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1. Can Biomarkers Correctly Predict Ventilator-associated Pneumonia in Patients Treated With Targeted Temperature Management After Cardiac Arrest? An Exploratory Study of the Multicenter Randomized Antibiotic (ANTHARTIC) Study

Author: Nicolas Deye, MD, PhD, Amelie Le Gouge, MSc, Bruno François, MD, Camille Chenevier-Gobeaux, MD, PhD, Thomas Daix, MD, Hamid Merdji, MD, PhD, Alain Cariou, MD, PhD, Pierre-François Dequin, MD, PhD, Christophe Guitton, MD, Bruno Mégarbane, MD, PhD, Jacques Callebert, PharmD, PhD, Bruno Giraudeau, PhD, Alexandre Mebazaa, MD, PhD, Nicolas Vodovar, PhD, for the Clinical Research in Intensive Care and Sepsis-TRIal Group for Global Evaluation and Research in SEPsis (TRIGGERSEP) Network and the ANtibiotherapy during Therapeutic HypothermiA to pRevenT Infectious Complications (ANTHARTIC) Study Group, Arnaud Desachy, Christophe Cracco, Laurence Robin, Marie Anne Fally, David Schnell, Olivier Baudin, Charles Lafon, Philippe Petua, Stéphane Rouleau, Cyrille Nowak, Gaétan Plantefeve, Hervé Mentec, Olivier Pajot, Damien Contou, Jo-Anna Tirolien, Constance Vuillard, Cécile Zylberfajn, Nadile Ali, Dieudonne Kilendo, Olivia Chauvel, Elias Karam, Pascal Chevallier, Dorothée Ducoux, Fabrice Raymond, Christophe Gellis, Jean-Pierre Quenot, Thérèse Devaux, Audrey Large, Sébastien Mortreux, Pierre-Emmanuel Charles, Sébastien Prin, Jean-Baptiste Roudaut, Pascal Andreu, Auguste Dargent, Nora Perrot, Audrey Massard, Solenne Villot, Corinne Pernot, Bruno Francois, Thomas Daix, Philippe Vignon, Nicolas Pichon, Celine Gonzalez, Nicolas Rodier, Jean François Mary, Ludmila Baudrillart, Christine Vallejo, Emmanuelle Begot, Claire Mancia, Michelle Nouaille, Cécile Duchiron, Sandrine Naturel, Marie-Anne De Vinzellles, Hélène Beacco, Thierry Boulain, Chantal Brossard, Armelle Mathonnet, Dalila Benzekri-Lefevre, Anne Bretagnol, Isabelle Runge, François Barbier, Grégoire Muller, Mai-Anh Nay, Julie Rossi, Lucie Muller, Sophie Tollec, Alain Cariou, Nathalie Marin, Camille Chenevier-Gobeaux, Michel Arnaout, Omar Ben Hadj Salem, Wulfran Bougouin, Simon Bourcier, Benoit Champigneulle, Matthieu Jamme, Alexis Ferre, Guillaume Geri, Frédéric Pene, Julien Charpentier, Jean-Daniel Chiche, Lucie Guillemet, Jean-Paul Mira, Marine Paul, Nicolas Deye, Bruno Megarbane, Alexandre Mebazaa, Isabelle Malissin, Sebastian Voicu, Nicolas Vodovar, Jacques Callebert, Claire Pernin, Lydia Suarez, Philippe Manivet, Dominique Vodovar, Anthony Checinski, Lamia Kerdjana, Pierre Garcon, Antoine Goury, Catherine Fauvaux, Salamata Agne, Nahima Gueblaoui, Aude Jacob, Loic Chimot, Catherine Huchet, Nadège Lacoste, Pierre-Henri Dessalles, Mélanie Saint-Leger, Yannick Monseau, Marie Heil, Ferhat Meziani, Hamid Merdji, DrKhoury, Samir Chenaf, Christine Kummerlen, Yannick Rabouel, Hayat Allam, Anne Hutt-Clauss, Alexandra Monnier, Pierre-François Dequin, Christine Mabilat, Emmanuelle Rouve, Charlotte Salmon-Gandonnière, Denis Garot, Youen Jouan, Stephan Ehrmann, Antoine Guillon, Laetitia Bodet–Contentin, Emmanuelle Mercier, Julie Mankikian, Stéphane Legriel, MrSébastien Cavelot, Christophe Guitton, Charlotte Garret, Cédric Bretonniere, Laurent Nicolat, Noëlle Brule, and Olivier Zambon
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: IMPORTANCE:. Ventilator-associated pneumonia (VAP) frequently occurs in patients with cardiac arrest. Diagnosis of VAP after cardiac arrest remains challenging, while the use of current biomarkers such as C-reactive protein (CRP) or procalcitonin (PCT) is debated. OBJECTIVES:. To evaluate biomarkers’ impact in helping VAP diagnosis after cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS:. This is a prospective ancillary study of the randomized, multicenter, double-blind placebo-controlled ANtibiotherapy during Therapeutic HypothermiA to pRevenT Infectious Complications (ANTHARTIC) trial evaluating the impact of antibiotic prophylaxis to prevent VAP in out-of-hospital patients with cardiac arrest secondary to shockable rhythm and treated with therapeutic hypothermia. An adjudication committee blindly evaluated VAP according to predefined clinical, radiologic, and microbiological criteria. All patients with available biomarker(s), sample(s), and consent approval were included. MAIN OUTCOMES AND MEASURES:. The main endpoint was to evaluate the ability of biomarkers to correctly diagnose and predict VAP within 48 hours after sampling. The secondary endpoint was to study the combination of two biomarkers in discriminating VAP. Blood samples were collected at baseline on day 3. Routine and exploratory panel of inflammatory biomarkers measurements were blindly performed. Analyses were adjusted on the randomization group. RESULTS:. Among 161 patients of the ANTHARTIC trial with available biological sample(s), patients with VAP (n = 33) had higher body mass index and Acute Physiology and Chronic Health Evaluation II score, more unwitnessed cardiac arrest, more catecholamines, and experienced more prolonged therapeutic hypothermia duration than patients without VAP (n = 121). In univariate analyses, biomarkers significantly associated with VAP and showing an area under the curve (AUC) greater than 0.70 were CRP (AUC = 0.76), interleukin (IL) 17A and 17C (IL17C) (0.74), macrophage colony-stimulating factor 1 (0.73), PCT (0.72), and vascular endothelial growth factor A (VEGF-A) (0.71). Multivariate analysis combining novel biomarkers revealed several pairs with p value of less than 0.001 and odds ratio greater than 1: VEGF-A + IL12 subunit beta (IL12B), Fms-related tyrosine kinase 3 ligands (Flt3L) + C–C chemokine 20 (CCL20), Flt3L + IL17A, Flt3L + IL6, STAM-binding protein (STAMBP) + CCL20, STAMBP + IL6, CCL20 + 4EBP1, CCL20 + caspase-8 (CASP8), IL6 + 4EBP1, and IL6 + CASP8. Best AUCs were observed for CRP + IL6 (0.79), CRP + CCL20 (0.78), CRP + IL17A, and CRP + IL17C. CONCLUSIONS AND RELEVANCE:. Our exploratory study shows that specific biomarkers, especially CRP combined with IL6, could help to better diagnose or predict early VAP occurrence in cardiac arrest patients.
Published: 2024
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2. Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study

Author: Laetitia Bodet-Contentin, Hélène Messet-Charrière, Valérie Gissot, Aurélie Renault, Grégoire Muller, Aurélie Aubrey, Pierrick Gadrez, Elsa Tavernier, and Stephan Ehrmann
Subjects: Language comprehension test, Critical care, Intubation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Purpose Communication of caregivers and relatives to patients is a major difficulty in intensive care units (ICU). Patient’s comprehension capabilities are variable over time and traditional comprehension tests cannot be implemented. Our purpose was to evaluate an oral comprehension test adapted for its automatic implementation using eye-tracking technology among ICU patients. Methods Prospective bi-centric cohort study was conducted on 60 healthy volunteers and 53 ICU patients. Subjects underwent an oral comprehension test using an eye-tracking device: Their results and characteristics were collected. The total duration of the test was 2 and a half minutes. Results While performing the test, 48 patients (92%) received invasive ventilation. Among healthy volunteers, the median rate of right answers was very high (93% [interquartile range 87, 100]), whereas it was lower (33% [20, 67]) for patients. For both groups, a significantly lower right answers rate was observed with advancing age (67% [27, 80] vs. 27% [20, 38] among patients and 93% [93, 100] vs. 87% [73, 93] among healthy volunteers, below and above 60 years of age, respectively) and in case of lack of a bachelor’s degree (60% [38, 87] vs. 27% [20, 57] among patients and 93% [93, 100] vs. 87% [73, 93] among healthy volunteers). For patients, the higher the severity of disease was, the lower the rate of correct answers was. Conclusion The eye-tracking-adapted comprehension test is easy and fast to use among ICU patients, and results seem coherent with various potential levels of comprehension as hypothesized in this study.
Published: 2022
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3. Ten actions to achieve gender equity among intensivists: the French Society of Intensive Care (FICS) model

Author: Olfa Hamzaoui, Florence Boissier, Charlotte Salmon Gandonnière, Cécile Aubron, Laetitia Bodet-Contentin, Muriel Sarah Fartoukh, Mélanie Faure, Mercedes Jourdain, Julien Le Marec, Fabienne Tamion, Nicolas Terzi, Caroline Hauw-Berlemont, Nadia Aissaoui, and FEMMIR Group for the SRLF Trial Group
Subjects: Gender equity, Working group, Sponsorship, Mentorship, Unconscius bias, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract In our recent survey, we aimed to collect information on perceived inequity as well as professional and personal fulfillment among women intensivists in France. For the 371 respondents out of the 732 persons who received the survey, the findings were unequivocal: for one-third of the respondents, being a woman was considered as an obstacle to careers or academic advancement, and for two thirds, pregnancy was viewed as a barrier to their career advancement. Gender discrimination had been experienced by 55% of the respondents. In 2019, to promote and achieve gender equity in the French Intensive Care Society (FICS), ten actions were initiated and are detailed in the present manuscript together with supporting data: (1) creation of a working group: the FEMMIR group; (2) promotion of mentorship; (3) implementation of concrete sponsorship; (4) transparency and public reporting of gender ratios in editorial boards; (5) workshops dedicated to unconscious gender bias; (6) workshops dedicated to improved women assertiveness; (7) role models; (8) creation of educational/information programs for young intensivists; (9) development of research on gender inequity and, as a perspective; and (10) development of a wide-ranging program. This review is aimed at providing a toolbox of organizational best practices designed to achieve gender equity. It is particularly important to share promising practical action engaged in our FEMMIR group with other concerned professionals around the world.
Published: 2022
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4. Rapid rEcognition of COrticosteRoiD resistant or sensitive Sepsis (RECORDS): study protocol for a multicentre, placebo-controlled, biomarker-guided, adaptive Bayesian design basket trial

Author: Shidasp Siami, Charlène Le Moal, Thomas DAIX, Sylvie Chevret, Yonatan Perez, Constance Vuillard, Damien Roux, Jonathan Messika, Stephan Ehrmann, Jean-Pierre Quenot, Dalila Benzekri, Gwenhaël Colin, Thierry Boulain, Julie Mankikian, Laura Federici, Jean Reignier, Jean-Paul Mira, Marie-Ange Azais, Djillali Annane, Jean-Claude Lacherade, Grégoire Muller, Christine Lebert, Nicholas Heming, Arthur Bailly, Emmanuelle Mercier, Jean-Baptiste Lascarrou, Julio Badie, Louis-Marie Dumont, Gaetan Plantefeve, Francis Schneider, Patrice Tirot, Isabelle Vinatier, Mickael Landais, Michel Djibré, Bruno Francois, Alexandra Monnier, Francois Barbier, Ferhat Meziani, Hamid Merdji, Pascal Andreu, Julie Helms, Laetitia Bodet-Contentin, Nicolas Pichon, Noémie Zucman, Mehran Monchi, Xavier Monnet, Marie Labruyère, Denis Garot, Hassène Rahmani, Jérôme Fleuriet, Pierre-Louis Declerq, Adrien Robine, Fabrice Uhel, Charles Cerf, Gilles Troché, Alexandrou Antigoni, Annane Djillali, Arlt Birte, Badie Julio, Benghanem Sarah, Berdaguer Ferrari Fernando, Cerf Charles, Chelly Dagdia Zaineb, Chevret Sylvie, Colin Gwenhaël, Daniel Christel, Declercq Pierre-Louis, Delbove Agathe, Devillier Philippe, Fleuriet Jérome, François Bruno, Garchon Henri-Jean, Godot Véronique, Grassin-Delyle Stanislas, Grisolia Mathieu, Guitton Christophe, Helms Julie, Heming Nicholas, Herzog Marielle, Kamel Toufik, Kedad Zoubida, Lassalle Philippe, Lhermite Guillaume, Megarbane Bruno, Mekontso Dessap Armand, Mercier Emmanuelle, Meziani Ferhat, Mira Jean-Paul, Monchi Mehran, Monnet Xavier, Muller Grégoire, Quenot Jean-Pierre, Reignier Jean, Robine Adrien, Rottman Martin, Roux Anne-Laure, Schneider Francis, Siami Shidasp, Tissieres Pierre, Troché Gilles, Uhel Fabrice, Zeitouni Karine, Plantefève Gaëtan, Walid Darwiche, Antoine Guillon, Youenn Jouan, Annick Legras, Marlene Morisseau, Emmanuelle Rouve, Charlotte Salmon-Gandonniere, Raphael Clere-Jehl, Laure Stiel, Antoine Studer, Jean-Baptiste Roudaut, Marine Jacquier, Sophie Jacquier, Armelle Mathonnet, Mai-Anh Nai, Isabelle Runge, Sophie Tollec, Marc Amouretti, Pierre Moine, Paris Meng, Rania Bounab, Muriel-Sarah Fartoukh, Alexandre Elabbadi, Konstantinos Bachoumas, Remi Bernardon, Gauthier Blonz, Luc Desmedt, Brian Emonet, Maud Fiancette, Matthieu Henry, Julien Lorber, Laurent Martin-Lefevre, Caroline Pouplet, Aihem Yehia, Sarah Benghanem, Julien Charpentier, Clara Vigneron, Anne-Laure Fedou, Claire Mancia, Emmanuelle Begot, Philippe Vignon, Antoine Galy, Celine Gonzalez, Marine Goudelin, Bruno Evrard, Arnaud Desachy, Julien Vaidie, Guillaume Gilbert, Cedric Darreau, Benoit Derrien, Marjorie Saint-Martin, Nicolas Chudeau, Jean Christophe Callahan, Dominique Vivier, Pierre-Yves Olivier, Remy Marnai, Nicolas Sedillot, Xavier Tchenio, Yves Poncelin, Remi Bruyere, Grimaldi Lamiae, and Derridj Nawal
Subjects: Medicine
Abstract: Introduction Corticosteroids affect variably survival in sepsis trials, suggesting heterogeneity in patients’ response to corticosteroids. The RECORDS (Rapid rEcognition of COrticosteRoiD resistant or sensitive Sepsis) trial aimed at defining endotypes associated with adults with sepsis responsiveness to corticosteroids.Methods and analysis RECORDS, a multicentre, placebo-controlled, biomarker-guided, adaptive Bayesian design basket trial, will randomly assign to a biomarker stratum 1800 adults with community-acquired pneumonia, vasopressor-dependent sepsis, septic shock or acute respiratory distress syndrome. In each stratum, patients will be randomly assigned to receive a 7-day course of hydrocortisone and fludrocortisone or their placebos. Patients with COVID-19 will be treated with a 10-day standard course of dexamethasone and randomised to fludrocortisone or its placebo. Primary outcome will be 90-day death or persistent organ dysfunction. Large simulation study will be performed across a range of plausible scenarios to foresee power to detect a 5%–10% absolute difference with corticosteroids. We will assess subset-by-treatment interaction by estimating in a Bayesian framework two quantities: (1) measure of influence, relying on the value of the estimation of corticosteroids’ effect in each subset, and (2) measure of interaction.Ethics and dissemination The protocol was approved by the Ethics Committee (Comité de Protection des Personnes, Dijon, France), on 6 April 2020. Trial results will be disseminated at scientific conferences and results will be published in peer-reviewed journals.Trial registration number ClinicalTrials.gov Registry (NCT04280497).
Published: 2023
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5. Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study: authors' response

Author: Hélène Messet-Charrière, Stephan Ehrmann, and Laetitia Bodet-Contentin
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2023
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6. Perceived inequity, professional and personal fulfillment by women intensivists in France

Author: Caroline Hauw-Berlemont, Cécile Aubron, Nadia Aissaoui, Laetitia Bodet-Contentin, Florence Boissier, Muriel Sarah Fartoukh, Mercedes Jourdain, Julien Le Marec, Julia Pestel, Charlotte Salmon Gandonnière, Fabienne Tamion, Olfa Hamzaoui, and FEMMIR Group for the SRLF Trial Group
Subjects: Quality of life, Work–life balance, Women in medicine, Intensive care, Women intensivists, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background The medical workforce has been feminized for the last two decades worldwide. Nonetheless, women remain under-represented among intensivists. We conducted a survey among French women intensivists to assess their professional and personal quality of life and their perception of potential gender discrimination at work. Methods We conducted an observational descriptive study by sending a survey, designed by the group FEMMIR (FEmmes Médecins en Médecine Intensive Réanimation), to women intensivists in France, using primarily the Société de Réanimation de Langue Française (SRLF) mailing list. The questionnaire was also available online between September 2019 and January 2020 and women intensivists were encouraged to answer through email reminders. It pertained to five main domains, including demographic characteristics, work position, workload and clinical/research activities, self-fulfillment scale, perceived discrimination at work and suggested measures to implement. Results Three hundred and seventy-one women responded to the questionnaire, among whom 16% had an academic position. Being a woman intensivist and pregnancy were both considered to increase difficulties in careers’ advancement by 31% and 73% of the respondents, respectively. Almost half of the respondents (46%) quoted their quality of life equal to or lower than 6 on a scale varying from 1 (very bad quality of life) to 10 (excellent quality of life). They were 52% to feel an imbalance between their personal and professional life at the cost of their personal life. Gender discrimination has been experienced by 55% of the respondents while 37% confided having already been subject of bullying or harassment. Opportunities to adjust their work timetable including part-time work, better considerations for pregnant women including increasing the number of intensivists and the systematic replacement during maternity leave, and the respect of the law regarding the paternity leave were suggested as key measures to enable better professional and personal accomplishment by women intensivists. Conclusion In this first large French survey in women intensivists, we pointed out issues felt by women intensivists that included an imbalance between professional and personal life, a perceived loss of opportunity due to the fact of being a woman, frequent reported bullying or harassment and a lack of consideration of the needs related to pregnancy and motherhood.
Published: 2021
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7. Determinants of hospital and one-year mortality among older patients admitted to intensive care units: results from the multicentric SENIOREA cohort

Author: Julien Demiselle, Guillaume Duval, Jean-François Hamel, Anne Renault, Laetitia Bodet-Contentin, Laurent Martin-Lefèvre, Dominique Vivier, Daniel Villers, Montaine Lefèvre, René Robert, Philippe Markowicz, Sylvain Lavoué, Anne Courte, Eddy Lebas, Stéphanie Chevalier, Cédric Annweiler, and Nicolas Lerolle
Subjects: Critical care outcomes, Older adults, Outcome assessment (health care), Mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. Methods We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. Results 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients’ place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. Conclusions The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171
Published: 2021
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8. Gender imbalance in intensive care: High time for action and evaluation!

Author: Caroline Hauw-Berlemont, Charlotte Salmon Gandonnière, Florence Boissier, Nadia Aissaoui, Laetitia Bodet-Contentin, Muriel Sarah Fartoukh, Mercedes Jourdain, Julien Le Marec, Fabienne Tamion, Olfa Hamzaoui, Cécile Aubron, and the FEMMIR (Femme Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2021
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9. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Author: Jean-François Timsit, Julien Baleine, Louis Bernard, Silvia Calvino-Gunther, Michael Darmon, Jean Dellamonica, Eric Desruennes, Marc Leone, Alain Lepape, Olivier Leroy, Jean-Christophe Lucet, Zied Merchaoui, Olivier Mimoz, Benoit Misset, Jean-Jacques Parienti, Jean-Pierre Quenot, Antoine Roch, Matthieu Schmidt, Michel Slama, Bertrand Souweine, Jean-Ralph Zahar, Walter Zingg, Laetitia Bodet-Contentin, and Virginie Maxime
Subjects: Catheter, Critically ill, Sepsis, Infection, Bacteremia, Prevention, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
Published: 2020
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10. Methodological quality of multivariate prognostic models for intracranial haemorrhages in intensive care units: a systematic review

Author: Denis Frasca, Fanny Feuillet, Maxime Leger, Raphaël Cinotti, Yohann Foucher, Jeanne Simon-Pimmel, Laetitia Bodet-Contentin, and Etienne Dantan
Subjects: Medicine
Abstract: Objectives Patients with severe spontaneous intracranial haemorrhages, managed in intensive care units, face ethical issues regarding the difficulty of anticipating their recovery. Prognostic tools help clinicians in counselling patients and relatives and guide therapeutic decisions. We aimed to methodologically assess prognostic tools for functional outcomes in severe spontaneous intracranial haemorrhages.Data sources Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, we conducted a systematic review querying Medline, Embase, Web of Science, and the Cochrane in January 2020.Study selection We included development or validation of multivariate prognostic models for severe intracerebral or subarachnoid haemorrhage.Data extraction We evaluated the articles following the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies and Transparent Reporting of multivariable prediction model for Individual Prognosis Or Diagnosis statements to assess the tools’ methodological reporting.Results Of the 6149 references retrieved, we identified 85 articles eligible. We discarded 43 articles due to the absence of prognostic performance or predictor selection. Among the 42 articles included, 22 did not validate models, 6 developed and validated models and 14 only externally validated models. When adding 11 articles comparing developed models to existing ones, 25 articles externally validated models. We identified methodological pitfalls, notably the lack of adequate validations or insufficient performance levels. We finally retained three scores predicting mortality and unfavourable outcomes: the IntraCerebral Haemorrhages (ICH) score and the max-ICH score for intracerebral haemorrhages, the SubArachnoid Haemorrhage International Trialists score for subarachnoid haemorrhages.Conclusions Although prognostic studies on intracranial haemorrhages abound in the literature, they lack methodological robustness or show incomplete reporting. Rather than developing new scores, future authors should focus on externally validating and updating existing scores with large and recent cohorts.
Published: 2021
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11. Nasal high-flow bronchodilator nebulization: a randomized cross-over study

Author: François Reminiac, Laurent Vecellio, Laetitia Bodet-Contentin, Valérie Gissot, Deborah Le Pennec, Charlotte Salmon Gandonnière, Maria Cabrera, Pierre-François Dequin, Laurent Plantier, and Stephan Ehrmann
Subjects: Albuterol, Respiratory function tests, Nebulizers and vaporizers, Chronic obstructive pulmonary disease, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background There is an absence of controlled clinical data showing bronchodilation effectiveness after nebulization via nasal high-flow therapy circuits. Results Twenty-five patients with reversible airflow obstruction received, in a randomized order: (1) 2.5 mg albuterol delivered via a jet nebulizer with a facial mask; (2) 2.5 mg albuterol delivered via a vibrating mesh nebulizer placed downstream of a nasal high-flow humidification chamber (30 L/min and 37 °C); and (3) nasal high-flow therapy without nebulization. All three conditions induced significant individual increases in forced expiratory volume in one second (FEV1) compared to baseline. The median change was similar after facial mask nebulization [+ 350 mL (+ 180; + 550); + 18% (+ 8; + 30)] and nasal high flow with nebulization [+ 330 mL (+ 140; + 390); + 16% (+ 5; + 24)], p = 0.11. However, it was significantly lower after nasal high-flow therapy without nebulization [+ 50 mL (− 10; + 220); + 3% (− 1; + 8)], p = 0.0009. FEV1 increases after facial mask and nasal high-flow nebulization as well as residual volume decreases were well correlated (p
Published: 2018
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12. 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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13. Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial

Author: Djillali, ANNANE, Christian, BRUN-BUISSON, Benoit, MISSET, Jean, CHASTRE, François, BRIVET, Julien, BOHE, Carole, SCHWEBEL, Shidasp, SIAMI, Michel, SLAMA, Olivier, LEROY, Gilles, CAPELLIER, Michel, WOLFF, Mohamed, ALI BEN ALI, François, ANTONINI, Jean-François, LORIFERNE, Franck, PETITPAS, Claire, CHARPENTIER, Jean-Michel, CONSTANTIN, Gilles, D'HONNEUR, Bertrand, SOUWEINE, Xavier, FORCEVILLE, Bruno, MEGARBANE, Francois, BAUDIN, Gwenhaël, COLIN, Karim, ASEHNOUNE, Jean-Pierre, QUENOT, Bruno, FRANCOIS, Thierry, BOULAIN, Emmanuelle, MERCIER, Jean, REIGNIER, Roland, AMATHIEU, Fabrice, COOK, Alain, CARIOU, Loic, CHIMOT, Fouad, Fadel, Andrea, Polito, Bernard, Clair, Virginie, Maxime, David, Luis, Tarek, Sharshar, David, Orlikowski, Keyvan, RAZAZI, Nicolas, DE PROST, Guillaume, CARTEAUX, Maité, GARROUSTE ORGEAS, François, Philippart, Alain, Combes, Ania, Nieszkowska, Frederic, Jacobs, Dominique, Prat, Patrick, Lafforgue, Claire, ARA SOMOHANO, Clémence, MINET, Maxime, LUGOSI, Julien, Maizel, Jean Christophe, Navellou, Bruno, Mourvillier, Lila, Bouadma, Jean François, Timsit, Claude Denis, Martin, Julien, Textoris, Sandrine, Wiramus, Clément, BRUN, Benoît, RAGONNET, Ali, Ait-Hssain, Samia, Touati, Jean, Kuba, Vincent, Willems, Pierre, Lahillaire, Mohammed, Lassi, Marion, ANTONA, Alia, MEGHENEM, Marine, DEMESMAY, Eric, Boulet, Olivier, LOUTREL, Romain, DUMONT, Antoine, ROQUILLY, Pierre-Joachim, MAHE, Dominique, DEMEURE dit LATTE, Philippe, CHAMPIN, Jean François, ARNOULD, Raphaël, CINOTTI, Ronan, Le FLOCH, Marc, Clavel, Philippe, Vignon, Nicolas, Pichon, Emmanuelle, BEGOT, Anne-Laure, FEDOU, Catherine, CHAPELLAS, Antoine, GALY, Dalila, Benzekri Lefevre, Armelle, Mathonnet, Anne, Bretagnol, Isabelle, Runge, François, BARBIER, Grégoire, MULLER, Denis, GAROT, Pierre François, DEQUIN, Dominique, PERROTIN, Annick, LEGRAS, Julie, MANKIKIAN, Patrice, TALEC, Stephan, EHRMANN, Aurélie, JORET, Claire, LHOMMET, Emmanuelle, ROUVE, Laetitia, BODET-CONTENTIN, Youenn, JOUAN, Charlotte, SALMONGANDONNIERE, Laurent, MARTIN-LEFEVRE, Matthieu, HENRY-LAGARRIGUE, Aihem, YEHIA, Jean-Baptiste, LASCARROU, Christine, LEBERT, Jean-Claude, LACHERADE, Eric, LEVESQUE, Yen-Lan, NGUYEN, Fabrice, DAVIAUD, Adrien, BOUGLE, Jean Paul, MIRA, Jean Daniel, CHICHE, Frederic, PENE, Tristan, MORICHAU-BEAUCHANT, Guillaume, GERI, Pierre Henri, DESSALLES, Yannick, MONSEAU, Mélanie, SAINT-LEGER, Sandrine, BEDON-CARTE, Laetitia, Bodet-Contentin, Walid, Darwiche, Stephan, Ehrmann, Denis, Garot, Antoine, Guillon, Youenn, Jouan, Annick, Legras, Julie, Mankikian, Emmanuelle, Mercier, Marlene, Morisseau, Yonatan, Perez, Emmanuelle, Rouve, Charlotte, Salmon-Gandonniere, Julie, Helms, Hassene, Rahmani, Alexandra, Monnier, Hamid, Merdji, Raphael, Clere-Jehl, Laure, Stiel, Antoine, Studer, Pascal, Andreu, Jean-Baptiste, Roudaut, Marie, Labruyere, Marine, Jacquier, Francois, Barbier, Dalila, Benzekri, Thierry, Boulain, Sophie, Jacquier, Gregoire, Muller, Mai-Anh, Nai, Sophie, Tollec, Damien, Roux, Jonathan, Messika, Constance, Vuillard, Louis-Marie, Dumont, Laura, Federici, Noemie, Zucman, Marc, Amouretti, Djillali, Annane, Pierre, Moine, Paris, Meng, Rania, Bounab, Muriel-Sarah, Fartoukh, Michel, Djibre, Alexandre, Elabbadi, Marie-Ange, Azais, Konstantinos, Bachoumas, Arthur, Bailly, Remi, Bernardon, Gauthier, Blonz, Luc, Desmedt, Brian, Emonet, Maud, Fiancette, Matthieu, Henry, Jean-Claude, Lacherade, Jean-Baptiste, Lascarrou, Christine, Lebert, Julien, Lorber, Laurent Martin-, Lefevre, Caroline, Pouplet, Isabelle, Vinatier, Aihem, Yehia, Sarah, Benghanem, Julien, Charpentier, Clara, Vigneron, Anne-Laure, Fedou, Claire, Mancia, Emmanuelle, Begot, Thomas, Daix, Antoine, Galy, Celine, Gonzalez, Marine, Goudelin, Bruno, Evrard, Arnaud, Desachy, Julien, Vaidie, Guillaume, Gilbert, Cedric, Darreau, Benoit, Derrien, Marjorie, Saint-Martin, Patrice, Tirot, Mickael, Landais, Nicolas, Chudeau, Jean Christophe, Callahan, Dominique, Vivier, Charlene, Le Moal, Pierre-Yves, Olivier, Remy, Marnai, Francis, Schneider, Nicolas, Sedillot, Xavier, Tchenio, Adrien, Robine, Yves, Poncelin, Remi, Bruyere, Heming, Nicholas, Renault, Alain, Kuperminc, Emmanuelle, Brun-Buisson, Christian, Megarbane, Bruno, Quenot, Jean-Pierre, Siami, Shidasp, Cariou, Alain, Forceville, Xavier, Schwebel, Carole, Leone, Marc, Timsit, Jean-Francois, Misset, Benoît, Benali, Mohamed Ali, Colin, Gwenhael, Souweine, Bertrand, Asehnoune, Karim, Mercier, Emmanuelle, Chimot, Loïc, Charpentier, Claire, François, Bruno, Boulain, Thierry, Petitpas, Frank, Constantin, Jean Michel, Dhonneur, Gilles, Baudin, François, Combes, Alain, Bohé, Julien, Loriferne, Jean-François, Cook, Fabrice, Slama, Michel, Leroy, Olivier, Capellier, Gilles, Dargent, Auguste, Hissem, Tarik, Bounab, Rania, Maxime, Virginie, Moine, Pierre, Bellissant, Eric, and Annane, Djillali
Published: 2024
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14. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial

Author: Delphine, Chatellier, Anne, Veinstein, Florence, Boissier, Faustine, Reynaud, Maeva, Rodriguez, Florent, Joly, François, Arrivé, Victor, De Roubin, René, Robert, Laetitia, Bodet-Contentin, Charlotte, Salmon Gandonnière, Emmanuelle, Mercier, Paul, Jaubert, Nathalie, Marin, Marine, Paul, Morgane, Faure, Suela, Demiri, Alexandre, Demoule, Clara, Candille, Anaïs, Dartevel, Florian, Sigaud, Vanessa, Jean Michel, Raphaël, Le Mao, Pierre, Bailly, Amélie, Seguin, Jean-Baptiste, Lascarrou, Emmanuel, Canet, Gaëtan, Plantefève, Radj, Cally, Joanna, Tirolien, Adel, Maamar, Benoit, Painvin, Julien, Carvelli, Marc, Gainnier, Gaëtan, Béduneau, Dorothée, Carpentier, Dominique, Malacrino, Mehdi, Marzouk, Clément, Saccheri, Nicolas, Mahr, Pauline, Soulier, Quentin, Levrat, Pascal, Andreu, David, Cortier, Mai Anh, Nay, Coudroy, Rémi, Frat, Jean-Pierre, Ehrmann, Stephan, Pène, Frédéric, Decavèle, Maxens, Terzi, Nicolas, Prat, Gwenaël, Garret, Charlotte, Contou, Damien, Gacouin, Arnaud, Bourenne, Jeremy, Girault, Christophe, Vinsonneau, Christophe, Dellamonica, Jean, Labro, Guylaine, Jochmans, Sébastien, Herbland, Alexandre, Quenot, Jean-Pierre, Devaquet, Jérôme, Benzekri, Dalila, Vivier, Emmanuel, Nseir, Saad, Colin, Gwenhaël, Thevenin, Didier, Grasselli, Giacomo, Bougon, David, Assefi, Mona, Guérin, Claude, Lherm, Thierry, Kouatchet, Achille, Ragot, Stephanie, and Thille, Arnaud W
Published: 2022
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15. Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial

Author: Heming, Nicholas, primary, Renault, Alain, additional, Kuperminc, Emmanuelle, additional, Brun-Buisson, Christian, additional, Megarbane, Bruno, additional, Quenot, Jean-Pierre, additional, Siami, Shidasp, additional, Cariou, Alain, additional, Forceville, Xavier, additional, Schwebel, Carole, additional, Leone, Marc, additional, Timsit, Jean-Francois, additional, Misset, Benoît, additional, Benali, Mohamed Ali, additional, Colin, Gwenhael, additional, Souweine, Bertrand, additional, Asehnoune, Karim, additional, Mercier, Emmanuelle, additional, Chimot, Loïc, additional, Charpentier, Claire, additional, François, Bruno, additional, Boulain, Thierry, additional, Petitpas, Frank, additional, Constantin, Jean Michel, additional, Dhonneur, Gilles, additional, Baudin, François, additional, Combes, Alain, additional, Bohé, Julien, additional, Loriferne, Jean-François, additional, Cook, Fabrice, additional, Slama, Michel, additional, Leroy, Olivier, additional, Capellier, Gilles, additional, Dargent, Auguste, additional, Hissem, Tarik, additional, Bounab, Rania, additional, Maxime, Virginie, additional, Moine, Pierre, additional, Bellissant, Eric, additional, Annane, Djillali, additional, Djillali, ANNANE, additional, Christian, BRUN-BUISSON, additional, Benoit, MISSET, additional, Jean, CHASTRE, additional, François, BRIVET, additional, Julien, BOHE, additional, Carole, SCHWEBEL, additional, Shidasp, SIAMI, additional, Michel, SLAMA, additional, Olivier, LEROY, additional, Gilles, CAPELLIER, additional, Michel, WOLFF, additional, Mohamed, ALI BEN ALI, additional, François, ANTONINI, additional, Jean-François, LORIFERNE, additional, Franck, PETITPAS, additional, Claire, CHARPENTIER, additional, Jean-Michel, CONSTANTIN, additional, Gilles, D'HONNEUR, additional, Bertrand, SOUWEINE, additional, Xavier, FORCEVILLE, additional, Bruno, MEGARBANE, additional, Francois, BAUDIN, additional, Gwenhaël, COLIN, additional, Karim, ASEHNOUNE, additional, Jean-Pierre, QUENOT, additional, Bruno, FRANCOIS, additional, Thierry, BOULAIN, additional, Emmanuelle, MERCIER, additional, Jean, REIGNIER, additional, Roland, AMATHIEU, additional, Fabrice, COOK, additional, Alain, CARIOU, additional, Loic, CHIMOT, additional, Fouad, Fadel, additional, Andrea, Polito, additional, Bernard, Clair, additional, Virginie, Maxime, additional, David, Luis, additional, Tarek, Sharshar, additional, David, Orlikowski, additional, Keyvan, RAZAZI, additional, Nicolas, DE PROST, additional, Guillaume, CARTEAUX, additional, Maité, GARROUSTE ORGEAS, additional, François, Philippart, additional, Alain, Combes, additional, Ania, Nieszkowska, additional, Frederic, Jacobs, additional, Dominique, Prat, additional, Patrick, Lafforgue, additional, Claire, ARA SOMOHANO, additional, Clémence, MINET, additional, Maxime, LUGOSI, additional, Julien, Maizel, additional, Jean Christophe, Navellou, additional, Bruno, Mourvillier, additional, Lila, Bouadma, additional, Jean François, Timsit, additional, Claude Denis, Martin, additional, Julien, Textoris, additional, Sandrine, Wiramus, additional, Clément, BRUN, additional, Benoît, RAGONNET, additional, Ali, Ait-Hssain, additional, Samia, Touati, additional, Jean, Kuba, additional, Vincent, Willems, additional, Pierre, Lahillaire, additional, Mohammed, Lassi, additional, Marion, ANTONA, additional, Alia, MEGHENEM, additional, Marine, DEMESMAY, additional, Eric, Boulet, additional, Olivier, LOUTREL, additional, Romain, DUMONT, additional, Antoine, ROQUILLY, additional, Pierre-Joachim, MAHE, additional, Dominique, DEMEURE dit LATTE, additional, Philippe, CHAMPIN, additional, Jean François, ARNOULD, additional, Raphaël, CINOTTI, additional, Ronan, Le FLOCH, additional, Marc, Clavel, additional, Philippe, Vignon, additional, Nicolas, Pichon, additional, Emmanuelle, BEGOT, additional, Anne-Laure, FEDOU, additional, Catherine, CHAPELLAS, additional, Antoine, GALY, additional, Dalila, Benzekri Lefevre, additional, Armelle, Mathonnet, additional, Anne, Bretagnol, additional, Isabelle, Runge, additional, François, BARBIER, additional, Grégoire, MULLER, additional, Denis, GAROT, additional, Pierre François, DEQUIN, additional, Dominique, PERROTIN, additional, Annick, LEGRAS, additional, Julie, MANKIKIAN, additional, Patrice, TALEC, additional, Stephan, EHRMANN, additional, Aurélie, JORET, additional, Claire, LHOMMET, additional, Emmanuelle, ROUVE, additional, Laetitia, BODET-CONTENTIN, additional, Youenn, JOUAN, additional, Charlotte, SALMONGANDONNIERE, additional, Laurent, MARTIN-LEFEVRE, additional, Matthieu, HENRY-LAGARRIGUE, additional, Aihem, YEHIA, additional, Jean-Baptiste, LASCARROU, additional, Christine, LEBERT, additional, Jean-Claude, LACHERADE, additional, Eric, LEVESQUE, additional, Yen-Lan, NGUYEN, additional, Fabrice, DAVIAUD, additional, Adrien, BOUGLE, additional, Jean Paul, MIRA, additional, Jean Daniel, CHICHE, additional, Frederic, PENE, additional, Tristan, MORICHAU-BEAUCHANT, additional, Guillaume, GERI, additional, Pierre Henri, DESSALLES, additional, Yannick, MONSEAU, additional, Mélanie, SAINT-LEGER, additional, Sandrine, BEDON-CARTE, additional, Laetitia, Bodet-Contentin, additional, Walid, Darwiche, additional, Stephan, Ehrmann, additional, Denis, Garot, additional, Antoine, Guillon, additional, Youenn, Jouan, additional, Annick, Legras, additional, Julie, Mankikian, additional, Emmanuelle, Mercier, additional, Marlene, Morisseau, additional, Yonatan, Perez, additional, Emmanuelle, Rouve, additional, Charlotte, Salmon-Gandonniere, additional, Julie, Helms, additional, Hassene, Rahmani, additional, Alexandra, Monnier, additional, Hamid, Merdji, additional, Raphael, Clere-Jehl, additional, Laure, Stiel, additional, Antoine, Studer, additional, Pascal, Andreu, additional, Jean-Baptiste, Roudaut, additional, Marie, Labruyere, additional, Marine, Jacquier, additional, Francois, Barbier, additional, Dalila, Benzekri, additional, Thierry, Boulain, additional, Sophie, Jacquier, additional, Gregoire, Muller, additional, Mai-Anh, Nai, additional, Sophie, Tollec, additional, Damien, Roux, additional, Jonathan, Messika, additional, Constance, Vuillard, additional, Louis-Marie, Dumont, additional, Laura, Federici, additional, Noemie, Zucman, additional, Marc, Amouretti, additional, Djillali, Annane, additional, Pierre, Moine, additional, Paris, Meng, additional, Rania, Bounab, additional, Muriel-Sarah, Fartoukh, additional, Michel, Djibre, additional, Alexandre, Elabbadi, additional, Marie-Ange, Azais, additional, Konstantinos, Bachoumas, additional, Arthur, Bailly, additional, Remi, Bernardon, additional, Gauthier, Blonz, additional, Luc, Desmedt, additional, Brian, Emonet, additional, Maud, Fiancette, additional, Matthieu, Henry, additional, Jean-Claude, Lacherade, additional, Jean-Baptiste, Lascarrou, additional, Christine, Lebert, additional, Julien, Lorber, additional, Laurent Martin-, Lefevre, additional, Caroline, Pouplet, additional, Isabelle, Vinatier, additional, Aihem, Yehia, additional, Sarah, Benghanem, additional, Julien, Charpentier, additional, Clara, Vigneron, additional, Anne-Laure, Fedou, additional, Claire, Mancia, additional, Emmanuelle, Begot, additional, Thomas, Daix, additional, Antoine, Galy, additional, Celine, Gonzalez, additional, Marine, Goudelin, additional, Bruno, Evrard, additional, Arnaud, Desachy, additional, Julien, Vaidie, additional, Guillaume, Gilbert, additional, Cedric, Darreau, additional, Benoit, Derrien, additional, Marjorie, Saint-Martin, additional, Patrice, Tirot, additional, Mickael, Landais, additional, Nicolas, Chudeau, additional, Jean Christophe, Callahan, additional, Dominique, Vivier, additional, Charlene, Le Moal, additional, Pierre-Yves, Olivier, additional, Remy, Marnai, additional, Francis, Schneider, additional, Nicolas, Sedillot, additional, Xavier, Tchenio, additional, Adrien, Robine, additional, Yves, Poncelin, additional, and Remi, Bruyere, additional
Published: 2024
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16. Eye tracking technology to improve communication with intubated critical care patients: a randomized study

Author: Emilie SZYMKOWICZ, Laetitia BODET-CONTENTIN, Yoann MARECHAL, and Stephan EHRMANN
Abstract: Background: Communication with patients undergoing mechanical ventilation in the intensive care unit represents a challenge. The aims of the study were (1) to describe communication difficulties related to mechanical ventilation as experienced by healthcare professionals and patients, and (2) to compare the use of a conventional low-tech communication board and a high-tech eye tracking technology-based device to improve communication effectiveness of mechanically ventilated patients in intensive care. Methods: This prospective study consisted of a descriptive cross-sectional part describing the communication difficulties in the intensive care unit and an experimental randomized crossover part comparing the use of two technologically opposed augmentative and alternative communication interfaces. A mixed method approach was applied with a quantitative primary method and a qualitative complementary method. The numerical data were analyzed quantitatively using Mann-Whitney (ordinal variables) and chi-square (binary variables) nonparametric tests. The non-numerical data were analyzed qualitatively using thematization and categorization. Results: A total of 101 healthcare professionals and 44 patients participated. Regarding the descriptive part, the communication difficulty analysis confirmed that mechanical ventilation constitutes a major problem in patient-caregiver communication. Regarding the quantitative experimental part, the treatment effects on transmitted messages quantity (2 median messages per exchange for the board versus 4 median messages per exchange for the eye tracking, p < 0.0001), success rate (80% for the board versus 100% for the eye tracking, p < 0.05) and patient satisfaction (68% negative satisfaction level for the board versus 100% positive satisfaction level for eye tracking, p < 0.0001) were significant. Regarding the qualitative experimental part, the communication content covered 8 themes for the board compared to 9 themes for the eye tracking and the use difficulties included 4 categories for the board as well as for the eye tracking. Conclusion: The eye tracking device may further improve communication effectiveness of mechanically ventilated patients compared to the conventional communication board, both quantitatively and qualitatively. Trial registration: Communication Strategies for Mechanically Ventilated Patients in Intensive Care Units, NCT05651984. Retrospectively registered on December 02, 2022 (https://clinicaltrials.gov/ct2/show/NCT05651984?term=NCT05651984&draw=2&rank=1).
Published: 2023

17. Eye tracking communication with intubated critically ill patients: a proof-of-concept multicenter pilot study

Author: Laetitia BODET-CONTENTIN, Emilie SZYMKOWICZ, Eric DELPIERRE, Delphine CHARTIER, Pierrick GADREZ, Grégoire MULLER, Aurélie RENAULT, and Stephan EHRMANN
Subjects: Adult, Male, Intensive Care Units, Anesthesiology and Pain Medicine, Communication, Critical Illness, Humans, Female, Pilot Projects, Prospective Studies, Middle Aged, Eye-Tracking Technology, Aged
Abstract: Communication is essential to establish patient-caregivers relationship in the intensive care unit. Intubated patients are not able to speak because the tracheal tube prevents vocalization. Use of communication tools such as eye tracking device could improve communication with intubated patients. The objective of this feasibility pilot study was to demonstrate that an eye tracking device specifically developed for the intensive care could be used easily by awake intubated patient with a very short training time.This prospective multicenter study was conducted in four intensive care units. We included awake adult intubated patients. The device used included an eye-tracking infrared detection and a communication interface specifically developed.A total of 151 patients were included: the median age of patients was 66 years (56-72) and 97 (64%) were male, 97 patients (64%) succeed totally (installation; calibration, succeed to select all three icons), 124 (82%) succeed to select at least one icon, and 111 (74%) succeed to point to at least two icons. The main reasons for failure to use the device were: difficulties to open or to keep the eyes open, difficulties to installing the device occurred, and patient fatigue.This study shows that the use of an eye tracking technology device specifically designed for the intensive care setting, with a short training is easy to use for intubated patient. Patients, relatives and caregivers showed high satisfaction.
Published: 2022

18. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial

Author: Coudroy, Rémi, primary, Frat, Jean-Pierre, additional, Ehrmann, Stephan, additional, Pène, Frédéric, additional, Decavèle, Maxens, additional, Terzi, Nicolas, additional, Prat, Gwenaël, additional, Garret, Charlotte, additional, Contou, Damien, additional, Gacouin, Arnaud, additional, Bourenne, Jeremy, additional, Girault, Christophe, additional, Vinsonneau, Christophe, additional, Dellamonica, Jean, additional, Labro, Guylaine, additional, Jochmans, Sébastien, additional, Herbland, Alexandre, additional, Quenot, Jean-Pierre, additional, Devaquet, Jérôme, additional, Benzekri, Dalila, additional, Vivier, Emmanuel, additional, Nseir, Saad, additional, Colin, Gwenhaël, additional, Thevenin, Didier, additional, Grasselli, Giacomo, additional, Bougon, David, additional, Assefi, Mona, additional, Guérin, Claude, additional, Lherm, Thierry, additional, Kouatchet, Achille, additional, Ragot, Stephanie, additional, Thille, Arnaud W, additional, Delphine, Chatellier, additional, Anne, Veinstein, additional, Florence, Boissier, additional, Faustine, Reynaud, additional, Maeva, Rodriguez, additional, Florent, Joly, additional, François, Arrivé, additional, Victor, De Roubin, additional, René, Robert, additional, Laetitia, Bodet-Contentin, additional, Charlotte, Salmon Gandonnière, additional, Emmanuelle, Mercier, additional, Paul, Jaubert, additional, Nathalie, Marin, additional, Marine, Paul, additional, Morgane, Faure, additional, Suela, Demiri, additional, Alexandre, Demoule, additional, Clara, Candille, additional, Anaïs, Dartevel, additional, Florian, Sigaud, additional, Vanessa, Jean Michel, additional, Raphaël, Le Mao, additional, Pierre, Bailly, additional, Amélie, Seguin, additional, Jean-Baptiste, Lascarrou, additional, Emmanuel, Canet, additional, Gaëtan, Plantefève, additional, Radj, Cally, additional, Joanna, Tirolien, additional, Adel, Maamar, additional, Benoit, Painvin, additional, Julien, Carvelli, additional, Marc, Gainnier, additional, Gaëtan, Béduneau, additional, Dorothée, Carpentier, additional, Dominique, Malacrino, additional, Mehdi, Marzouk, additional, Clément, Saccheri, additional, Nicolas, Mahr, additional, Pauline, Soulier, additional, Quentin, Levrat, additional, Pascal, Andreu, additional, David, Cortier, additional, and Mai Anh, Nay, additional
Published: 2022
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19. Virtual reality during work breaks to reduce fatigue of intensive unit caregivers: A crossover, pilot, randomised trial

Author: Laetitia Bodet-Contentin, Mélanie Letourneur, and Stephan Ehrmann
Subjects: Emergency Nursing, Critical Care Nursing
Abstract: Intensive care unit (ICU) caregivers are exposed to high levels of stress. Work-related stress can impact quality of life and may lead to burnout. Virtual reality (VR) simulates a person's presence in a pleasant and enjoyable artificial environment. Thus, VR may be used to improve breaktime efficacy during the work shift of ICU caregivers.The study objectives were to evaluate the feasibility and efficacy of VR to decrease stress, anxiety, and fatigue, as well as to increase work disconnection during the breaktime.We conducted a prospective, monocentric, open-label, crossover, randomised study comparing a half an hour breaktime including an 8-min-long VR session and a usual breaktime among ICU caregivers, on two consecutive work shifts. Participants were evaluated before and after the breaktime as well as at the end of the work shift for stress, anxiety, fatigue, and work disconnection using visual analog scales.For the 88 participants, VR was easy to use. VR induced a significantly higher reduction in the fatigue score after the breaktime. Individual changes in the fatigue score were +0.17 (1.87) vs. -0.33 (1.87). A significantly higher feeling of disconnection from the work environment at the end of the breaktime was also observed with VR: 5.98 (3.04) vs. 4.20 (2.64). No significant difference was observed for other parameters, in particular at the end of the shift.VR sessions could improve the efficacy of breaktimes among ICU caregivers and contribute to a better quality of work life; repeated or longer sessions may be required to induce sustained effects.
Published: 2021

20. Prévalence élevée des caractéristiques cliniques et biologiques du syndrome métabolique chez les patients atteints de lipomatose épidurale : étude rétrospective monocentrique

Author: Heïdi Doize, Laetitia Bodet-Contentin, Thibault Dhalluin, François Maillot, Philippe Goupille, and Denis Mulleman
Subjects: Rheumatology
Published: 2022

21. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial

Author: Stephan Ehrmann, Jie Li, Miguel Ibarra-Estrada, Yonatan Perez, Ivan Pavlov, Bairbre McNicholas, Oriol Roca, Sara Mirza, David Vines, Roxana Garcia-Salcido, Guadalupe Aguirre-Avalos, Matthew W Trump, Mai-Anh Nay, Jean Dellamonica, Saad Nseir, Idrees Mogri, David Cosgrave, Dev Jayaraman, Joan R Masclans, John G Laffey, Elsa Tavernier, Ahmad A Elshafei, Brady J Scott, Tyler Weiss, Ramandeep Kaur, Lauren J Harnois, Amanda Miller, Flor Cerda, Andrew Klein, Jacob R Burd, Kathleen Posa-Kearney, Matthew Trump, Julie Jackson, Trevor Oetting, Mark Greenwood, Lindsay Hazel, Lisa Kingery, Lindsey Morris, Joon Yong Moon, Julianne Garnett, Shijing Jia, Kristine Nelson, Camilla Giacomini, John Laffey, Aoife Brennan, Conor Judge, Maeve Kernan, Claire Kelly, Ritika Ranjan, Siobhan Casey, Kevin O'Connell, Evelyn Newell, David Gallagher, Alistair Nichol, Ger Curley, Miguel Ibarra Estrada, Roxana García-Salcido, Alexandra Vargas-Obieta, Sara A Aguirre-Díaz, Luz Alcántar-Vallín, Montserrat Alvarado-Padilla, Quetzalcóatl Chávez-Peña, José A López-Pulgarín, Julio C Mijangos-Méndez, Miguel Marín-Rosales, Jorge E García-Alvarado, Oscar G Baltazar-González, Maura C González-Guerrero, Paola G Gutiérrez Ramírez, Sean Gilman, Patrice Plamondon, Rachel Roy, Jason Shahin, Raham Ragoshai, Aasmine Kaur, Josie Campisi, Joseph Dahine, Stefanie Perron, Slimane Achouri, Ronald Racette, Anne Kulenkamp, Andrés Pacheco, Marina García-de-Acilu, Irene Dot, Laetitia Bodet-Contentin, Denis Garot, Emmanuelle Mercier, Charlotte Salmon Gandonnière, Marlène Morisseau, Youenn Jouan, Walid Darwiche, Annick Legras, Antoine Guillon, Pierre-François Dequin, Anne-Charlotte Tellier, Jean Reignier, Jean-Baptiste Lascarrou, Amélie Seguin, Luc Desmedt, Emmanuel Canet, Christophe Guitton, Rémy Marnai, Jean-Christophe Callahan, Mickaël Landais, Nicolas Chudeau, Cédric Darreau, Patrice Tirot, Marjorie Saint Martin, Charlene Le Moal, Grégoire Muller, Sophie Jacquier, Gwenaël Prat, Pierre Bailly, Nicola Ferrière, Arnaud W Thille, Jean-Pierre Frat, Clément Saccheri, Matthieu Buscot, Gaëtan Plantefève, Damien Contou, Damien Roux, Jean-Damien Ricard, Laura Federici, Noémie Zucman, Santiago Freita Ramos, Marc Amouretti, Sébastien Besset, Coralie Gernez, Agathe Delbove, Guillaume Voiriot, Alexandre Elabbadi, Muriel Fartoukh, Sébastien Préau, Raphaël Favory, Alexandre Pierre, Arnaud Sement, Nicolas Terzi, Florian Sigaud, Clara Candille, Emanuele Turbil, Julien Maizel, Clément Brault, Yoan Zerbib, Aurélie Joret, Cédric Daubin, Laurent Lefebvre, Alais Giraud, Adrien Auvet, Christophe Vinsonneau, Mehdi Marzouk, Jean-Pierre Quenot, Pascal Andreu, Marie Labruyère, Jean-Baptiste Roudaut, François Aptel, Alexandre Boyer, Philippe Boyer, Jean-Claude Lacherade, Hugo Hille, Marie Bouteloup, Matthieu Jeannot, Marc Feller, Guillaume Grillet, Bruno Levy, Antoine Kimmoun, Service de Médecine Intensive Réanimation [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d'Etude des Pathologies Respiratoires (CEPR), UMR 1100. Equipe 3 'Aérosolthérapie et biothérapies à visée respiratoire' (CEPR. Equipe 3), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), 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), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Pulmonary and Respiratory Medicine, Canada, medicine.medical_specialty, medicine.medical_treatment, medicine.disease_cause, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Patient Positioning, 03 medical and health sciences, 0302 clinical medicine, Correspondence, Prone Position, medicine, Humans, Intubation, Prospective Studies, 030212 general & internal medicine, Wakefulness, Mexico, ComputingMilieux_MISCELLANEOUS, SARS-CoV-2, business.industry, Incidence (epidemiology), Hazard ratio, COVID-19, United States, 3. Good health, Prone position, Treatment Outcome, 030228 respiratory system, Respiratory failure, Spain, Relative risk, Emergency medicine, Observational study, France, Respiratory Insufficiency, business, Ireland, Nasal cannula
Abstract: Summary Background Awake prone positioning has been reported to improve oxygenation for patients with COVID-19 in retrospective and observational studies, but whether it improves patient-centred outcomes is unknown. We aimed to evaluate the efficacy of awake prone positioning to prevent intubation or death in patients with severe COVID-19 in a large-scale randomised trial. Methods In this prospective, a priori set up and defined, collaborative meta-trial of six randomised controlled open-label superiority trials, adults who required respiratory support with high-flow nasal cannula for acute hypoxaemic respiratory failure due to COVID-19 were randomly assigned to awake prone positioning or standard care. Hospitals from six countries were involved: Canada, France, Ireland, Mexico, USA, Spain. Patients or their care providers were not masked to allocated treatment. The primary composite outcome was treatment failure, defined as the proportion of patients intubated or dying within 28 days of enrolment. The six trials are registered with ClinicalTrials.gov , NCT04325906 , NCT04347941 , NCT04358939 , NCT04395144 , NCT04391140 , and NCT04477655 . Findings Between April 2, 2020 and Jan 26, 2021, 1126 patients were enrolled and randomly assigned to awake prone positioning (n=567) or standard care (n=559). 1121 patients (excluding five who withdrew from the study) were included in the intention-to-treat analysis. Treatment failure occurred in 223 (40%) of 564 patients assigned to awake prone positioning and in 257 (46%) of 557 patients assigned to standard care (relative risk 0·86 [95% CI 0·75−0·98]). The hazard ratio (HR) for intubation was 0·75 (0·62−0·91), and the HR for mortality was 0·87 (0·68−1·11) with awake prone positioning compared with standard care within 28 days of enrolment. The incidence of prespecified adverse events was low and similar in both groups. Interpretation Awake prone positioning of patients with hypoxaemic respiratory failure due to COVID-19 reduces the incidence of treatment failure and the need for intubation without any signal of harm. These results support routine awake prone positioning of patients with COVID-19 who require support with high-flow nasal cannula. Funding Open AI inc, Rice Foundation, Projet Hospitalier de Recherche Clinique Interregional, Appel d'Offre 2020, Groupement Interregional de Recherche Clinique et d'Innovation Grand Ouest, Association pour la Promotion a Tours de la Reanimation Medicale, Fond de dotation du CHRU de Tours, Fisher & Paykel Healthcare Ltd.
Published: 2021

22. Glomerular Hyper- and Hypofiltration During Acute Circulatory Failure

Author: Isabelle Benz-de Bretagne, Emmanuelle Mercier, Jean-Michel Halimi, Dalila Benzekri-Lefevre, Laetitia Bodet-Contentin, Olivier Le Tilly, Ferhat Meziani, Charlotte Salmon Gandonnière, Julie Helms, Anne Bretagnol, Stephan Ehrmann, and Chantal Barin-Le Guellec
Subjects: Adult, Male, medicine.medical_specialty, Metabolic Clearance Rate, Critical Illness, Iohexol, Urinary system, Population, Urology, Renal function, Kidney Function Tests, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Pharmacokinetics, Interquartile range, Humans, Medicine, Prospective Studies, Renal Insufficiency, Chronic, Prospective cohort study, education, education.field_of_study, business.industry, 030208 emergency & critical care medicine, Middle Aged, 3. Good health, Intensive Care Units, 030228 respiratory system, Creatinine, Arterial blood, Female, business, medicine.drug
Abstract: To assess glomerular filtration rate in the early phase of acute circulatory failure by measuring iohexol plasma clearance.Interventional prospective multicentric study.Three French ICUs in tertiary teaching hospitals.Patients with acute circulatory failure within 12 hours after ICU admission.IV administration of a nontoxic 5-mL dose of iohexol. Collection of nine arterial blood samples over 24 hours for iohexol plasma concentration measurements. Iohexol clearance calculation with a population pharmacokinetic model. Iohexol clearance was an estimation of the mean glomerular filtration rate over 24 hours.Among 99 included patients, we could calculate iohexol clearance for 85. The median iohexol clearance was 31 mL/min (interquartile range, 16-44). According to iohexol clearance, 41 patients (48%) had severe hypofiltration (clearance,30 mL/min), 29 (34%) had moderate hypofiltration, and 10 (12%) had mild hypofiltration (clearance, 30-60 and 60-90 mL/min, respectively). Four patients (5%) had normal glomerular filtration rate, and only one (1%) showed hyperfiltration (clearance,130 mL/min). Urinary creatinine clearance underestimated renal impairment in one patient out of two; the bias of iohexol clearance toward 24-hour urinary creatinine clearance over the same period was -18.1 mL/min (limits of agreement, -73.5 to 37.4).We demonstrated the feasibility of iohexol clearance measurement in unstable critically ill patients. Normal kidney function is exceptional during the early phase of acute circulatory failure. Glomerular filtration rate estimation by urinary creatinine clearance frequently fails to detect renal impairment. Hyperfiltration is very infrequent.
Published: 2019

23. Quel effectif médical dans les services de réanimation et surveillance continue en France ? Une position du syndicat des médecins réanimateurs des hôpitaux publics

Author: Jean-Philippe Rigaud, Nicolas Terzi, Jean-Luc Chagnon, Benoit Misset, Hervé Outin, Olivier Lesieur, Djillali Annane, Jean Luc Diehl, Jonathan Messika, Samia Touati, Laetitia Bodet-Contentin, Didier Dreyfuss, Didier Thevenin, and A. Sement
Subjects: Emergency Medicine, Emergency Nursing
Published: 2019

24. A telepresence robot in the room of a COVID-19 patient can provide virtual family presence

Author: Antoine Guillon, Adrien Lociciro, Laetitia Bodet-Contentin, Bodet-Contentin, Laetitia, Service de Médecine Intensive Réanimation [Tours], Service de Médecine Intensive et Réanimation [Tours], 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), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pain medicine, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), [SDV]Life Sciences [q-bio], 03 medical and health sciences, User-Computer Interface, 0302 clinical medicine, Anesthesiology, Medicine, critical illness, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Family health, Telerobotics, business.industry, family health, SARS-CoV-2, COVID-19, 030208 emergency & critical care medicine, General Medicine, Robotics, medicine.disease, Telemedicine, [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, Anesthesia, Critical illness, Images, Medical emergency, business, advanced technology
Abstract: International audience
Published: 2021

25. High prevalence of clinical and biological features of metabolic syndrome in patients with epidural lipomatosis: A single-center, retrospective study

Author: François Maillot, Thibault Dhalluin, Heïdi Doize, Denis Mulleman, Philippe Goupille, and Laetitia Bodet-Contentin
Subjects: Epidural Space, Metabolic Syndrome, Pediatrics, medicine.medical_specialty, High prevalence, business.industry, Retrospective cohort study, Single Center, medicine.disease, Magnetic Resonance Imaging, Epidural lipomatosis, Rheumatology, Prevalence, Humans, Lipomatosis, Medicine, In patient, Metabolic syndrome, medicine.symptom, business, Abdominal obesity, Retrospective Studies
Published: 2022

26. Promises and challenges of eye-tracking technology to evaluate the care process in the ICU

Author: Laetitia Bodet-Contentin, Stephan Ehrmann, 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), Service de Médecine Intensive Réanimation [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)
Subjects: Technology, Care process, business.industry, [SDV]Life Sciences [q-bio], MEDLINE, Pilot Projects, Airway Extubation, medicine.disease, Intensive Care Units, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, medicine, Humans, Eye tracking, ArtClinique, 030212 general & internal medicine, Medical emergency, Eye-Tracking Technology, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2020

27. Determinants of hospital and one-year mortality among older patients admitted to intensive care units: results from the multicentric SENIOREA cohort

Author: René Robert, Laetitia Bodet-Contentin, Cédric Annweiler, Laurent Martin-Lefevre, Stéphanie Chevalier, Nicolas Lerolle, Jean-François Hamel, Montaine Lefèvre, Eddy Lebas, Daniel Villers, Julien Demiselle, Philippe Markowicz, Sylvain Lavoué, Dominique Vivier, Anne Renault, Guillaume T. Duval, and Anne Courte
Subjects: medicine.medical_specialty, Population, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Quality of life, Intensive care, Critical care outcomes, Medicine, Outcome assessment (health care), education, Critical Care Outcomes, Survival rate, education.field_of_study, business.industry, Mortality rate, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, 030228 respiratory system, Older adults, Emergency medicine, Cohort, business, Cohort study
Abstract: Background Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. Methods We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. Results 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients’ place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. Conclusions The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171
Published: 2020

28. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Author: Alain Lepape, Michel Slama, Louis Bernard, Virginie Maxime, Michael Darmon, Jean-Pierre Quenot, Olivier Leroy, Matthieu Schmidt, Marc Leone, Walter Zingg, Zied Merchaoui, Antoine Roch, Jean-François Timsit, Eric Desruennes, Bertrand Souweine, Jean-Christophe Lucet, Julien Baleine, Benoit Misset, Jean-Jacques Parienti, Silvia Calvino-Gunther, Laetitia Bodet-Contentin, Jean Dellamonica, Jean-Ralph Zahar, Olivier Mimoz, Gestionnaire, Hal Sorbonne Université, Inflammation, microbiome, immunosurveillance (MI2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, 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, Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Universitaire [Grenoble] (CHU), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, 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), Hospices Civils de Lyon (HCL), Laboratoire des pathogènes émergents -- Emerging Pathogens Laboratory (LPE-Fondation Mérieux), Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Génétique et Biologie du Développement, Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Liège, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer (LabEx LipSTIC), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), 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), Hôpital Raymond Poincaré [AP-HP], Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), École Pratique des Hautes Études (EPHE), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université Lille Nord de France (COMUE)-UNICANCER, Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Université de Caen Normandie (UNICAEN), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Bacteremia, Review, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Sepsis, Intensive care, Medicine, 030212 general & internal medicine, Critically ill, Vein, Brachiocephalic vein, Dialysis, ddc:616, Catheter, 0303 health sciences, 030306 microbiology, business.industry, Prevention, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, Arterial catheter, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Clinical Practice, medicine.anatomical_structure, Emergency medicine, Infection, business
Abstract: The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
Published: 2020

29. 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

30. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

Author: Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge, Hervé Dupont, Marc Pierrot, François Beloncle, Danièle Combaux, Romain Mercier, Hadrien Winiszewski, Gilles Capellier, Gilles Hilbert, Didier Gruson, Pierre Kalfon, Bertrand Souweine, Elizabeth Coupez, Jean-Damien Ricard, Jonathan Messika, François Bougerol, Pierre-Louis Declercq, Auguste Dargent, Audrey Large, Djillali Annane, Bernard Clair, Agnès Bonadona, Rebecca Hamidfar, Christian Richard, Mathieu Henry-Lagarrigue, Ahiem Yehia Yehia, Johanna Temime, Stephanie Barrailler, Raphaël Favory, Erika Parmentier-Decrucq, Mercé Jourdain, Loredana Baboi, Marie Simon, Thomas Baudry, Mehran Monchi, Jérôme Roustan, Patrick Bardou, Alice Cottereau, Philippe Guiot, Noelle Brule, Mickael Landais, Antoine Roquilly, Thierry Boulain, Dalila Benzekri, Benoit Champigneulle, Jalel Tahiri, Gabriel Preda, Benoit Misset, Virginie Lemiale, Lara Zafrani, Muriel Fartoukh, Guillaume Thiéry, Delphine Chatellier, Rémi Coudroy, Renaud Chouquer, Samuel Gay, Christine Brasse, Arnaud Delahaye, Luis Ferreira, Régine Vermesch, Stéphanie Chevalier, Charlotte Quentin, Quentin Maestraggi, Francis Schneider, Ferhat Meziani, Charles Cerf, Grégoire Trebbia, Charlotte Salmon-Gandonnière, Laetitia Bodet-Contentin, Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Réanimation Médicale [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Stress vasculaire et tissulaire en transplantation : microparticules et environnement, Université de Strasbourg (UNISTRA), Service de réanimation médicale [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Groupement Hospitalier - Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon (HCL), Service de médecine intensive - réanimation et médecine hyperbare [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service de réanimation et de surveillance continue [CH Mautauban], Centre hospitalier de Montauban, Service de réanimation (CH Saint-Malo), Centre hospitalier de Saint-Malo, Service de Réanimation Polyvalente - CHR d’Orleans, Service de Réanimation Médicale [CHU Bordeaux], CHU Bordeaux [Bordeaux]-Hôpital Pellegrin, Service d’anesthésie-réanimation [AP-HP Hôpital Saint-Louis], 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), réanimation et soins continus [CH Saint-Denis], Centre Hospitalier de Saint-Denis [Ile-de-France], Service des Urgences et de Réanimation Médicale (Urg - SAINT ETIENNE), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Service de réanimation polyvalente [Hôpital Foch, Suresnes], Hôpital Foch [Suresnes], Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], CHU Tenon [AP-HP], Service de réanimation chirurgicale [Centre Hospitalier Emile Muller, Mulhouse], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA)-Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), 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), Unité de Soins Intensifs [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Le Mans (CH Le Mans), Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et nanosciences d'Alsace (FMNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation (CH La Roche-sur-Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer (LabEx LipSTIC), Institut National de la Recherche Agronomique (INRA)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université Paris-Sud - Paris 11 (UP11)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France, Radiopharmaceutiques biocliniques (LRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), 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), CIC - Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale, CHU Gabriel Montpied, CHU de Clermont-Ferrand, France, AP-HP Hôpital Saint-Louis, Service de réanimation et USC médico-chirurgicale [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université Paris-Sud - Paris 11 (UP11)-École pratique des hautes études (EPHE)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc (CRLCC - CGFL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-France-Comté] (EFS [Bourgogne-France-Comté])-Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC)-Université de Montpellier (UM), Radiopharmaceutiques biocliniques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), CIC Tours, Hôpital Bretonneau-Université de Tours-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôtel-Dieu-Centre hospitalier universitaire de Nantes ( CHU Nantes ), Université de Strasbourg ( UNISTRA ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Hospices Civils de Lyon ( HCL ), CHU Angers, CH Saint-Denis, Service des Urgences et de Réanimation Médicale ( Urg - SAINT ETIENNE ), Centre Hospitalier Universitaire de Saint-Etienne ( CHU de Saint-Etienne ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Tenon [APHP], Centre Hospitalier Emile Muller [Mulhouse] ( CH E.Muller Mulhouse ), Groupe Hospitalier de Territoire Haute Alsace ( GHTHA ) -Groupe Hospitalier de Territoire Haute Alsace ( GHTHA ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), 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 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Centre Hospitalier Le Mans, Biomatériaux et Bioingénierie, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Matériaux et nanosciences d'Alsace, Université de Strasbourg ( UNISTRA ) -Université de Haute-Alsace (UHA) Mulhouse - Colmar ( Université de Haute-Alsace (UHA) ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Strasbourg ( UNISTRA ) -Université de Haute-Alsace (UHA) Mulhouse - Colmar ( Université de Haute-Alsace (UHA) ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Lipides - Nutrition - Cancer [Dijon - U1231] ( LNC ), Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer ( LabEx LipSTIC ), Institut National de la Recherche Agronomique ( INRA ) -Université Montpellier 2 - Sciences et Techniques ( UM2 ) -Université Paris-Sud - Paris 11 ( UP11 ) -École pratique des hautes études ( EPHE ) -Institut Gustave Roussy ( IGR ) -Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Université de Bourgogne ( UB ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Fédération Francophone de la Cancérologie Digestive, FFCD-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-France-Comté] ( EFS [Bourgogne-France-Comté] ) -Centre National de la Recherche Scientifique ( CNRS ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université de Franche-Comté ( UFC ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Bretonneau-Université de Tours-CHRU Tours-Institut National de la Santé et de la Recherche Médicale ( INSERM ), and CHRU Tours-Institut National de la Santé et de la Recherche Médicale ( INSERM )
Subjects: Adult, Male, Parenteral Nutrition, Pediatrics, medicine.medical_specialty, Time Factors, Critical Care, Secondary infection, Enteral feeding, Clinical nutrition, Enteral administration, law.invention, 03 medical and health sciences, Enteral Nutrition, 0302 clinical medicine, Randomized controlled trial, law, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Humans, Vasoconstrictor Agents, Medicine, Cumulative incidence, Hospital Mortality, 030212 general & internal medicine, Nutritional support, Aged, Acute critical illness, business.industry, Malnutrition, Hazard ratio, Shock, 030208 emergency & critical care medicine, General Medicine, Length of Stay, Middle Aged, Interim analysis, Respiration, Artificial, The enteral route, 3. Good health, Treatment Outcome, Parenteral nutrition, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BackgroundWhether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition.MethodsIn this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate
Published: 2018

31. Salbutamol Nebulization During Noninvasive Ventilation in Exacerbated Chronic Obstructive Pulmonary Disease Patients: A Randomized Controlled Trial

Author: Bruno Giraudeau, Elsa Tavernier, Denis Garot, Deborah Le Pennec, Jean-Pierre Frat, Laetitia Bodet-Contentin, Thierry Boulain, Antoine Guillon, Laurent Vecellio, Stephan Ehrmann, Pierre-François Dequin, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours, 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 d'Orléans (CHRO), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Tours (UT), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Pulmonary and Respiratory Medicine, β2-agonist, medicine.medical_treatment, Pharmaceutical Science, Pulmonary disease, mechanical ventilation, point-of-care spirometry, 030226 pharmacology & pharmacy, law.invention, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, FEV1, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, law, Forced Expiratory Volume, Administration, Inhalation, medicine, Humans, Albuterol, Pharmacology (medical), Beta (finance), Adrenergic beta-2 Receptor Agonists, Aged, Aerosols, Mechanical ventilation, Noninvasive Ventilation, β2 agonists, business.industry, Nebulizers and Vaporizers, Middle Aged, respiratory system, Bronchodilator Agents, 3. Good health, respiratory tract diseases, 030228 respiratory system, Spirometry, Anesthesia, Salbutamol, Female, Noninvasive ventilation, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: International audience; Background: Although nebulizing beta 2-agonists during noninvasive ventilation (NIV) could prove helpful, this administration route has to date never been studied in unstable chronic obstructive pulmonary disease (COPD) patients. We sought to demonstrate that salbutamol could be nebulized through an NIV circuit in COPD exacerbation and improve forced expiratory volume in 1 second (FEV1) as compared with placebo.Patient and Methods: This is a bench study to determine the optimal pattern of nebulization followed by a randomized double-blind parallel-group trial comparing salbutamol and placebo aerosols delivered during NIV to 43 intensive care unit patients. Aerosols were generated by a vibrating mesh nebulizer positioned just after the Y-piece. Spirometry was performed immediately before and at several predetermined time points after nebulization. Clinical and biological safety parameters were recorded.Results: We failed to demonstrate a difference between salbutamol and placebo when changes in FEV1 were assessed immediately after nebulization (−20 vs. −35 mL, p = 0.66). However, FEV1 increased significantly from baseline to 40 minutes after the end of salbutamol nebulization, as compared with placebo (+30 vs. −50 mL, p = 0.04). Nebulization was well tolerated.Conclusion: When assessing FEV1 changes 40 minutes after the end of 5 mg salbutamol nebulization in patients undergoing NIV, we observed a slight improvement that was statistically significant compared with the changes observed with an equivalent saline volume.
Published: 2019

32. Sample size estimation in clinical trials using ventilator-free days as the primary outcome: a systematic review

Author: Laurent Renard Triché, Emmanuel Futier, Manuela De Carvalho, Nathalie Piñol-Domenech, Laëtitia Bodet-Contentin, Matthieu Jabaudon, and Bruno Pereira
Subjects: Respiration, artificial, Respiratory insufficiency, Time factors, Treatment outcome, Ventilators, mechanical, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Ventilator-free days (VFDs) are a composite endpoint increasingly used as the primary outcome in critical care trials. However, because of the skewed distribution and competitive risk between components, sample size estimation remains challenging. This systematic review was conducted to systematically assess whether the sample size was congruent, as calculated to evaluate VFDs in trials, with VFDs’ distribution and the impact of alternative methods on sample size estimation. Methods A systematic literature search was conducted within the PubMed and Embase databases for randomized clinical trials in adults with VFDs as the primary outcome until December 2021. We focused on peer-reviewed journals with 2021 impact factors greater than five. After reviewing definitions of VFDs, we extracted the sample size and methods used for its estimation. The data were collected by two independent investigators and recorded in a standardized, pilot-tested forms tool. Sample sizes were calculated using alternative statistical approaches, and risks of bias were assessed with the Cochrane risk-of-bias tool. Results Of the 26 clinical trials included, 19 (73%) raised “some concerns” when assessing risks of bias. Twenty-four (92%) trials were two-arm superiority trials, and 23 (89%) were conducted at multiple sites. Almost all the trials (96%) were unable to consider the unique distribution of VFDs and death as a competitive risk. Moreover, significant heterogeneity was found in the definitions of VFDs, especially regarding varying start time and type of respiratory support. Methods for sample size estimation were also heterogeneous, and simple models, such as the Mann–Whitney–Wilcoxon rank-sum test, were used in 14 (54%) trials. Finally, the sample sizes calculated varied by a factor of 1.6 to 17.4. Conclusions A standardized definition and methodology for VFDs, including the use of a core outcome set, seems to be required. Indeed, this could facilitate the interpretation of findings in clinical trials, as well as their construction, especially the sample size estimation which is a trade-off between cost, ethics, and statistical power. Systematic review registration PROSPERO ID: CRD42021282304. Registered 15 December 2021 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282304 ).
Published: 2023
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33. Impact of oversedation prevention in ventilated critically ill patients: a randomized trial-the AWARE study

Author: Thierry Jacques, Bernard De Jonghe, Qin Lu, Jean-Luc Baudel, Vincent Das, Jean Reignier, Guillaume Carteaux, Stephan Ehrmann, Gaëtan Plantefève, Bernard Lambermont, Emmanuelle Gourdin, Jean-Philippe Rigaud, Nadia Aissaoui, Hervé Clavier, Hervé Hyvernat, Michael Piagnerelli, Romain Hernu, Lucas Liaudet, David Grimaldi, Karim Chergui, Annabelle Stoclin, Jean-François Hicter, Jean-Claude Lacherade, François Vincent, Philippe Michel, Grégoire Muller, Aurélie Cravoisy-Popovic, Laurent Guérin, Olfa Hamzaoui, F. Brouard, Emmanuel Vivier, Sébastien Ena, Nicolas Devos, Jugurtha Aliane, Antoine Kimmoun, Laurence Donetti, Pierre-François Laterre, Frédérique Ganster, Antoine Gros, Laetitia Bodet-Contentin, Alexandre Duguet, Jean-Paul Mira, Djillali Annane, Cédric Cleophax, Jean-Damien Ricard, Siu-Ming Au, Alexis Soumer, Stéphane Merat, Walter Picard, Alexandre Cambonie, Charles-Edouard Luyt, Nicolas Deye, Charlotte Quentin, Julie Léger, Frédéric Jacobs, Patrick Girardie, Sandie Dauriac, Isabelle Camilatto, Jean-Luc Desmaretz, Xavier Monnet, Philippe Obbee, René Robert, Daniel da Silva, Christophe Girault, Corinne Audoin, Alain Mercat, D.A. Reuter, Renaud Chouquer, Mohebbi Amoli Abolfazl, Fabienne Plouvier, Elie Azoulay, Thierry Boulain, Maleka Schenck, Bruno Giraudeau, Gilles Troché, Jérôme Aboab, Stéphane Legriel, SRLF Trial Group, de Jonghe, B., Aboab, J., Aissaoui, N., Annane, D., Audoin, C., Baudel, J.L., Brouard, F., Cambonie, A., Camilatto, I., Chergui, K., Das, V., da Silva, D., Devos, N., Deye, N., Ehrmann, S., Ganster, F., Giraudeau, B., Grimaldi, D., Gourdin, E., Gros, A., Hamzaoui, O., Jacobs, F., Kimmoun, A., Lacherade, J.C., Lambermont, B., Laterre, P.F., Leger, J., Legriel, S., Liaudet, L., Luyt, C.E., Michel, P., Mira, J.P., Monnet, X., Muller, G., Piagnerelli, M., Plantefeve, G., Reignier, J., Ricard, J.D., Vincent, F., Aliane, J., Plouvier, F., Mercat, A., Abolfazl, M.A., Cleophax, C., Carteaux, G., Troche, G., Guerin, L., Girardie, P., Vivier, E., Hernu, R., Obbee, P., Donetti, L., Jacques, T., Cravoisy-Popovic, A., Boulain, T., Lu, Q., Reuter, D., Azoulay, E., Clavier, H., Picard, W., Robert, R., Chouquer, R., Girault, C., Merat, S., Quentin, C., Hicter, J.F., Schenck, M., Dauriac, S., Desmaretz, J.L., Hyvernat, H., Soumer, A., Stoclin, A., Rigaud, J.P., Duguet, A., Bodet-Contentin, L., Au, S.M., Ena, S., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, and UCL - (SLuc) Service de soins intensifs
Subjects: medicine.medical_specialty, Sedation, medicine.medical_treatment, Weaning, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Randomized controlled trial, law, medicine, 030212 general & internal medicine, Mortality, Intensive care medicine, Intensive care units, business.industry, Critically ill, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.symptom, business
Abstract: Background Although oversedation has been associated with increased morbidity in ventilated critically ill patients, it is unclear whether prevention of oversedation improves mortality. We aimed to assess 90-day mortality in patients receiving a bundle of interventions to prevent oversedation as compared to usual care. Methods In this randomized multicentre trial, all adult patients requiring mechanical ventilation for more than 48 h were included. Two groups were compared: patients managed according to usual sedation practices (control), and patients receiving sedation according to an algorithm which provided a gradual multilevel response to pain, agitation, and ventilator dyssynchrony with no specific target to alter consciousness and no use of sedation scale and promoted the use of alternatives to continuous infusion of midazolam or propofol (intervention). Results Inclusions were stopped before reaching the planned enrolment. Between 2012 and 2014, 584 patients were included in the intervention group and 590 in the control group. Baseline characteristics were well balanced between groups. Although the use of midazolam and propofol was significantly lower in the intervention group, 90-day mortality was not significantly lower (39.4 vs. 44.2% in the control group, p = 0.09). There were no significant differences in 1-year mortality between the two groups. The time to first spontaneous breathing trial and time to successful extubation were significantly shorter in the intervention group than in the control group. These last results should be interpreted with precaution regarding the several limitations of the trial including the early termination. Conclusions This underpowered study of severely ill patients was unable to show that a strategy to prevent oversedation could significantly reduce mortality. Trial registration NCT01617265
Published: 2018

34. Eye-tracking and speech-generating technology to improve communication with intubated intensive care unit patients: initial experience

Author: Stephan Ehrmann, Pierrick Gadrez, Laetitia Bodet-Contentin, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT), and Université de Tours
Subjects: medicine.medical_specialty, Critical Care, Pain medicine, MEDLINE, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Medicine, Humans, Speech, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, 030504 nursing, business.industry, Communication, medicine.disease, Intensive care unit, 3. Good health, Intensive Care Units, Eye tracking, Medical emergency, 0305 other medical science, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience
Published: 2018

35. Ventilator-Free Day Outcomes Can Be Misleading

Author: Yohann Foucher, Fanny Feuillet, Denis Frasca, Elsa Tavernier, Bruno Giraudeau, Laetitia Bodet-Contentin, 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), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Adult, medicine.medical_specialty, Time Factors, Outcome Assessment, medicine.medical_treatment, [SDV]Life Sciences [q-bio], MEDLINE, Acute respiratory distress, Outcome assessment, Critical Care and Intensive Care Medicine, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Respiration, Respiration, Artificial, 3. Good health, Health Care, 030228 respiratory system, Emergency medicine, Artificial, ArtClinique, business, Ventilator Weaning
Abstract: International audience; INTRODUCTION: Acute respiratory distress syndrome often requires invasive mechanical ventilation, with both mortality and mechanical ventilation duration as outcomes of interest. The concept of ventilator-free days has been proposed as an outcome combining these two outcomes. Here we analyzed the construction of the ventilator-free day outcome and provided a hypothetical scenario to alert physicians that such an outcome can lead to misleading interpretations. METHODS: We proposed the isoventilator-free day curve concept and, using an analytical development, illustrated how a median ventilator-free day value can actually result from very different combinations of death rates and mechanical ventilation durations. We also used a hypothetical example to compare the Student t test, Wilcoxon rank-sum test, and Gray test (which accounts for death as a competing event with extubation) in comparing exposition to mechanical ventilation. RESULTS: A median ventilator-free day value of 10 days may mean that 10% of the patients died while survivors were ventilated during a median of 14 days or that 40% died while survivors were ventilated during a median of 5 days. Changing the time horizon affected the Student t test but not the Wilcoxon rank-sum result. The Gray test was more relevant than both the Student t test and Wilcoxon rank-sum test in identifying differences in groups showing highly different mechanical ventilation duration, despite equal median ventilator-free days. This approach was also illustrated using real data. CONCLUSIONS: Use of ventilator-free days as an outcome appears to have many drawbacks. Suitable methods of analyzing time to extubation should be preferred.
Published: 2018

36. Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients

Author: Alexis Donzeau, Arnaud Desachy, Ferran Roche-Campo, Héctor León Yoshido, Carlos Vicent, Josep Trenado-Alvarez, Laetitia Bodet-Contentin, Carlos Wilson Gomes Lopes, Metaxia Papanikolaou, Jonathan Dugernier, David Thévoz, Keyvan Razazi, Lise Piquilloud, Daniel Isabey, Karim Lakhal, Antoine Edelson, Gabriela Apiou-Sbirlea, François Vermeulen, Stephan Ehrmann, Laurent Brochard, Ehrmann, Stephan, Roche-Campo, Ferran, Bodet-Contentin, Laetitia, Razazi, Keyvan, Dugernier, Jonathan, Trenado-Alvarez, Josep, Donzeau, Alexi, Vermeulen, Françoi, Thévoz, David, Papanikolaou, Metaxia, Edelson, Antoine, León Yoshido, Héctor, Piquilloud, Lise, Lakhal, Karim, Lopes, Carlo, Vicent, Carlo, Desachy, Arnaud, Apiou-Sbirlea, Gabriela, Isabey, Daniel, Brochard, Laurent, Reva Research NetworkAT@ICU Study Group: [.., Stefano Nava, and ]
Subjects: Male, Cross-sectional study, Critical Care and Intensive Care Medicine, Aerosol therapy, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Prospective Studies, Prospective cohort study, Aerosolization, Aged, 80 and over, Metered dose inhalers [MeSH], Bacterial Infections, Middle Aged, respiratory system, Anti-Bacterial Agents, Bronchodilator Agents, Administration, inhalation [MeSH], Breathing, Female, Intermediate care, Anti-bacterial agents [MeSH], Human, Adult, medicine.medical_specialty, Critical Care, Bacterial Infection, 03 medical and health sciences, Bronchodilator agents [MeSH], Anesthesiology, Anti-Bacterial Agent, Administration, Inhalation, medicine, Humans, Intensive care medicine, Aerosol, Bronchodilator Agent, Aged, Cross-Sectional Studie, Aerosols, Critically ill, business.industry, Nebulizers and Vaporizers, 030208 emergency & critical care medicine, Nebulizers and vaporizers [MeSH], Prospective Studie, Respiration, artificial [MeSH], Cross-Sectional Studies, 030228 respiratory system, Emergency medicine, business, Nebulizers and Vaporizer
Abstract: Purpose: Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice. Methods: Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted. Results: A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22–26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (
Published: 2015

37. Retour d’expérience d’une revue de la littérature de scores pronostiques : application à la neuro-réanimation

Author: R. Cinotti, Fanny Feuillet, Laetitia Bodet-Contentin, Etienne Dantan, Yohann Foucher, M. Leger, J. Simon-Pimmel, and Denis Frasca
Subjects: Epidemiology, Public Health, Environmental and Occupational Health
Abstract: Introduction A l’ere de la medecine 4P, les patients peuvent participer a leur prise en charge a l’aide notamment d’outils pronostiques. Le groupe TRIPOD a publie en 2015 des recommandations pour l’elaboration de ces outils pronostiques. Leur developpement doit s’appuyer sur une selection de predicteurs combines dans une approche multivariee a partir d’un echantillon d’apprentissage. Leur performances predictives (globales, discrimination ou/et calibration) doivent etre validees de maniere interne (« bootstrapping », « cross-validation », « splitting », etc.) et/ou de maniere externe (population independante). En reanimation neurologique (traumatismes crâniens severes (TC), accidents vasculaires cerebraux (AVC), etc.), le risque d’evolution vers un handicap severe, un etat vegetatif ou le deces est eleve. Chez ces patients jeunes, de nombreux outils pronostiques ont deja ete proposes afin d’objectiver le devenir et d’orienter le niveau des soins. Nous avons mene une revue systematique pour en evaluer la qualite methodologique et son evolution apres les recommandations du TRIPOD. Methodes Nous avons suivi les recommandations CHARMS pour les revues systematiques de scores predictifs. Nos criteres d’inclusion portaient sur les etudes developpant ou validant un modele pronostiquant la mortalite ou un critere de jugement de la recuperation neurologique de patients adultes atteints de TC ou AVC hemorragique en service de reanimation. Les bases de donnees consultees etaient Medline, Embase, Web of Science et Cochrane. Apres selection sur titres et abstracts, les articles eligibles etaient analyses en double lecture, en aveugle. Resultats Au total, 7341 references ont ete identifiees. Parmi les 367 eligibles sur titres et abstracts, nous en avons retenues 292. Parmi celles-la, 160 (55 %) ont ete exclues : 100 (63 %) etudiaient un marqueur seul sans volonte de developper un score multivarie, 60 (37 %) developpaient un score multivarie sans rapporter leurs performances pronostiques. Parmi les 132 etudes incluses, 52 etudes (40 %) developpaient un outil multivarie en ne presentant que les performances pronostiques apparentes (obtenues sur l’echantillon d’apprentissage) ; 25 (19 %) developpaient et validaient leur outil, dont 7 (25 %) rapportaient la performance globale (Brier score, R2), 20 (71 %) calculaient un AUC et 12 (43 %) presentaient une methode de calibration (graphique ou test statistique) ; 55 (42 %) etudes validaient en externe un outil deja existant, dont 5 (9 %) presentaient la performance globale, 52 (95 %) l’AUC et 31 (56 %) une methode de calibration. Conclusion Dans le contexte de la neuro-reanimation, seuls un tiers des articles publies suivent les bonnes pratiques d’elaboration d’un outil pronostique (developpement et validation), telles que le recommande le TRIPOD. On constate egalement une heterogeneite dans le rapport des indicateurs de performance, avec le rapport preferentiel de l’AUC qui n’est pas le meilleur indicateur de prediction individuelle. La publication de ces recommandations n’a pas permis l’amelioration des travaux publies, ce qui illustre un manque de rigueur ou une meconnaissance des approches methodologiques. Publiees dans des revues medicales, elles avaient pour objectif de democratiser les bonnes pratiques d’elaboration et d’usage des outils. Cet effort de dissemination doit etre poursuivi, ce d’autant plus que de nouvelles approches methodologiques continues a etre nouvellement proposees.
Published: 2019

38. Human metapneumovirus infection is associated with a substantial morbidity and mortality burden in adult inpatients

Author: Quentin Philippot, Blandine Rammaert, Gaëlle Dauriat, Cédric Daubin, Frédéric Schlemmer, Adrien Costantini, Yacine Tandjaoui-Lambiotte, Mathilde Neuville, Emmanuelle Desrochettes, Alexis Ferré, Laetitia Bodet Contentin, François-Xavier Lescure, Bruno Megarbane, Antoine Belle, Jean Dellamonica, Sylvain Jaffuel, Jean-Luc Meynard, Jonathan Messika, Nicolas Lau, Nicolas Terzi, Isabelle Runge, Olivier Sanchez, Benjamin Zuber, Emmanuel Guerot, Anahita Rouze, Patricia Pavese, François Bénézit, Jean-Pierre Quenot, Xavier Souloy, Anne Lyse Fanton, David Boutoille, Vincent Bunel, Astrid Vabret, Jacques Gaillat, Anne Bergeron, Nathanaël Lapidus, Muriel Fartoukh, and Guillaume Voiriot
Subjects: Human metapneumovirus, Pneumonia, Viral pneumonia, Respiratory viruses, Science (General), Q1-390, Social sciences (General), H1-99
Abstract: Background: Human metapneumovirus (hMPV) is one of the leading respiratory viruses. This prospective observational study aimed to describe the clinical features and the outcomes of hMPV-associated lower respiratory tract infections in adult inpatients. Methods: Consecutive adult patients admitted to one of the 31 participating centers with an acute lower respiratory tract infection and a respiratory multiplex PCR positive for hMPV were included. A primary composite end point of complicated course (hospital death and/or the need for invasive mechanical ventilation) was used. Results: Between March 2018 and May 2019, 208 patients were included. The median age was 74 [62–84] years. Ninety-seven (47 %) patients were men, 187 (90 %) had at least one coexisting illness, and 67 (31 %) were immunocompromised. Median time between first symptoms and hospital admission was 3 [2–7] days. The two most frequent symptoms were dyspnea (86 %) and cough (85 %). The three most frequent clinical diagnoses were pneumonia (42 %), acute bronchitis (20 %) and acute exacerbation of chronic obstructive pulmonary disease (16 %). Among the 52 (25 %) patients who had a lung CT-scan, the most frequent abnormality was ground glass opacity (41 %). While over four-fifths of patients (81 %) received empirical antibiotic therapy, a bacterial coinfection was diagnosed in 61 (29 %) patients. Mixed flora (16 %) and enterobacteria (5 %) were the predominant documentations. The composite criterion of complicated course was assessable in 202 (97 %) patients, and present in 37 (18 %) of them. In the subpopulation of pneumonia patients (42 %), we observed a more complicated course in those with a bacterial coinfection (8/24, 33 %) as compared to those without (5/60, 8 %) (p = 0.02). Sixty (29 %) patients were admitted to the intensive care unit. Among them, 23 (38 %) patients required invasive mechanical ventilation. In multivariable analysis, tachycardia and alteration of consciousness were identified as risk factors for complicated course. Conclusion: hMPV-associated lower respiratory tract infections in adult inpatients mostly involved elderly people with pre-existing conditions. Bacterial coinfection was present in nearly 30 % of the patients. The need for mechanical ventilation and/or the hospital death were observed in almost 20 % of the patients.
Published: 2024
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39. Gender imbalance in intensive care: High time for action and evaluation!

Author: Hauw-Berlemont, Caroline, Salmon Gandonnière, Charlotte, Boissier, Florence, Aissaoui, Nadia, Bodet-Contentin, Laetitia, Fartoukh, Muriel, Jourdain, Mercedes, Le Marec, Julien, Tamion, Fabienne, Hamzaoui, Olfa, Aubron, Cécile, Group For The French Intensive Care Society, The Femmir (femme Médecins En Médecine Intensive Réanimation), Gestionnaire, Hal Sorbonne Université, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), 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), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), 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), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Lille, Recherche translationnelle sur le diabète - U 1190 (RTD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), 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), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé (UBO UFR MSS), Université de Brest (UBO), The FEMMIR (Femme Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society : Caroline Hauw-Berlemont, Charlotte Salmon Gandonnière, Florence Boissier, Nadia Aissaoui, Laetitia Bodet-Contentin, Muriel Sarah Fartoukh, Mercedes Jourdain, Julien Le Marec, Fabienne Tamion, Olfa Hamzaoui & Cécile Aubron, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Critical Care, business.industry, RC86-88.9, [SDV]Life Sciences [q-bio], Research, Sexism, MEDLINE, 030208 emergency & critical care medicine, Medical emergencies. Critical care. Intensive care. First aid, Critical Care and Intensive Care Medicine, medicine.disease, [SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Editorial, 030228 respiratory system, Action (philosophy), Intensive care, Medicine, Humans, Medical emergency, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2021

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