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1. Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study

Author

Khalil Chaïbi, Franck Ehooman, Bertrand Pons, Laurent Martin-Lefevre, Eric Boulet, Alexandre Boyer, Guillaume Chevrel, Nicolas Lerolle, Dorothée Carpentier, Nicolas de Prost, Alexandre Lautrette, Anne Bretagnol, Julien Mayaux, Saad Nseir, Bruno Megarbane, Marina Thirion, Jean-Marie Forel, Julien Maizel, Hodane Yonis, Philippe Markowicz, Guillaume Thiery, Frédérique Schortgen, Cécile Couchoud, Didier Dreyfuss, and Stephane Gaudry

Subjects
Acute kidney injury, Renal replacement therapy, Long-term outcomes, Worsening renal failure, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The extent of the consequences of an episode of severe acute kidney injury (AKI) on long-term outcome of critically ill patients remain debated. We conducted a prospective follow-up of patients included in a large multicenter clinical trial of renal replacement therapy (RRT) initiation strategy during severe AKI (the Artificial Kidney Initiation in Kidney Injury, AKIKI) to investigate long-term survival, renal outcome and health related quality of life (HRQOL). We also assessed the influence of RRT initiation strategy on these outcomes. Results Follow-up of patients extended from 60 days to a median of 3.35 years [interquartile range (IQR), 1.89 to 4.09] after the end of initial study. Of the 619 patients included in the AKIKI trial, 316 survived after 60 days. The overall survival rate at 3 years from inclusion was 39.4% (95% CI 35.4 to 43.4). A total of 46 patients (on the 175 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up [overall incidence of 26%, cumulative incidence at 4 years: 20.6% (CI 95% 13.0 to 28.3)]. Fifteen patients required chronic dialysis (5% of patients who survived after day 90). Among the 226 long-term survivors, 80 (35%) answered the EQ-5D questionnaire. The median index value reported was 0.67 (IQR 0.40 to 1.00) indicating a noticeable alteration of quality of life. Initiation strategy for RRT had no effect on any long-term outcome. Conclusion Severe AKI in critically ill patients was associated with a high proportion of death within the first 2 months but less so during long-term follow-up. A quarter of long-term survivors experienced a WRF and suffered from a noticeable impairment of quality of life. Renal replacement therapy initiation strategy was not associated with mortality outcome. Graphical Abstract

Published
2023
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2. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial

Author

Nicolas Benichou, Saïd Lebbah, David Hajage, Laurent Martin-Lefèvre, Bertrand Pons, Eric Boulet, Alexandre Boyer, Guillaume Chevrel, Nicolas Lerolle, Dorothée Carpentier, Nicolas de Prost, Alexandre Lautrette, Anne Bretagnol, Julien Mayaux, Saad Nseir, Bruno Megarbane, Marina Thirion, Jean-Marie Forel, Julien Maizel, Hodane Yonis, Philippe Markowicz, Guillaume Thiery, Frederique Schortgen, Florence Tubach, Jean-Damien Ricard, Didier Dreyfuss, and Stéphane Gaudry

Subjects
Renal replacement therapy, Acute kidney injury, Vascular access, Catheter, Critical care, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury. Patients and methods We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected. Results Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34–4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98–1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64—1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred. Conclusion Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.

Published
2021
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3. Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

Author

Florence Boissier, Valérie Seegers, Amélie Seguin, Stéphane Legriel, Alain Cariou, Samir Jaber, Jean-Yves Lefrant, Thomas Rimmelé, Anne Renault, Isabelle Vinatier, Armelle Mathonnet, Danielle Reuter, Olivier Guisset, Christophe Cracco, Jacques Durand-Gasselin, Béatrice Éon, Marina Thirion, Jean-Philippe Rigaud, Bénédicte Philippon-Jouve, Laurent Argaud, Renaud Chouquer, Laurent Papazian, Céline Dedrie, Hugues Georges, Eddy Lebas, Nathalie Rolin, Pierre-Edouard Bollaert, Lucien Lecuyer, Gérald Viquesnel, Marc Leone, Ludivine Chalumeau-Lemoine, Maité Garrouste-Orgeas, Elie Azoulay, and Nancy Kentish-Barnes

Subjects
Caregivers, Intensive care unit, End-of-life experience, Death, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. Conclusion We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.

Published
2020
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5. Management of renal replacement therapy among adults in French intensive care units

Author

Florian Jolly, Marine Jacquier, Delphine Pecqueur, Marie Labruyère, Christophe Vinsonneau, Isabelle Fournel, Jean-Pierre Quenot, Bruno Megarbane, Olivier Lesieur, Maxime Leloup, Nicolas Weiss, Fabienne Tamion, Pascal Beuret, Mehran Monchi, Claire Delcourte, Jan Hayon, Kada Klouche, Annabelle Stoclin, Sébastien Gibot, Vincent Peigne, Chaouki Mezher, Frédéric Martino, Maxime Nguyen, Khaldoun Kuteifan, Guillaume Louis, Guillaume Rigault, Michel Masuccio, Aude Garin, Pierre Asfar, Maude Andrieu, Johann Auchabie, Florence Daviet, Guillaume Lacave, Hotman Benhamida, Bérengère Vivet, Claire Chaignat, Maxime Desgrouas, Béatrice La-Combe, Fabienne Plouvier, Jean-Christophe Richard, Clément Haddadi, Dorian Czolnowski, Nicolas Lau, Frédéric Jacobs, Marina Thirion, Antoine Pons, Nicolas Pichon, René-Gilles Patrigeon, Antoine Vieillard-Baron, Fabrice Uhel, Jean-Philippe Rigaud, Yannis Bouhake, Dominique Zagozda, Romain Arrestier, Camille Vinclair, Anne-Laure Fedou, Auguste Dargent, Jean Dellamonica, Brice Rey, Alexandre Gachet, Mathieu Serie, Cédric Bruel, Antoine Troger, Vivien Berthoud, Agathe Delbove, Cyril Goulenok, Wulfran Bouguoin, David Osman, Nadia Anguel, Laurent Guerin, Camille Foucault, Sébastien Preau, Ouriel Saura, Yvonnick Boue, Nicholas Sedillot, Laetitia Covin, Fabien Lambiotte, Carole Guignon, Sophie Perinel-Ragey, Xavier Souloy, Cécile Defaux-Chevillard, Anne Renault, Nadège Mme-Ngapmen, Mercedes Jourdain, Thierry Van Der Linden, Clémentine Levy, François Thouy, Guillaume Degouy, and Center of Experimental and Molecular Medicine

Subjects
Bedside, Renal replacement therapy, Intensive care unit, Practice evaluation, Critical Care and Intensive Care Medicine, Acute kidney injury
Abstract

Background: This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs). Methods: From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit. Results: A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively. Conclusions: Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Published
2023

6. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

Author

Maïté Garrouste-Orgeas, Cécile Flahault, Léonor Fasse, Stéphane Ruckly, Nora Amdjar-Badidi, Laurent Argaud, Julio Badie, Amélie Bazire, Naike Bige, Eric Boulet, Lila Bouadma, Cédric Bretonnière, Bernard Floccard, Alain Gaffinel, Xavier de Forceville, Hubert Grand, Rebecca Halidfar, Olfa Hamzaoui, Mercé Jourdain, Paul-Henri Jost, Eric Kipnis, Audrey Large, Alexandre Lautrette, Olivier Lesieur, Virginie Maxime, Emmanuelle Mercier, Jean Paul Mira, Yannick Monseau, Erika Parmentier-Decrucq, Jean-Philippe Rigaud, Antoine Rouget, François Santoli, Georges Simon, Fabienne Tamion, Nathalie Thieulot-Rolin, Marina Thirion, Sandrine Valade, Isabelle Vinatier, Christel Vioulac, Sebastien Bailly, and Jean-François Timsit

Subjects
ICU diary, Intensive care unit, Stress disorders, post-traumatic, Family, Anxiety, Medicine (General), R5-920
Abstract

Abstract Background Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient’s story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death. Methods A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary. Discussion This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay. Trial registration ClinicalTrial.gov, ID: NCT02519725 . Registered on 13 July 2015.

Published
2017
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7. Relying on pulse oximetry to avoid hypoxaemia and hyperoxia: A multicentre prospective cohort study in patients with circulatory failure

Author

Thierry Boulain, Mai-Anh Nay, Pierre-François Dequin, Jean-Baptiste Lascarrou, Philippe Vignon, Toufik Kamel, Grégoire Muller, Stephan Ehrmann, Olivier Baudin, Sylvie Calvat, Christophe Cracco, Arnault Desachy, Charles Lafon, Emmanuelle Boitrou, Arnaud Follin, Hervé Mentec, Olivier Pajot, Gaëtan Plantefève, Marina Thirion, Rémi Bruyère, Jean-Pierre Quenot, Konstantinos Bachoumas, Maud Fiancette, Jean Claude Lacherade, Christine Lebert, Laurent Martin-Lefèvre, Jean Reignier, Isabelle Vinatier, Aihem Yehia, Emmanuelle Begot, Remy Bellier, Marc Clavel, Bruno François, Antoine Galy, Nicolas Pichon, Patrick Bardou, Frédéric Bellec, Michel Bonnivard, Anne Marco, Jérôme Roustan, Sylvie Vimeux, Anne Bretagnol, Armelle Mathonnet, Nicolas Bercault, François Réminiac, Isabelle Runge, Marie Skarzynski, Delphine Chatellier, Rémi Coudroy, Jean-Pierre Frat, Véronique Goudet, René Robert, Anne Veinstein, Vlad Botoc, Stéphanie Chevalier, François Collet, Jean-Paul Gouello, Julie Badin, Antoine Guillon, Annick Legras, Elodie Masseret, Emmanuelle Mercier, and Patrice Talec

Subjects
Emergency Nursing, Critical Care Nursing
Abstract

The purpose of this study was to assess the predictive performance of pulse oximetry (SpOSpOFive hundred seventy-one patients (mean [standard deviation] Simplified Acute Physiology Score II: 58.7 [20.1]; mechanically ventilated 75.6%) with 2643 available SaO

Published
2022

8. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial

Author

Alexandre Boyer, Nicolas Lerolle, Guillaume Thiery, Anne Bretagnol, Saad Nseir, Guillaume Chevrel, Julien Maizel, Jean-Damien Ricard, Jean-Marie Forel, Laurent Martin-Lefevre, Alexandre Lautrette, Hodane Yonis, Philippe Markowicz, Eric Boulet, David Hajage, Florence Tubach, Bertrand Pons, Bruno Mégarbane, Frédérique Schortgen, Said Lebbah, Nicolas de Prost, Didier Dreyfuss, Julien Mayaux, Stéphane Gaudry, Marina Thirion, Dorothée Carpentier, Nicolas Benichou, 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), Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Département de Biostatistique, Santé Publique et Information Médicale [CHU Pitié-Salpêtrière] (BIOSPIM ), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Centre d'investigation clinique Paris Est (CIC Paris-Est), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier René Dubos [Pontoise], Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Sud Francilien, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Rouen, Normandie Université (NU), CHU Henri Mondor, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Régional d'Orléans (CHRO), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Lille, Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Victor Dupouy, Hôpital Nord [CHU - APHM], Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Intercommunal de Cornouaille (CHIC), 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 Louis Mourier - AP-HP [Colombes], Service de Réanimation Médico-Chirurgicale [Avicenne], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Sorbonne Paris Nord, Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière] (CIC Paris-Est), Centre d'investigation clinique pluridisciplinaire [CHU Pitié Salpêtrière] (CIC-P 1421), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Gestionnaire, Hal Sorbonne Université, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, CH Evry-Corbeil, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Hôpital Lariboisière-Fernand-Widal [APHP], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, medicine, Cumulative incidence, 030212 general & internal medicine, Renal replacement therapy, Prospective cohort study, Mechanical ventilation, Catheter, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Acute kidney injury, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Intensive care unit, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Critical care, Vascular access, business
Abstract

BackgroundVascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury.Patients and methodsWe performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected.ResultsAmong the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34–4.07),p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98–1.00),p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64—1.25),p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred.ConclusionFemoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.

Published
2021

9. Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

Author

Jacques Durand-Gasselin, Olivier Guisset, Isabelle Vinatier, Céline Dedrie, Maité Garrouste-Orgeas, Marc Leone, Eddy Lebas, Christophe Cracco, Stéphane Legriel, Nathalie Rolin, Jean-Philippe Rigaud, Jean-Yves Lefrant, Renaud Chouquer, Marina Thirion, Danielle Reuter, Laurent Argaud, Pierre-Edouard Bollaert, Anne Renault, Lucien Lecuyer, Valérie Seegers, Amélie Seguin, Elie Azoulay, Samir Jaber, Thomas Rimmelé, Laurent Papazian, Bénédicte Philippon-Jouve, Alain Cariou, Gérald Viquesnel, Nancy Kentish-Barnes, Hugues Georges, Béatrice Eon, Armelle Mathonnet, Ludivine Chalumeau-Lemoine, Florence Boissier, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Unité de Soins Intensifs [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), COIITSS Study Investigators, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), 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), CHU Bordeaux [Bordeaux], Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Centre Hospitalier de Toulon-La Seyne, Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Victor Dupouy, De la Préhistoire à l'Actuel : Culture, Environnement et Anthropologie (PACEA), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Nord [CHU - APHM], Service de Réanimation polyvalente et des Maladies infectieuses, Centre Hospitalier Gustave Dron, Faculté de Médecine [Nancy], Université de Lorraine (UL), Service de biostatistiques et information médicale [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de la Recherche Scientifique (CNRS)-Université de Bordeaux (UB), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), MORNET, Dominique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Cochin [AP-HP], Institut de Physique de Rennes (IPR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional d'Orléans (CHR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and PHRC 10 104, Ministère des Affaires Sociales, de la Santé et des Droits des Femmes

Subjects
Adult, Male, medicine.medical_specialty, Attitude to Death, Psychometrics, Attitude of Health Personnel, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Nurses, Critical Care and Intensive Care Medicine, law.invention, Life Change Events, 03 medical and health sciences, 0302 clinical medicine, Pain control, law, Physicians, Surveys and Questionnaires, medicine, Humans, Intensive care unit, Prospective Studies, End-of-life experience, Cardiopulmonary resuscitation, Decision control, ComputingMilieux_MISCELLANEOUS, Job strain, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Reproducibility of Results, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, 3. Good health, Death, [SDV] Life Sciences [q-bio], Intensive Care Units, Caregivers, Multicenter study, Family medicine, Cohort, Female, business
Abstract

Background As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. Conclusion We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.

Published
2020

10. Journal club in an ICU: rate and factors associated with practice-changing articles. Analysis of 1712 articles read over a 13-year period (2007–2019)

Author

Marina Thirion, Gaëtan Plantefève, Hervé Mentec, Damien Contou, and Olivier Pajot

Subjects
medicine.medical_specialty, Journal Club, business.industry, Practice-changing article, Intensive Care, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, Continuing medical education, Critical Care and Intensive Care Medicine, Anesthesiology, Intensive care, Family medicine, medicine, Medical journal, Journal club, business, Letter to the Editor, Medical Journal, Period (music)
Published
2020

11. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

Author

Audrey Large, Eric Boulet, Fabienne Tamion, Jean-Philippe Rigaud, Jean Paul Mira, Marina Thirion, Olivier Lesieur, Isabelle Vinatier, Eric Kipnis, Paul-Henri Jost, Jean-François Timsit, Virginie Maxime, Lila Bouadma, Nathalie Thieulot-Rolin, Cécile Flahault, Sandrine Valade, Rebecca Halidfar, Cédric Bretonnière, Nora Amdjar-Badidi, Emmanuelle Mercier, Amélie Bazire, Christel Vioulac, Julio Badie, Yannick Monseau, Alexandre Lautrette, Mercé Jourdain, Hubert Grand, Stéphane Ruckly, Alain Gaffinel, François Santoli, Léonor Fasse, Sébastien Bailly, Olfa Hamzaoui, Georges Simon, Antoine Rouget, Xavier Forceville, Maité Garrouste-Orgeas, Erika Parmentier-Decrucq, Bernard Floccard, Laurent Argaud, and Naïke Bigé

Subjects
Time Factors, Health Status, health care facilities, manpower, and services, Medicine (miscellaneous), Anxiety, Hospital Anxiety and Depression Scale, Medical Records, law.invention, Stress Disorders, Post-Traumatic, ICU diary, Study Protocol, 0302 clinical medicine, Cost of Illness, law, Surveys and Questionnaires, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, Depression (differential diagnoses), lcsh:R5-920, Narration, Depression, Syndrome, Intensive care unit, Icu admission, Intensive Care Units, Mental Health, Research Design, Family Relations, France, medicine.symptom, lcsh:Medicine (General), post-traumatic, medicine.medical_specialty, Critical Care, Patients, 03 medical and health sciences, Memory, Intervention (counseling), medicine, Humans, In patient, Family, Intensive care medicine, Stress syndrome, business.industry, 030208 emergency & critical care medicine, Stress disorders, Quality of Life, business
Abstract

Background Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient’s story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death. Methods A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary. Discussion This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay. Trial registration ClinicalTrial.gov, ID: NCT02519725. Registered on 13 July 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2283-y) contains supplementary material, which is available to authorized users.

Published
2017

12. Hypothermia for Neuroprotection in Convulsive Status Epilepticus

Author

Stephane, Legriel, Virginie, Lemiale, Maleka, Schenck, Jonathan, Chelly, Virginie, Laurent, Fabrice, Daviaud, Mohamed, Srairi, Aicha, Hamdi, Guillaume, Geri, Thomas, Rossignol, Julia, Hilly-Ginoux, Julie, Boisramé-Helms, Benjamin, Louart, Isabelle, Malissin, Nicolas, Mongardon, Benjamin, Planquette, Marina, Thirion, Sybille, Merceron, Emmanuel, Canet, Fernando, Pico, Yves-Roger, Tran-Dinh, Jean-Pierre, Bedos, Elie, Azoulay, Matthieu, Resche-Rigon, Alain, Cariou, and P, Jabre

Subjects
Adult, Male, medicine.medical_treatment, Glasgow Outcome Scale, Status epilepticus, Electroencephalography, Body Temperature, law.invention, 03 medical and health sciences, Status Epilepticus, 0302 clinical medicine, Randomized controlled trial, Refractory, Hypothermia, Induced, law, Multicenter trial, medicine, Humans, Hospital Mortality, Aged, Mechanical ventilation, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Hypothermia, Combined Modality Therapy, Respiration, Artificial, Neuroprotection, nervous system diseases, Treatment Outcome, Anesthesia, Anticonvulsants, Female, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Convulsive status epilepticus often results in permanent neurologic impairment. We evaluated the effect of induced hypothermia on neurologic outcomes in patients with convulsive status epilepticus.In a multicenter trial, we randomly assigned 270 critically ill patients with convulsive status epilepticus who were receiving mechanical ventilation to hypothermia (32 to 34°C for 24 hours) in addition to standard care or to standard care alone; 268 patients were included in the analysis. The primary outcome was a good functional outcome at 90 days, defined as a Glasgow Outcome Scale (GOS) score of 5 (range, 1 to 5, with 1 representing death and 5 representing no or minimal neurologic deficit). The main secondary outcomes were mortality at 90 days, progression to electroencephalographically (EEG) confirmed status epilepticus, refractory status epilepticus on day 1, "super-refractory" status epilepticus (resistant to general anesthesia), and functional sequelae on day 90.A GOS score of 5 occurred in 67 of 138 patients (49%) in the hypothermia group and in 56 of 130 (43%) in the control group (adjusted common odds ratio, 1.22; 95% confidence interval [CI], 0.75 to 1.99; P=0.43). The rate of progression to EEG-confirmed status epilepticus on the first day was lower in the hypothermia group than in the control group (11% vs. 22%; odds ratio, 0.40; 95% CI, 0.20 to 0.79; P=0.009), but there were no significant differences between groups in the other secondary outcomes. Adverse events were more frequent in the hypothermia group than in the control group.In this trial, induced hypothermia added to standard care was not associated with significantly better 90-day outcomes than standard care alone in patients with convulsive status epilepticus. (Funded by the French Ministry of Health; HYBERNATUS ClinicalTrials.gov number, NCT01359332 .).

Published
2016

13. 'It Was the Only Thing I Could Hold Onto, But…': Receiving a Letter of Condolence After Loss of a Loved One in the ICU: A Qualitative Study of Bereaved Relatives' Experience

Author

Nancy, Kentish-Barnes, Zoé, Cohen-Solal, Virginie, Souppart, Marion, Galon, Benoît, Champigneulle, Marina, Thirion, Marion, Gilbert, Olivier, Lesieur, Anne, Renault, Maïté, Garrouste-Orgeas, Laurent, Argaud, Marion, Venot, Alexandre, Demoule, Olivier, Guisset, Isabelle, Vinatier, Gilles, Troché, Julien, Massot, Samir, Jaber, Caroline, Bornstain, Véronique, Gaday, René, Robert, Jean-Philippe, Rigaud, Raphaël, Cinotti, Mélanie, Adda, François, Thomas, and Elie, Azoulay

Subjects
Adult, Male, Attitude to Death, Social Support, Middle Aged, Correspondence as Topic, Article, Intensive Care Units, Professional-Family Relations, Adaptation, Psychological, Humans, Family, Female, France, Attitude to Health, Qualitative Research, Aged, Bereavement
Abstract

Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members' experience of receiving a letter of condolence.Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team. This study was designed to provide insight into the results of a larger randomized, controlled, multicenter study.Twenty-two ICUs in France.Family members who lost a loved one in the ICU and who received a letter of condolence.Thematic analysis was used and was based on 52 interviews and 26 letters. Six themes emerged: 1) a feeling of support, 2) humanization of the medical system, 3) an opportunity for reflection, 4) an opportunity to describe their loved one, 5) continuity and closure, and 6) doubts and ambivalence. Possible difficulties emerged, notably the re-experience of the trauma, highlighting the absence of further support.This study describes the benefits of receiving a letter of condolence; mainly, it humanizes the medical institution (feeling of support, confirmation of the role played by the relative, supplemental information). However, this study also shows a common ambivalence about the letter of condolence's benefit. Healthcare workers must strive to adapt bereavement follow-up to each individual situation.

Published
2017

14. Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation

Author

Eric Kipnis, Emmanuelle Mercier, Xavier Forceville, Maité Garrouste-Orgeas, Antoine Rouget, Yannick Monseau, Julio Badie, Stéphane Ruckly, Georges Simon, Isabelle Vinatier, Sébastien Bailly, Lilia Soufir, Lucie Bellalou, Jean-Philippe Rigaud, Olfa Hamzaoui, Marina Thirion, Olivier Lesieur, Virginie Maxime, Nora Amdjar-Badidi, Benoit Misset, Laurent Argaud, Sandrine Valade, Paul-Henri Jost, Cécile Flahault, Alexandre Lautrette, Anne Renault, Rebecca Hamidfar, Mercé Jourdain, Marie Annick Leborgne, Léonor Fasse, Lila Bouadma, Audrey Large, François Santoli, Jean-Paul Mira, Bernard Floccard, Christel Vioulac, Nathalie Thieulot-Rolin, Naïke Bigé, Erika Parmentier-Decrucq, Eric Boulet, Fabienne Tamion, Hubert Grand, Alain Gaffinel, Jean-François Timsit, and Cédric Bretonnière

Subjects
medicine.medical_specialty, medicine.medical_treatment, Hospital Anxiety and Depression Scale, 01 natural sciences, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Interquartile range, Internal medicine, medicine, 030212 general & internal medicine, 0101 mathematics, Depression (differential diagnoses), Original Investigation, Mechanical ventilation, business.industry, Minimal clinically important difference, 010102 general mathematics, General Medicine, Intensive care unit, 3. Good health, Anxiety, medicine.symptom, business
Abstract

Importance Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. Objectives To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. Design, Setting, and Participants Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. Interventions Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. Main Outcomes and Measures The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. Results Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, −4% [95% CI, −15% to 6%];P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, −1.47 [95% CI, −1.93 to 4.87];P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. Conclusions and Relevance Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. Trial Registration ClinicalTrials.gov Identifier:NCT02519725

Published
2019

15. CAESAR: a new tool to assess relatives' experience of dying and death in the ICU

Author

Maité Garrouste-Orgeas, Danielle Reuter, Alain Cariou, Bénédicte Philippon-Jouve, Jean Yves Lefrant, Pierre-Edouard Bollaert, Olivier Guisset, Marina Thirion, Nancy Kentish-Barnes, Sylvie Chevret, Fabienne Tamion, Ludivine Chalumeau-Lemoine, Jacques Durand-Gasselin, Hugues Georges, Armelle Mathonnet, Nathalie Rolin, Bruno Falissard, Isabelle Vinatier, Lucien Lecuyer, Christophe Cracco, Zoé Cohen-Solal, Amélie Seguin, Renaud Chouquer, Eddy Lebas, Mélanie Adda, Laurent Argaud, Elie Azoulay, Marc Leone, Jean-Philippe Rigaud, Stéphane Legriel, Anne Renault, Céline Dedrie, Béatrice Eon, Samir Jaber, Laurent Papazian, Gérald Viquesnel, Bernard Floccard, Valérie Seegers, Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service de Réanimation Médicale (BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre de recherche en éducation de Nantes (CREN), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital St-André, Réanimation, CHU Bordeaux [Bordeaux], Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Service de Soins Intensifs [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier de Dieppe, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente et des Maladies infectieuses, Centre Hospitalier Gustave Dron, Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de biostatistiques et information médicale [Saint-Louis], Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université Paris-Sud - Paris 11 (UP11), Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) - Université de Montpellier (UM) - Centre National de la Recherche Scientifique (CNRS), Pôle d'anesthésie-réanimation-urgences, CHU de Nimes - Hôpital Carémeau, Université de Nantes (UN), Centre Hospitalier Régional d'Orléans (CHR), Centre Hospitalier d'Angoulême, Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Henri Mondor, Service des soins intensives, CHU Caen, Hôpital Edouard Herriot, Hospices Civils de Lyon - Hôpital Edouard Herriot, Centre National de la Recherche Scientifique (CNRS) - IFR48 - Institut National de la Santé et de la Recherche Médicale (INSERM) - Aix Marseille Université (AMU) - Institut de Recherche pour le Développement (IRD), Service de Réanimation médicale, CHU Nancy, France, Assistance publique - Hôpitaux de Paris (AP-HP) - Groupe Hospitalier Saint-Louis-Lariboisière- Fernand-Widal - Université Paris Diderot - Paris 7 (UPD7), Université Joseph Fourier - Grenoble 1 (UJF) - Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale, Hôpital Charles Nicolle - CHU Rouen, Institut de Recherche et d'Innovation Biomédicale (IRIB), Université de Rouen Normandie, Normandie Université (NU) - Normandie Université (NU), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) - Université Paris-Sud - Paris 11 (UP11) - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7) - Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Institut National de la Recherche Agronomique (INRA) - Université Paris Diderot - Paris 7 (UPD7) - Université Paris Descartes - Paris 5 (UPD5) - Université Paris 13 - Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint Louis Paris, CHU, Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4) - Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Montpellier (UM)-Université Montpellier 1 (UM1), Service de réanimation médicale [Rouen], and CHU Saint Louis [APHP]

Subjects
Male, medicine.medical_specialty, Attitude to Death, Time Factors, media_common.quotation_subject, Decision Making, Anxiety, Critical Care and Intensive Care Medicine, Hospital Anxiety and Depression Scale, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Surveys and Questionnaires, Medicine, Humans, Family, 030212 general & internal medicine, Prospective Studies, Intensive care medicine, Prospective cohort study, Depression (differential diagnoses), Qualitative Research, ComputingMilieux_MISCELLANEOUS, media_common, business.industry, Depression, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, Intensive care unit, Complicated grief, Intensive Care Units, Cohort, Commentary, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Grief, Female, medicine.symptom, business
Abstract

International audience; Purpose: To develop an instrument designed specifically to assess the experience of relatives of patients who die in the intensive care unit (ICU). Methods: The instrument was developed using a mixed methodology and validated in a prospective multicentre study. Relatives of patients who died in 41 ICUs completed the questionnaire by telephone 21 days after the death, then completed the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Inventory of Complicated Grief after 3, 6, and 12 months. Results: A total of 600 relatives were included, 475 in the main cohort and 125 in the reliability cohort. The 15-item questionnaire, named CAESAR, covered the patient's preferences and values, interactions with/around the patient and family satisfaction. We defined three groups based on CAESAR score tertiles: lowest (= 69, n = 121, 29.3 %). Factorial analysis showed a single dimension. Cronbach's alpha in the main and reliability cohorts was 0.88 (0.85-0.90) and 0.85 (0.79-0.89), respectively. Compared to a high CAESAR score, a low CAESAR score was associated with greater risks of anxiety and depression at 3 months [1.29 (1.13-1.46), p = 0.001], post-traumatic stress-related symptoms at 3 [1.34 (1.17-1.53), p < 0.001], 6 [OR = 1.24 (1.06-1.44), p = 0.008] and 12 [OR = 1.26 (1.06-1.50), p = 0.01] months and complicated grief at 6 [OR = 1.40 (1.20-1.63), p < 0.001] and 12 months [OR = 1.27 (1.06-1.52), p = 0.01]. Conclusions: The CAESAR score 21 days after death in the ICU is strongly associated with post-ICU burden in the bereaved relatives. The CAESAR score should prove a useful primary endpoint in trials of interventions to improve relatives' well-being.

Published
2016

16. Etiologies, clinical features and outcome of cardiac arrest in HIV-infected patients

Author

Romain Sonneville, Marina Thirion, Nicolas Deye, Charles-Edouard Luyt, Alain Cariou, Guillaume Geri, Nicolas Mongardon, Antoine Kimmoun, Armelle Mathonnet, Nicolas Lerolle, Virginie Lemiale, Stéphane Legriel, Laurent Argaud, David Luis, Frédéric Pène, Laurent Bodson, Florence Boissier, Jean-Paul Mira, Stéphane Gaudry, Julien Mayaux, Laurent Camous, Sébastien Perbet, Bertrand Guidet, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)

Subjects
Adult, CD4-Positive T-Lymphocytes, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], HIV Infections, 030204 cardiovascular system & hematology, Sudden death, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Internal medicine, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, Viral Load, medicine.disease, 3. Good health, Surgery, Heart Arrest, Intensive Care Units, Cohort, Etiology, Female, Cardiology and Cardiovascular Medicine, business, Viral load, Cohort study
Abstract

International audience; BACKGROUND: Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS: Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012). Characteristics and outcome of HIV-infected patients were compared to those of a large cohort of HIV-uninfected patients admitted after CA in the Cochin Hospital ICU during the same period. RESULTS: 99 patients were included (median CD4 lymphocyte count 233/mm(3), viral load 43 copies/ml). When compared with the control cohort of 1701 patients, HIV-infected patients were younger, with a predominance of male, a majority of in-hospital CA (52%), and non-shockable initial rhythm (80.8%). CA was mostly related to respiratory cause (n=36, including 23 pneumonia), cardiac cause (n=33, including 16 acute myocardial infarction), neurologic cause (n=8) and toxic cause (n=5). CA was deemed directly related to HIV infection in 18 cases. Seventy-one patients died in the ICU, mostly for care withdrawal after post-anoxic encephalopathy. After propensity score matching, ICU mortality was not significantly affected by HIV infection. Similarly, HIV disease characteristics had no impact on ICU outcome. CONCLUSIONS: Etiologies of CA in HIV-infected patients are miscellaneous and mostly not related to HIV infection. Outcome remains bleak but is similar to outcome of HIV-negative patients.

Published
2015

17. Complicated grief after death of a relative in the intensive care unit

Author

Elie Azoulay, Marina Thirion, Armelle Mathonnet, Marine Chaize, Isabelle Vinatier, Christophe Cracco, Lucien Lecuyer, Zoé Cohen-Solal, Amélie Seguin, Bénédicte Philippon-Jouve, Sylvie Chevret, Jacques Durand-Gasselin, Bernard Floccard, Jean-Philippe Rigaud, Céline Dedrie, Hugues Georges, Olivier Guisset, Pierre-Edouard Bollaert, Bruno Falissard, Valérie Seegers, Anne Renault, Alain Cariou, Nancy Kentish-Barnes, Béatrice Eon, Maité Garrouste, Danielle Reuter, Laurent Argaud, Eddy Lebas, Ludivine Chalumeau-Lemoine, Benoît Schlemmer, Nathalie Rolin, Jean-Yves Lefrant, Renaud Chouquer, Mélanie Adda, Samir Jaber, Gérard Viquesnel, Marc Leone, Stéphane Legriel, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4)-Centre National de la Recherche Scientifique (CNRS), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service de réanimation chirurgicale, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital St-André, Réanimation, CHU Bordeaux [Bordeaux], Hopital Saint-Louis [AP-HP] (AP-HP), Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Service de réanimation médicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Assistance Publique - Hôpitaux de Marseille (APHM), Centre hospitalier de Dieppe, Groupement Hospitalier - Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon (HCL), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente et des Maladies infectieuses, Centre Hospitalier Gustave Dron, Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de biostatistiques et information médicale [Saint-Louis], Département d'anesthésie, réanimation et pathologie infectieuse (DARPI), Institut Gustave Roussy (IGR), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Intensivist, Anxiety, Hospital Anxiety and Depression Scale, Severity of Illness Index, law.invention, Stress Disorders, Post-Traumatic, Treatment Refusal, 03 medical and health sciences, 0302 clinical medicine, law, Severity of illness, medicine, Humans, Family, Prospective Studies, 030212 general & internal medicine, Psychiatry, ComputingMilieux_MISCELLANEOUS, media_common, Principal Component Analysis, Depression, business.industry, Communication, 030208 emergency & critical care medicine, Loneliness, medicine.disease, Intensive care unit, humanities, Complicated grief, 3. Good health, Death, Intensive Care Units, Female, Grief, medicine.symptom, Intubation, business
Abstract

An increased proportion of deaths occur in the intensive care unit (ICU). We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements. End-of-life care and communication in the ICU are associated with the prevalence of complicated grief

Published
2015

18. Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (akiki)

Author

Laurent Martin-Lefevre, Isabelle Hoffmann, Saad Nseir, Guillaume Chevrel, Guillemette Thomas, Nicolas de Prost, Naïke Bigé, Stéphane Gaudry, Alexandre Boyer, Eric Boulet, Marina Thirion, Anne Bretagnol, Clarisse Blayau, Alexandre Lautrette, Florence Tubach, Bertrand Pons, Philippe Markowicz, Nicolas Lerolle, Julien Maizel, Michael Darmon, Didier Dreyfuss, Bruno Mégarbane, Jean Dellamonica, Frédérique Schortgen, Jean-Damien Ricard, Benjamin Zuber, David Hajage, Hodane Yonis, Dorothée Carpentier, Yann Loubières, Julien Mayaux, Jack Richecoeur, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Intercommunal de Créteil (CHIC), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), AP-HP - Hôpital Bichat - Claude Bernard [Paris], CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier René Dubos [Pontoise], Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Rouen, Normandie Université (NU), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Régional d'Orléans (CHRO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Nord [CHU - APHM], Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Université Paris Diderot, Sorbonne Paris Cité, Paris, France, Université Paris Diderot - Paris 7 (UPD7), CHI Poissy-Saint-Germain, CHU Tenon [AP-HP], CHU Amiens-Picardie, Centre Hospitalier de Versailles André Mignot (CHV), Lille Inflammation Research International Center - U 995 (LIRIC), 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), CHU Saint-Antoine [AP-HP], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), CHU Lille, Inserm, Université de Lille, Lille Inflammation Research International Center (LIRIC) - U995, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables [ECEVE (U1123 / UMR_S_1123)], Centre Hospitalier Intercommunal de Créteil [CHIC], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon [CHD Vendée], Centre Hospitalier Universitaire d'Angers [CHU Angers], Centre Hospitalier Régional d'Orléans [CHRO], Centre Hospitalier Universitaire de Nice [CHU Nice], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] [CHU ST-E], Centre Hospitalier de Versailles André Mignot [CHV], Lille Inflammation Research International Center - U 995 [LIRIC], and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)

Subjects
medicine.medical_treatment, Mesh:Time Factors, Mesh:Acute Kidney Injury/diagnosis, urologic and male genital diseases, law.invention, Mesh:Biomarkers/blood, Study Protocol, 0302 clinical medicine, Clinical Protocols, Mesh:Risk Factors, Pharmacology (medical), Mesh:Clinical Protocols, Prospective Studies, Treatment outcome, Mesh:Treatment Outcome, Acute kidney injury, female genital diseases and pregnancy complications, 3. Good health, Mesh:Intensive Care Units, Mesh:Risk Assessment, Mesh:Renal Replacement Therapy/adverse effects, medicine.medical_specialty, Critical Illness, Risk Assessment, Decision Support Techniques, Renal replacement therapy, Critical care, 03 medical and health sciences, Humans, Intensive care medicine, Mesh:France, Patient Selection, Mesh:Acute Kidney Injury/blood, medicine.disease, Clinical trial, Biomarkers, Time Factors, Mesh:Decision Support Techniques, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Medicine (miscellaneous), Mesh:Prospective Studies, Injury Severity Score, Randomized controlled trial, Mesh:Patient Selection, law, Risk Factors, 030212 general & internal medicine, Mesh:Critical Illness, Intensive care unit, Intensive Care Units, Mesh:Renal Replacement Therapy/methods, Research Design, France, medicine.symptom, Mesh:Acute Kidney Injury/therapy, Randomization, Mesh:Research Design, Mesh:Acute Kidney Injury/physiopathology, Time-to-Treatment, Predictive Value of Tests, Mesh:Predictive Value of Tests, medicine, Mesh:Injury Severity Score, Mesh:Renal Replacement Therapy/mortality, Mesh:Time-to-Treatment, Mechanical ventilation, business.industry, Mesh:Acute Kidney Injury/mortality, Mesh:Humans, Emergency medicine, Anuria, business
Abstract

International audience; BACKGROUND: There is currently no validated strategy for the timing of renal replacement therapy (RRT) for acute kidney injury (AKI) in the intensive care unit (ICU) when short-term life-threatening metabolic abnormalities are absent. No adequately powered prospective randomized study has addressed this issue to date. As a result, significant practice heterogeneity exists and may expose patients to either unnecessary hazardous procedures or undue delay in RRT.METHODS: This is a multicenter, prospective, randomized, open-label parallel-group clinical trial that compares the effect of two RRT initiation strategies on overall survival of critically ill patients receiving intravenous catecholamines or invasive mechanical ventilation and presenting with AKI classification stage 3 (KDIGO 2012). In the 'early' strategy, RRT is initiated immediately. In the 'delayed' strategy, clinical and metabolic conditions are closely monitored and RRT is initiated only when one or more events (severity criteria) occur, including: oliguria or anuria for more than 72 hours after randomization, serum urea concentration >40 mmol/l, serum potassium concentration >6 mmol/l, serum potassium concentration >5.5 mmol/l persisting despite medical treatment, arterial blood pH 5 l/min to maintain SpO2 > 95% or FiO2 > 50% under invasive or noninvasive mechanical ventilation. The primary outcome measure is overall survival, measured from randomization (D0) until death, regardless of the cause. The minimum follow-up duration for each patient will be 60 days. Two interim analyses are planned, blinded to group allocation. It is expected that there will be 620 subjects in all.CONCLUSIONS: The AKIKI study will be one of the very few large randomized controlled trials evaluating mortality according to the timing of RRT in critically ill patients with AKI classification stage 3 (KDIGO 2012). Results should help clinicians decide when to initiate RRT.BACKGROUND: ClinicalTrials.gov NCT01932190.

Published
2015

19. Important questions asked by family members of intensive care unit patients

Author

Anne Renault, Sylvie Chevret, Maité Garrouste-Orgeas, Benoît Schlemmer, Dany Toledano, Vincent Peigne, Bruno Falissard, Bernard Regnier, Achille Kouatchet, Fabienne Fieux, Alexandre Lautrette, Marina Thirion, Hugues Georges, Elie Azoulay, Marine Chaize, Nicolas Bele, Katerina Rusinova, Stéphane Legriel, Bruno Mégarbane, Jean-François Timsit, Frédéric Pochard, Alain Cariou, Nancy Kentish-Barnes, and Mercé Jourdain

Subjects
Health Knowledge, Attitudes, Practice, Critical Care, business.industry, media_common.quotation_subject, Communication, Decision Making, MEDLINE, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, Nursing, Multicenter study, law, Professional-Family Relations, Intensive care, Needs assessment, Medicine, Humans, Family, business, Autonomy, Needs Assessment, SITUATIONAL STRESS, Qualitative research, media_common
Abstract

Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit.This was a multicenter study. Questions asked by relatives of intensive care unit patients were collected from five different sources (literature, panel of 28 intensive care unit nurses and physicians, 1-wk survey of nurses and 1-wk survey of physicians in 14 intensive care units, and in-depth interviews with 14 families). After a qualitative analysis (framework approach and thematic analysis), questions were rated by 22 relatives and 14 intensive care unit physicians, and the ratings were analyzed using principal component analysis and hierarchical clustering.The five sources produced 2,135 questions. Removal of duplicates and redundancies left 443 questions, which were distributed among nine predefined domains using a framework approach ("diagnosis," "treatment," "prognosis," "comfort," "interaction," "communication," "family," "end of life," and "postintensive care unit management"). Thematic analysis in each domain led to the identification of 46 themes, which were reworded as 46 different questions. Ratings by relatives and physicians showed that 21 of these questions were particularly important for relatives of intensive care unit patients.This study increases knowledge about the informational needs of relatives of intensive care unit patients. This list of questions may prove valuable for both relatives and intensive care unit physicians as a tool for improving communication in the intensive care unit.

Published
2011

20. Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study

Author

Elie Azoulay, Sylvie Chevret, Jerome Aboab, Nicolas Roche, Alexandre Lautrette, Frédéric Pochard, Sandra de Miranda, Marina Thirion, Nicolas Bele, Virginie Lemiale, Jésus Gonzalez-Bermejo, Thomas Similowski, Bruno Mégarbane, Marine Chaize, Antoine Cuvelier, and Benoît Schlemmer

Subjects
medicine.medical_specialty, Time Factors, Critical Care, Anxiety, Critical Care and Intensive Care Medicine, Risk Assessment, law.invention, Cohort Studies, Pulmonary Disease, Chronic Obstructive, Sex Factors, Quality of life, law, Recurrence, Intensive care, Sickness Impact Profile, Adaptation, Psychological, medicine, Confidence Intervals, Odds Ratio, Humans, Prospective Studies, Prospective cohort study, Intensive care medicine, Depression (differential diagnoses), Aged, business.industry, Depression, Respiratory disease, Age Factors, Continuity of Patient Care, Middle Aged, medicine.disease, Intensive care unit, Patient Discharge, Intensive Care Units, Logistic Models, Caregivers, Emergency medicine, Multivariate Analysis, Quality of Life, Female, France, medicine.symptom, business, Stress, Psychological, Cohort study, Follow-Up Studies
Abstract

To determine the prevalence and risk factors of symptoms of anxiety, depression, and posttraumatic stress disorder-related symptoms in patients with chronic obstructive pulmonary disease and their relatives after an intensive care unit stay.Prospective multicenter study.Nineteen French intensive care units.One hundred twenty-six patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and 102 relatives.None.Patients and relatives were interviewed at intensive care unit discharge and 90 days later to assess symptoms of anxiety and depression using Hospital Anxiety and Depression Scale (HADS) and posttraumatic stress disorder-related symptoms using the Impact of Event Scale (IES). At intensive care unit discharge, 90% of patients recollected traumatic psychological events in the intensive care unit. At day 90, we were able to conduct telephone interviews with 53 patients and 47 relatives. Hospital Anxiety and Depression Scale scores indicated symptoms of anxiety and depression in 52% and 45.5% of patients at intensive care unit discharge and in 28.3% and 18.9% on day 90, respectively. Corresponding prevalence in relatives were 72.2% and 25.7% at intensive care unit discharge and 40.4% and 14.9% on day 90, respectively. The Impact of Event Scale indicated posttraumatic stress disorder-related symptoms in 20.7% of patients and 29.8% of relatives on day 90. Peritraumatic dissociation assessed using the Peritraumatic Dissociative Experiences Questionnaire was independently associated with posttraumatic stress disorder-related symptoms in the patients and relatives. Previous intensive care unit experience and recollection of bothersome noise in the intensive care unit predicted posttraumatic stress disorder-related symptoms in the patients.Psychiatric symptoms were found to be common in a group of 126 patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and their relatives at intensive care unit discharge and 90 days later. Peritraumatic dissociation at intensive care unit discharge was found to independently predict posttraumatic stress disorder-related symptoms in this sample of patients and relatives.

Published
2010

21. Dendritic cells and autoimmunity

Author

Srini V. Kaveri, Namita Misra, Sandrine Delignat, Michel D. Kazatchkine, Marina Thirion, Sébastien Lacroix-Desmazes, and Jagadeesh Bayry

Subjects
Antigen Presentation, medicine.medical_treatment, T-Lymphocytes, Immunology, Immunotherapy, Cell Communication, Dendritic Cells, Biology, medicine.disease_cause, Phenotype, Autoimmunity, Autoimmune Diseases, Rats, Pathogenesis, Mice, Immune system, Lymphatic system, Self Tolerance, Antigen, medicine, Immunology and Allergy, Animals, Humans, Function (biology)
Abstract

Dendritic cells (DC) are professional antigen-presenting cells that are specialized in the uptake of antigens and their transport from peripheral tissues to the lymphoid organs. Because of their capacity to stimulate naive T cells, DC have a central role in the initiation of primary immune responses and are considered promising tools and targets for immunotherapy. Emerging data suggest a role for DC in initiating autoimmune attacks. Direct analysis of DC phenotypes and DC–T-cell interactions in rodent and human autoimmune diseases should shed light on how pathogenesis occurs, and suggest novel avenues of treatment aimed at alleviating deviant DC function.

Published
2003

22. Antifungal Alternatives for Invasive Candidiasis Refractory to Caspofungin in Liver Transplant Recipients: A Report of Two Cases

Author

Olivier Lortholary, André Paugam, Marina Thirion, Gérald Choukroun, Frédéric Pène, Olivier Scatton, Filomena Conti, and Yvon Calmus

Subjects
Antifungal, Transplantation, medicine.medical_specialty, medicine.drug_class, business.industry, MEDLINE, Invasive candidiasis, Drug resistance, medicine.disease, chemistry.chemical_compound, Refractory, chemistry, medicine, Caspofungin, business, Intensive care medicine, Echinocandins
Published
2006

Catalog

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