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2. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

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Pham, T, Heunks, L, Bellani, G, Madotto, F, Aragao, I, Beduneau, G, Goligher, E, Grasselli, G, Laake, J, Mancebo, J, Penuelas, O, Piquilloud, L, Pesenti, A, Wunsch, H, van Haren, F, Brochard, L, Laffey, J, Abrough, F, Acharya, S, Amin, P, Arabi, Y, Bauer, P, Beitler, J, Berkius, J, Bugedo, G, Camporota, L, Cerny, V, Cho, Y, Clarkson, K, Estenssoro, E, Gritsan, A, Hashemian, S, Hermans, G, Jovanovic, B, Kurahashi, K, Matamis, D, Moerer, O, Molnar, Z, Ozyilmaz, E, Panka, B, Papali, A, Perbet, S, Qiu, H, Razek, A, Rittayamai, N, Roldan, R, Serpa Neto, A, Szuldrzynski, K, Talmor, D, Tomescu, D, Villagomez, A, Zeggwagh, A, Abe, T, Aboshady, A, Acampo-de Jong, M, Adderley, J, Adiguzel, N, Agrawal, V, Aguilar, G, Aguirre, G, Aguirre-Bermeo, H, Ahlstrom, B, Akbas, T, Akker, M, Al Sadeh, G, Alamri, S, Algaba, A, Ali, M, Aliberti, A, Allegue, J, Alvarez, D, Amador, J, Andersen, F, Ansari, S, Apichatbutr, Y, Apostolopoulou, O, Arellano, D, Arica, M, Arikan, H, Arinaga, K, Arnal, J, Asano, K, Asin-Corrochano, M, Avalos Cabrera, J, Avila Fuentes, S, Aydemir, S, Aygencel, G, Azevedo, L, Bacakoglu, F, Badie, J, Baedorf Kassis, E, Bai, G, Balaraj, G, Ballico, B, Banner-Goodspeed, V, Banwarie, P, Barbieri, R, Baronia, A, Barrett, J, Barrot, L, Barrueco-Francioni, J, Barry, J, Bawangade, H, Beavis, S, Beck, E, Beehre, N, Belenguer Muncharaz, A, Belliato, M, Bellissima, A, Beltramelli, R, Ben Souissi, A, Benitez-Cano, A, Benlamin, M, Benslama, A, Bento, L, Benvenuti, D, Bernabe, L, Bersten, A, Berta, G, Bertini, P, Bertram-Ralph, E, Besbes, M, Bettini, L, Beuret, P, Bewley, J, Bezzi, M, Bhakhtiani, L, Bhandary, R, Bhowmick, K, Bihari, S, Bissett, B, Blythe, D, Bocher, S, Boedjawan, N, Bojanowski, C, Boni, E, Boraso, S, Borelli, M, Borello, S, Borislavova, M, Bosma, K, Bottiroli, M, Boyd, O, Bozbay, S, Briva, A, Bruel, C, Bruni, A, Buehner, U, Bulpa, P, Burt, K, Buscot, M, Buttera, S, Cabrera, J, Caccese, R, Caironi, P, Canchos Gutierrez, I, Canedo, N, Cani, A, Cappellini, I, Carazo, J, Cardonnet, L, Carpio, D, Carriedo, D, Carrillo, R, Carvalho, J, Caser, E, Castelli, A, Castillo Quintero, M, Castro, H, Catorze, N, Cengiz, M, Cereijo, E, Ceunen, H, Chaintoutis, C, Chang, Y, Chaparro, G, Chapman, C, Chau, S, Chavez, C, Chelazzi, C, Chelly, J, Chemouni, F, Chen, K, Chena, A, Chiarandini, P, Chilton, P, Chiumello, D, Chou-Lie, Y, Chudeau, N, Cinel, I, Cinnella, G, Clark, M, Clark, T, Clementi, S, Coaguila, L, Codecido, A, Collins, A, Colombo, R, Conde, J, Consales, G, Cook, T, Coppadoro, A, Cornejo, R, Cortegiani, A, Coxo, C, Cracchiolo, A, Crespo Ramirez, M, Crova, P, Cruz, J, Cubattoli, L, Cukurova, Z, Curto, F, Czempik, P, D'Andrea, R, da Silva Ramos, F, Dangers, L, Danguy des Deserts, M, Danin, P, Dantas, F, Daubin, C, Dawei, W, de Haro, C, de Jesus Montelongo, F, De Mendoza, D, de Pablo, R, De Pascale, G, De Rosa, S, Decavele, M, Declercq, P, Deicas, A, del Carmen Campos Moreno, M, Dellamonica, J, Delmas, B, Demirkiran, O, Demirkiran, H, Dendane, T, di Mussi, R, Diakaki, C, Diaz, A, Diaz, W, Dikmen, Y, Dimoula, A, Doble, P, Doha, N, Domingos, G, Dres, M, Dries, D, Duggal, A, Duke, G, Dunts, P, Dybwik, K, Dykyy, M, Eckert, P, Efe, S, Elatrous, S, Elay, G, Elmaryul, A, Elsaadany, M, Elsayed, H, Elsayed, S, Emery, M, Ena, S, Eng, K, Englert, J, Erdogan, E, Ergin Ozcan, P, Eroglu, E, Escobar, M, Esen, F, Esen Tekeli, A, Esquivel, A, Esquivel Gallegos, H, Ezzouine, H, Facchini, A, Faheem, M, Fanelli, V, Farina, M, Fartoukh, M, Fehrle, L, Feng, F, Feng, Y, Fernandez, I, Fernandez, B, Fernandez-Rodriguez, M, Ferrando, C, Ferreira da Silva, M, Ferreruela, M, Ferrier, J, Flamm Zamorano, M, Flood, L, Floris, L, Fluckiger, M, Forteza, C, Fortunato, A, Frans, E, Frattari, A, Fredes, S, Frenzel, T, Fumagalli, R, Furche, M, Fusari, M, Fysh, E, Galeas-Lopez, J, Galerneau, L, Garcia, A, Garcia, M, Garcia, E, Garcia Olivares, P, Garlicki, J, Garnero, A, Garofalo, E, Gautam, P, Gazenkampf, A, Gelinotte, S, Gelormini, D, Ghrenassia, E, Giacomucci, A, Giannoni, R, Gigante, A, Glober, N, Gnesin, P, Gollo, Y, Gomaa, D, Gomero Paredes, R, Gomes, R, Gomez, R, Gomez, O, Gomez, A, Gondim, L, Gonzalez, M, Gonzalez, I, Gonzalez-Castro, A, Gordillo Romero, O, Gordo, F, Gouin, P, Graf Santos, J, Grainne, R, Grando, M, Granov Grabovica, S, Grasso, S, Grasso, R, Grimmer, L, Grissom, C, Gu, Q, Guan, X, Guarracino, F, Guasch, N, Guatteri, L, Gueret, R, Guerin, C, Guerot, E, Guitard, P, Gul, F, Gumus, A, Gurjar, M, Gutierrez, P, Hachimi, A, Hadzibegovic, A, Hagan, S, Hammel, C, Han Song, J, Hanlon, G, Heines, S, Henriksson, J, Herbrecht, J, Heredia Orbegoso, G, Hermon, A, Hernandez, R, Hernandez, C, Herrera, L, Herrera-Gutierrez, M, Hidalgo, J, Hill, D, Holmquist, D, Homez, M, Hongtao, X, Hormis, A, Horner, D, Hornos, M, Hou, M, House, S, Housni, B, Hugill, K, Humphreys, S, Humbert, L, Hunter, S, Hwa Young, L, Iezzi, N, Ilutovich, S, Inal, V, Innes, R, Ioannides, P, Iotti, G, Ippolito, M, Irie, H, Iriyama, H, Itagaki, T, Izura, J, Izza, S, Jabeen, R, Jamaati, H, Jamadarkhana, S, Jamoussi, A, Jankowski, M, Jaramillo, L, Jeon, K, Jeong Lee, S, Jeswani, D, Jha, S, Jiang, L, Jing, C, Jochmans, S, Johnstad, B, Jongmin, L, Joret, A, Junhasavasdikul, D, Jurado, M, Kam, E, Kamohara, H, Kane, C, Kara, I, Karakurt, S, Karnjanarachata, C, Kataoka, J, Katayama, S, Kaushik, S, Kelebek Girgin, N, Kerr, K, Kerslake, I, Khairnar, P, Khalid, A, Khan, A, Khanna, A, Khorasanee, R, Kienhorst, D, Kirakli, C, Knafelj, R, Kol, M, Kongpolprom, N, Kopitko, C, Korkmaz Ekren, P, Kubisz-Pudelko, A, Kulcsar, Z, Kumasawa, J, Kuriyama, A, Kutchak, F, Labarca, E, Labat, F, Laborda, C, Laca Barrera, M, Lagache, L, Landaverde Lopez, A, Lanspa, M, Lascari, V, Le Meur, M, Lee, S, Lee, Y, Lee, J, Lee, W, Legernaes, T, Leiner, T, Lemiale, V, Leonor, T, Lepper, P, Li, D, Li, H, Li, O, Lima, A, Lind, D, Litton, E, Liu, N, Liu, L, Liu, J, Llitjos, J, Llorente, B, Lopez, R, Lopez, C, Lopez Nava, C, Lovazzano, P, Lu, M, Lucchese, F, Lugano, M, Lugo Goytia, G, Luo, H, Lynch, C, Macheda, S, Madrigal Robles, V, Maggiore, S, Magret Iglesias, M, Malaga, P, Mallapura Maheswarappa, H, Malpartida, G, Malyarchikov, A, Mansson, H, Manzano, A, Marey, I, Marin, N, Marin, M, Markman, E, Martin, F, Martin, A, Martin Dal Gesso, C, Martinez, F, Martinez-Fidalgo, C, Martin-Loeches, I, Mas, A, Masaaki, S, Maseda, E, Massa, E, Mattsson, A, Maugeri, J, Mccredie, V, Mccullough, J, Mcguinness, S, Mckown, A, Medve, L, Mei, C, Mellado Artigas, R, Mendes, V, Mervat, M, Michaux, I, Mikhaeil, M, Milagros, O, Milet, I, Millan, M, Minwei, Z, Mirabella, L, Mishra, S, Mistraletti, G, Mochizuki, K, Moghal, A, Mojoli, F, Molin, A, Montiel, R, Montini, L, Monza, G, Mora Aznar, M, Morakul, S, Morales, M, Moreno Torres, D, Morocho Tutillo, D, Motherway, C, Mouhssine, D, Mouloudi, E, Munoz, T, Munoz de Cabo, C, Mustafa, M, Muthuchellappan, R, Muthukrishnan, M, Muttini, S, Nagata, I, Nahar, D, Nakanishi, M, Nakayama, I, Namendys-Silva, S, Nanchal, R, Nandakumar, S, Nasi, A, Nasir, K, Navalesi, P, Naz Aslam, T, Nga Phan, T, Nichol, A, Niiyama, S, Nikolakopoulou, S, Nikolic, E, Nitta, K, Noc, M, Nonas, S, Nseir, S, Nur Soyturk, A, Obata, Y, Oeckler, R, Oguchi, M, Ohshimo, S, Oikonomou, M, Ojados, A, Oliveira, M, Oliveira Filho, W, Oliveri, C, Olmos, A, Omura, K, Orlandi, M, Orsenigo, F, Ortiz-Ruiz De Gordoa, L, Ota, K, Ovalle Olmos, R, Oveges, N, Oziemski, P, Ozkan Kuscu, O, Pachas Alvarado, F, Pagella, G, Palaniswamy, V, Palazon Sanchez, E, Palmese, S, Pan, G, Pan, W, Papanikolaou, M, Papavasilopoulou, T, Parekh, A, Parke, R, Parrilla, F, Parrilla, D, Pasha, T, Pasin, L, Patao, L, Patel, M, Patel, G, Pati, B, Patil, J, Pattnaik, S, Paul, D, Pavesi, M, Pavlotsky, V, Paz, G, Paz, E, Pecci, E, Pellegrini, C, Pena Padilla, A, Perchiazzi, G, Pereira, T, Pereira, V, Perez, M, Perez Calvo, C, Perez Cheng, M, Perez Maita, R, Perez-Araos, R, Perez-Teran, P, Perez-Torres, D, Perkins, G, Persona, P, Petnak, T, Petrova, M, Philippart, F, Picetti, E, Pierucci, E, Piervincenzi, E, Pinciroli, R, Pintado, M, Piraino, T, Piras, S, Piras, C, Pirompanich, P, Pisani, L, Platas, E, Plotnikow, G, Porras, W, Porta, V, Portilla, M, Portugal, J, Povoa, P, Prat, G, Pratto, R, Preda, G, Prieto, I, Prol-Silva, E, Pugh, R, Qi, Y, Qian, C, Qin, T, Qu, H, Quintana, T, Quispe Sierra, R, Quispe Soto, R, Rabbani, R, Rabee, M, Rabie, A, Rahe Pereira, M, Rai, A, Raj Ashok, S, Rajab, M, Ramdhani, N, Ramey, E, Ranieri, M, Rathod, D, Ray, B, Redwanul Huq, S, Regli, A, Reina, R, Resano Sarmiento, N, Reynaud, F, Rialp, G, Ricart, P, Rice, T, Richardson, A, Rieder, M, Rinket, M, Rios, F, Risso Vazquez, A, Riva, I, Rivette, M, Roca, O, Roche-Campo, F, Rodriguez, C, Rodriguez, G, Rodriguez Gonzalez, D, Rodriguez Tucto, X, Rogers, A, Romano, M, Rortveit, L, Rose, A, Roux, D, Rouze, A, Rubatto Birri, P, Ruilan, W, Ruiz Robledo, A, Ruiz-Aguilar, A, Sadahiro, T, Saez, I, Sagardia, J, Saha, R, Saiphoklang, N, Saito, S, Salem, M, Sales, G, Salgado, P, Samavedam, S, Sami Mebazaa, M, Samuelsson, L, San Juan Roman, N, Sanchez, P, Sanchez-Ballesteros, J, Sandoval, Y, Sani, E, Santos, M, Santos, C, Sanui, M, Saravanabavan, L, Sari, S, Sarkany, A, Sauneuf, B, Savioli, M, Sazak, H, Scano, R, Schneider, F, Schortgen, F, Schultz, M, Schwarz, G, Seckin Yucesoy, F, Seely, A, Seiler, F, Seker Tekdos, Y, Seok Chan, K, Serano, L, Serednicki, W, Setten, M, Shah, A, Shah, B, Shang, Y, Shanmugasundaram, P, Shapovalov, K, Shebl, E, Shiga, T, Shime, N, Shin, P, Short, J, Shuhua, C, Siddiqui, S, Silesky Jimenez, J, Silva, D, Silva Sales, B, Simons, K, Sjobo, B, Slessor, D, Smiechowicz, J, Smischney, N, Smith, P, Smith, T, Smith, M, Snape, S, Snyman, L, Soetens, F, Sook Hong, K, Sosa Medellin, M, Soto, G, Souloy, X, Sousa, E, Sovatzis, S, Sozutek, D, Spadaro, S, Spagnoli, M, Spangfors, M, Spittle, N, Spivey, M, Stapleton, A, Stefanovic, B, Stephenson, L, Stevenson, E, Strand, K, Strano, M, Straus, S, Sun, C, Sun, R, Sundaram, V, Sunpark, T, Surlemont, E, Sutherasan, Y, Szabo, Z, Tainter, C, Takaba, A, Tallott, M, Tamasato, T, Tang, Z, Tangsujaritvijit, V, Taniguchi, L, Taniguchi, D, Tarantino, F, Teerapuncharoen, K, Temprano, S, Terragni, P, Terzi, N, Thakur, A, Theerawit, P, Thille, A, Thomas, M, Thungtitigul, P, Thyrault, M, Tilouch, N, Timenetsky, K, Tirapu, J, Todeschini, M, Tomas, R, Tomaszewski, C, Tonetti, T, Tonnelier, A, Trinder, J, Trongtrakul, K, Truwit, J, Tsuei, B, Tulaimat, A, Turan, S, Turkoglu, M, Tyagi, S, Ubeda, A, Vagginelli, F, Valenti, M, Vallverdu, I, Van Axel, A, van den Hul, I, van der Hoeven, H, Van Der Meer, N, Vanhoof, M, Vargas-Ordonez, M, Vaschetto, R, Vascotto, E, Vatsik, M, Vaz, A, Vazquez-Sanchez, A, Ventura, S, Vermeijden, J, Vidal, A, Vieira, J, Vilela Costa Pinto, B, Villagra, A, Villegas Succar, C, Vinorum, O, Vitale, G, Vj, R, Vochin, A, Voiriot, G, Volta, C, von Seth, M, Wajdi, M, Walsh, D, Wang, S, Wardi, G, Ween-Velken, N, Wei, B, Weller, D, Welsh, D, Welters, I, Wert, M, Whiteley, S, Wilby, E, Williams, E, Williams, K, Wilson, A, Wojtas, J, Won Huh, J, Wrathall, D, Wright, C, Wu, J, Xi, G, Xing, Z, Xu, H, Yamamoto, K, Yan, J, Yanez, J, Yang, X, Yates, E, Yazicioglu Mocin, O, Ye, Z, Yildirim, F, Yoshida, N, Yoshido, H, Young Lee, B, Yu, R, Yu, G, Yu, T, Yuan, B, Yuangtrakul, N, Yumoto, T, Yun, X, Zakalik, G, Zaki, A, Zalba-Etayo, B, Zambon, M, Zang, B, Zani, G, Zarka, J, Zerbi, S, Zerman, A, Zetterquist, H, Zhang, J, Zhang, H, Zhang, W, Zhang, G, Zhao, H, Zheng, J, Zhu, B, Zumaran, R, Pham T., Heunks L., Bellani G., Madotto F., Aragao I., Beduneau G., Goligher E. C., Grasselli G., Laake J. H., Mancebo J., Penuelas O., Piquilloud L., Pesenti A., Wunsch H., van Haren F., Brochard L., Laffey J. G., Abrough F., Acharya S. P., Amin P., Arabi Y., Bauer P., Beitler J., Berkius J., Bugedo G., Camporota L., Cerny V., Cho Y. -J., Clarkson K., Estenssoro E., Goligher E., Gritsan A., Hashemian S. M., Hermans G., Heunks L. M., Jovanovic B., Kurahashi K., Matamis D., Moerer O., Molnar Z., Ozyilmaz E., Panka B., Papali A., Perbet S., Qiu H., Razek A. A., Rittayamai N., Roldan R., Serpa Neto A., Szuldrzynski K., Talmor D., Tomescu D., Villagomez A., Zeggwagh A. A., Abe T., Aboshady A., Acampo-de Jong M., Acharya S., Adderley J., Adiguzel N., Agrawal V. K., Aguilar G., Aguirre G., Aguirre-Bermeo H., Ahlstrom B., Akbas T., Akker M., Al Sadeh G., Alamri S., Algaba A., Ali M., Aliberti A., Allegue J. M., Alvarez D., Amador J., Andersen F. H., Ansari S., Apichatbutr Y., Apostolopoulou O., Arellano D., Arica M., Arikan H., Arinaga K., Arnal J. -M., Asano K., Asin-Corrochano M., Avalos Cabrera J. M., Avila Fuentes S., Aydemir S., Aygencel G., Azevedo L., Bacakoglu F., Badie J., Baedorf Kassis E., Bai G., Balaraj G., Ballico B., Banner-Goodspeed V., Banwarie P., Barbieri R., Baronia A., Barrett J., Barrot L., Barrueco-Francioni J. E., Barry J., Bawangade H., Beavis S., Beck E., Beehre N., Belenguer Muncharaz A., Belliato M., Bellissima A., Beltramelli R., Ben Souissi A., Benitez-Cano A., Benlamin M., Benslama A., Bento L., Benvenuti D., Bernabe L., Bersten A., Berta G., Bertini P., Bertram-Ralph E., Besbes M., Bettini L. R., Beuret P., Bewley J., Bezzi M., Bhakhtiani L., Bhandary R., Bhowmick K., Bihari S., Bissett B., Blythe D., Bocher S., Boedjawan N., Bojanowski C. M., Boni E., Boraso S., Borelli M., Borello S., Borislavova M., Bosma K. J., Bottiroli M., Boyd O., Bozbay S., Briva A., Bruel C., Bruni A., Buehner U., Bulpa P., Burt K., Buscot M., Buttera S., Cabrera J., Caccese R., Caironi P., Canchos Gutierrez I., Canedo N., Cani A., Cappellini I., Carazo J., Cardonnet L. P., Carpio D., Carriedo D., Carrillo R., Carvalho J., Caser E., Castelli A., Castillo Quintero M., Castro H., Catorze N., Cengiz M., Cereijo E., Ceunen H., Chaintoutis C., Chang Y., Chaparro G., Chapman C., Chau S., Chavez C. E., Chelazzi C., Chelly J., Chemouni F., Chen K., Chena A., Chiarandini P., Chilton P., Chiumello D., Chou-Lie Y., Chudeau N., Cinel I., Cinnella G., Clark M., Clark T., Clementi S., Coaguila L., Codecido A. J., Collins A., Colombo R., Conde J., Consales G., Cook T., Coppadoro A., Cornejo R., Cortegiani A., Coxo C., Cracchiolo A. N., Crespo Ramirez M., Crova P., Cruz J., Cubattoli L., Cukurova Z., Curto F., Czempik P., D'Andrea R., da Silva Ramos F., Dangers L., Danguy des Deserts M., Danin P. -E., Dantas F., Daubin C., Dawei W., de Haro C., de Jesus Montelongo F., De Mendoza D., de Pablo R., De Pascale G., De Rosa S., Decavele M., Declercq P. -L., Deicas A., del Carmen Campos Moreno M., Dellamonica J., Delmas B., Demirkiran O., Demirkiran H., Dendane T., di Mussi R., Diakaki C., Diaz A., Diaz W., Dikmen Y., Dimoula A., Doble P., Doha N., Domingos G., Dres M., Dries D., Duggal A., Duke G., Dunts P., Dybwik K., Dykyy M., Eckert P., Efe S., Elatrous S., Elay G., Elmaryul A. S., Elsaadany M., Elsayed H., Elsayed S., Emery M., Ena S., Eng K., Englert J. A., Erdogan E., Ergin Ozcan P., Eroglu E., Escobar M., Esen F., Esen Tekeli A., Esquivel A., Esquivel Gallegos H., Ezzouine H., Facchini A., Faheem M., Fanelli V., Farina M. F., Fartoukh M., Fehrle L., Feng F., Feng Y., Fernandez I., Fernandez B., Fernandez-Rodriguez M. L., Ferrando C., Ferreira da Silva M. J., Ferreruela M., Ferrier J., Flamm Zamorano M. J., Flood L., Floris L., Fluckiger M., Forteza C., Fortunato A., Frans E., Frattari A., Fredes S., Frenzel T., Fumagalli R., Furche M. A., Fusari M., Fysh E., Galeas-Lopez J. L., Galerneau L. -M., Garcia A., Garcia M. F., Garcia E., Garcia Olivares P., Garlicki J., Garnero A., Garofalo E., Gautam P., Gazenkampf A., Gelinotte S., Gelormini D., Ghrenassia E., Giacomucci A., Giannoni R., Gigante A., Glober N., Gnesin P., Gollo Y., Gomaa D., Gomero Paredes R., Gomes R., Gomez R. A., Gomez O., Gomez A., Gondim L., Gonzalez M., Gonzalez I., Gonzalez-Castro A., Gordillo Romero O., Gordo F., Gouin P., Graf Santos J., Grainne R., Grando M., Granov Grabovica S., Grasso S., Grasso R., Grimmer L., Grissom C., Gu Q., Guan X. -D., Guarracino F., Guasch N., Guatteri L., Gueret R., Guerin C., Guerot E., Guitard P. -G., Gul F., Gumus A., Gurjar M., Gutierrez P., Hachimi A., Hadzibegovic A., Hagan S., Hammel C., Han Song J., Hanlon G., Heines S., Henriksson J., Herbrecht J. -E., Heredia Orbegoso G. O., Hermon A., Hernandez R., Hernandez C., Herrera L., Herrera-Gutierrez M., Hidalgo J., Hill D., Holmquist D., Homez M., Hongtao X., Hormis A., Horner D., Hornos M. C., Hou M., House S., Housni B., Hugill K., Humphreys S., Humbert L., Hunter S., Hwa Young L., Iezzi N., Ilutovich S., Inal V., Innes R., Ioannides P., Iotti G. A., Ippolito M., Irie H., Iriyama H., Itagaki T., Izura J., Izza S., Jabeen R., Jamaati H., Jamadarkhana S., Jamoussi A., Jankowski M., Jaramillo L. A., Jeon K., Jeong Lee S., Jeswani D., Jha S., Jiang L., Jing C., Jochmans S., Johnstad B. A., Jongmin L., Joret A., Junhasavasdikul D., Jurado M. T., Kam E., Kamohara H., Kane C., Kara I., Karakurt S., Karnjanarachata C., Kataoka J., Katayama S., Kaushik S., Kelebek Girgin N., Kerr K., Kerslake I., Khairnar P., Khalid A., Khan A., Khanna A. K., Khorasanee R., Kienhorst D., Kirakli C., Knafelj R., Kol M. K., Kongpolprom N., Kopitko C., Korkmaz Ekren P., Kubisz-Pudelko A., Kulcsar Z., Kumasawa J., Kuriyama A., Kutchak F., Labarca E., Labat F., Laborda C., Laca Barrera M. A., Lagache L., Landaverde Lopez A., Lanspa M., Lascari V., Le Meur M., Lee S. H., Lee Y. J., Lee J., Lee W. -Y., Legernaes T., Leiner T., Lemiale V., Leonor T., Lepper P. M., Li D., Li H., Li O., Lima A. R., Lind D., Litton E., Liu N., Liu L., Liu J., Llitjos J. -F., Llorente B., Lopez R., Lopez C. E., Lopez Nava C., Lovazzano P., Lu M., Lucchese F., Lugano M., Lugo Goytia G., Luo H., Lynch C., Macheda S., Madrigal Robles V. H., Maggiore S. M., Magret Iglesias M., Malaga P., Mallapura Maheswarappa H., Malpartida G., Malyarchikov A., Mansson H., Manzano A., Marey I., Marin N., Marin M. D. C., Markman E., Martin F., Martin A., Martin Dal Gesso C., Martinez F., Martinez-Fidalgo C., Martin-Loeches I., Mas A., Masaaki S., Maseda E., Massa E., Mattsson A., Maugeri J., McCredie V., McCullough J., McGuinness S., McKown A., Medve L., Mei C., Mellado Artigas R., Mendes V., Mervat M. K. E., Michaux I., Mikhaeil M., Milagros O., Milet I., Millan M. T., Minwei Z., Mirabella L., Mishra S., Mistraletti G., Mochizuki K., Moghal A., Mojoli F., Molin A., Montiel R., Montini L., Monza G., Mora Aznar M., Morakul S., Morales M., Moreno Torres D., Morocho Tutillo D. R., Motherway C., Mouhssine D., Mouloudi E., Munoz T., Munoz de Cabo C., Mustafa M., Muthuchellappan R., Muthukrishnan M., Muttini S., Nagata I., Nahar D., Nakanishi M., Nakayama I., Namendys-Silva S. A., Nanchal R., Nandakumar S., Nasi A., Nasir K., Navalesi P., Naz Aslam T., Nga Phan T., Nichol A., Niiyama S., Nikolakopoulou S., Nikolic E., Nitta K., Noc M., Nonas S., Nseir S., Nur Soyturk A., Obata Y., Oeckler R., Oguchi M., Ohshimo S., Oikonomou M., Ojados A., Oliveira M. T., Oliveira Filho W., Oliveri C., Olmos A., Omura K., Orlandi M. C., Orsenigo F., Ortiz-Ruiz De Gordoa L., Ota K., Ovalle Olmos R., Oveges N., Oziemski P., Ozkan Kuscu O., Pachas Alvarado F., Pagella G., Palaniswamy V., Palazon Sanchez E. L., Palmese S., Pan G., Pan W., Papanikolaou M., Papavasilopoulou T., Parekh A., Parke R., Parrilla F. J., Parrilla D., Pasha T., Pasin L., Patao L., Patel M., Patel G., Pati B. K., Patil J., Pattnaik S., Paul D., Pavesi M., Pavlotsky V. 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M., Regli A., Reina R., Resano Sarmiento N., Reynaud F., Rialp G., Ricart P., Rice T., Richardson A., Rieder M., Rinket M., Rios F., Risso Vazquez A., Riva I., Rivette M., Roca O., Roche-Campo F., Rodriguez C., Rodriguez G., Rodriguez Gonzalez D., Rodriguez Tucto X. Y., Rogers A., Romano M. E., Rortveit L., Rose A., Roux D., Rouze A., Rubatto Birri P. N., Ruilan W., Ruiz Robledo A., Ruiz-Aguilar A. L., Sadahiro T., Saez I., Sagardia J., Saha R., Saiphoklang N., Saito S., Salem M., Sales G., Salgado P., Samavedam S., Sami Mebazaa M., Samuelsson L., San Juan Roman N., Sanchez P., Sanchez-Ballesteros J., Sandoval Y., Sani E., Santos M., Santos C., Sanui M., Saravanabavan L., Sari S., Sarkany A., Sauneuf B., Savioli M., Sazak H., Scano R., Schneider F., Schortgen F., Schultz M. J., Schwarz G. 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W., Thomas M., Thungtitigul P., Thyrault M., Tilouch N., Timenetsky K., Tirapu J., Todeschini M., Tomas R., Tomaszewski C., Tonetti T., Tonnelier A., Trinder J., Trongtrakul K., Truwit J., Tsuei B., Tulaimat A., Turan S., Turkoglu M., Tyagi S., Ubeda A., Vagginelli F., Valenti M. F., Vallverdu I., Van Axel A., van den Hul I., van der Hoeven H., Van Der Meer N., Vanhoof M., Vargas-Ordonez M., Vaschetto R., Vascotto E., Vatsik M., Vaz A., Vazquez-Sanchez A., Ventura S., Vermeijden J. W., Vidal A., Vieira J., Vilela Costa Pinto B., Villagra A., Villegas Succar C., Vinorum O. G., Vitale G., Vj R., Vochin A., Voiriot G., Volta C. A., von Seth M., Wajdi M., Walsh D., Wang S., Wardi G., Ween-Velken N. 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A., Jeon K., Jeong Lee S., Jeswani D., Jha S., Jiang L., Jing C., Jochmans S., Johnstad B. A., Jongmin L., Joret A., Junhasavasdikul D., Jurado M. T., Kam E., Kamohara H., Kane C., Kara I., Karakurt S., Karnjanarachata C., Kataoka J., Katayama S., Kaushik S., Kelebek Girgin N., Kerr K., Kerslake I., Khairnar P., Khalid A., Khan A., Khanna A. K., Khorasanee R., Kienhorst D., Kirakli C., Knafelj R., Kol M. K., Kongpolprom N., Kopitko C., Korkmaz Ekren P., Kubisz-Pudelko A., Kulcsar Z., Kumasawa J., Kuriyama A., Kutchak F., Labarca E., Labat F., Laborda C., Laca Barrera M. A., Lagache L., Landaverde Lopez A., Lanspa M., Lascari V., Le Meur M., Lee S. H., Lee Y. J., Lee J., Lee W. -Y., Legernaes T., Leiner T., Lemiale V., Leonor T., Lepper P. M., Li D., Li H., Li O., Lima A. R., Lind D., Litton E., Liu N., Liu L., Liu J., Llitjos J. -F., Llorente B., Lopez R., Lopez C. E., Lopez Nava C., Lovazzano P., Lu M., Lucchese F., Lugano M., Lugo Goytia G., Luo H., Lynch C., Macheda S., Madrigal Robles V. H., Maggiore S. M., Magret Iglesias M., Malaga P., Mallapura Maheswarappa H., Malpartida G., Malyarchikov A., Mansson H., Manzano A., Marey I., Marin N., Marin M. D. C., Markman E., Martin F., Martin A., Martin Dal Gesso C., Martinez F., Martinez-Fidalgo C., Martin-Loeches I., Mas A., Masaaki S., Maseda E., Massa E., Mattsson A., Maugeri J., McCredie V., McCullough J., McGuinness S., McKown A., Medve L., Mei C., Mellado Artigas R., Mendes V., Mervat M. K. E., Michaux I., Mikhaeil M., Milagros O., Milet I., Millan M. T., Minwei Z., Mirabella L., Mishra S., Mistraletti G., Mochizuki K., Moghal A., Mojoli F., Molin A., Montiel R., Montini L., Monza G., Mora Aznar M., Morakul S., Morales M., Moreno Torres D., Morocho Tutillo D. R., Motherway C., Mouhssine D., Mouloudi E., Munoz T., Munoz de Cabo C., Mustafa M., Muthuchellappan R., Muthukrishnan M., Muttini S., Nagata I., Nahar D., Nakanishi M., Nakayama I., Namendys-Silva S. A., Nanchal R., Nandakumar S., Nasi A., Nasir K., Navalesi P., Naz Aslam T., Nga Phan T., Nichol A., Niiyama S., Nikolakopoulou S., Nikolic E., Nitta K., Noc M., Nonas S., Nseir S., Nur Soyturk A., Obata Y., Oeckler R., Oguchi M., Ohshimo S., Oikonomou M., Ojados A., Oliveira M. T., Oliveira Filho W., Oliveri C., Olmos A., Omura K., Orlandi M. C., Orsenigo F., Ortiz-Ruiz De Gordoa L., Ota K., Ovalle Olmos R., Oveges N., Oziemski P., Ozkan Kuscu O., Pachas Alvarado F., Pagella G., Palaniswamy V., Palazon Sanchez E. L., Palmese S., Pan G., Pan W., Papanikolaou M., Papavasilopoulou T., Parekh A., Parke R., Parrilla F. J., Parrilla D., Pasha T., Pasin L., Patao L., Patel M., Patel G., Pati B. K., Patil J., Pattnaik S., Paul D., Pavesi M., Pavlotsky V. A., Paz G., Paz E., Pecci E., Pellegrini C., Pena Padilla A. G., Perchiazzi G., Pereira T., Pereira V., Perez M., Perez Calvo C., Perez Cheng M., Perez Maita R., Perez-Araos R., Perez-Teran P., Perez-Torres D., Perkins G., Persona P., Petnak T., Petrova M., Philippart F., Picetti E., Pierucci E., Piervincenzi E., Pinciroli R., Pintado M. -C., Piraino T., Piras S., Piras C., Pirompanich P., Pisani L., Platas E., Plotnikow G., Porras W., Porta V., Portilla M., Portugal J., Povoa P., Prat G., Pratto R., Preda G., Prieto I., Prol-Silva E., Pugh R., Qi Y., Qian C., Qin T., Qu H., Quintana T., Quispe Sierra R., Quispe Soto R., Rabbani R., Rabee M., Rabie A., Rahe Pereira M. A., Rai A., Raj Ashok S., Rajab M., Ramdhani N., Ramey E., Ranieri M., Rathod D., Ray B., Redwanul Huq S. M., Regli A., Reina R., Resano Sarmiento N., Reynaud F., Rialp G., Ricart P., Rice T., Richardson A., Rieder M., Rinket M., Rios F., Risso Vazquez A., Riva I., Rivette M., Roca O., Roche-Campo F., Rodriguez C., Rodriguez G., Rodriguez Gonzalez D., Rodriguez Tucto X. Y., Rogers A., Romano M. E., Rortveit L., Rose A., Roux D., Rouze A., Rubatto Birri P. N., Ruilan W., Ruiz Robledo A., Ruiz-Aguilar A. L., Sadahiro T., Saez I., Sagardia J., Saha R., Saiphoklang N., Saito S., Salem M., Sales G., Salgado P., Samavedam S., Sami Mebazaa M., Samuelsson L., San Juan Roman N., Sanchez P., Sanchez-Ballesteros J., Sandoval Y., Sani E., Santos M., Santos C., Sanui M., Saravanabavan L., Sari S., Sarkany A., Sauneuf B., Savioli M., Sazak H., Scano R., Schneider F., Schortgen F., Schultz M. J., Schwarz G. L., Seckin Yucesoy F., Seely A., Seiler F., Seker Tekdos Y., Seok Chan K., Serano L., Serednicki W., Setten M., Shah A., Shah B., Shang Y., Shanmugasundaram P., Shapovalov K., Shebl E., Shiga T., Shime N., Shin P., Short J., Shuhua C., Siddiqui S., Silesky Jimenez J. I., Silva D., Silva Sales B., Simons K., Sjobo B. A., Slessor D., Smiechowicz J., Smischney N., Smith P., Smith T., Smith M., Snape S., Snyman L., Soetens F., Sook Hong K., Sosa Medellin M. A., Soto G., Souloy X., Sousa E., Sovatzis S., Sozutek D., Spadaro S., Spagnoli M., Spangfors M., Spittle N., Spivey M., Stapleton A., Stefanovic B., Stephenson L., Stevenson E., Strand K., Strano M. T., Straus S., Sun C., Sun R., Sundaram V., SunPark T., Surlemont E., Sutherasan Y., Szabo Z., Tainter C., Takaba A., Tallott M., Tamasato T., Tang Z., Tangsujaritvijit V., Taniguchi L., Taniguchi D., Tarantino F., Teerapuncharoen K., Temprano S., Terragni P., Terzi N., Thakur A., Theerawit P., Thille A. W., Thomas M., Thungtitigul P., Thyrault M., Tilouch N., Timenetsky K., Tirapu J., Todeschini M., Tomas R., Tomaszewski C., Tonetti T., Tonnelier A., Trinder J., Trongtrakul K., Truwit J., Tsuei B., Tulaimat A., Turan S., Turkoglu M., Tyagi S., Ubeda A., Vagginelli F., Valenti M. F., Vallverdu I., Van Axel A., van den Hul I., van der Hoeven H., Van Der Meer N., Vanhoof M., Vargas-Ordonez M., Vaschetto R., Vascotto E., Vatsik M., Vaz A., Vazquez-Sanchez A., Ventura S., Vermeijden J. W., Vidal A., Vieira J., Vilela Costa Pinto B., Villagra A., Villegas Succar C., Vinorum O. G., Vitale G., Vj R., Vochin A., Voiriot G., Volta C. A., von Seth M., Wajdi M., Walsh D., Wang S., Wardi G., Ween-Velken N. C., Wei B. -L., Weller D., Welsh D., Welters I., Wert M., Whiteley S., Wilby E., Williams E., Williams K., Wilson A., Wojtas J., Won Huh J., Wrathall D., Wright C., Wu J. -F., Xi G., Xing Z. -J., Xu H., Yamamoto K., Yan J., Yanez J., Yang X., Yates E., Yazicioglu Mocin O., Ye Z., Yildirim F., Yoshida N., Yoshido H. H. L., Young Lee B., Yu R., Yu G., Yu T., Yuan B., Yuangtrakul N., Yumoto T., Yun X., Zakalik G., Zaki A., Zalba-Etayo B., Zambon M., Zang B., Zani G., Zarka J., Zerbi S. M., Zerman A., Zetterquist H., Zhang J., Zhang H., Zhang W., Zhang G., Zhao H., Zheng J., Zhu B., and Zumaran R.

Abstract

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 d

Published
2023

9. Temporal changes of short and long-term outcome after aortic valve replacement

Author

Schröder, E., primary, Jamart, J., additional, Eucher, P., additional, Guédès, A., additional, Louagie, Y., additional, Mbende, C., additional, Michaux, I., additional, Macq, A., additional, Guillaume, L., additional, Richard, M., additional, Dahin, G., additional, Cuvelier, N., additional, Lusuka, R., additional, and Buche, M., additional

Published
2021
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15. Nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences

Author

Noël, A., primary, Vastrade, C., additional, Dupont, S., additional, de Barsy, M., additional, Huang, T.D., additional, Van Maerken, T., additional, Leroux-Roels, I., additional, Delaere, B., additional, Melly, L., additional, Rondelet, B., additional, Dransart, C., additional, Dincq, A.S., additional, Michaux, I., additional, Bogaerts, P., additional, and Glupczynski, Y., additional

Published
2019
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17. Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation

Author

Filipovic, M., Wang, J., Michaux, I., Hunziker, P., Skarvan, K., Seeberger, M. D., Filipovic, M., Wang, J., Michaux, I., Hunziker, P., Skarvan, K., and Seeberger, M. D.

Abstract

Background. There is limited knowledge of the effects of anaesthetics on left ventricular (LV) diastolic function in humans. Our aim was to evaluate these effects in humans free from cardiovascular disease. Methods. Sixty patients (aged 18-47 yr) who had no history or signs of cardiovascular disease were randomized to receive general anaesthesia with halothane, sevoflurane or propofol. Echocardiography was performed at baseline and during spontaneous respiration at 1 minimum alveolar concentration (MAC) of the inhalational agents or propofol 4 µg ml−1 (step 1), and repeated during positive-pressure ventilation with 1 and 1.5 MAC of the inhalational agents or with propofol 4 and 6 µg ml−1 (steps 2a and 2b). Analysis of echocardiographic measurements focused on heart rate corrected isovolumic relaxation time (IVRTc) and early diastolic peak velocity of the lateral mitral annulus (Ea). Results. IVRTc decreased from baseline to step 1 in the halothane group (82 [95% CI, 76-88] ms and 74 [95% CI, 68-80] ms respectively; P=0.02), remained stable in the sevoflurane group (78 [95% CI, 72-83] ms and 73 [95% CI, 67-81] ms; n.s.) and increased in the propofol group (80 [95% CI, 74-86] ms and 92 [95% CI, 84-102] ms; P=0.02). Ea decreased in the propofol group only (18.8 [95% CI, 16.5-19.9] cm s−1 and 16.0 [95% CI, 14.9-17.9] cm s−1; P=0.003). From step 2a to step 2b, IVRTc increased further in the propofol group (109 [95% CI, 99-121] ms and 119 [95% CI, 99-135] ms; P=0.04) but remained stable in the other two groups. Ea did not change from step 2a to step 2b. Conclusions. Halothane and sevoflurane did not impair LV relaxation, whereas propofol caused a mild impairment. However, the impairment by propofol was of a magnitude that is unlikely to cause clinical diastolic dysfunction

Published
2017

18. Quality control assessment in cardiac surgery: single center experience in aortic valve replacement by mechanical prosthesis

Author

Guillaume, L., primary, Schröder, E., additional, Bihin, B., additional, Michaux, I., additional, Dive, A., additional, Hanet, C., additional, Guédès, A., additional, Dangoisse, V., additional, Gabriel, L., additional, Seldrum, S., additional, Gérard, M., additional, Eucher, P.H., additional, Louagie, Y., additional, and Buche, M., additional

Published
2017
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21. Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients undergoing off-pump coronary surgery.

Author

Wang J, Seeberger MD, Skarvan K, Michaux I, Bernet F, Arsenic R, Buser P, Filipovic M, Wang, J, Seeberger, M D, Skarvan, K, Michaux, I, Bernet, F, Arsenic, R, Buser, P, and Filipovic, M

Abstract

Background and Objective: Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery. Methods: Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass after opening of the sternum (baseline) and during grafting of the left anterior descending artery. Peak early (E) and peak late (A) transmitral velocities and their ratio (E/A) were recorded. Myocardial ischaemia was defined by standard criteria using two-dimensional echocardiography and seven-lead electrocardiogram. Results: Thirty-one patients (64 +/- 8 yr, 9 women) fulfilled the predefined inclusion criteria for analysis. During distal revascularization, 16 patients showed myocardial ischaemia and 15 did not. The use of vasoactive drugs, haemodynamic findings and transmitral inflow patterns were similar in both groups at baseline and during grafting. In the ischaemic group, E was 67.1 +/- 13.9 cm s-1 at baseline and 69.5 +/- 23.2 cm s-1 during grafting, and the E/A ratios were 1.3 +/- 0.3 and 1.4 +/- 0.9, respectively. In the non-ischaemic group, E was 64.0 +/- 17.1 cm s-1 at baseline and 60.9 +/- 14.8 cm s-1 during grafting, and the E/A ratios were 1.4 +/- 0.7 and 1.2 +/- 0.3, respectively. Conclusions: Analysis of Doppler findings of transmitral inflow patterns did not allow for detection of myocardial ischaemia during surgical revascularization of the myocardium. [ABSTRACT FROM AUTHOR]

Published
2008

28. Effects of sevoflurane and propofol on left ventricular diastolic function in patients with pre-existing diastolic dysfunction

Author

Filipovic, M., Michaux, I., Wang, J., Hunziker, P., Skarvan, K., Seeberger, M., Filipovic, M., Michaux, I., Wang, J., Hunziker, P., Skarvan, K., and Seeberger, M.

Abstract

Background. The effects of anaesthetics on left ventricular (LV) diastolic function in patients with pre-existing diastolic dysfunction are not well known. We hypothesized that propofol but not sevoflurane will worsen the pre-existing LV diastolic dysfunction. Methods. Of 24 randomized patients, 23 fulfilled the predefined echocardiographic criterion for diastolic dysfunction. They received general anaesthesia with sevoflurane 1 MAC (n=12) or propofol 4 μg ml−1 (n=11). Echocardiographic examinations were performed at baseline and in anaesthetized patients under spontaneous breathing and under positive pressure ventilation. Analysis focused on peak early diastolic velocity of the mitral annulus (Ea). Results. During spontaneous breathing, Ea was higher in the sevoflurane than in the propofol group [mean (95% CI) 7.0 (5.9-8.1) vs 5.5 (4.7-6.3) cm s−1; P<0.05], reflecting an increase of Ea from baseline only in the sevoflurane group (P<0.01). Haemodynamic findings were similar in both groups, but the end-tidal carbon dioxide content was more elevated in the propofol group (P<0.01). During positive pressure ventilation, Ea was similarly low in the sevoflurane and propofol groups [5.3 (4.2-6.3) and 4.4 (3.6-5.2) cm s−1, respectively]. Conclusions. During spontaneous breathing, early diastolic function improved in the sevoflurane but not in the propofol group. However, during positive pressure ventilation and balanced anaesthesia, there was no evidence of different effects caused by the two anaesthetics

29. Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation

Author

Filipovic, M., Wang, J., Michaux, I., Hunziker, P., Skarvan, K., Seeberger, M. D., Filipovic, M., Wang, J., Michaux, I., Hunziker, P., Skarvan, K., and Seeberger, M. D.

Abstract

Background. There is limited knowledge of the effects of anaesthetics on left ventricular (LV) diastolic function in humans. Our aim was to evaluate these effects in humans free from cardiovascular disease. Methods. Sixty patients (aged 18-47 yr) who had no history or signs of cardiovascular disease were randomized to receive general anaesthesia with halothane, sevoflurane or propofol. Echocardiography was performed at baseline and during spontaneous respiration at 1 minimum alveolar concentration (MAC) of the inhalational agents or propofol 4 µg ml−1 (step 1), and repeated during positive-pressure ventilation with 1 and 1.5 MAC of the inhalational agents or with propofol 4 and 6 µg ml−1 (steps 2a and 2b). Analysis of echocardiographic measurements focused on heart rate corrected isovolumic relaxation time (IVRTc) and early diastolic peak velocity of the lateral mitral annulus (Ea). Results. IVRTc decreased from baseline to step 1 in the halothane group (82 [95% CI, 76-88] ms and 74 [95% CI, 68-80] ms respectively; P=0.02), remained stable in the sevoflurane group (78 [95% CI, 72-83] ms and 73 [95% CI, 67-81] ms; n.s.) and increased in the propofol group (80 [95% CI, 74-86] ms and 92 [95% CI, 84-102] ms; P=0.02). Ea decreased in the propofol group only (18.8 [95% CI, 16.5-19.9] cm s−1 and 16.0 [95% CI, 14.9-17.9] cm s−1; P=0.003). From step 2a to step 2b, IVRTc increased further in the propofol group (109 [95% CI, 99-121] ms and 119 [95% CI, 99-135] ms; P=0.04) but remained stable in the other two groups. Ea did not change from step 2a to step 2b. Conclusions. Halothane and sevoflurane did not impair LV relaxation, whereas propofol caused a mild impairment. However, the impairment by propofol was of a magnitude that is unlikely to cause clinical diastolic dysfunction

31. 4CPS-230 Prospective study to explore the impact of a clinical pharmacist in a cardiac surgical population or after acute coronary syndrome

Author

Braibant, M, Larock, AS, Dive, A, Horlait, G, Bulpa, P, Michaux, I, Hecq, JD, Krug, B, and Spinewine, A

Abstract

BackgroundPatients in the intensive care unit (ICU) are at risk of medication errors (polypharmacy, critical nature of their illnesses and use of high-risk drugs). Collaboration with a clinical pharmacist can be helpful in minimising these risks. In order to develop and sustain clinical pharmacy activity in the ICU at our hospital, formal evaluation of the potential benefit was required.PurposeTo describe the characteristics of interventions performed by an ICU clinical pharmacist, including their clinical relevance and likelihood of preventing adverse drug events (ADEs), as well as carrying out a cost analysis on a subgroup of critical interventions.Material and methodsA prospective interventional study was conducted in the cardiac and cardio-surgical ICU of a university teaching hospital. The clinical pharmacist provided pharmaceutical care to cardiovascular surgical and acute coronary syndrome ICU patients over a 9 week period.All clinical pharmacy interventions (CPIs) were recorded and evaluated by two independent evaluators for clinical relevance and likelihood of preventing ADEs. The CPIs were categorised in a risk classification system adapted from the Society of Hospital Pharmacists of Australia.For the cost analysis, we relied on German adverse drug events micro-costing data by Rottenkolber et al.ResultsA total of 230 CPIs were performed in 58 patients. The acceptance rate was 85.5%. The medication classes most frequently involved were: blood and coagulation (16.9%), cardiovascular system (14.8%), pain and fever drugs (14.8%). Sixty-six (33.8%) interventions were considered high/extreme risk, and anticoagulants and antiplatelet agents alone accounted for 25.8% of those.The cut-off to cover the salary of the clinical pharmacist could be reached, if 24 severe adverse events on anticoagulants and antiplatelet agents were avoided per 7 weeks.Two-thirds of all CPIs required the presence of the pharmacist in the unit. Analysis of the medical record (45.1%) and contact with a primary care provider (46.7%) were proportionally the sources of information most often used in the case of high/extreme CPIs.ConclusionThis study provides data that supports the expansion of clinical pharmacy services to cardiovascular surgical patients in the ICU.Reference and/or Acknowledgements1. Rottenkolber D, et al. Costs of adverse drug events in German hospitals – a microcosting study. Value Health2012Sep–Oct;15(6):868–875.No conflict of interest

Published
2018
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34. Impact of Pre-Transplant Left Ventricular Diastolic Pressure on Primary Graft Dysfunction after Lung Transplantation: A Narrative Review.

Author

Henry JP, Carlier F, Higny J, Benoit M, Xhaët O, Blommaert D, Telbis AM, Robaye B, Gabriel L, Guedes A, Michaux I, Demeure F, and Luchian ML

Abstract

Lung transplantation (LT) constitutes the last therapeutic option for selected patients with end-stage respiratory disease. Primary graft dysfunction (PGD) is a form of severe lung injury, occurring in the first 72 h following LT and constitutes the most common cause of early death after LT. The presence of pulmonary hypertension (PH) has been reported to favor PGD development, with a negative impact on patients' outcomes while complicating medical management. Although several studies have suggested a potential association between pre-LT left ventricular diastolic dysfunction (LVDD) and PGD occurrence, the underlying mechanisms of such an association remain elusive. Importantly, the heterogeneity of the study protocols and the various inclusion criteria used to define the diastolic dysfunction in those patients prevents solid conclusions from being drawn. In this review, we aim at summarizing PGD mechanisms, risk factors, and diagnostic criteria, with a further focus on the interplay between LVDD and PGD development. Finally, we explore the predictive value of several diastolic dysfunction diagnostic parameters to predict PGD occurrence and severity.

Published
2024
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35. Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches.

Author

Colle B, Demeure F, Higny J, Benoit M, Henry JP, Michaux I, Robaye B, Xhaët O, Gabriel L, Guedes A, Blommaert D, Dulieu N, Berners Y, Wery F, Droogmans S, Cosyns B, and Luchian ML

Abstract

This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.

Published
2024
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36. Adsorptive therapies in sepsis and inflammation: description of the various adsorptive techniques and their failure to improve outcomes.

Author

Honore PM, Blackman S, Perriens E, Oueslati I, Haddad C, Al-Sammour C, Bendoumou M, Ramos-Prieto M, Vornicu O, Dincq AS, Evrard P, Bulpa P, and Michaux I

Subjects
Humans, Adsorption, Endotoxins, Sepsis therapy
Abstract

Blood purification as an adjunctive therapy has been studied for several decades. In this review, we will focus on the most recent studies, particularly on adsorption techniques. These include hemofilters with adsorptive membranes, both endotoxin-specific and non-specific. In addition, we will discuss sorbents that target endotoxins, as well as devices that non-selectively capture viruses and bacteria. For each technique, we will also explore the reasons why blood purification methods have thus far failed to improve survival. Conventionally, reasons for the lack of success in blood purification techniques have been attributed to the need for better patient stratification through bedside measurements of interleukins and endotoxins. The choice of assay is also crucial, with endotoxin activity assays being preferable to other forms of limulus amoebocyte lysate assays. Another critical factor is timing, as administering blood purification at the wrong moment can potentially harm the patient. Mechanistic studies are still lacking for most devices, leaving us to treat patients blindly, except in endotoxin cases. In the context of viruses, especially COVID-19, we require a deeper understanding of the complexities involved in viral replication, as this could significantly impact the efficacy of blood purification techniques. The failures highlighted for each device should be viewed as potential areas for improvement. Despite the challenges, we remain hopeful that these techniques will eventually succeed and prove beneficial in the future.

Published
2023
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37. Convalescent Plasma for Covid-19-Induced ARDS in Mechanically Ventilated Patients.

Author

Misset B, Piagnerelli M, Hoste E, Dardenne N, Grimaldi D, Michaux I, De Waele E, Dumoulin A, Jorens PG, van der Hauwaert E, Vallot F, Lamote S, Swinnen W, De Schryver N, Fraipont V, de Mey N, Dauby N, Layios N, Mesland JB, Meyfroidt G, Moutschen M, Compernolle V, Gothot A, Desmecht D, Taveira da Silva Pereira MI, Garigliany M, Najdovski T, Bertrand A, Donneau AF, and Laterre PF

Subjects
Adult, Humans, Antibodies, Neutralizing immunology, Antibodies, Neutralizing therapeutic use, Respiration, Artificial, SARS-CoV-2, Treatment Outcome, COVID-19 complications, COVID-19 immunology, COVID-19 therapy, COVID-19 Serotherapy, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome immunology, Respiratory Distress Syndrome therapy
Abstract

Background: Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are available regarding the use of convalescent plasma in patients with Covid-19-induced acute respiratory distress syndrome (ARDS)., Methods: In this open-label trial, we randomly assigned adult patients with Covid-19-induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28., Results: A total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P = 0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups., Conclusions: The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19-induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation. (Funded by the Belgian Health Care Knowledge Center; ClinicalTrials.gov number, NCT04558476.)., (Copyright © 2023 Massachusetts Medical Society.)

Published
2023
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38. Mortality reduction in severe community-acquired pneumonia: key findings from a large randomized controlled trial and their clinical implications.

Author

Vornicu O, Perriens E, Blackman S, Smoos E, Al Sammour C, Oueslati I, Philippot A, Bankier DV, Haddad C, Bendoumou M, François T, Michaux I, Dincq AS, Evrard P, Bulpa P, and Honore PM

Abstract

Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-23-1719/coif). The authors have no conflicts of interest to declare.

Published
2023
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39. Chronic thromboembolic pulmonary hypertension: early recognition leads to optimal therapy and drastically decreases mortality!

Author

Honore PM, Bousbiat I, Perriens E, Blackman S, Vornicu O, Michaux I, Dincq AS, Evrard P, and Bulpa P

Abstract

Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-23-1288/coif). The authors have no conflicts of interest to declare.

Published
2023
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40. Reduced anticoagulation targets in extracorporeal life support (RATE): study protocol for a randomized controlled trial.

Author

van Minnen O, Oude Lansink-Hartgring A, van den Boogaard B, van den Brule J, Bulpa P, Bunge JJH, Delnoij TSR, Elzo Kraemer CV, Kuijpers M, Lambermont B, Maas JJ, de Metz J, Michaux I, van de Pol I, van de Poll M, Raasveld SJ, Raes M, Dos Reis Miranda D, Scholten E, Simonet O, Taccone FS, Vallot F, Vlaar APJ, and van den Bergh WM

Subjects
Adult, Anticoagulants adverse effects, Heparin adverse effects, Heparin, Low-Molecular-Weight adverse effects, Humans, Randomized Controlled Trials as Topic, Extracorporeal Membrane Oxygenation adverse effects, Extracorporeal Membrane Oxygenation methods, Ischemic Stroke
Abstract

Background: Although life-saving in selected patients, ECMO treatment still has high mortality which for a large part is due to treatment-related complications. A feared complication is ischemic stroke for which heparin is routinely administered for which the dosage is usually guided by activated partial thromboplastin time (aPTT). However, there is no relation between aPTT and the rare occurrence of ischemic stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome., Methods: We will conduct a three-arm non-inferiority randomized controlled trial, in adult patients treated with ECMO. Participants will be randomized between heparin administration with a target of 2-2.5 times baseline aPTT, 1.5-2 times baseline aPTT, or low molecular weight heparin guided by weight and renal function. Apart from anticoagulation targets, treatment will be according to standard care. The primary outcome parameter is a combined endpoint consisting of major bleeding including hemorrhagic stroke, severe thromboembolic complications including ischemic stroke, and mortality at 6 months., Discussion: We hypothesize that with lower anticoagulation targets or anticoagulation with LMWH during ECMO therapy, patients will have fewer hemorrhagic complications without an increase in thromboembolic complication or a negative effect on their outcome. If our hypothesis is confirmed, this study could lead to a change in anticoagulation protocols and a better outcome for patients treated with ECMO., Trial Registration: ClinicalTrials.gov NCT04536272 . Registered on 2 September 2020. Netherlands Trial Register NL7969., (© 2022. The Author(s).)

Published
2022
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41. Monitoring of Unfractionated Heparin Therapy in the Intensive Care Unit Using a Point-of-Care aPTT: A Comparative, Longitudinal Observational Study with Laboratory-Based aPTT and Anti-Xa Activity Measurement.

Author

Lardinois B, Hardy M, Michaux I, Horlait G, Rotens T, Jacqmin H, Lessire S, Bulpa P, Dive A, and Mullier F

Abstract

Continuous intravenous unfractionated heparin (UFH) is administered routinely in the intensive care unit (ICU) for the anticoagulation of patients, and monitoring is performed by the activated partial thromboplastin time (APTT) or anti-Xa activity. However, these strategies are associated with potentially large time intervals before dose adjustments, which could be detrimental to the patient. The aim of the study was to compare a point-of-care (POCT) version of the APTT to (i) laboratory-based APTT and (ii) measurements of anti-Xa activity in terms of correlation, agreement and turnaround time (TAT). Thirty-five ICU patients requiring UFH therapy were prospectively included and followed longitudinally for a maximum duration of 15 days. UFH was administered according to a local adaptation of Raschke and Amanzadeh’s aPTT nomograms. Simultaneous measurements of POCT-APTT (CoaguCheck® aPTT Test, Roche Diagnostics) on a drop of fresh whole blood, laboratory-based APTT (C.K. Prest®, Stago) and anti-Xa activity (STA®Liquid anti-Xa, Stago) were systematically performed two to six times a day. Antithrombin, C-reactive protein, fibrinogen, factor VIII and lupus anticoagulant were measured. The time tracking of sampling and analysis was recorded. The overall correlation between POCT-APTT and laboratory APTT (n = 795 pairs) was strongly positive (rs = 0.77, p < 0.0001), and between POCT-APTT and anti-Xa activity (n = 729 pairs) was weakly positive (rs = 0.46, p < 0.0001). Inter-method agreement (Cohen’s kappa (k)) between POCT and laboratory APTT was 0.27, and between POCT and anti-Xa activity was 0.30. The median TATs from sample collection to the lab delivery of results for lab-APTT and anti-Xa were 50.9 min (interquartile range (IQR), 38.4−69.1) and 66.3 min (IQR, 49.0−91.8), respectively, while the POCT delivered results in less than 5 min (p < 0.0001). Although the use of the POCT-APTT device significantly reduced the time to results, the results obtained were poorly consistent with those obtained by lab-APTT or anti-Xa activity, and therefore it should not be used with the nomograms developed for lab-APTT.

Published
2022
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43. Prothrombotic disturbances of hemostasis of patients with severe COVID-19: A prospective longitudinal observational study.

Author

Hardy M, Michaux I, Lessire S, Douxfils J, Dogné JM, Bareille M, Horlait G, Bulpa P, Chapelle C, Laporte S, Testa S, Jacqmin H, Lecompte T, Dive A, and Mullier F

Subjects
Anticoagulants therapeutic use, Biological Variation, Individual, Blood Coagulation Tests, C-Reactive Protein analysis, COVID-19 complications, Female, Fibrin Fibrinogen Degradation Products analysis, Fibrinolysis, Humans, Male, Plasminogen Activator Inhibitor 1 blood, Prospective Studies, Thrombin analysis, Thrombophilia blood, Thrombophilia drug therapy, Time Factors, COVID-19 blood, Hemostasis, SARS-CoV-2, Thrombophilia etiology
Published
2021
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44. Prothrombotic hemostasis disturbances in patients with severe COVID-19: Individual daily data.

Author

Hardy M, Michaux I, Lessire S, Douxfils J, Dogné JM, Bareille M, Horlait G, Bulpa P, Chapelle C, Laporte S, Testa S, Jacqmin H, Lecompte T, Dive A, and Mullier F

Abstract

This data article accompanies the manuscript entitled: "Prothrombotic Disturbances of hemostasis of Patients with Severe COVID-19: a Prospective Longitudinal Observational Cohort Study" submitted to Thrombosis Research by the same authors. We report temporal changes of plasma levels of an extended set of laboratory parameters during the ICU stay of the 21 COVID-19 patients included in the monocentre cohort: CRP, platelet count, prothrombin time; Clauss fibrinogen and clotting factors II, V and VIII levels, D-dimers, antithrombin activity, protein C, free protein S, total and free tissue factor pathway inhibitor, PAI-1 levels, von Willebrand factor antigen and activity, ADAMTS-13 (plasma levels); and of two integrative tests of coagulation (thrombin generation with ST Genesia) and fibrinolysis (global fibrinolytic capacity - GFC). Regarding hemostasis, we used double-centrifuged frozen citrated plasma prospectively collected after daily performance of usual coagulation tests. Demographic and clinical characteristics of patients and thrombotic and hemorrhagic complications were also collected from patient's electronic medical reports., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that have or could be perceived to have influenced the work reported in this article., (© 2020 The Authors.)

Published
2020
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45. Severe influenza/respiratory syncytial virus infections and hospital antimicrobial stewardship opportunities: impact of a 4-year surveillance including molecular diagnosis.

Author

Bourgeois M, Ausselet N, Gerard V, de Canniere L, Scius N, Michaux I, Huang TD, Bogaerts P, Vandamme C, Bihin B, and Delaere B

Subjects
Adult, Hospitalization, Hospitals, Humans, Infant, Retrospective Studies, Antimicrobial Stewardship, Influenza, Human diagnosis, Influenza, Human drug therapy, Influenza, Human epidemiology, Respiratory Syncytial Virus Infections diagnosis, Respiratory Syncytial Virus Infections drug therapy, Respiratory Syncytial Virus Infections epidemiology, Respiratory Syncytial Virus, Human, Respiratory Tract Infections diagnosis, Respiratory Tract Infections drug therapy, Respiratory Tract Infections epidemiology
Abstract

Objective: To assess the prevalence of influenza and respiratory syncytial virus (RSV) in adults hospitalized for a respiratory infection in the winter months and to evaluate the impact of a viral diagnosis on empirical antimicrobial management (antibiotics and antivirals)., Design: Observational cohort study., Setting: Acute-care university hospital., Patients: The study included 963 adult patients hospitalized over a 4-year surveillance period., Methods: Annual surveillance timelines were defined according to epidemiological criteria related to the circulation of RSV and influenza viruses in the general population. Patients were screened following a severe acute respiratory infection (SARI) case definition at the emergency department and were enrolled for molecular assay targeting influenza/RSV viruses after oral informed consent. Epidemiological and clinical data were recorded prospectively, microbiological investigations, antimicrobial management, and outcome data were reviewed retrospectively., Results: An influenza or RSV virus was documented in 316 of 963 patients (33%). Optimization of antimicrobial management (AM) was achieved in 162 of 265 patients (61%) with a positive viral diagnosis and no bacterial infection at admission (AM treatment not initiated, n = 111; discontinued, n = 51). In contrast, only 128 of 462 patients (28%) with negative microbiological investigations did not have AM treatment initiated (n = 116) or had such treatment discontinued (n = 12). Early, targeted antiviral treatment was prescribed in 235 of 253 patients (93%) confirmed with influenza. Epidemiological, clinical, and outcome data were similar in both groups., Conclusion: Epidemiological surveillance associated with influenza/RSV molecular diagnosis in adults hospitalized for severe winter respiratory infections dramatically enhanced antimicrobial management.

Published
2020
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46. Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery.

Author

Bolliger D, Poltera C, Cheung AT, Couture P, Michaux I, Poelaert J, Preisman S, Skarvan K, Buse GL, and Seeberger MD

Abstract

Objective: Normative values of left ventricular (LV) end-diastolic area and diameter (EDA and EDD) for intraoperative transoesophageal echocardiography (TEE) have not been established. We aimed to define the ranges of LV EDA and EDD for intraoperative TEE examinations in patients undergoing coronary artery bypass graft (CABG) surgery., Methods: A MEDLINE search for studies reporting LV EDA and EDD in CABG patients was performed. Individual-level dataset from 333 anaesthetised and mechanically ventilated patients with preserved LV function (study population) were received from 8 studies. EDA and calculated EDD values in the study population were compared with summary mean EDD values obtained by transthoracic echocardiography (TTE) in 2 studies of 500 awake patients with coronary artery disease (CAD). Further, the influence of prespecified factors on EDD was evaluated through a multivariate regression model., Results: LV EDA and EDD values measured by TEE in anaesthetised CABG patients were 16.7±4.7 cm 2 and 4.6±0.6 cm, respectively. EDD values measured by TEE in anaesthetised patients were 10% to 13% less those measured by TTE in 2 studies of awake patients (p<0.001). Body surface area, age and fractional area change but not sex were factors that affected LV EDD., Conclusion: LV EDD values measured by intraoperative TEE in anaesthetised and mechanically ventilated CABG patients were 10% to 13% less than those measured by TTE in awake CAD patients. This finding indicates that independent normative values specific for intraoperative TEE should be established for guiding intraoperative clinical decisions., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Published
2017
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47. Persistent heparin-induced thrombocytopenia: danaparoid cross-reactivity or delayed-onset heparin-induced thrombocytopenia? A case report.

Author

Horlait G, Minet V, Mullier F, and Michaux I

Subjects
Anticoagulants administration & dosage, Chondroitin Sulfates administration & dosage, Dermatan Sulfate administration & dosage, Heparitin Sulfate administration & dosage, Humans, Male, Middle Aged, Anticoagulants therapeutic use, Chondroitin Sulfates therapeutic use, Dermatan Sulfate therapeutic use, Heparin adverse effects, Heparitin Sulfate therapeutic use, Thrombocytopenia chemically induced
Abstract

Clinical suspicion of immune heparin-induced thrombocytopenia (HIT) requires cessation of heparin and initiation of an alternative anticoagulant. The platelet count will subsequently recover. This case report describes the clinical course of a patient after a cardiovascular surgery. HIT was clinically and biologically confirmed. Unexpectedly, the platelet count did not recover despite the arrest of heparin. Danaparoid was initiated, and thrombocytopenia persisted. Danaparoid cross-reactivity was suspected, and laboratory assay was performed. Results were misinterpreted because no comparative buffer control was performed to ensure that the platelet aggregation was caused by danaparoid. Moreover, plasma/serum must be diluted to demonstrate this effect. Danaparoid cross-reactivity was incorrectly concluded, and the patient was switched to bivalirudin. The severe thrombocytopenia persisted. Plasmapheresis was started, and platelet count finally increased. The clinical course suggested a delayed-onset HIT. This case report illustrates the need for appropriate testing to differentiate drug cross-reactivity from delayed-onset HIT.

Published
2017
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49. Functional status and medium-term prognosis of very elderly patients after an ICU stay: a prospective observational study.

Author

Magnette C, De Saint Hubert M, Swine C, Bouhon S, Jamart J, Dive A, and Michaux I

Subjects
Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Length of Stay, Male, Prognosis, Prospective Studies, Survival Analysis, Treatment Outcome, Critical Care statistics & numerical data, Intensive Care Units statistics & numerical data
Abstract

Background: Because the proportion of elderly patients admitted to the intensive care unit (ICU) is increasing, the objective of this study was to test the hypothesis that very elderly patients with better preadmission functional status would have better medium-term survival and functional status after an ICU stay., Methods: In this observational study, 96 patients (68% surgical and 32% medical) aged ≥80 years and admitted to the ICU between May 2008 and June 2009 were recruited. Functional status was assessed using a modified Katz Scale and the Lawton Scale. Primary outcomes were: one-year mortality and its independent predictive factors, one-year functional status and perceived quality of life., Results: Multivariate analysis showed that type of admission (surgical vs. medical), existence of cancer, Sequential Organ Failure Assessment (SOFA) Score at ICU admission and occurrence of septic complications during the ICU stay were independent predictive factors for one-year mortality, but preadmission functional status was not. At one year, despite functional decline in 50% of survivors, 68% perceived their health status to be equivalent to or better than before and 82.6% would agree to a further ICU stay., Conclusion: One-year mortality of very elderly patients after an ICU stay is not related to preadmission functional status but to the type of admission, existence of cancer, SOFA Score at ICU admission and occurrence of septic complications during the ICU stay. Despite functional decline in half of these patients, one year after admission 82.6% would agree to another ICU stay.

Published
2015

50. "Piece" of mind: end of life in the intensive care unit statement of the Belgian Society of Intensive Care Medicine.

Author

Vincent JL, Schetz M, De Waele JJ, de Cléty SC, Michaux I, Sottiaux T, Hoste E, Ledoux D, De Weerdt A, and Wilmer A

Subjects
Belgium, Critical Care standards, Humans, Intensive Care Units standards, Patient Care Team, Societies, Medical, Terminal Care standards, Withholding Treatment, Critical Care methods, Intensive Care Units organization & administration, Terminal Care methods
Published
2014
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