, Critical care, Renal replacement therapy, Treatment outcome, Medicine (General), R5-920
Abstract

Abstract Background The Artificial Kidney Initiation in Kidney Injury (AKIKI) trial showed that a delayed renal replacement therapy (RRT) strategy for severe acute kidney injury (AKI) in critically ill patients was safe and associated with major reduction in RRT initiation compared with an early strategy. The five criteria which mandated RRT initiation in the delayed arm were: severe hyperkalemia, severe acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia, serum urea concentration > 40 mmol/l and oliguria/anuria > 72 h. However, duration of anuria/oliguria and level of blood urea are still criteria open to debate. The objective of the study is to compare the delayed strategy used in AKIKI (now termed “standard”) with another in which RRT is further delayed for a longer period (termed “delayed strategy”). Methods/design This is a prospective, multicenter, open-label, two-arm randomized trial. The study is composed of two stages (observational and randomization stages). At any time, the occurrence of a potentially severe condition (severe hyperkalemia, severe metabolic or mixed acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia) suggests immediate RRT initiation. Patients receiving (or who have received) intravenously administered catecholamines and/or invasive mechanical ventilation and presenting with AKI stage 3 of the KDIGO classification and with no potentially severe condition are included in the observational stage. Patients presenting a serum urea concentration > 40 mmol/l and/or an oliguria/anuria for more than 72 h are randomly allocated to a standard (RRT is initiated within 12 h) or a delayed RRT strategy (RRT is initiated only if an above-mentioned potentially severe condition occurs or if the serum urea concentration reaches 50 mmol/l). The primary outcome will be the number of RRT-free days at day 28. One interim analysis is planned. It is expected to include 810 patients in the observational stage and to randomize 270 subjects. Discussion The AKIKI2 study should improve the knowledge of RRT initiation criteria in critically ill patients. The potential reduction in RRT use allowed by a delayed RRT strategy might be associated with less invasive care and decreased costs. Enrollment is ongoing. Inclusions are expected to be completed by November 2019. Trial registration ClinicalTrials.gov, ID: NCT03396757. Registered on 11 January 2018.

Published
2019
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6. Empirical Antibiotic Therapy for Gram-Negative Bacilli Ventilator-Associated Pneumonia: Observational Study and Pharmacodynamic Assessment

Author

Olivier Pajot, Karim Lakhal, Jérome Lambert, Antoine Gros, Cédric Bruel, Thierry Boulain, Denis Garot, Vincent Das, Jean François Timsit, Charles Cerf, Bertrand Souweine, Cendrine Chaffaut, Hervé Mentec, Jean Ralph Zahar, Jean Paul Mira, and Vincent Jullien

Subjects
VAP, pharmacokinetics, pharmacodynamics, intensive care unit, Therapeutics. Pharmacology, RM1-950
Abstract

Background: Strong evidence suggests a correlation between pharmacodynamics (PD) index and antibiotic efficacy while dose adjustment should be considered in critically ill patients due to modified pharmacokinetic (PK) parameters and/or higher minimum inhibitory concentrations (MICs). This study aimed to assess pharmacodynamic (PD) target attainment considering both antibiotics serum concentrations and measured MICs in these patients. Method: A multicentric prospective open-label trial conducted in 11 French ICUs involved patients with Gram-negative bacilli (GNB) ventilator-associated pneumonia (VAP) confirmed by quantitative cultures. Results: We included 117 patients. Causative GNBs were P. aeruginosa (40%), Enterobacter spp. (23%), E. coli (20%), and Klebsiella spp. (16%). Hence, 117 (100%) patients received β-lactams, 65 (58%) aminoglycosides, and two (1.5%) fluoroquinolones. For β-lactams, 83% of the patients achieved a Cmin/MIC > 1 and 70% had a Cmin/MIC > 4. In the case of high creatinine clearance (CrCL > 100 mL/min/1.73 m2), 70.4% of the patients achieved a Cmin/MIC ratio > 1 versus 91% otherwise (p = 0.041), and 52% achieved a Cmin/MIC ratio > 4 versus 81% (p = 0.018). For aminoglycosides, 94% of the patients had a Cmax/MIC ratio > 8. Neither β-lactams nor aminoglycosides PK/PD parameters were associated clinical outcomes, but our data suggest a correlation between β-lactams Cmin/MIC and microbiological success. Conclusion: In our ICU patients treated for GNB VAP, using recommended antibiotic dosage led in most cases to PK/PD targets attainment for aminoglycosides and β-lactams. High creatinine clearance should encourage clinicians to focus on PK/PD issues.

Published
2022
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7. Time course of fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study

Author

Claire Roger, Laurent Zieleskiewicz, Christophe Demattei, Karim Lakhal, Gael Piton, Benjamin Louart, Jean-Michel Constantin, Russell Chabanne, Jean-Sébastien Faure, Yazine Mahjoub, Isabelle Desmeulles, Hervé Quintard, Jean-Yves Lefrant, Laurent Muller, and AzuRea Group

Subjects
Fluid responsiveness, Fluid challenge, ICU, Shock, Echocardiography, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC. Methods This is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T 0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC. Results From May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43–63], median SOFA score 10 [8–12]). Among the 76/143 (53%) patient responders to FC at T 10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T 30 (49%, 95%CI = [37–60]), and 39 (51%, 95%CI = [38–62]) patients were persistent responders (PR), i.e., remained responders at T 30. Among the 67 NR at T 10, 4 became responders at T30, (6%, 95%CI = [1.9–15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups. Conclusions This study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent. Trial registration ClinicalTrials.gov, NCT02116413. Registered on April 16, 2014

Published
2019
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8. Pneumonia-Specific Escherichia coli with Distinct Phylogenetic and Virulence Profiles, France, 2012–2014

Author

Béatrice La Combe, Olivier Clermont, Jonathan Messika, Matthieu Eveillard, Achille Kouatchet, Sigismond Lasocki, Stéphane Corvec, Karim Lakhal, Typhaine Billard-Pomares, Romain Fernandes, Laurence Armand-Lefevre, Sandra Bourdon, Jean Reignier, Vincent Fihman, Nicolas de Prost, Julien Bador, Julien Goret, Frederic Wallet, Erick Denamur, and Jean-Damien Ricard

Subjects
Nosocomial infection, ventilator-associated pneumonia, Escherichia coli, virulence factors, antimicrobial resistance, bacteria, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

In a prospective, nationwide study in France of Escherichia coli responsible for pneumonia in patients receiving mechanical ventilation, we determined E. coli antimicrobial susceptibility, phylotype, O-type, and virulence factor gene content. We compared 260 isolates with those of 2 published collections containing commensal and bacteremia isolates. The preponderant phylogenetic group was B2 (59.6%), and the predominant sequence type complex (STc) was STc73. STc127 and STc141 were overrepresented and STc95 underrepresented in pneumonia isolates compared with bacteremia isolates. Pneumonia isolates carried higher proportions of virulence genes sfa/foc, papGIII, hlyC, cnf1, and iroN compared with bacteremia isolates. Virulence factor gene content and antimicrobial drug resistance were higher in pneumonia than in commensal isolates. Genomic and phylogenetic characteristics of E. coli pneumonia isolates from critically ill patients indicate that they belong to the extraintestinal pathogenic E. coli pathovar but have distinguishable lung-specific traits.

Published
2019
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9. Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients

Author

Emmanuelle Rouve, Karim Lakhal, Charlotte Salmon Gandonnière, Youenn Jouan, Laetitia Bodet-Contentin, and Stephan Ehrmann

Subjects
Acute kidney injury, Iodinated contrast media, Biomarkers, TIMP-2, IGFBP-7, Iohexol, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Abstract Background Iodinated contrast media may contribute to acute kidney injury. However, several recent works suggest that this toxicity is minimal in the clinical setting. Recently, urinary G1 cell-cycle arrest proteins tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin like growth factor binding protein 7 (IGFBP-7) were identified as highly sensitive and specific biomarkers for early detection of kidney aggression. The impact of contrast administration on those biomarkers has not been specifically evaluated but could provide clues about the toxicity of contrast media. This study aimed at measuring changes in TIMP-2 and IGFBP-7 urinary concentrations before and after a contrast-enhanced computed tomography in critically ill patients. Methods 77 patients were included in a prospective observational cohort study. Urinary [TIMP -2]·[IGFBP-7] was measured before, 6 and 24 h after contrast infusion. Urine output and serum creatinine were followed 3 days. Results Median [TIMP-2]·[IGFBP-7] was 0.06 [interquartile range 0.04;0.26], 0.07 [0.03;0.34] and 0.10 [0.04;0.37] (ng/mL)2/1000 respectively before, 6 and 24 h after contrast infusion. Individual changes from baseline were − 0.01 [− 0.11;0.11] and 0.00 [− 0.10;0.09] (ng/ml)2/1000 at 6 and 24 h. These changes were not higher among the patients increasing their Kidney Disease Improving Global Outcome (KDIGO) classification within 3 days after contrast infusion (n = 14 [18%] based on creatinine criterion only, n = 42 [55%] based on creatinine and urine output). Conclusions Changes in [TIMP-2]·[IGFBP-7] urinary concentration after contrast-enhanced computed tomography were insignificant, suggesting minimal kidney aggression by modern iodinated contrast media.

Published
2018
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10. Evaluation of the FilmArray® Pneumonia Plus Panel for Rapid Diagnosis of Hospital-Acquired Pneumonia in Intensive Care Unit Patients

Author

Lise Crémet, Benjamin Gaborit, Marwan Bouras, Thomas Drumel, Florian Guillotin, Cécile Poulain, Elise Persyn, Karim Lakhal, Bertrand Rozec, Marie-Anne Vibet, Antoine Roquilly, and Sophie Gibaud

Subjects
multiplex syndromic testing, hospital-acquired pneumonia, rapid diagnosis, coinfection, antibiotic resistance, Microbiology, QR1-502
Abstract

The FilmArray® Pneumonia plus Panel (FAPP) is a new multiplex molecular test for hospital-acquired pneumonia (HAP), which can rapidly detect 18 bacteria, 9 viruses, and 7 resistance genes. We aimed to compare the diagnosis performance of FAPP with conventional testing in 100 intensive care unit (ICU) patients who required mechanical ventilation, with clinically suspected HAP. A total of 237 samples [76 bronchoalveolar lavages (BALDS) and 82 endotracheal aspirates (ETADS) obtained at HAP diagnosis, and 79 ETA obtained during follow-up (ETATT)], were analyzed independently by routine microbiology testing and FAPP. 58 patients had paired BALDS and ETADS. The positivity thresholds of semi-quantified bacteria were 103–104 CFUs/mL or 104 copies/mL for BAL, and 105 CFUs/mL or copies/mL for ETA. Respiratory commensals (H. influenzae, S. aureus, E. coli, S. pneumoniae) were the most common pathogens. Discordant results for bacterial identification were observed in 33/76 (43.4%) BALDS and 36/82 (43.9%) ETADS, and in most cases, FAPP identified one supplemental bacteria (23/33 BALDS and 21/36 ETADS). An absence of growth, or polybacterial cultures, explained almost equally the majority of the non-detections in culture. No linear relationship was observed between bin and CFUs/mL variables. Concordant results between paired BALDS and ETADS were obtained in 46/58 (79.3%) patients with FAPP. One of the 17 resistance genes detected with FAPP (mecA/C and MREJ) was not confirmed by conventional testing. Overall, FAPP enhanced the positivity rate of diagnostic testing, with increased recognition of coinfections. Implementing this strategy may allow clinicians to make more timely and informed decisions.

Published
2020
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11. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures

Author

Samir Jaber, Hervé Quintard, Raphael Cinotti, Karim Asehnoune, Jean-Michel Arnal, Christophe Guitton, Catherine Paugam-Burtz, Paer Abback, Armand Mekontso Dessap, Karim Lakhal, Sigismond Lasocki, Gaetan Plantefeve, Bernard Claud, Julien Pottecher, Philippe Corne, Carole Ichai, Zied Hajjej, Nicolas Molinari, Gerald Chanques, Laurent Papazian, Elie Azoulay, and Audrey De Jong

Subjects
Airway, Extubation, Non-airway, weaning, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Patients liberated from invasive mechanical ventilation are at risk of extubation failure, including inability to breathe without a tracheal tube (airway failure) or without mechanical ventilation (non-airway failure). We sought to identify respective risk factors for airway failure and non-airway failure following extubation. Methods The primary endpoint of this prospective, observational, multicenter study in 26 intensive care units was extubation failure, defined as need for reintubation within 48 h following extubation. A multinomial logistic regression model was used to identify risk factors for airway failure and non-airway failure. Results Between 1 December 2013 and 1 May 2015, 1514 patients undergoing extubation were enrolled. The extubation-failure rate was 10.4% (157/1514), including 70/157 (45%) airway failures, 78/157 (50%) non-airway failures, and 9/157 (5%) mixed airway and non-airway failures. By multivariable analysis, risk factors for extubation failure were either common to airway failure and non-airway failure: intubation for coma (OR 4.979 (2.797–8.864), P 8 days (OR 1.956 (1.087–3.518), P = 0.025), copious secretions (OR 4.066 (2.268–7.292), P

Published
2018
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12. Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trial

Author

Mickaël Landais, Mai-Anh Nay, Johann Auchabie, Noemie Hubert, Aurélien Frerou, Aihem Yehia, Alain Mercat, Maud Jonas, Frédéric Martino, Mikael Moriconi, Anne Courte, Vincent Robert-Edan, Alexandre Conia, Florent Bavozet, Pierre-Yves Egreteau, Cédric Bruel, Anne Renault, Olivier Huet, Marc Feller, Nicolas Chudeau, Martine Ferrandiere, Anne Rebion, Alain Robert, Bruno Giraudeau, Jean Reignier, Arnaud W Thille, Elsa Tavernier, Stephan Ehrmann, Satar MORTAZA, Julien DEMISELLE, Taoufik SASSI, Charles DELALE, Julien GROUILLE, Anne DE TINTENIAC, Marie GESLAIN, Herve FLOCH, Pierre BAILLY, Laetitia BODENES, Gwenaël PRAT, Pierre KALFON, Gaetan BADRE, Cecile JOURDAIN, Thierry MAZZONI, Anthony LE MEUR, Pierre Marie FAYOLLE, Anne HERON, Odile MAILLET, Nelly LEDOUX, Amélie ROLLE, Régine RICHARD, Marc VALETTE, Marie-Ange AZAIS, Caroline POUPLET, Konstantinos BACHOUMAS, Jean Christophe CALLAHAN, Christophe GUITTON, Cedric DARREAU, Montaine LEFEVRE, Guillaume LELOUP, Mélanie BERTEL, Jerome DAUVERGNE, Laurence PACAUD, Karim LAKHAL, Maelle MARTIN, Charlotte GARRET, Jean-Baptiste LASCARROU, Thierry BOULAIN, Armelle MATHONNET, Grégoire MULLER, François PHILIPPART, Marc TRAN, Julien FOURNIER, Jean-Pierre FRAT, Remi COUDROY, Delphine CHATELLIER, Guillaume HALLEY, Arnaud GACOUIN, Jerome HOFF, Servane VASTAL, Anne-Charlotte TELLIER, Mathilde BARBAZ, Charlotte SALMON GANDONNIERE, Emmanuelle MERCIER, and Walid DARWICHE

Subjects
Pulmonary and Respiratory Medicine
Published
2023

13. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author

Federico Angriman, Bruno L. Ferreyro, Natalia Angeloni, Bruno R. da Costa, Ron Wald, Sean M. Bagshaw, Neill K.J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Glenn M. Eastwood, Leah Peck, Helen Young, Peter Kruger, Gordon Laurie, Emma Saylor, Jason Meyer, Ellen Venz, Krista Wetzig, Craig French, Forbes McGain, John Mulder, Gerard Fennessy, Sathyajith Koottayi, Samantha Bates, Miriam Towns, Rebecca Morgan, Anna Tippett, Andrew Udy, Chris Mason, Elisa Licari, Dashiell Gantner, Jason McClure, Alistair Nichol, Phoebe McCracken, Jasmin Board, Emma Martin, Shirley Vallance, Meredith Young, Chelsey Vladic, Steve McGloughlin, David Gattas, Heidi Buhr, Jennifer Coles, Debra Hutch, James Wun, Louise Cole, Christina Whitehead, Julie Lowrey, Kristy Masters, Rebecca Gresham, Victoria Campbell, David Gutierrez, Jane Brailsford, Loretta Forbes, Lauren Murray, Teena Maguire, Martina NiChonghaile, Neil Orford, Allison Bone, Tania Elderkin, Tania Salerno, Tim Chimunda, Jason Fletcher, Emma Broadfield, Sanjay Porwal, Cameron Knott, Catherine Boschert, Julie Smith, Angus Richardson, Dianne Hill, Graeme Duke, Peter Oziemski, Santiago Cegarra, Peter Chan, Deborah Welsh, Stephanie Hunter, Owen Roodenburg, John Dyett, Nicos Kokotsis, Max Moser, Yang Yang, Laven Padayachee, Joseph Vetro, Himangsu Gangopadhyay, Melissa Kaufman, Angaj Ghosh, Simone Said, Alpesh Patel, Shailesh Bihari, Elisha Matheson, Xia Jin, Tapaswi Shrestha, Kate Schwartz, Rosalba Cross, Winston Cheung, Helen Wong, Mark Kol, Asim Shah, Amanda Y. Wang, Zoltan Endre, Celia Bradford, Pierre Janin, Simon Finfer, Naomi Diel, Jonathan Gatward, Naomi Hammond, Anthony Delaney, Frances Bass, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Nerilee Baker, Romuald Bellmann, Andreas Peer, Julia Hasslacher, Paul Koglberger, Sebastian Klein, Klemens Zotter, Anna Brandtner, Armin Finkenstedt, Adelheid Ditlbacher, Frank Hartig, Dietmar Fries, Mirjam Bachler, Bettina Schenk, Martin Wagner, Philipp Eller, Thomas Staudinger, Esther Tiller, Peter Schellongowski, Andja Bojic, Eric A. Hoste, Stephanie Bracke, Luc De Crop, Daisy Vermeiren, Fernando Thome, Bianca Chiella, Lucia Fendt, Veronica Antunes, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Élaine Carbonnaeu, Joannie Marchand, Marie-Hélène Masse, Marilène Ladouceur, Alexis F. Turgeon, François Lauzier, David Bellemare, Charles Langis Francoeur, Guillaume LeBlanc, Gabrielle Guilbault, Stéphanie Grenier, Eve Cloutier, Annick Boivin, Charles Delisle-Thibault, Panagiota Giannakouros, Olivier Costerousse, Jean-François Cailhier, François-Martin Carrier, Ali Ghamraoui, Martine Lebrasseur, Fatna Benettaib, Maya Salamé, Dounia Boumahni, Ying Tung Sia, Jean-François Naud, Isabelle Roy, Henry T. Stelfox, Stacey Ruddell, Braden J. Manns, Shelley Duggan, Dominic Carney, Jennifer Barchard, Richard P. Whitlock, Emilie Belley-Cote, Nevena Savija, Alexandra Sabev, Troy Campbell, Thais Creary, Kelson Devereaux, Shira Brodutch, Claudio Rigatto, Bojan Paunovic, Owen Mooney, Anna Glybina, Oksana Harasemiw, Michelle Di Nella, John Harmon, Navdeep Mehta, Louis Lakatos, Nicole Haslam, Francois Lellouche, Mathieu Simon, Ying Tung, Patricia Lizotte, Pierre-Alexandre Bourchard, Bram Rochwerg, Tim Karachi, Tina Millen, John Muscedere, David Maslove, J. Gordon Boyd, Stephanie Sibley, John Drover, Miranda Hunt, Ilinca Georgescu, Randy Wax, Ilan Lenga, Kavita Sridhar, Andrew Steele, Kelly Fusco, Taneera Ghate, Michael Tolibas, Holly Robinson, Matthew A. Weir, Ravi Taneja, Ian M. Ball, Amit Garg, Eileen Campbell, Athena Ovsenek, Sean van Diepen, Nadia Baig, Sheldon Magder, Han Yao, Ahsan Alam, Josie Campisi, Erika MacIntyre, Ella Rokosh, Kimberly Scherr, Stephen Lapinsky, Sangeeta Mehta, Sumesh Shah, Daniel J. Niven, Michael Russell, Kym Jim, Gillian Brown, Kerry Oxtoby, Adam Hall, Luc Benoit, Colleen Sokolowski, Bhanu Prasad, Jag Rao, Shelley Giebel, Demetrios J. Kutsogiannis, Patricia Thompson, Tayne Thompson, Robert Cirone, Kanthi Kavikondala, Mark Soth, France Clarke, Alyson Takaoka, David Mazer, Karen Burns, Jan Friedrich, David Klein, Gyan Sandhu, Marlene Santos, Imrana Khalid, Jennifer Hodder, Peter Dodek, Najib Ayas, Victoria Alcuaz, Gabriel Suen, Oleksa Rewa, Gurmeet Singh, Sean Norris, Neil Gibson, Castro Arias, Aysha Shami, Celine Pelletier, Alireza Zahirieh, Andre Amaral, Nicole Marinoff, Navjot Kaur, Adic Perez, Jane Wang, Gregory Haljan, Christopher Condin, Lauralyn McIntyre, Brigette Gomes, Rebecca Porteous, Irene Watpool, Swapnil Hiremath, Edward Clark, Margaret S. Herridge, Felicity Backhouse, M. Elizabeth Wilcox, Karolina Walczak, Vincent Ki, Asheer Sharman, Martin Romano, R.T. Noel Gibney, Adam S. Romanovsky, Lorena McCoshen, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Carney, Meili Duan, Xiaojun Ji, Dongchen Guo, Zhili Qi, Jin Lin, Meng Zhang, Lei Dong, Jingfeng Liu, Pei Liu, Deyuan Zhi, Guoqiang Bai, Yu Qiu, Ziqi Yang, Jing Bai, Zhuang Liu, Haizhou Zhuang, Haiman Wang, Jian Li, Mengya Zhao, Xiao Zhou, Xianqing Shi, Baning Ye, Manli Liu, Jing Wu, Yongjian Fu, Dali Long, Yu Pan, Jinlong Wang, Huaxian Mei, Songsong Zhang, Mingxiang Wen, Enyu Yang, Sijie Mu, Jianquan Li, Tingting Hu, Bingyu Qin, Min Li, Cunzhen Wang, Xin Dong, Kaiwu Wang, Haibo Wang, Jianxu Yang, Chuanyao Wang, Dongxin Wang, Nan Li, Zhui Yu, Song Xu, Lan Yao, Guo Hou, Zhou Liu, Liping Lu, Yingtao Lian, Chunting Wang, Jichen Zhang, Ruiqi Ding, Guoqing Qi, Qizhi Wang, Peng Wang, Zhaoli Meng, Man Chen, Xiaobo Hu, Xiandi He, Shibing Zhao, Lele Hang, Rui Li, Suhui Qin, Kun Lu, Shijuan Dun, Cheng Liu, Qi Zhou, Zhenzhen Chen, Jing Mei, Minwei Zhang, Hao Xu, Jincan Lin, Qindong Shi, Lijuan Fu, Qinjing Zeng, Hongye Ma, Jinqi Yan, Lan Gao, Hongjuan Liu, Lei Zhang, Hao Li, Xiaona He, Jingqun Fan, Litao Guo, Yu Liu, Xue Wang, Jingjing Sun, Zhongmin Liu, Juan Yang, Lili Ding, Lulu Sheng, Xingang Liu, Jie Yan, Quihui Wang, Yifeng Wang, Dan Zhao, Shuangping Zhao, Chenghuan Hu, Jing Li, Fuxing Deng, Haibo Qui, Yi Yang, Min Mo, Chun Pan, Changde Wu, Yingzi Huang, Lili Huang, Airan Liu, Anna-Maija Korhonen, Sanna Törnblom, Sari Sutinen, Leena Pettilä, Jonna Heinonen, Eliria Lappi, Taria Suhonen, Sari Karlsson, Sanna Hoppu, Ville Jalkanen, Anne Kuitunen, Markus Levoranta, Jaakko Långsjö, Sanna Ristimäki, Kaisa Malila, Anna Wootten, Simo Varila, Mikko J Järvisalo, Outi Inkinen, Satu Kentala, Keijo Leivo, Paivi Haltia, Jean-Damien Ricard, Jonathan Messika, Abirami Tiagarajah, Malo Emery, Aline Dechanet, Coralie Gernez, Damien Roux, Laurent Martin-Lefevre, Maud Fiancette, Isabelle Vinatier, Jean Claude Lacherade, Gwenhaël Colin, Christine Lebert, Marie-Ange Azais, Aihem Yehia, Caroline Pouplet, Matthieu Henry- Lagarrigue, Amélie Seguin, Laura Crosby, Julien Maizel, Dimitri Titeca-Beauport, Alain Combes, Ania Nieszkowska, Paul Masi, Alexandre Demoule, Julien Mayaux, Martin Dres, Elise Morawiec, Maxens Decalvele, Suela Demiri, Morgane Faure, Clémence Marios, Maxime Mallet, Marie Amélie Ordon, Laura Morizot, Marie Cantien, François Pousset, Florent Poirson, Yves Cohen, Laurent Argaud, Martin Cour, Laurent Bitker, Marie Simon, Romain Hernu, Thomas Baudry, Sylvie De La Salle, Adrien Robine, Nicholas Sedillot, Xavier Tchenio, Camille Bouisse, Sylvie Roux, Fabienne Tamion, Steven Grangé, Dorothée Carpentier, Guillaume Chevrel, Luis Ensenyat-Martin, Sophie Marque, Jean-Pierre Quenot, Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Chudeau, Mickael Landais, Benoit Derrien, Jean Christophe Callahan, Christophe Guitton, Charlène Le Moal, Alain Robert, Karim Asehnoune, Raphaël Cinotti, Nicolas Grillot, Dominique Demeure, Christophe Vinsonneau, Imen Rahmani, Mehdi Marzouk, Thibault Dekeyser, Caroline Sejourne, Mélanie Verlay, Fabienne Thevenin, Lucie Delecolle, Didier Thevenin, Bertrand Souweine, Elisabeth Coupez, Mireille Adda, Jean-Pierre Eraldi, Antoine Marchalot, Nicolas De Prost, Armand Mekontso Dessap, Keyvan Razazi, Ferhat Meziani, Julie Boisrame-Helms, Raphael Clere-Jehl, Xavier Delabranche, Christine Kummerlen, Hamid Merdji, Alexandra Monnier, Yannick Rabouel, Hassene Rahmani, Hayat Allam, Samir Chenaf, Vincenta Franja, Bertrand Pons, Michel Carles, Frédéric Martino, Régine Richard, Benjamin Zuber, Guillaume Lacave, Karim Lakhal, Bertrand Rozec, Hoa Dang Van, Éric Boulet, Fouad Fadel, Cedric Cleophax, Nicolas Dufour, Caroline Grant, Marie Thuong, Jean Reignier, Emmanuel Canet, Laurent Nicolet, Thierry Boulain, Mai-Anh Nay, Dalila Benzekri, François Barbier, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Marie Skarzynski, Julie Rossi, Amandine Pradet, Sandra Dos Santos, Aurore Guery, Lucie Muller, Luis Felix, Julien Bohé, Guillaume Thiéry, Nadia Aissaoui, Damien Vimpere, Morgane Commeureuc, Jean-Luc Diehl, Emmanuel Guerot, Orfeas Liangos, Monika Wittig, Alexander Zarbock, Mira Küllmar, Thomas van Waegeningh, Nadine Rosenow, Kathy Brickell, Peter Doran, Patrick T. Murray, Giovanni Landoni, Rosalba Lembo, Alberto Zangrillo, Giacomo Monti, Margherita Tozzi, Matteo Marzaroli, Gaetano Lombardi, Gianluca Paternoster, Michelangelo Vitiello, Shay McGuinness, Rachael Parke, Magdalena Butler, Eileen Gilder, Keri-Anne Cowdrey, Samantha Wallace, Jane Hallion, Melissa Woolett, Philippa Neal, Karina Duffy, Stephanie Long, Colin McArthur, Catherine Simmonds, Yan Chen, Rachael McConnochie, Lynette Newby, David Knight, Seton Henderson, Jan Mehrtens, Stacey Morgan, Anna Morris, Kymbalee Vander Hayden, Tara Burke, Matthew Bailey, Ross Freebairn, Lesley Chadwick, Penelope Park, Christine Rolls, Liz Thomas, Ulrike Buehner, Erin Williams, Jonathan Albrett, Simon Kirkham, Carolyn Jackson, Troy Browne, Jennifer Goodson, David Jackson, James Houghton, Owen Callender, Vicki Higson, Owen Keet, Clive Dominy, Paul Young, Anna Hunt, Harriet Judd, Cassie Lawrence, Shaanti Olatunji, Yvonne Robertson, Charlotte Latimer-Bell, Deborah Hendry, Agnes Mckay-Vucago, Nina Beehre, Eden Lesona, Leanlove Navarra, Chelsea Robinson, Ryan Jang, Andrea Junge, Bridget Lambert, Michel Thibault, Philippe Eckert, Sébastien Kissling, Erietta Polychronopoulos, Elettra Poli, Marco Altarelli, Madeleine Schnorf, Samia Abed Mallaird, Claudia Heidegger, Aurelie Perret, Philippe Montillier, Frederic Sangla, Seigenthaller Neils, Aude De Watteville, Mandeep-Kaur Phull, Aparna George, Nauman Hussain, Tatiana Pogreban, Steve Lobaz, Alison Daniels, Mishell Cunningham, Deborah Kerr, Alice Nicholson, Pradeep Shanmugasundaram, Judith Abrams, Katarina Manso, Geraldine Hambrook, Elizabeth McKerrow, Juvy Salva, Stephen Foulkes, Matthew Wise, Matt Morgan, Jenny Brooks, Jade Cole, Tracy Michelle Davies, Helen Hill, Emma Thomas, Marcela Vizcaychipi, Behrad Baharlo, Jaime Carungcong, Patricia Costa, Laura Martins, Ritoo Kapoor, Tracy Hazelton, Angela Moon, Janine Musselwhite, Ben Shelley, Philip McCall, Gill Arbane, Aneta Bociek, Martina Marotti, Rosario Lim, Sara Campos, Neus Grau Novellas, Armando Cennamo, Andrew Slack, Duncan Wyncoll, Luigi Camporota, Simon Sparkes, Rosalinde Tilley, Austin Rattray, Gayle Moreland, Jane Duffy, Elizabeth McGonigal, Philip Hopkins, Clare Finney, John Smith, Harriet Noble, Hayley Watson, Claire-Louise Harris, Emma Clarey, Eleanor Corcoran, James Beck, Clare Howcroft, Nora Youngs, Elizabeth Wilby, Bethan Ogg, Adam Wolverson, Sandra Lee, Susie Butler, Maryanne Okubanjo, Julia Hindle, Ingeborg Welters, Karen Williams, Emily Johnson, Julie Patrick-Heselton, David Shaw, Victoria Waugh, Richard Stewart, Esther Mwaura, Lynn Wren, Louise Mew, Sara-Beth Sutherland, Jane Adderley, Jim Ruddy, Margaret Harkins, Callum Kaye, Teresa Scott, Wendy Mitchell, Felicity Anderson, Fiona Willox, Vijay Jagannathan, Michele Clark, Sarah Purv, Andrew Sharman, Megan Meredith, Lucy Ryan, Louise Conner, Cecilia Peters, Dan Harvey, Ashraf Roshdy, Amy Collins, Malcolm Sim, Steven Henderson, Nigel Chee, Sally Pitts, Katie Bowman, Maria Dilawershah, Luke Vamplew, Elizabeth Howe, Paula Rogers, Clara Hernandez, Clara Prendergast, Jane Benton, Alex Rosenberg, Lui G. Forni, Alice Grant, Paula Carvelli, Ajay Raithatha, Sarah Bird, Max Richardson, Matthew Needham, Claire Hirst, Jonathan Ball, Susannah Leaver, Luisa Howlett, Carlos Castro Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Gipsy Joseph, Francesca Robinson, Ascanio Tridente, Clare Harrop, Karen Shuker, Derek McLaughlan, Judith Ramsey, Sharon Meehan, Bernd Oliver Rose, Rosie Reece-Anthony, Babita Gurung, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Andy Johnston, Lauren Cooper, Ron Carrera, Karen Ellis, Emma Fellows, Samanth Harkett, Colin Bergin, Elaine Spruce, Liesl Despy, Stephanie Goundry, Natalie Dooley, Tracy Mason, Amy Clark, Gemma Dignam, Geraldine Ward, Ben Attwood, Penny Parsons, Sophie Mason, Michael Margarson, Jenny Lord, Philip McGlone, Luke E. Hodgson, Indra Chadbourn, Raquel Gomez, Jordi Margalef, Rinus Pretorius, Alexandra Hamshere, Joseph Carter, Hazel Cahill, Lia Grainger, Kate Howard, Greg Forshaw, Zoe Guy, Kianoush B. Kashani, Robert C. Albright, Amy Amsbaugh, Anita Stoltenberg, Alexander S. Niven, Matthew Lynch, AnnMarie O'Mara, Syed Naeem, Sairah Sharif, Joyce McKenney Goulart, Ashita Tolwani, Claretha Lyas, Laura Latta, Azra Bihorac, Haleh Hashemighouchani, Philip Efron, Matthew Ruppert, Julie Cupka, Sean Kiley, Joshua Carson, Peggy White, George Omalay, Sherry Brown, Laura Velez, Alina Marceron, Javier A. Neyra, Juan Carlos Aycinena, Madona Elias, Victor M. Ortiz-Soriano, Caroline Hauschild, and Robert Dorfman

Subjects
Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published
2022

15. The accuracy of intensive care nurses' interpretation of chest radiographs to recognise misplacement of endotracheal and nasogastric tubes after a single training session and comparison with residents' interpretation

Author

Toufik Kamel, Brice Sauvage, Karim Lakhal, Grégoire Ottavy, Ralf Janssen-Langenstein, Marine Jacquier, Charlotte Larrat, Gwenaëlle Jacq, Jérôme E. Dauvergne, Diane Maugars, Marie Labruyere, Véronique Simeon, Cécile Cugnart, Christophe Girault, and Thierry Boulain

Subjects
Emergency Nursing, Critical Care Nursing
Published
2023

17. Intravenous Milrinone for Cerebral Vasospasm in Subarachnoid Hemorrhage: The MILRISPASM Controlled Before–After Study

Author

Marion Fresco, Bertrand Rozec, Pierre-André Rodie-Talbere, Romain Bourcier, Vincent Robert-Edan, Pierre-Louis Alexandre, Antoine Hivert, Karim Lakhal, Xavier Ambrosi, and Julien Cadiet

Subjects
Subarachnoid hemorrhage, business.industry, medicine.medical_treatment, Renal function, Vasospasm, Subarachnoid Hemorrhage, Critical Care and Intensive Care Medicine, medicine.disease, Treatment Outcome, Cerebral vasospasm, Controlled Before-After Studies, Modified Rankin Scale, Anesthesia, Angioplasty, medicine, Humans, Vasospasm, Intracranial, Milrinone, Neurology (clinical), Hyponatremia, business, Retrospective Studies, medicine.drug
Abstract

Intravenous (IV) milrinone, in combination with induced hypertension, has been proposed as a treatment option for cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). However, data on its safety and efficacy are scarce. This was a controlled observational study conducted in an academic hospital with prospectively and retrospectively collected data. Consecutive patients with cerebral vasospasm following aSAH and treated with both IV milrinone (0.5 µg/kg/min−1, as part of a strict protocol) and induced hypertension were compared with a historical control group receiving hypertension alone. Multivariable analyses aimed at minimizing potential biases. We assessed (1) 6-month functional disability (defined as a score between 2 and 6 on the modified Rankin Scale) and vasospasm-related brain infarction, (2) the rate of first-line or rescue endovascular angioplasty for vasospasm, and (3) immediate tolerance to IV milrinone. Ninety-four patients were included (41 and 53 in the IV milrinone and the control group, respectively). IV milrinone infusion was independently associated with a lower likelihood of 6-month functional disability (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI] = 0.10–0.77]) and vasospasm-related brain infarction (aOR = 0.19, 95% CI 0.04–0.94). Endovascular angioplasty was less frequent in the IV milrinone group (6 [15%] vs. 28 [53%] patients, p = 0.0001, aOR = 0.12, 95% CI 0.04–0.38). IV milrinone (median duration of infusion, 5 [2–8] days) was prematurely discontinued owing to poor tolerance in 12 patients, mostly (n = 10) for “non/hardly-attained induced hypertension” (mean arterial blood pressure

Published
2021

18. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial

Author

Nicolas de Prost, Saber Barbar, Stéphane Gaudry, Jean-Pierre Quenot, Christophe Vinsonneau, Laurent Argaud, Eric Boulet, Didier Thevenin, Didier Dreyfuss, Marion Beuzelin, Adrien Robine, Cyril Cadoz, Steven Grangé, Béatrice La Combe, Dimitri Titeca-Beauport, Julien Mayaux, Julio Badie, Saad Nseir, Guillaume Chevrel, Karim Asehnoune, Florent Poirson, Kada Klouche, Sébastien Moschietto, Guillaume Louis, Guillaume Thiery, Marc Leone, David Hajage, Pascal Andreu, Elisabeth Coupez, Bertrand Pons, Said Lebbah, Jean-Damien Ricard, Jean-Marie Forel, Laurent Martin-Lefevre, Julien Bohé, Guillaume Geri, Sébastien Besset, Karim Lakhal, Nicolas Chudeau, Alain Combes, Bertrand Rozec, Nadia Aissaoui, Guillaume Lacave, Jean Reignier, CarMeN, laboratoire, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), UFR Santé, Médecine et Biologie Humaine (UFR SMBH), Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), 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), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Laboratoire Informatique, Image et Interaction - EA 2118 (L3I), La Rochelle Université (ULR), Centre Hospitalier Henri Duffaut (Avignon), CHU Amiens-Picardie, Université de Bretagne Sud - Lorient (UBS Lorient), Université de Bretagne Sud (UBS), Centre d'Etudes Lasers Intenses et Applications (CELIA), Université de Bordeaux (UB)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Hôpital Henri Mondor, Laboratoire Sciences Analytiques, Bioanalytiques, et Miniaturisation (LSABM), Chimie-Biologie-Innovation (UMR 8231) (CBI), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier de Dieppe, CH Belfort-Montbéliard, Centre Hospitalier Sud Francilien, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Le Mans (CH Le Mans), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Assistance Publique - Hôpitaux de Marseille (APHM), Centre Hospitalier de Lens, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), Géomécanique, Matériaux et Structures (GEOMAS), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA), 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 Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre Hospitalier de Versailles André Mignot (CHV), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Ambroise Paré [AP-HP], 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 Saint-Etienne (CHU de Saint-Etienne), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Louis Mourier - AP-HP [Colombes], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Programme Hospitalier de Recherche Clinique., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Université de La Rochelle (ULR), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Bordeaux (UB), Laboratoire de Tribologie et Dynamique des Systèmes (LTDS), École Centrale de Lyon (ECL), Université de Lyon-Université de Lyon-École Nationale des Travaux Publics de l'État (ENTPE)-Ecole Nationale d'Ingénieurs de Saint Etienne-Centre National de la Recherche Scientifique (CNRS), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Centre Hospitalier Fleyriat [Bourg en Bresse], Centre Hospitalier Sud Francilien [Corbeil-Essonnes] (CH Sud Francilien), Centre Hospitalier de Béthune Beuvry (CH Béthune Beuvry), Hôpital Nord [CHU - APHM], GH Carnelle Portes de l'Oise, Hôpital Lapeyronie [Montpellier] (CHU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord

Subjects
medicine.medical_specialty, MESH: Acute Kidney Injury, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, urologic and male genital diseases, MESH: Severity of Illnes Index, 03 medical and health sciences, MESH: Aged, 80 and over, 0302 clinical medicine, Oliguria, Intensive care, Internal medicine, Medicine, MESH: Time-to-Treatment, 030212 general & internal medicine, Renal replacement therapy, education, Blood urea nitrogen, MESH: Aged, education.field_of_study, MESH: Humans, MESH: Middle Aged, business.industry, Hazard ratio, Acute kidney injury, General Medicine, medicine.disease, MESH: Male, MESH: Prospective Studies, 3. Good health, [SDV] Life Sciences [q-bio], MESH: France, MESH: Intensive Care Units, medicine.symptom, MESH: Renal Remplacement Therapy, business, MESH: Female, Kidney disease
Abstract

International audience; BACKGROUND: Delaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury and no severe complication is safe and allows optimisation of the use of medical devices. Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy. METHODS: This was an unmasked, multicentre, prospective, open-label, randomised, controlled trial done in 39 intensive care units in France. We monitored critically ill patients with severe acute kidney injury (defined as Kidney Disease: Improving Global Outcomes stage 3) until they had oliguria for more than 72 h or a blood urea nitrogen concentration higher than 112 mg/dL. Patients were then randomly assigned (1:1) to either a strategy (delayed strategy) in which RRT was started just after randomisation or to a more-delayed strategy. With the more-delayed strategy, RRT initiation was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen concentration reached 140 mg/dL. The primary outcome was the number of days alive and free of RRT between randomisation and day 28 and was done in the intention-to-treat population. The study is registered with ClinicalTrial.gov, NCT03396757 and is completed. FINDINGS: Between May 7, 2018, and Oct 11, 2019, of 5336 patients assessed, 278 patients underwent randomisation; 137 were assigned to the delayed strategy and 141 to the more-delayed strategy. The number of complications potentially related to acute kidney injury or to RRT were similar between groups. The median number of RRT-free days was 12 days (IQR 0-25) in the delayed strategy and 10 days (IQR 0-24) in the more-delayed strategy (p=0·93). In a multivariable analysis, the hazard ratio for death at 60 days was 1·65 (95% CI 1·09-2·50, p=0·018) with the more-delayed versus the delayed strategy. The number of complications potentially related to acute kidney injury or renal replacement therapy did not differ between groups. INTERPRETATION: In severe acute kidney injury patients with oliguria for more than 72 h or blood urea nitrogen concentration higher than 112 mg/dL and no severe complication that would mandate immediate RRT, longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm. FUNDING: Programme Hospitalier de Recherche Clinique.

Published
2021

19. Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review

Author

Vincent Robert-Edan, Karim Lakhal, and Stephan Ehrmann

Subjects
Diagnostic Imaging, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, Case vignette, Contrast-induced nephropathy, Contrast Media, Disease, Review, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Kidney, Intensive care units (MeSH D007362), Iodinated contrast media, 03 medical and health sciences, 0302 clinical medicine, Iodinated contrast, Risk Factors, X-ray computed (MeSH: D015898), Medicine, Post-contrast acute kidney injury, Humans, Intensive care medicine, business.industry, Acute kidney injury, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Imaging Procedures, Drug-related side effects and adverse reactions (MeSH D064420), lcsh:RC86-88.9, Acute Kidney Injury, medicine.disease, Tomography scanners, Percutaneous coronary interventions (MeSH: D062645), Contrast media (MeSH: D003287), Administration, Intravenous, business, Clinical vignette, Iodine
Abstract

As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.

Published
2020

20. Plasma haemolysis index and interleukine-6 for the early prediction of cardiac surgery-associated acute kidney injury. A proof-of-concept study

Author

Karim Lakhal, Bertrand Rozec, Fouzia Souab, Thomas Senage, Maxime Leroy, Arnaud Legrand, Elodie Boissier, and Edith Bigot-Corbel

Subjects
Advanced and Specialized Nursing, Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine, Safety Research
Abstract

Introduction Haemolysis and inflammation contribute to cardiac surgery-associated acute kidney injury (CS-AKI). We aimed to assess the performance of plasma haemolysis index (HI) and interleukine-6 (IL-6) for the prediction of all-stage CS-AKI. We also assessed their ability to predict moderate-to-severe CS-AKI and to discriminate persistent from transient CS-AKI. Methods Adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were prospectively included. Haemolysis index and IL-6 were measured immediately after the end of CPB and 6 hours later. Correction for haemodilution relied upon changes in albuminaemia. Persistent CS-AKI was defined as a steady/increasing CS-AKI stage between the 48th and the 60th postoperative hour as compared with the worst stage observed within the 48 first hours. Results Among 82 patients, CS-AKI occurred in 37 (45%) patients. Postoperative HI and IL-6 were positively correlated to the duration of CPB (r ≤ 0.51, p ≤ 0.0003). Whether we considered isolated measurements of HI or IL-6, their indexation to haemodilution or not, their kinetics and/or their combination, the prediction of all stage CS-AKI was inaccurate (area under the receiver operating characteristic curve [AUCROC]≤ 0.68) whereas moderate-to-severe CS-AKI (6 patients only) was predicted with an honourable performance (AUCROC = 0.77 [95%CI 0.67;0.86] and 0.87 [95%CI 0.77;0.93] for HI and IL-6, respectively). The persistent/transient nature of CS-AKI was inaccurately predicted (AUCROC ≤ 0.68). Conclusions In a population in which most CS-AKI cases were mild, although they frequently (41%) persisted >48 hours, CS-AKI was inaccurately predicted by HI and/or IL-6. A better performance for moderate-to-severe CS-AKI prediction is likely. These preliminary findings are yet to be validated.

Published
2022

21. Switch from parenteral to oral antibiotics for brain abscesses: a retrospective cohort study of 109 patients

Author

Antoine, Asquier-Khati, Colin, Deschanvres, David, Boutoille, Maeva, Lefebvre, Paul, Le Turnier, Benjamin, Gaborit, Karim, Lakhal, Kevin, Buffenoir, Lydie, Khatchatourian, Nathalie, Asseray, and Chan, Ngohou

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Brain Abscess, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, Humans, Medicine, Pharmacology (medical), 030212 general & internal medicine, Brain abscess, Retrospective Studies, Pharmacology, business.industry, Glasgow Outcome Scale, Glasgow Coma Scale, Retrospective cohort study, Prognosis, medicine.disease, Comorbidity, Anti-Bacterial Agents, Regimen, Treatment Outcome, Infectious Diseases, Quality of Life, business
Abstract

Objectives Brain abscess is one of the most serious diseases of the CNS and is associated with high morbidity and mortality. With regard to the lack of data supporting an optimal therapeutic strategy, this study aimed to explore the prognostic factors of brain abscess, putting emphasis on the impact of therapeutic decisions. Methods We retrospectively included patients hospitalized for brain abscess during a period of 13 years. Comorbidities (Charlson scale), clinical presentation, microbiology culture, radiological features and therapeutic management were collected. Glasgow Outcome Scale (GOS) at 3 months and length of hospital stay were, respectively, the main and the secondary outcomes. Logistic regression was used to determine factors associated with outcome independently. Results Initial Glasgow Coma Scale (GCS) ≤14 and comorbidities (Charlson scale ≥2) were associated with poor neurological outcome while oral antibiotic switch was associated with better neurological outcome. Oral switch did not appear to be associated with an unfavourable evolution in the subset of patients without initial neurological severity (GCS >14) on admission. Duration of IV regimen and time to oral switch were associated with the length of inpatient stay. Conclusions This study confirms the role of GCS and comorbidities as prognostic factors and presents reassuring data regarding the safety of oral switch for the antibiotic treatment of brain abscesses. Oral switch could prevent catheter-induced iatrogenic complications and allow a higher quality of life for patients.

Published
2020

22. Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomised controlled study

Author

Bertrand Rozec, Karim Lakhal, Jérôme E. Dauvergne, Anne-Laure Geffray, and Karim Asehnoune

Subjects
Adult, Male, Critical Care, medicine.medical_treatment, Pneumonia, Aspiration, Critical Care and Intensive Care Medicine, Automation, 03 medical and health sciences, 0302 clinical medicine, Intubation, Intratracheal, Humans, Medicine, Intubation, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Trial registration, Aged, Mechanical ventilation, business.industry, Incidence, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, General Medicine, Length of Stay, Middle Aged, Anesthesiology and Pain Medicine, Cuff pressure, Anesthesia, Cuff, Female, Endotracheal tube cuff, Anesthesia, Inhalation, business, Airway
Abstract

Background Endotracheal tube cuff underinflation contributes to microaspiration of contaminated oropharyngeal content, source of pneumonia. Overinflation exposes to airway damage. Intermittent manual adjustment of the cuff pressure (P cuff ) may delay the detection of under- or overinflation. Devices for automated continuous adjustment of P cuff are promising but some are inconvenient, expensive or even harmful. This prospective randomized controlled study tested whether the Tracoe Smart Cuff Manager TM reduced the rate of patients undergoing ≥1 episode of underinflation (P cuff 30 cmH 2 O), of the incidence of under- and overinflation episodes and of their magnitude. Methods Patients likely to receive invasive mechanical ventilation for >48 hours because of acute brain injury were randomly allocated to receive, during 48 hours, automated P cuff adjustment (combined with manual adjustment) or manual adjustment alone. In each group, P cuff was measured with a dedicated manual manometer, at least every 8 hours. Results Sixty patients were analyzed (28 patients with automated and 32 with manual P cuff adjustment) for 506 measurements of P cuff (237 and 269, respectively). As compared with manual adjustment, automated adjustment of P cuff was associated with 1) a lower rate of patients with ≥1 episode of underinflation (63% and 18%, respectively, p0.99). Conclusions The adjunction of a continuous P cuff control with the Tracoe Smart Cuff Manager TM to routine manual intermittent adjustment reduced both the incidence of P cuff underinflation episodes and their magnitude without provoking overinflation.

Published
2020

23. Early Acute Kidney Injury in Patients with Non-Traumatic Subarachnoid Hemorrhage who Undergo Catheter Angiography: Incidence, Associated Risk Factors and Impact on Outcome

Author

Laureen Guillemin, Thomas Goronflot, Hubert Desal, Bertrand Rozec, and Karim Lakhal

Subjects
Intensive Care Units, Catheters, Risk Factors, Incidence, Rehabilitation, Angiography, Oliguria, Humans, Surgery, Neurology (clinical), Acute Kidney Injury, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

After subarachnoid hemorrhage (SAH), potential renal insults are numerous but the burden of early acute kidney injury (AKI) is unclear. We determined its incidence, rate of persistence, risk factors, and impact on patients' outcomes.Patients with non-traumatic SAH were retrospectively included if they underwent catheter angiography within the 48 h after their admission to the intensive care unit. Early AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria, analyzed from the time of catheter angiography. Early AKI was considered as persistent if the KDIGO stage did not decrease between the 48th and the 60th hour.Among 499 consecutive patients, early AKI (mostly oliguria) occurred in 132 (26%): stage 1, 2 and 3 in 72 (14%), 44 (9%), and 16 (3%) patients, respectively. It persisted in 36% of cases. Early AKI occurred more likely when SAH was severe or renal function was impaired at hospital admission: adjusted odds ratio of 2.76 [95% 1.77-4.30] and 3.32 [1.17-9.46], respectively. ICU and hospital lengths of stay were longer in patients who developed early AKI than in patients who did not: 16 [9-29] versus 12 [4-24] days (p = 0.0003) and 21 [14-43] versus 16 [11-32] days (p = 0.007), respectively. There was an independent link between early AKI and renal outcome (n = 274 in the model) but not with hospital mortality (n = 453).One quarter of our population developed early AKI, mostly oliguria. It persisted beyond the 48th hour in one third of cases. The associated risk factors we identified were non-modifiable.

Published
2021

24. Early recognition of cardiac surgery-associated acute kidney injury: lack of added value of TIMP2 IGFBP7 over short-term changes in creatinine (an observational pilot study)

Author

Edith Bigot-Corbel, Arnaud Legrand, Lucile Figueres, Floris Chabrun, Thomas Senage, Karim Lakhal, Émilie Sacchetto, Bertrand Rozec, Maxime Leroy, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Hôtel-Dieu de Nantes, Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Malbec, Odile

Subjects
Male, Tissue inhibitor of Metalloproteinase-2/urine* [MeSH], [SDV]Life Sciences [q-bio], Pilot Projects, law.invention, chemistry.chemical_compound, 0302 clinical medicine, Aortic valve replacement, 030202 anesthesiology, law, Anesthesiology, RD78.3-87.3, Prospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, Cardiopulmonary Bypass, biology, Acute kidney injury, Insulin-like growth factor binding proteins/urine* [MeSH], Acute Kidney Injury, Cardiac surgery, [SDV] Life Sciences [q-bio], Insulin-Like Growth Factor Binding Proteins, Creatinine/blood [MeSH], Lipocalins/metabolism* [MeSH], 030220 oncology & carcinogenesis, Aortic Valve, Cardiac surgical procedures [MeSH], Female, medicine.medical_specialty, Urology, Context (language use), Sensitivity and Specificity, 03 medical and health sciences, medicine, Cardiopulmonary bypass, Humans, Acute kidney injury [MeSH], Cystatin C, Aged, Creatinine, Tissue Inhibitor of Metalloproteinase-2, business.industry, Research, Perioperative, medicine.disease, Anesthesiology and Pain Medicine, Early Diagnosis, chemistry, biology.protein, business, Tissue inhibitor of Metalloproteinase-2 [MeSH], Biomarkers
Abstract

Background For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesized that, in the context of perioperative haemodilution, lack of postoperative decrease in pCr would be of honourable performance for the detection of CS-AKI. We therefore aimed at comparing these biomarkers and their kinetics (primary objective). As secondary objectives, we assessed plasma neutrophil gelatinase-associated lipocalin (pNGAL), cystatin C (pCysC) and urea (pUrea). We also determined the ability of these biomarkers to early discriminate persistent from transient CS-AKI. Methods Patients over 75 years-old undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in this prospective observational study. Biomarkers were measured before/after CPB and at the sixth postoperative hour (H6). Results In 65 patients, CS-AKI occurred in 27 (42%). ∆pCr from post-CPB to H6 (∆pCrpostCPB-H6): outperformed TIMP2 IGFBP7 at H6 and its intra- or postoperative changes: area under the receiver operating characteristic curve (AUCROC) of 0.84 [95%CI:0.73–0.92] vs. ≤0.67 [95%CI:0.54–0.78], p ≤ 0.03. The AUCROC of pNGAL, pCysC and pUrea did not exceed 0.72 [95%CI:0.59–0.83]. Indexing biomarkers levels for blood or urine dilution did not improve their performance. Combining TIMP2 IGFBP7 and ∆pCrpostCPB-H6 was of no evident added value over considering ∆pCrpostCPB-H6 alone. For the early recognition of persistent CS-AKI, no biomarker outperformed ∆pCrpostCPB-H6 (AUCROC = 0.69 [95%CI:0.48–0.85]). Conclusions In this hypothesis-generating study mostly testing early detection of mild CS-AKI, there was no evident added value of the tested modern biomarkers over early minimal postoperative changes in pCr: despite the common perioperative hemodilution in the setting of cardiac surgery, if pCr failed to decline within the 6 h after CPB, the development of CS-AKI was likely. Confirmatory studies with more severe forms of CS-AKI are required.

Published
2021

25. Emergence of methicillin-resistant Staphylococcus epidermidis resistant to linezolid: activity of ceftaroline versus ceftobiprole in a French University Hospital

Author

Pascale Bémer, Arthur Aubry, Eve Tessier, Louise Ruffier d'Epenoux, Karim Lakhal, Thierry Lepoivre, David Boutoille, Colin Deschanvres, Raphaël Lecomte, Dominique Navas, Aurélie Guillouzouic, Stéphane Corvec, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôtel-Dieu de Nantes, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Nantes Université (Nantes Univ), Immunology and New Concepts in ImmunoTherapy (INCIT), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), and Pecqueret, Valérie

Subjects
Methicillin-Resistant Staphylococcus aureus, Microbiology (medical), [SDV]Life Sciences [q-bio], Linezolid, Microbial Sensitivity Tests, General Medicine, Staphylococcal Infections, Hospitals, Anti-Bacterial Agents, Cephalosporins, [SDV] Life Sciences [q-bio], Infectious Diseases, Staphylococcus epidermidis, Humans, Methicillin Resistance, Pharmacology (medical), ComputingMilieux_MISCELLANEOUS
Abstract

International audience; No abstract available

Published
2022

26. Haemolysis index: validation for haemolysis detection during extracorporeal membrane oxygenation

Author

Philippe Bizouarn, Bertrand Rozec, Johanna Nicolet, Edith Bigot-Corbel, Thierry Lepoivre, Mickael Vourc'h, Thomas Senage, Karim Lakhal, Elodie Boissier, and Jean-Christian Roussel

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Acute kidney injury, Reproducibility of Results, Acute Kidney Injury, medicine.disease, Haemolysis, Hemolysis, law.invention, Extracorporeal Membrane Oxygenation, Anesthesiology and Pain Medicine, law, Free haemoglobin, Internal medicine, Extracorporeal membrane oxygenation, Cardiopulmonary bypass, Cardiology, Humans, Medicine, Prospective Studies, business
Published
2020

27. Pneumonia-SpecificEscherichia coliwith Distinct Phylogenetic and Virulence Profiles, France, 2012–2014

Author

Romain Fernandes, Vincent Fihman, Typhaine Billard-Pomares, Béatrice La Combe, Achille Kouatchet, Erick Denamur, Sandra Bourdon, Julien Goret, Matthieu Eveillard, Frédéric Wallet, Jean-Damien Ricard, Olivier Clermont, Julien Bador, Sigismond Lasocki, Karim Lakhal, Laurence Armand-Lefevre, Nicolas de Prost, Stéphane Corvec, Jonathan Messika, Jean Reignier, Service de Réanimation Médico-Chirurgicale [Hôpital Louis Mourier], Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), and 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)

Subjects
0301 basic medicine, Epidemiology, virulence factors, lcsh:Medicine, medicine.disease_cause, Virulence factor, Nosocomial infection, 0302 clinical medicine, Public Health Surveillance, bacteria, Escherichia coli Infections, Phylogeny, Phylotype, Virulence, Phylogenetic tree, Anti-Bacterial Agents, 3. Good health, Infectious Diseases, Pathovar, France, Pneumonia (non-human), Microbiology (medical), 030231 tropical medicine, 030106 microbiology, Microbial Sensitivity Tests, Biology, Serogroup, History, 21st Century, lcsh:Infectious and parasitic diseases, Microbiology, respiratory infections, ventilator-associated pneumonia, 03 medical and health sciences, Antibiotic resistance, Drug Resistance, Bacterial, Pneumonia, Bacterial, Escherichia coli, medicine, pneumonia, Humans, lcsh:RC109-216, antimicrobial resistance, Research, lcsh:R, biology.organism_classification, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Molecular Typing, Pneumonia-Specific Escherichia coli with Distinct Phylogenetic and Virulence Profiles, France, 2012–2014, Genes, Bacterial
Abstract

International audience; In a prospective, nationwide study in France of Escherichia coli responsible for pneumonia in patients receiving mechanical ventilation, we determined E. coli antimicrobial susceptibility, phylotype, O-type, and virulence factor gene content. We compared 260 isolates with those of 2 published collections containing commensal and bacteremia isolates. The preponderant phylogenetic group was B2 (59.6%), and the predominant sequence type complex (STc) was STc73. STc127 and STc141 were overrepresented and STc95 underrepresented in pneumonia isolates compared with bacteremia isolates. Pneumonia isolates carried higher proportions of virulence genes sfa/foc, papGIII, hlyC, cnf1, and iroN compared with bacteremia isolates. Virulence factor gene content and antimicrobial drug resistance were higher in pneumonia than in commensal isolates. Genomic and phylogenetic characteristics of E. coli pneumonia isolates from critically ill patients indicate that they belong to the extraintestinal pathogenic E. coli pathovar but have distinguishable lung-specific traits.

Published
2019

28. Intravenous Milrinone for Cerebral Vasospasm: Here Comes the Sun?

Author

Pierre-André Rodie-Talbere, Marion Fresco, Vincent Robert-Edan, Karim Lakhal, and Xavier Ambrosi

Subjects
medicine.medical_specialty, Cerebral vasospasm, Neurology, business.industry, Anesthesia, medicine, Milrinone, Neurology (clinical), Neurosurgery, Critical Care and Intensive Care Medicine, business, medicine.drug
Published
2021

29. Induced Hypertension or Intravenous Milrinone for Cerebral Vasospasm: Why Choose?

Author

Bertrand Rozec, Antoine Hivert, Julien Cadiet, and Karim Lakhal

Subjects
medicine.medical_specialty, Neurology, business.industry, Subarachnoid Hemorrhage, Critical Care and Intensive Care Medicine, Cerebral Angiography, Cerebral vasospasm, Text mining, Anesthesia, Hypertension, medicine, Humans, Vasospasm, Intracranial, Milrinone, Neurology (clinical), Neurosurgery, business, medicine.drug
Published
2021

30. Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy

Author

Yvonnick Blanloeil, Mohamed Srairi, Anaïs Guéguen, Catherine Paugam-Burtz, Fanny Feuillet, Vincent Atthar, Karim Asehnoune, Aurélie Le Thuaut, Nicolas Bruder, Julien Pottecher, Thomas Geeraerts, Doris Vigouroux, Thibault Triglia, Julien Josserand, Bertrand Rozec, Hélène Beloeil, Michel Galliez, Raphaël Cinotti, Karim Lakhal, and Simon Viquesnel

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Glasgow Coma Scale, MEDLINE, Intensive care unit, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, law, Predictive value of tests, Emergency medicine, Medicine, Observational study, business, Prospective cohort study, 030217 neurology & neurosurgery, Craniotomy, Cohort study
Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting. Methods Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in–intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression. Results Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In–intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively. Conclusions The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score’s performance before routine use.

Published
2018

31. Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients

Author

Stephan Ehrmann, Emmanuelle Rouve, Youenn Jouan, Laetitia Bodet-Contentin, Karim Lakhal, Charlotte Salmon Gandonnière, Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Ehrmann, Stephan

Subjects
Male, Nephrology, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Contrast Media, lcsh:RC870-923, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Prospective Studies, 030212 general & internal medicine, Kidney, Acute kidney injury, Middle Aged, medicine.anatomical_structure, Iodinated contrast media, Female, Research Article, medicine.drug, medicine.medical_specialty, Critical Illness, Urinary system, Iohexol, Urology, 03 medical and health sciences, TIMP-2, Internal medicine, medicine, Humans, Aged, Tissue Inhibitor of Metalloproteinase-2, Creatinine, business.industry, Iopromide, Iobitridol, 030208 emergency & critical care medicine, Cell Cycle Checkpoints, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, IGFBP-7, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, chemistry, Tomography, X-Ray Computed, business, Biomarkers, Kidney disease
Abstract

International audience; Background: Iodinated contrast media may contribute to acute kidney injury. However, several recent works suggest that this toxicity is minimal in the clinical setting. Recently, urinary G1 cell-cycle arrest proteins tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin like growth factor binding protein 7 (IGFBP-7) were identified as highly sensitive and specific biomarkers for early detection of kidney aggression. The impact of contrast administration on those biomarkers has not been specifically evaluated but could provide clues about the toxicity of contrast media. This study aimed at measuring changes in TIMP-2 and IGFBP-7 urinary concentrations before and after a contrast-enhanced computed tomography in critically ill patients.Methods: 77 patients were included in a prospective observational cohort study. Urinary [TIMP -2]·[IGFBP-7] was measured before, 6 and 24 h after contrast infusion. Urine output and serum creatinine were followed 3 days.Results: Median [TIMP-2]·[IGFBP-7] was 0.06 [interquartile range 0.04;0.26], 0.07 [0.03;0.34] and 0.10 [0.04;0.37] (ng/mL)2/1000 respectively before, 6 and 24 h after contrast infusion. Individual changes from baseline were − 0.01 [− 0.11;0.11] and 0.00 [− 0.10;0.09] (ng/ml)2/1000 at 6 and 24 h. These changes were not higher among the patients increasing their Kidney Disease Improving Global Outcome (KDIGO) classification within 3 days after contrast infusion (n = 14 [18%] based on creatinine criterion only, n = 42 [55%] based on creatinine and urine output).Conclusions: Changes in [TIMP-2]·[IGFBP-7] urinary concentration after contrast-enhanced computed tomography were insignificant, suggesting minimal kidney aggression by modern iodinated contrast media.

Published
2018

33. Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial

Author

Achille Sossou, Rémy Bellier, Kevin Lagarde, Alexandre Mansour, Jean-Michel Constantin, Marc Leone, Céline Monard, Brice Fermier, Cedric Carrie, Sigismond Lasocki, Armine Rouhani, Alexy Tran Dinh, Pierre-François Perrigault, Antoine Roquilly, Jerôme Morel, Ghilain Beauplet, Sami Blidi, Claire Dahyot-Fizelier, Christian Isetta, Marie-Anne Vibet, Mathilde Holleville, Philippe Guerci, Clément Gakuba, Fanny Feuillet, Karim Asehnoune, Jeremy Bourenne, Marc Danguy des Déserts, Benjamin G. Chousterman, Karim Lakhal, Alexandru Cupaciu, Arnaud Foucrier, Gerald Chanques, Calypso Mathieu, Adrien Oudotte, Véronique Sébille, Hugues De Courson, Pauline Cailliez, Jonathan Au Duong, Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département Anesthésie Réanimation, CHU d'Angers, Université d'Angers, Angers, Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Beaujon (AP/HP), Beaujon, Intensive Care Unit, Simone Veil Hospital, Blois, Department of Neuro-Critical Care, Pellegrin Hospital, Bordeaux, Surgical and trauma Intensive Care, Pellegrin Hospital, Bordeaux, Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, Department of Anesthesiology and Critical Care, CHU Caen, Caen, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Department of neuro-critical care, AP/HP, Creteil, Intensive Care Unit, Eaubonne Hospital, Eaubonne, Department of Anesthesiology and Critical Care, Emile Roux Hospital, Le Puy en Velay, Intensive Care Unit, Lorient Hospital, Lorient, Department of Anesthesiology and Critical Care, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, Department of Neuro-Critical Care, Hospices Civils de Lyon, Lyon, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Emergency Intensive Care Unit, Hopital la Timone, Marseille, Department of Anesthesiology and Cardiothoracic Intensive Care, Pierre Zobda-Quitman, Martinique, Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, Severe Burn Intensive Care Unit, Hotel Dieu, CHU Nantes, Nantes, Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Nancy, Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Bichat (AP/ HP), Paris, Department of Anesthesiology and Critical Care, Severe Burn Unit, Centre Hospitalier Universitaire de Lariboisiere (AP/HP), Paris, Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Saint Louis (AP/ HP), Paris, Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, Neuro-Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, Intensive Care Unit, Department of Anesthesiology and Critical Care, Rangueil Hospital, Centre Hospitalier Universitaire, Toulouse, Department of Anesthesiology and Critical Care, Pontchaillou Hospital, CHU Rennes, Rennes, Department of Anesthesiology and Critical Care, CHU Saint Etienne, Saint Etienne, Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Université de Nantes, Nantes, DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), MORNET, Dominique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Pontchaillou [Rennes], Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Microbes évolution phylogénie et infections (MEPHI), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Microbiology (medical), medicine.medical_specialty, Critical Care, [SDV]Life Sciences [q-bio], Audit, Hospital-acquired pneumonia, law.invention, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, law, Intensive care, Humans, Medicine, 030212 general & internal medicine, Cluster randomised controlled trial, ComputingMilieux_MISCELLANEOUS, business.industry, Hazard ratio, Healthcare-Associated Pneumonia, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, Intensive care unit, Hospitals, 3. Good health, Clinical trial, [SDV] Life Sciences [q-bio], Intensive Care Units, Infectious Diseases, Emergency medicine, business
Abstract

Background We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) can improve the outcomes of patients in intensive care units (ICUs). Methods This study was conducted at 35 ICUs in 30 hospitals. We included consecutive, adult patients hospitalized in ICUs for 3 days or more. After a 3-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a 3-month cluster-randomized trial. We randomly assigned ICUs to either receive audit and feedback (intervention group) or participate in a national registry (control group). The primary outcome was the duration of ICU stay. Results Among 1856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measures of compliance were 47% (interquartile range [IQR], 38–56%) in the intervention group and 42% (IQR, 25–53%) in the control group (P = .001). As compared to the baseline period, the ICU lengths of stay were reduced by 3.2 days in the intervention period (P = .07) and by 2.8 days in the control period (P = .02). The durations of ICU stay were 7 days (IQR, 5–14 days) in the control group and 9 days (IQR, 5–20 days) in the intervention group (P = .10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from the ICU in the control group was 1.17 (95% confidence interval, .69–2.01; P = .10). Conclusions The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes. Clinical Trials Registration NCT03348579.

Published
2020

34. The centrifuge brake impacts neither routine coagulation assays nor platelet count in platelet-poor plasma

Author

Thomas Senage, Bertrand Rozec, Laurie Talon, Thomas Sinegre, Aurélien Lebreton, Elodie Boissier, Karim Lakhal, and Jean-Christian Roussel

Subjects
Blood Platelets, medicine.medical_specialty, medicine.drug_class, Clinical Biochemistry, Centrifugation, Gastroenterology, Plasma, Internal medicine, Medicine, Humans, Platelet, Blood Coagulation, Platelet-poor plasma, Centrifuge, Hemostasis, business.industry, Pre analytical, Platelet Count, Biochemistry (medical), Anticoagulant, Reproducibility of Results, General Medicine, Coagulation, Blood Coagulation Tests, business
Published
2019

35. In the Name of Contrast-Induced Acute Kidney Injury…

Author

Stephan Ehrmann, Vincent Robert-Edan, and Karim Lakhal

Subjects
Pulmonary and Respiratory Medicine, business.industry, media_common.quotation_subject, Critical Illness, MEDLINE, Acute kidney injury, Contrast Media, Acute Kidney Injury, Critical Care and Intensive Care Medicine, medicine.disease, Bioinformatics, Text mining, Critical illness, Medicine, Contrast (vision), Humans, Cardiology and Cardiovascular Medicine, business, media_common
Published
2019

36. Cost-effectiveness of point-of-care viscoelastic haemostatic assays in the management of bleeding during cardiac surgery: protocol for a prospective multicentre pragmatic study with stepped-wedge cluster randomised controlled design and 1-year follow-up (the IMOTEC study)

Author

Isabelle Durand-Zaleski, J.-C. Rigal, Bertrand Rozec, Elodie Boissier, Valéry-Pierre Riche, and Karim Lakhal

Subjects
medicine.medical_specialty, Blood transfusion, perioperative care, Cost effectiveness, medicine.medical_treatment, Cost-Benefit Analysis, Point-of-Care Systems, Clinical Decision-Making, blood transfusion, Postoperative Hemorrhage, law.invention, 03 medical and health sciences, 0302 clinical medicine, Health Economics, Quality of life, law, Pragmatic Clinical Trials as Topic, medicine, Coagulopathy, Cardiopulmonary bypass, Protocol, Humans, 030212 general & internal medicine, Prospective Studies, Cardiac Surgical Procedures, Intensive care medicine, Randomized Controlled Trials as Topic, Mechanical ventilation, business.industry, General Medicine, Blood Coagulation Disorders, medicine.disease, Intensive care unit, Cardiac surgery, Thrombelastography, Point-of-Care Testing, haemorrhage, business, 030217 neurology & neurosurgery, cardiac surgery
Abstract

IntroductionDuring cardiac surgery-associated bleeding, the early detection of coagulopathy is crucial. However, owing to time constraints or lack of suitable laboratory tests, transfusion of haemostatic products is often inappropriately triggered, either too late (exposing to prolonged bleeding and thus to avoidable administration of blood products) or blindly to the coagulation status (exposing to unnecessary haemostatic products administration in patients with no coagulopathy). Undue exposition to transfusion risks and additional healthcare costs may arise. With the perspective of secondary care-related costs, the IMOTEC study (Intérêt MédicO-économique de la Thrombo-Elastographie, dans le management transfusionnel des hémorragies péri-opératoires de chirurgies Cardiaques sous circulation extracorporelle) aims at assessing the cost-effectiveness of a point-of-care viscoelastic haemostatic assay (VHA: RoTem or TEG)-guided management of bleeding. Among several outcome measures, particular emphasis will be put on quality of life with a 1-year follow-up.Methods and analysisThis is a multicentre, prospective, pragmatic study with stepped-wedge cluster randomised controlled design. Over a 36-month period (24 months of enrolment and 12 months of follow-up), 1000 adult patients undergoing cardiac surgery with cardiopulmonary bypass will be included if a periprocedural significant bleeding occurs. The primary outcome is the cost-effectiveness of a VHA-guided algorithm over a 1-year follow-up, including patients’ quality of life. Secondary outcomes are the cost-effectiveness of the VHA-guided algorithm with regard to the rate of surgical reexploration and 1-year mortality, its cost per-patient, its effectiveness with regard to haemorrhagic, infectious, renal, neurological, cardiac, circulatory, thrombotic, embolic complications, transfusion requirements, mechanical ventilation free-days, duration of intensive care unit and in-hospital stay and mortality.Ethics and disseminationThe study was registered at Clinicaltrials.gov and was approved by the Committee for the Protection of Persons of Nantes University Hospital, The French Advisory Board on Medical Research Data Processing and the French Personal Data Protection Authority. A publication of the results in a peer-reviewed journal is planned.Trial registration numberNCT02972684; Pre-results.

Published
2019

37. Noninvasive BP Monitoring in the Critically Ill

Author

Stephan Ehrmann, Karim Lakhal, and Thierry Boulain

Subjects
Pulmonary and Respiratory Medicine, Applanation tonometry, medicine.medical_specialty, Critically ill, business.industry, 030208 emergency & critical care medicine, Arterial catheter, Critical Care and Intensive Care Medicine, law.invention, Pulse pressure, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, Bp monitoring, law, Shock (circulatory), Cuff, medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Abstract

Although its reliability is often questioned, noninvasive BP (NIBP)-monitoring with an oscillometric arm cuff is widely used, even in critically ill patients in shock. When correctly implemented, modern arm NIBP devices can provide accurate and precise measurements of mean BP, as well as clinically meaningful information such as identification of hypotension and hypertension and monitoring of patient response to therapy. Even in specific circumstances such as arrhythmia, hypotension, vasopressor infusion, and possibly in obese patients, arm NIBP may be useful, contrary to widespread belief. Hence, postponing the arterial catheter insertion pending the initiation of more urgent diagnostic and therapeutic measures could be a suitable strategy. Given the arterial catheter-related burden, fully managing critically ill patients without any arterial catheter may also be an option. Indeed, the benefit that patients may experience from an arterial catheter has been questioned in studies failing to show that its use reduces mortality. However, randomized controlled trials to confirm that NIBP can safely fully replace the arterial catheter have yet to be performed. In addition to intermittent measurements, continuous NIBP monitoring is a booming field, as illustrated by the release onto the market of user-friendly devices, based on digital volume clamp and applanation tonometry. Although the imperfect accuracy and precision of these devices would probably benefit from technical refinements, their good ability to track, in real time, the direction of changes in BP is an undeniable asset. Their drawbacks and advantages and whether these devices are currently ready to use in the critically ill patient are discussed in this review.

Published
2018

38. Continuous intravenous milrinone for severe reversible cerebral vasoconstriction syndrome (a case report)

Author

Nathalie Testard, Bertrand Rozec, Benjamin Daumas-Duport, Karim Lakhal, Pierre-André Rodie-Talbere, and Pierre-Louis Alexandre

Subjects
medicine.medical_specialty, Text mining, Neurology, business.industry, Internal medicine, medicine, Cardiology, Milrinone, Neurology (clinical), business, medicine.disease, Reversible cerebral vasoconstriction syndrome, medicine.drug
Published
2019

40. Assessment of nutritional status by monitoring quadriceps muscle layer thickness with ultrasonography in intensive care unit: an observational study

Author

Karim Asehnoune, Bertrand Rozec, L. Brisard, M. Fresco, A. Le Thuaut, Olivier Zambon, D. Demeure dit Latte, L. Nicolet, Raphaël Cinotti, Johanna Nicolet, Karim Lakhal, Thierry Lepoivre, and J. Reigner

Subjects
medicine.medical_specialty, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, Quadriceps muscle, Nutritional status, Layer thickness, Intensive care unit, law.invention, law, Physical therapy, Medicine, Observational study, Ultrasonography, business
Published
2020

41. A 2-min at 4500 g rather than a 15-min at 2200 g centrifugation does not impact the reliability of 10 critical coagulation assays

Author

Marc Trossaert, Aurélie Le Thuaut, J.-C. Rigal, Mathieu Sévin-Allouet, Solène De Gaalon, Elodie Boissier, Karim Lakhal, and Bertrand Rozec

Subjects
Prothrombin time, 030213 general clinical medicine, Chromatography, medicine.diagnostic_test, Chemistry, Pre analytical, Biochemistry (medical), Clinical Biochemistry, General Medicine, 030204 cardiovascular system & hematology, Molecular biology, 03 medical and health sciences, 0302 clinical medicine, Hemostasis, medicine, Coagulation (water treatment), Centrifugation, Blood coagulation test
Published
2017

42. Change in end-tidal carbon dioxide outperforms other surrogates for change in cardiac output during fluid challenge

Author

Stephan Ehrmann, Mai-Anh Nay, T Kamel, B Lortat-Jacob, Thierry Boulain, Karim Lakhal, and Bertrand Rozec

Subjects
Male, medicine.medical_specialty, Cardiac output, Critical Care, Cardiac Output, Low, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Heart rate, Tidal Volume, Humans, Medicine, Prospective Studies, Systole, Tidal volume, Aged, Capnography, medicine.diagnostic_test, business.industry, Cardiac arrhythmia, 030208 emergency & critical care medicine, Carbon Dioxide, Middle Aged, Respiration, Artificial, Surgery, Pulse pressure, Anesthesiology and Pain Medicine, 030228 respiratory system, Echocardiography, Breathing, Cardiology, Fluid Therapy, Female, France, business
Abstract

Background During fluid challenge, volume expansion (VE)-induced increase in cardiac output (ΔVECO) is seldom measured. Methods In patients with shock undergoing strictly controlled mechanical ventilation and receiving VE, we assessed minimally invasive surrogates for ΔVECO (by transthoracic echocardiography): fluid-induced increases in end-tidal carbon dioxide (ΔVE E ′ CO 2 ); pulse (ΔVEPP), systolic (ΔVESBP), and mean systemic blood pressure (ΔVEMBP); and femoral artery Doppler flow (ΔVEFemFlow). In the absence of arrhythmia, fluid-induced decrease in heart rate (ΔVEHR) and in pulse pressure respiratory variation (ΔVEPPV) were also evaluated. Areas under the receiver operating characteristic curves (AUCROCs) reflect the ability to identify a response to VE (ΔVECO ≥15%). Results In 86 patients, ΔVE E ′ CO 2 had an AUCROC=0.82 [interquartile range 0.73–0.90], significantly higher than the AUCROC for ΔVEPP, ΔVESBP, ΔVEMBP, and ΔVEFemFlow (AUCROC=0.61–0.65, all P 1 mm Hg (>0.13 kPa) had good positive (5.0 [2.6–9.8]) and fair negative (0.29 [0.2–0.5]) likelihood ratios. The 16 patients with arrhythmia had similar relationships between ΔVE E ′ CO 2 and ΔVECO to patients with regular rhythm (r2=0.23 in both subgroups). In 60 patients with no arrhythmia, ΔVE E ′ CO 2 (AUCROC=0.84 [0.72–0.92]) outperformed ΔVEHR (AUCROC=0.52 [0.39–0.66], P1 mm Hg (>0.13 kPa) indicated a likely response to VE.

Published
2017

43. Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis

Author

Vincent Robert-Edan, Stephan Ehrmann, Tài Pham, Yimin Geng, Genevieve Lyons, Chaan S. Ng, Roland M. H. Schein, Cynthia M. Cely, Andrew A Quartin, Cynthia S. Bell, Brian P. Hobbs, and Karim Lakhal

Subjects
Adult, Male, medicine.medical_specialty, Critical Care, Contrast Media, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Iodinated contrast, Renal Dialysis, Risk Factors, Internal medicine, Anesthesiology, Odds Ratio, Humans, Medicine, Propensity Score, Intensive care medicine, Aged, Aged, 80 and over, business.industry, Incidence, Incidence (epidemiology), Acute kidney injury, Bayes Theorem, 030208 emergency & critical care medicine, Odds ratio, Acute Kidney Injury, Middle Aged, medicine.disease, Intensive Care Units, Contrast medium, Meta-analysis, Administration, Intravenous, Female, Observational study, Tomography, X-Ray Computed, business, Iodine
Abstract

Critically ill patients, among whom acute kidney injury is common, are often considered particularly vulnerable to iodinated contrast medium nephrotoxicity. However, the attributable incidence remains uncertain given the paucity of observational studies including a control group. This study assessed acute kidney injury incidence attributable to iodinated contrast media in critically ill patients based on new data accounting for sample and effect size and including a control group. Systematic review of studies measuring incidence of acute kidney injury in critically ill patients following contrast medium exposure compared to matched unexposed patients. Patient-level meta-analysis implementing a Bayesian nested mixed effects multiple logistic regression model. Ten studies were identified; only four took into account the baseline acute kidney injury risk, three by patient matching (560 patients). Objective meta-analysis of these three studies (vague and impartial a priori hypothesis concerning attributable acute kidney injury risk) did not find that iodinated contrast media increased the incidence of acute kidney injury (odds ratio 0.95, 95% highest posterior density interval 0.45–1.62). Bayesian analysis demonstrated that, to conclude in favor of a statistically significant incidence of acute kidney injury attributable to contrast media despite this observed lack of association, one’s a priori belief would have to be very strongly biased, assigning to previous uncontrolled reports 3–12 times the weight of evidence strength provided by the matched studies including a control group. Meta-analysis of matched cohort studies of iodinated contrast medium exposure does not support a significant incidence of acute kidney injury attributable to iodinated contrast media in critically ill patients.

Published
2017

45. The CNAP™ Finger Cuff for Noninvasive Beat-To-Beat Monitoring of Arterial Blood Pressure

Author

Bertrand Rozec, Karim Asehnoune, Thierry Boulain, M. Martin, Karim Lakhal, S. Faiz, Yvonnick Blanloeil, and Stephan Ehrmann

Subjects
Male, Critical Care, Population, Beat (acoustics), law.invention, Fingers, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, Transducers, Pressure, Humans, Medicine, Arterial Pressure, Prospective Studies, education, Aged, education.field_of_study, Blood pressure monitors, business.industry, Blood Pressure Determination, 030208 emergency & critical care medicine, Middle Aged, Intensive care unit, Blood Pressure Monitors, Intensive Care Units, Anesthesiology and Pain Medicine, Blood pressure, Continuous noninvasive arterial pressure, Anesthesia, Cuff, Female, business
Abstract

Continuous and intermittent noninvasive measurements of arterial blood pressure (BP) have not been compared in the same population. In a large panel of intensive care unit patients, we assessed the agreement between CNAP™ (Continuous Noninvasive Arterial Pressure) finger cuff beat-to-beat monitoring of BP and reference intraarterial measurements. Two automated oscillometric brachial cuff devices were also tested: CNAP brachial cuff (used for CNAP finger cuff calibration) and an alternative device. The performance for detecting hypotension (intraarterial mean BP65 mm Hg or systolic BP90 mm Hg), response to therapy (therapy-induced increase in mean BP10%), and hypertension (intraarterial systolic BP140 mm Hg) was evaluated. We also assessed the between-calibration drift of CNAP finger cuff BP in specific situations: cardiovascular intervention or no intervention.With each device, 3 pairs of noninvasive and intraarterial measurements were prospectively collected and analyzed according to current guidelines, the International Organization for Standardization (ISO) standard. The trending ability and drift of the CNAP finger cuff BP were assessed over a 15-minute observation period.In 182 patients, CNAP finger cuff and CNAP brachial cuff readings did not conform to ISO standard requirements (mean bias ± SD exceeding the maximum tolerated 5 ± 8 mm Hg), whereas the alternative automated brachial cuff succeeded for mean and diastolic BP. CNAP finger cuff trending ability was poor (concordance rate70% over a 15-minute period) owing to a significant drift since calibration, especially if a cardiovascular intervention was performed (n = 75, -7.5 ± 10.2 mm Hg at the 14th minute, ie, before recalibration, versus -2.9 ± 7.9 mm Hg if no cardiovascular intervention occurred, n = 103, P = 0.0008). However, a similar and reliable performance was observed for the detection of hypotension with the CNAP finger cuff (within 4 minutes after calibration) and with the 2 automated brachial cuffs (area under the receiver operating characteristic curve ≥0.91, positive and negative likelihood ratios ≥5 and ≤0.20, respectively). The performance for the detection of response to therapy or of hypertension was slightly lower.In a large population of intensive care unit patients, CNAP did not fulfill the ISO criteria and exhibited a relevant between-calibration drift. However, CNAP measurements collected within 4 minutes after calibration were reliable for detecting hypotension, as were oscillometric devices, while providing beat-to-beat measurements. Interestingly, an alternative automated brachial cuff was more reliable than the native one, used for calibration. This information is important to clinicians using those devices and for further development of the CNAP technology.

Published
2016

46. High-Dosage Cefazolin Achieves Sufficient Cerebrospinal Diffusion To Treat an External Ventricular Drainage-Related Staphylococcus aureus Ventriculitis

Author

Raphaël Lecomte, Eric Dailly, Benjamin Gaborit, Ronan Bellouard, Karim Lakhal, David Boutoille, Matthieu Grégoire, Xavier Ambrosi, Colin Deschanvres, Nathalie Asseray, Guillaume Deslandes, Centre hospitalier universitaire de Nantes (CHU Nantes), The Enteric Nervous System in gut and brain disorders [U1235] (TENS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Microbiotes, Hôtes, Antibiotiques et Résistances bactériennes (MiHAR) (MiHAR), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Service des maladies infectieuses et tropicales [CHU Nantes], and NantesU M, Dépôt

Subjects
medicine.drug_class, [SDV]Life Sciences [q-bio], Antibiotics, Cephalosporin, Cefazolin, MESH: Adult Anti-Bacterial Agents / administration & dosage Anti-Bacterial Agents / therapeutic use Cefazolin / administration & dosage Cefazolin / therapeutic use* Cerebral Ventriculitis / drug therapy* Cerebral Ventriculitis / microbiology Humans Meningitis / drug therapy Meningitis / microbiology Microbial Sensitivity Tests Staphylococcal Infections / drug therapy Staphylococcal Infections / microbiology Staphylococcus aureus / drug effects Staphylococcus aureus / pathogenicity, medicine.disease_cause, cerebrospinal fluid, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, healthcare-associated infection, polycyclic compounds, medicine, Ventriculitis, Pharmacology (medical), 030212 general & internal medicine, pharmacokinetics, Pharmacology, 0303 health sciences, 030306 microbiology, business.industry, meningitis, Liter, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, medicine.disease, [SDV] Life Sciences [q-bio], Infectious Diseases, Staphylococcus aureus, Anesthesia, cefazolin, business, Meningitis, medicine.drug
Abstract

A patient received continuous infusion of cefazolin 10 g then 8 g daily for an external ventricular drainage-related methicillin-susceptible Staphylococcus aureus (MSSA) ventriculitis. Median free concentrations in the cerebrospinal fluid were 11.9 and 6.1 mg/liter after 10- and 8-g doses, respectively. Free concentrations in the cerebrospinal fluid were always above the MIC usually displayed by methicillin-susceptible Staphylococcus aureus (MSSA) isolates. These results support the use of high-dose cefazolin to achieve sufficient meningeal concentrations.

Published
2019

47. Evolution of Neurological Recovery during the First Year after Subarachnoid Haemorrhage in a French University Centre

Author

Bertrand Rozec, Hubert Desal, Kevin Buffenoir, Karim Asehnoune, Karim Lakhal, Denis Frasca, Bernard Allaouchiche, Jean-Baptiste Putegnat, Raphaël Cinotti, Amandine Chenet, Hôtel-Dieu de Nantes, Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Hôpital Saint-Jacques [Nantes], MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hospices Civils de Lyon (HCL), Agressions Pulmonaires et Circulatoires dans le Sepsis - UR (APCSé), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and CCSD, Accord Elsevier

Subjects
Male, Pediatrics, medicine.medical_specialty, Time Factors, Health Status, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Logistic regression, Hospitals, University, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030202 anesthesiology, Modified Rankin Scale, Recovery, Clinical endpoint, Humans, Vasospasm, Intracranial, Medicine, Glasgow Coma Scale, cardiovascular diseases, Aged, Outcome, Subarachnoid haemorrhage, Memory Disorders, business.industry, Mental Disorders, Incidence (epidemiology), Age Factors, Intracranial Aneurysm, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Subarachnoid Hemorrhage, University hospital, Embolization, Therapeutic, 3. Good health, [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, Drainage, Female, France, Angiographic vasospasm, Intracranial Hypertension, business
Abstract

International audience; INTRODUCTION: The evolution of neurological recovery during the first year after aneurysmal Subarachnoid Haemorrhage (SAH) is poorly described. PATIENTS: Patients with SAH in one university hospital from March the 1st 2010, to December 31st 2012, with a one-year follow-up. METHOD: Evaluation was performed via phone call at 3, 6 and 12\,months. Primary endpoint was poor neurological recovery (modified Rankin Scale 3-4-5-6), one year after SAH. Secondary endpoints were the incidence of lack of self-perceived previous health status recovery and incidence of cognitive disorders, one year after SAH. Risk factors of poor neurological recovery were retrieved with multivariable logistic regression. RESULTS: Two hundred and eleven patients were included and 208 had a complete follow-up. One hundred and twenty (57.7%) patients were female, 112 (53.8%) had a WFNS grade I-II-III. Seventy (33.6%) patients displayed one-year poor neurological outcome and risk factors of poor outcome were age, baseline Glasgow Coma Score\,≤q\,8, external ventricular drainage, intra-cranial hypertension and angiographic vasospasm. We observed an improvement in good outcome at 3\,months [112 (53.8%) patients], 6 months [127 (61.1%) patients] and one-year [138 (66.3%) patients]. Fifty-nine (35.3%) patients recovered previous health status, 96 (57.5%) had persistent behaviour disorders, and 71 (42.5%) suffered from memory losses at one year. DISCUSSION: Neurological recovery seems to improve over time. The same key complications should be targeted worldwide in SAH patients. CONCLUSION: Neurological complications in the following of SAH should be actively treated in order to improve outcome. The early neuro-ICU phase remains a key determinant of long-term recovery.

Published
2019

48. The Artificial Kidney Initiation in Kidney Injury 2 (AKIKI2): study protocol for a randomized controlled trial

Author

Béatrice La Combe, Guillaume Thiery, Guillaume Lacave, Julio Badie, Julien Mayaux, Guillaume Louis, Dimitri Titeca-Beauport, Nicolas Chudeau, Didier Thevenin, Nadia Aissaoui, Jean Reignier, Jean Marie Forel, Eric Boulet, Marc Leone, Laurent Argaud, Karim Asehnoune, Adrien Robine, Elisabeth Coupez, Bertrand Pons, Laurent Martin-Lefevre, Sébastien Besset, Guillaume Geri, Jean Pierre Quenot, Marion Beuzelin, Nicolas de Prost, Steven Grangé, Florent Poirson, Saber Barbar, Karim Lakhal, David Hajage, Stéphane Gaudry, Julien Bohé, Christophe Vinsonneau, Alain Combes, Didier Dreyfuss, Jean-Damien Ricard, Saad Nseir, Guillaume Chevrel, Kada Klouche, Sébastien Moschietto, Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de Biostatistique, Santé Publique et Information Médicale [CHU Pitié-Salpêtrière] (BIOSPIM ), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer [Boulogne] (INCA)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Service de Néphrologie-Dialyse-Transplantation [CHU Amiens-Picardie], CHU Amiens-Picardie, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de Réanimation Médico-Chirurgicale [Hôpital Louis Mourier], Hôpital Louis Mourier - AP-HP [Colombes], Centre hospitalier de Dieppe, Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Hôpital les oudaries, Service de Réanimation Médicale Sud, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre hospitalier Marc Jacquet (Melun), Centre hospitalier universitaire de Nantes (CHU Nantes), 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 de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Urgence respiratoire et réanimation médicale, Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Immunologie - Immunopathologie - Immunothérapeutique (I3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital avicenne, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris 13 (UP13)-Hôpital Avicenne, Service de Biostatistique Santé Publique et Information Médicale [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer [Boulogne] (INCA)-CHU Saint Louis [APHP], 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), Medical ICU, Avenue Albert Raymond, Saint-Priest en Jarez 42270, France, Saint-Etienne University Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Laboratoire de Tribologie et Dynamique des Systèmes (LTDS), École Centrale de Lyon (ECL), Université de Lyon-Université de Lyon-École Nationale des Travaux Publics de l'État (ENTPE)-Ecole Nationale d'Ingénieurs de Saint Etienne-Centre National de la Recherche Scientifique (CNRS), Institut de géologie, Université Scientifique et Médicale de Grenoble, CHU Clermont-Ferrand-Hôpital Gabriel Montpied, Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-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)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Ecologie et Evolution des Microorganismes (EEM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Time Factors, Hyperkalemia, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Medicine (miscellaneous), 030204 cardiovascular system & hematology, Kidney, urologic and male genital diseases, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, law.invention, Time-to-Treatment, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Randomized controlled trial, law, Oliguria, medicine, Humans, Multicenter Studies as Topic, Pharmacology (medical), 030212 general & internal medicine, Renal replacement therapy, Prospective Studies, Treatment outcome, Randomized Controlled Trials as Topic, Mechanical ventilation, lcsh:R5-920, business.industry, Acute kidney injury, Recovery of Function, Interim analysis, medicine.disease, female genital diseases and pregnancy complications, 3. Good health, Critical care, Anesthesia, Anuria, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, medicine.symptom, business, lcsh:Medicine (General), Kidneys, Artificial
Abstract

Background The Artificial Kidney Initiation in Kidney Injury (AKIKI) trial showed that a delayed renal replacement therapy (RRT) strategy for severe acute kidney injury (AKI) in critically ill patients was safe and associated with major reduction in RRT initiation compared with an early strategy. The five criteria which mandated RRT initiation in the delayed arm were: severe hyperkalemia, severe acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia, serum urea concentration > 40 mmol/l and oliguria/anuria > 72 h. However, duration of anuria/oliguria and level of blood urea are still criteria open to debate. The objective of the study is to compare the delayed strategy used in AKIKI (now termed “standard”) with another in which RRT is further delayed for a longer period (termed “delayed strategy”). Methods/design This is a prospective, multicenter, open-label, two-arm randomized trial. The study is composed of two stages (observational and randomization stages). At any time, the occurrence of a potentially severe condition (severe hyperkalemia, severe metabolic or mixed acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia) suggests immediate RRT initiation. Patients receiving (or who have received) intravenously administered catecholamines and/or invasive mechanical ventilation and presenting with AKI stage 3 of the KDIGO classification and with no potentially severe condition are included in the observational stage. Patients presenting a serum urea concentration > 40 mmol/l and/or an oliguria/anuria for more than 72 h are randomly allocated to a standard (RRT is initiated within 12 h) or a delayed RRT strategy (RRT is initiated only if an above-mentioned potentially severe condition occurs or if the serum urea concentration reaches 50 mmol/l). The primary outcome will be the number of RRT-free days at day 28. One interim analysis is planned. It is expected to include 810 patients in the observational stage and to randomize 270 subjects. Discussion The AKIKI2 study should improve the knowledge of RRT initiation criteria in critically ill patients. The potential reduction in RRT use allowed by a delayed RRT strategy might be associated with less invasive care and decreased costs. Enrollment is ongoing. Inclusions are expected to be completed by November 2019. Trial registration ClinicalTrials.gov, ID: NCT03396757. Registered on 11 January 2018.

Published
2019

49. Rôle de la fonte musculaire acquise en réanimation sur le devenir du patient traité par ventilation mécanique invasive : étude de cohorte observationnelle

Author

L. Brisard, A. Le Thuaut, Karim Asehnoune, Jean Reignier, Bertrand Rozec, Karim Lakhal, and M. Fresco

Subjects
Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Internal Medicine
Abstract

Introduction et but de l’etude La denutrition est definie par une reduction de la masse musculaire [1] . En reanimation, le suivi du diametre du quadriceps (dquad) par echographie est une technique prometteuse permettant de depister la fonte musculaire au lit du patient. L’objectif principal de cette etude etait d’evaluer l’impact de l’echo-denutrition (Decho) sur le devenir clinique. Materiel et methodes Resultats issus d’une cohorte prospective observationnelle (etude MALICUS– NCT 02564159 ) sur le suivi echographique du dquad menee dans 4 unites de reanimation d’un CHU pendant la periode 2014–2018. Les patients adultes admis en reanimation avec une duree previsible de ventilation mecanique invasive (VM) > 48 h et l’absence de criteres de denutrition severe etaient inclus. Des paires de mesures du dquad (muscles droit femoral et vaste intermediaire) a mi-cuisse etaient realisees toutes les 48 h entre l’admission (j0) et le 8e ± 1 jour (j8) ainsi que le jour d’extubation (Jext). La Decho etait definie par une diminution du dquad > 10 % par rapport a j0. Un suivi des criteres de devenir clinique etait realise a J8, Jext et J-sortie. Resultats exprimes en moyenne(± ecart-type). Comparaison des donnees quantitatives par test t de Student et des donnees qualitatives par test du Chi2. La capacite du dquad a predire le devenir etait evaluee par l’aire sous la courbe ROC (AUC). p Resultats et analyse statistique Nous avons inclus 218 patients representant 1059 paires de mesures du dquad : majoritairement des hommes (n = 145, 67 %) admis pour surveillance postoperatoire (n = 98, 45 %) en contexte d’urgence (58 %). L’âge, l’IMC, l’IGS-II, l’index de Buzby et l’albuminemie etaient respectivement de 58(± 16) ans, 28(± 5) kg/m2, 47(± 17), 89(± 14) et 33(± 4) g/L. Pendant la 1re semaine, dquad diminuait de 32,3(± 10,2) mm a 31,4(± 9,7) mm. En analyse per-protocole, 149 patients avaient des mesures conjointes du dquad analysables a j0 et j8. La prevalence de la Decho a j8 etait de 39,6 % (55/149 patients). Le taux de mortalite en reanimation [Decho = 15/55(27 %) ; p = 0,09], la duree de sejour en reanimation [Decho = 33(±50) ; p = 0,7], le nombre de jours libres sans VM [Decho = 8(± 9) ; p = 0,3], le taux d’infections nosocomiales [Decho = 42/55(76 %) ; p = 0,3] et le taux d’echec d’extubation [Decho = 6/55(11 %) ; p = 0,3] ne differaient pas en l’absence de Decho. Le developpement d’une Decho ne permettait pas de predire le deces en reanimation [AUC = 0,59]. Conclusion La fonte musculaire acquise en reanimation etait peut frequente dans notre cohorte polyvalente de patients. Elle n’apparaissait pas comme un facteur predictif du devenir clinique. Des recherches complementaires sur des populations ciblees avec des seuils differents de perte musculaire apparaissent necessaires.

Published
2021

50. Influence of surgical bleeding on the relationship between admission coagulopathy and risk of massive transfusion: lesson from 704 severe trauma patients

Author

Pauline Deras, A. Dehon, Pascal Latry, Jean-François Schved, E. Boissier, Jonathan Charbit, Karim Lakhal, Xavier Capdevila, Hôpital Lapeyronie [Montpellier] (CHU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'hématologie biologique[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)

Subjects
Adult, Male, Risk, medicine.medical_specialty, Adolescent, education, Acute trauma coagulopathy, Blood Loss, Surgical, 030204 cardiovascular system & hematology, Logistic regression, standard coagulation tests, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Odds Ratio, Coagulopathy, Humans, Medicine, Blood Transfusion, Retrospective Studies, Prothrombin time, Receiver operating characteristic, medicine.diagnostic_test, business.industry, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, 030208 emergency & critical care medicine, Retrospective cohort study, prediction, Hematology, General Medicine, Blood Coagulation Disorders, Middle Aged, medicine.disease, prothrombin time, Surgery, ROC Curve, Severe trauma, Area Under Curve, trauma management, haemorrhagic shock, Wounds and Injuries, Population study, Female, Partial Thromboplastin Time, business, Packed red blood cells
Abstract

Background This study hypothesized that the relationship between early coagulopathy and massive transfusion (MT) in trauma was highly dependent on the presence of surgical bleeding. Methods Consecutive severe trauma patients admitted to our institution over a 4-year period were included in this retrospective study. Surgical bleeding was defined as an injury requiring an invasive endovascular or surgical haemostatic procedure. The ability of prothrombin time ratio (PTr) and activated partial thromboplastin time ratio (aPTTr) to predict MT (≥10 units of packed red blood cells during the first 24 h) was determined by ROC curves. The strength of association and interaction between PTr, surgical bleeding and MT was assessed using a logistic regression analysis. Results Among the 704 patients included (ISS 21·0 ± 16·2), MT rate was higher in patients with surgical bleeding than in those with no surgical bleeding (47% vs. 5%; P

Published
2016

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