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1. Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences

Author: Matthieu Le Dorze, Romain Barthélémy, Olivier Lesieur, Gérard Audibert, Marie-Ange Azais, Dorothée Carpentier, Charles Cerf, Gaëlle Cheisson, Renaud Chouquer, Vincent Degos, Marion Fresco, Fabien Lambiotte, Emmanuelle Mercier, Jérôme Morel, Laurent Muller, Erika Parmentier-Decrucq, Sébastien Prin, Armine Rouhani, France Roussin, Jean-Christophe Venhard, Mathieu Willig, Catherine Vernay, Benjamin Chousterman, Nancy Kentish-Barnes, and the CARE-M3 Research Group
Subjects: Organ donation, Controlled donation after circulatory death, End-of-life care, Withdrawal of life sustaining therapies, Intensive Care Units, Medical philosophy. Medical ethics, R723-726
Abstract: Abstract Background The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians’ and nurses’ experiences with cDCD. Methods In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation. Results Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27–38) in OD(-) vs. 32 (27–40) in OD( +), p = 0.911, for physicians and 32 (25–37) in OD(-) vs. 39 (26–37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall. Conclusions cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses. Trial registration This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).
Published: 2024
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2. Clinical description and outcome of overall varicella-zoster virus-related organ dysfunctions admitted in intensive care units: the VAZOREA cohort study

Author: Jolan Malherbe, Pierre Godard, Jean-Claude Lacherade, Valentin Coirier, Laurent Argaud, Hervé Hyvernat, Francis Schneider, Julien Charpentier, Florent Wallet, Juliette Pocquet, Gaëtan Plantefeve, Jean-Pierre Quenot, Pierre Bay, Agathe Delbove, Hugues Georges, Tomas Urbina, David Schnell, Charlène Le Moal, Matthieu Stanowski, Corentin Muris, Maud Jonas, Bertrand Sauneuf, Olivier Lesieur, Amaury Lhermitte, Laure Calvet, Ines Gueguen, and Damien du Cheyron
Subjects: Varicella-Zoster virus, Intensive care units, Encephalitis, Pneumonia, Immunocompromised host, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Due to aging population and increasing part of immunocompromised patients, a raise in life-threatening organ damage related to VZV can be expected. Two retrospective studies were already conducted on VZV in ICU but focused on specific organ injury. Patients with high-risk of VZV disease still must be identified. The objective of this study was to report the clinical features and outcome of all life-threatening VZV manifestations requiring intensive care unit (ICU) admission. This retrospective cohort study was conducted in 26 French ICUs and included all adult patients with any life-threatening VZV-related event requiring ICU admission or occurring in ICU between 2010 and 2019. Results One-hundred nineteen patients were included with a median SOFA score of 6. One hundred eight patients (90.8%) were admitted in ICU for VZV disease, leaving 11 (9.2%) with VZV disease occurring in ICU. Sixty-one patients (51.3%) were immunocompromised. Encephalitis was the most prominent organ involvement (55.5%), followed by pneumonia (44.5%) and hepatitis (9.2%). Fifty-four patients (45.4%) received norepinephrine, 72 (60.5% of the total cohort) needed invasive mechanical ventilation, and 31 (26.3%) received renal-replacement therapy. In-hospital mortality was 36.1% and was significantly associated with three independent risk factors by multivariable logistic regression: immunosuppression, VZV disease occurring in ICU and alcohol abuse. Hierarchical clustering on principal components revealed five phenotypically distinct clusters of patients: VZV-related pneumonia, mild encephalitis, severe encephalitis in solid organ transplant recipients, encephalitis in other immunocompromised hosts and VZV disease occurring in ICU. In-hospital mortality was highly different across phenotypes, ranging from zero to 75% (p
Published: 2024
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3. Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study

Author: Jean Baptiste Lascarrou, Wulfran Bougouin, Jonathan Chelly, Jeremy Bourenne, Cedric Daubin, Olivier Lesieur, Pierre Asfar, Gwenhael Colin, Marine Paul, Nicolas Chudeau, Gregoire Muller, Guillaume Geri, Sophier Jacquier, Nicolas Pichon, Thomas Klein, Bertrand Sauneuf, Kada Klouche, Martin Cour, Caroline Sejourne, Filippo Annoni, Jean-Herle Raphalen, Arnaud Galbois, Cedric Bruel, Nicolas Mongardon, Nadia Aissaoui, Nicolas Deye, Julien Maizel, Florence Dumas, Stephane Legriel, Alain Cariou, and the AfterROSC Network
Subjects: Cardiac arrest, Outcome prediction, Neurological prognosis, Functional outcome, Score, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis is useful to adapt therapeutic strategy, tailor intensity of care, and inform relatives. We aimed primarily to undertake a prospective multicentric study to evaluate predictive performance of the Cardiac Arrest Prognosis (CAHP) Score as compare to historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was to evaluate other dedicated scores for predicting outcome after OHCA and to compare them to Utstein style criteria. Methods We prospectively collected data from 24 French and Belgium Intensive Care Units (ICUs) between August 2020 and June 2022. All cases of non-traumatic OHCA (cardiac and non-cardiac causes) patients with stable return of spontaneous circulation (ROSC) and comatose at ICU admission (defined by Glasgow coma score ≤ 8) on ICU admission were included. The primary outcome was the modified Rankin scale (mRS) at day 90 after cardiac arrest, assessed by phone interviews. A wide range of developed scores (CAHP, OHCA, CREST, C-Graph, TTM, CAST, NULL-PLEASE, and MIRACLE2) were included, and their accuracies in predicting poor outcome at 90 days after OHCA (defined as mRS ≥ 4) were determined using the area under the receiving operating characteristic curve (AUROC) and the calibration belt. Results During the study period, 907 patients were screened, and 658 were included in the study. Patients were predominantly male (72%), with a mean age of 61 ± 15, most having collapsed from a supposed cardiac cause (64%). The mortality rate at day 90 was 63% and unfavorable neurological outcomes were observed in 66%. The performance (AUROC) of Utstein criteria for poor outcome prediction was moderate at 0.79 [0.76–0.83], whereas AUROCs from other scores varied from 0.79 [0.75–0.83] to 0.88 [0.86–0.91]. For each score, the proportion of patients for whom individual values could not be calculated varied from 1.4% to 17.4%. Conclusions In patients admitted to ICUs after a successfully resuscitated OHCA, most of the scores available for the evaluation of the subsequent prognosis are more efficient than the usual Utstein criteria but calibration is unacceptable for some of them. Our results show that some scores (CAHP, sCAHP, mCAHP, OHCA, rCAST) have superior performance, and that their ease and speed of determination should encourage their use. Trial registration https://clinicaltrials.gov/ct2/show/NCT04167891
Published: 2023
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4. Epidemiology and outcome predictors in 450 patients with hanging-induced cardiac arrest: a retrospective study

Author: Marie Salvetti, Guillaume Schnell, Nicolas Pichon, Maleka Schenck, Pierrick Cronier, Sebastien Perbet, Jean-Baptiste Lascarrou, Christophe Guitton, Olivier Lesieur, Laurent Argaud, Gwenhael Colin, Bernard Cholley, Jean-Pierre Quenot, Hamid Merdji, Thomas Geeraerts, Michael Piagnerelli, Gwenaelle Jacq, Marine Paul, Jonathan Chelly, Louise de Charentenay, Nicolas Deye, Marc Danguy des Déserts, Guillaume Thiery, Marc Simon, Vincent Das, Frederic Jacobs, Charles Cerf, Julien Mayaux, Pascal Beuret, Abdelkader Ouchenir, Antoine Lafarge, Bertrand Sauneuf, Cedric Daubin, Alain Cariou, Stein Silva, and Stephane Legriel
Subjects: near-hanging, intensive care unit, coma/therapy, outcome, cardiopulmonary resuscitation, Neurology. Diseases of the nervous system, RC346-429
Abstract: BackgroundCardiac arrest is the most life-threatening complication of attempted suicide by hanging. However, data are scarce on its characteristics and outcome predictors.MethodsThis retrospective observational multicentre study in 31 hospitals included consecutive adults admitted after cardiac arrest induced by suicidal hanging. Factors associated with in-hospital mortality were identified by multivariate logistic regression with multiple imputations for missing data and adjusted to the temporal trends over the study period.ResultsOf 450 patients (350 men, median age, 43 [34–52] years), 305 (68%) had a psychiatric history, and 31 (6.9%) attempted hanging while hospitalized. The median time from unhanging to cardiopulmonary resuscitation was 0 [0–5] min, and the median time to return of spontaneous circulation (ROSC) was 20 [10–30] min. Seventy-nine (18%) patients survived to hospital discharge. Three variables were independently associated with higher in-hospital mortality: time from collapse or unhanging to ROSC>20 min (odds ratio [OR], 4.71; 95% confidence intervals [95%CIs], 2.02–10.96; p = 0.0004); glycaemia >1.4 g/L at admission (OR, 6.38; 95%CI, 2.60–15.66; p < 0.0001); and lactate >3.5 mmol/L at admission (OR, 6.08; 95%CI, 1.71–21.06; p = 0.005). A Glasgow Coma Scale (GCS) score of >5 at admission was associated with lower in-hospital mortality (OR, 0.009; 95%CI, 0.02–0.37; p = 0.0009).ConclusionIn patients with hanging-induced cardiac arrest, time from collapse or unhanging to return of spontaneous circulation, glycaemia, arterial lactate, and coma depth at admission were independently associated with survival to hospital discharge. Knowledge of these risk factors may help guide treatment decisions in these patients at high risk of hospital mortality.
Published: 2023
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5. Effects of mean arterial pressure target on mottling and arterial lactate normalization in patients with septic shock: a post hoc analysis of the SEPSISPAM randomized trial

Author: Nicolas Fage, Julien Demiselle, Valérie Seegers, Hamid Merdji, Fabien Grelon, Bruno Mégarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, Remi Coudroy, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Jean Pierre Bedos, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien Du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher, and Pierre Asfar
Subjects: Arterial lactate, Lactate clearance, Mean arterial pressure, Microcirculation, Mottling, Septic shock, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient’s outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling
Published: 2022
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6. Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study

Author: Florian Reizine, Agathe Delbove, Alexandre Dos Santos, Laetitia Bodenes, Pierre Bouju, Pierre Fillâtre, Aurélien Frérou, Guillaume Halley, Olivier Lesieur, Maud Jonas, Florian Berteau, Jean Morin, David Luque-Paz, Rémy Marnai, Anthony Le Meur, Cécile Aubron, Jean Reignier, Jean-Marc Tadié, and Arnaud Gacouin
Subjects: Drowning, ICU, ARDS, Saltwater, Freshwater, Cardiac arrest, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients’ prognosis remains poorly explored in Intensive Care Units (ICUs) patients. Methods We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. Results Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03–3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p
Published: 2021
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7. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

Author: Carole Ruault, Nathalie Zappella, Julien Labreuche, Pierrick Cronier, Baptiste Claude, Marc Garnier, Antoine Vieillard-Baron, Sofia Ortuno, Maxime Mallet, Olga Cosic, Laura Crosby, Olivier Lesieur, Nicolas Pichon, Arnaud Galbois, Cedric Bruel, Kenneth Ekpe, Bertrand Sauneuf, Damien Roux, and Stephane Legriel
Subjects: Medicine, Science
Abstract: Abstract Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38–9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
Published: 2021
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8. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

Author: Alexandra Laurent, Alicia Fournier, Florent Lheureux, Guillaume Louis, Saad Nseir, Gwenaelle Jacq, Cyril Goulenok, Grégoire Muller, Julio Badie, Bélaïd Bouhemad, Marjolaine Georges, Paul-Michel Mertes, Hamid Merdji, Vincent Castelain, Caroline Abdulmalak, Olivier Lesieur, Gaëtan Plantefeve, Jean-Claude Lacherade, Jean-Philippe Rigaud, Nicholas Sedillot, Damien Roux, Nicolas Terzi, Pascal Beuret, Antoine Monsel, Anne-Laure Poujol, Khaldoun Kuteifan, Thierry Vanderlinden, Anne Renault, Bérengère Vivet, Christophe Vinsonneau, Saber Davide Barbar, Gilles Capellier, Jean Dellamonica, Stephan Ehrmann, Thomas Rimmelé, Julien Bohé, Pierre Bouju, Sébastien Gibot, Bruno Lévy, Johanna Temime, Cyrille Pichot, David Schnell, Diane Friedman, Pierre Asfar, Eddy Lebas, Philippe Mateu, Kada Klouche, Juliette Audibert, Fiona Ecarnot, Nicolas Meunier-Beillard, Mélanie Loiseau, Irène François-Pursell, Christine Binquet, Jean-Pierre Quenot, and PsyCOVID-ICU Trial Investigators and the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
Subjects: Mental health, Stress factors, ICU, Healthcare professionals, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. Methods This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. Results In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p
Published: 2021
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9. Impact of targeted hypothermia in expanded-criteria organ donors on recipient kidney-graft function: study protocol for a multicentre randomised controlled trial (HYPOREME)

Author: Thomas Kerforne, Christiane Mousson, Karim Asehnoune, Fanny Feuillet, Olivier Huet, Bertrand Rozec, Aude Garin, Alexandre Hertig, Jeremy Bourenne, Nassim Kamar, Emmanuel Morelon, Denis Glotz, Morgane Péré, Thierry Boulain, Jean Reignier, René Robert, Dominique Bertrand, Pierre-Yves Egreteau, Thierry Benard, Raphaëlle Larmet, Luc Frimat, Sophie Girerd, Mathias Büchler, Anne Renault, Patrice Tirot, Cécile Vigneau, Eric Delpierre, David Schnell, Olivier Lesieur, Lionel Rostaing, Mathieu Lesouhaitier, Laurent Martin-Lefevre, Antoine Durrbach, Noëlle Brulé, Emmanuel Canet, Maryvonne Hourmant, Agnes Duveau, Laurent Dube, Marc Pierrot, Stanislas Humbert, Jean-Marc Boyer, François Labadie, Antoine Thierry, Jean-François Vincent, Angelique Goepp, Pierre Bouju, Charlotte Quentin, Yannick Le Meur, Jean-Christophe Venhard, Olivier Michel, Marie-Hélène Voellmy, Fabien Herve, Anne Courte, Lucile Amrouche, Marc Hazzan, Valerie Moal, Moglie Le Quintrec-Donnette, Philippe Grimbert, Anne Elisabeth Heng, Pierre Merville, Christian Hiesse, Brice Fermier, Charlotte Guyot-Colosio, Nicolas Bouvier, Jean-Philippe Rerolle, Sarah Drouin, Sophie Caillard, Laetitia Albano, Pierre-Francois Westeel, Florent Montini, Dider Dorez, Eric Alamartine, Carole Ouisse, and Veronique Sebille
Subjects: Medicine
Abstract: Introduction Expanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and mortality. HYPOREME will be a multicentre randomised controlled trial (RCT) comparing targeted hypothermia to normothermia in ECDs, in a country where the use of machine perfusion for organ storage is the standard of care. We hypothesise that hypothermia will decrease the incidence of DGF.Methods and analysis HYPOREME is a multicentre RCT comparing the effect on kidney function in recipients of targeted hypothermia (34°C–35°C) and normothermia (36.5°C–37.5°C) in the ECDs. The temperature intervention starts from randomisation and is maintained until aortic clamping in the operating room. We aim to enrol 289 ECDs in order to analyse the kidney function of 516 recipients in the 53 participating centres. The primary outcome is the occurrence of DGF in kidney recipients, defined as a requirement for renal replacement therapy within 7 days after transplantation (not counting a single session for hyperkalemia during the first 24 hours). Secondary outcomes include the proportion of patients with individual organs transplanted in each group; the number of organs transplanted from each ECD and the vital status and kidney function of the recipients 7 days, 28 days, 3 months and 1 year after transplantation. An interim analysis is planned after the enrolment of 258 kidney recipients.Ethics and dissemination The trial was approved by the ethics committee of the French Intensive Care Society (CE-SRLF-16-07) on 26 April 2016 and by the competent French authorities on 20 April 2016 (Comité de Protection des Personnes-TOURS-Région Centre-Ouest 1, registration #2016-S3). Findings will be published in peer-reviewed journals and presented during national and international scientific meetings.Trial registration number NCT03098706.
Published: 2022
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10. Multicentre observational status-epilepticus registry: protocol for ICTAL

Author: Cédric Bruel, Nicolas Mongardon, Jean-Pierre Quenot, Didier Ledoux, Pierre Bailly, Jean-Baptiste Lascarrou, Gaetan Plantefeve, Jean Philippe Rigaud, Arnaud Galbois, David Schnell, Annabelle Stoclin, Gwenaelle Jacq, Jonathan Chelly, Pauline Soulier, Olivier Lesieur, Pascal Beuret, Mathilde Holleville, Bertrand Sauneuf, Caroline Sejourne, Marine Arrayago, Candice Fontaine, François Perier, Wulfran Bougouin, Nicolas Pichon, and Stephane Legriel
Subjects: Medicine
Published: 2022
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11. Admission criteria and management of critical care patients in a pandemic context: position of the Ethics Commission of the French Intensive Care Society, update of April 2021

Author: Olivier Lesieur, Jean Pierre Quenot, Zoé Cohen-Solal, Raphaëlle David, Laure De Saint Blanquat, Maxime Elbaz, Bénédicte Gaillard Le Roux, Cyril Goulenok, Sylvain Lavoué, Virginie Lemiale, Emmanuelle Mercier, Chaouki Mezher, Benoît Misset, Gwendolyn Penven, Anne Laure Poujol, Bertrand Quentin, Régis Quéré, Thierry Van Der Linden, and Jean Philippe Rigaud
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Intensive care unit professionals have experience in critical care and its proportionality, collegial decision-making, withholding or withdrawal of treatment deemed futile, and communication with patients’ relatives. These elements rely on ethical values from which we must not deviate in a pandemic situation. The recommendations made by the Ethics Commission of the French Intensive Care Society reflect an approach of responsibility and solidarity towards our citizens regarding the potential impact of a pandemic on critical care resources in France, with the fundamental requirement of respect for human dignity and equal access to health care for all.
Published: 2021
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12. Intensive care units, the Achilles heel of France in the COVID-19 battle

Author: Djillali Annane, Laura Federici, Jean-Luc Chagnon, Jean Luc Diehl, Didier Dreyfuss, Philippe Guiot, Etienne Javouhey, Nicolas Joram, Olivier Lesieur, Jean Philippe Rigaud, Hervé Outin, Arnaud Sement, Chantal Sevens, Didier Thévenin, Samia Touati, and Nicolas Terzi
Subjects: Public aspects of medicine, RA1-1270
Published: 2021
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13. Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

Author: Denis Frasca, Christophe Guitton, Jean-Pierre Frat, Stephan Ehrmann, Nicolas Terzi, Damien Contou, Jean-Pierre Quenot, Saad Nseir, Didier Thévenin, Arnaud W Thille, Bertrand Guidet, Laura Federici, Jean Reignier, René Robert, Christophe Vinsonneau, Michel Djibré, C Girault, Suela Demiri, Juliette Masse, Olivier Lesieur, Pascal Beuret, Julie Badin, Dalila Benzekri-Llefevre, Hassène Rahmani, Laurent Argaud Argaud, Erwan I'her, Khaldoune Kuteifan, Francois Thouy, Martial Thyrault, Juliette Audibert, Alexandre Boyer, Riad Chelha, G Piton, and Nadia Aissaoui
Subjects: Medicine
Abstract: Introduction A palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysis This is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and dissemination The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration number NCT03673631
Published: 2021
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14. 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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15. Correction: Determinants of Recovery from Severe Posterior Reversible Encephalopathy Syndrome.

Author: Stephane Legriel, Olivier Schraub, Elie Azoulay, Philippe Hantson, Eric Magalhaes, Isaline Coquet, Cedric Bretonniere, Olivier Gilhodes, Nadia Anguel, Bruno Megarbane, Laurent Benayoun, David Schnell, Gaetan Plantefeve, Julien Charpentier, Laurent Argaud, Bruno Mourvillier, Arnaud Galbois, Ludivine Chalumeau-Lemoine, Michel Rivoal, François Durand, Arnaud Geffroy, Marc Simon, Annabelle Stoclin, Jean-Louis Pallot, Charlotte Arbelot, Martine Nyunga, Olivier Lesieur, Gilles Troché, Fabrice Bruneel, Yves-Sébastien Cordoliani, Jean-Pierre Bedos, and Fernando Pico
Subjects: Medicine, Science
Published: 2013
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16. Determinants of recovery from severe posterior reversible encephalopathy syndrome.

Author: Stephane Legriel, Olivier Schraub, Elie Azoulay, Philippe Hantson, Eric Magalhaes, Isaline Coquet, Cedric Bretonniere, Olivier Gilhodes, Nadia Anguel, Bruno Megarbane, Laurent Benayoun, David Schnell, Gaetan Plantefeve, Julien Charpentier, Laurent Argaud, Bruno Mourvillier, Arnaud Galbois, Ludivine Chalumeau-Lemoine, Michel Rivoal, François Durand, Arnaud Geffroy, Marc Simon, Annabelle Stoclin, Jean-Louis Pallot, Charlotte Arbelot, Martine Nyunga, Olivier Lesieur, Gilles Troché, Fabrice Bruneel, Yves-Sébastien Cordoliani, Jean-Pierre Bedos, Fernando Pico, and Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS)
Subjects: Medicine, Science
Abstract: ObjectiveFew outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.Design70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.Main resultsConsciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOSConclusionsBy day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement.
Published: 2012
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17. 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

18. Les vieux, le tri et le réanimateur

Author: Olivier Lesieur, Jean-Pierre Quenot, and Jean-Philippe Rigaud
Subjects: Anesthesiology and Pain Medicine, Oncology, Oncology (nursing)
Published: 2022

19. Global Comparison of Communication of End-of-Life Decisions in the ICU

Author: Charles Feldman, Charles L. Sprung, Spyros D. Mentzelopoulos, Anne Pohrt, Christiane S. Hartog, Christopher Danbury, Manfred Weiss, Alexander Avidan, Angel Estella, Gavin M. Joynt, Alexandre Lautrette, Edoardo Geat, Gábor Élő, Eldar Søreide, Olivier Lesieur, Maria G. Bocci, Sudakshina Mullick, Annette Robertsen, Roshni Sreedharan, Hans-Henrik Bülow, Paulo A. Maia, Mariá Cruz Martin-Delgado, Joseph F. Cosgrove, Nikki Blackwell, Silvia Perez-Protto, and Guy A. Richards
Subjects: Death, Pulmonary and Respiratory Medicine, Intensive Care Units, Terminal Care, Communication, Decision Making, Humans, Prospective Studies, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, Retrospective Studies
Abstract: Prolonging life in the ICU increasingly is possible, so decisions to limit life-sustaining therapies frequently are made and communicated to patients and families or surrogates. Little is known about worldwide communication practices and influencing factors.Are there regional differences in end-of-life communication practices in ICUs worldwide?This analysis of data from a prospective, international study specifically addressed end-of-life communications in consecutive patients who died or had limitation of life-sustaining therapy over 6 months in 199 ICUs in 36 countries, grouped regionally. End-of-life decisions were recorded for each patient and ethical practice was assessed retrospectively for each ICU using a 12-point questionnaire developed previously.Of 87,951 patients admitted, 12,850 died or experienced a limitation of therapy (14.6%). Of these, 1,199 patients (9.3%) were known to have an advance directive, and wishes were elicited from 6,456 patients (50.2%). Limitations of life-sustaining therapy were implemented for 10,401 patients (80.9%), 1,970 (19.1%) of whom had mental capacity at the time, and were discussed with 1,507 patients (14.5%) and 8,461 families (81.3%). Where no discussions with patients occurred (n = 8,710), this primarily was because of a lack of mental capacity in 8,114 patients (93.2%), and where none occurred with families (n = 1,622), this primarily was because of unavailability (n = 720 [44.4%]). Regional variation was noted for all end points. In generalized estimating equation (GEE) analyses, the odds for discussions with the patient or family increased by 30% (OR, 1.30; 95% CI, 1.18-1.44; P .001) for every one-point increase in the Ethical Practice Score and by 92% (OR, 1.92; 95% CI, 1.28-2.89; P = .002) in the presence of an advance directive.End-of-life communication with patients and families or surrogates varies markedly in different global regions. GEE analysis supports the hypothesis that communication may increase with ethical practice and an advance directive. Greater effort is needed to align treatment with patients' wishes.
Published: 2022

20. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial

Author: Nancy, Kentish-Barnes, Sylvie, Chevret, Sandrine, Valade, Samir, Jaber, Lionel, Kerhuel, Olivier, Guisset, Maëlle, Martin, Amélie, Mazaud, Laurent, Papazian, Laurent, Argaud, Alexandre, Demoule, David, Schnell, Eddy, Lebas, Frédéric, Ethuin, Emmanuelle, Hammad, Sybille, Merceron, Juliette, Audibert, Clarisse, Blayau, Pierre-Yves, Delannoy, Alexandre, Lautrette, Olivier, Lesieur, Anne, Renault, Danielle, Reuter, Nicolas, Terzi, Bénédicte, Philippon-Jouve, Maud, Fiancette, Michel, Ramakers, Jean-Philippe, Rigaud, Virginie, Souppart, Karim, Asehnoune, Benoît, Champigneulle, Dany, Goldgran-Toledano, Jean-Louis, Dubost, Pierre-Edouard, Bollaert, Renaud, Chouquer, Frédéric, Pochard, Alain, Cariou, and Elie, Azoulay
Subjects: Adult, Male, Patient Care Team, Terminal Care, Attitude to Death, Communication, Standard of Care, General Medicine, Middle Aged, Intensive Care Units, Professional-Family Relations, Humans, Family, Female, Grief, Empathy, Aged, Bereavement
Abstract: In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes.We undertook a prospective, multicentre, cluster randomised controlled trial in 34 ICUs in France, to compare standard care with a physician-driven, nurse-aided, three-step support strategy for families throughout the dying process, following a decision to withdraw or withhold life support. Inclusion criteria were relatives of patients older than 18 years with an ICU length of stay 2 days or longer. Participating ICUs were randomly assigned (1:1 ratio) into an intervention cluster and a control cluster. The randomisation scheme was generated centrally by a statistician not otherwise involved in the study, using permutation blocks of non-released size. In the intervention group, three meetings were held with relatives: a family conference to prepare the relatives for the imminent death, an ICU-room visit to provide active support, and a meeting after the patient's death to offer condolences and closure. ICUs randomly assigned to the control group applied their best standard of care in terms of support and communication with relatives of dying patients. The primary endpoint was the proportion of relatives with prolonged grief (measured with PG-13, score ≥30) 6 months after the death. Analysis was by intention to treat, with the bereaved relatives as the unit of observation. The study is registered with ClinicalTrials.gov, NCT02955992.Between Feb 23, 2017, and Oct 8, 2019, we enrolled 484 relatives of ICU patients to the intervention group and 391 to the control group. 379 (78%) relatives in the intervention group and 309 (79%) in the control group completed the 6-month interview to measure the primary endpoint. The intervention significantly reduced the number of relatives with prolonged grief symptoms (66 [21%] vs 57 [15%]; p=0·035) and the median PG-13 score was significantly lower in the intervention group than in the control group (19 [IQR 14-26] vs 21 [15-29], mean difference 2·5, 95% CI 1·04-3·95).Among relatives of patients dying in the ICU, a physician-driven, nurse-aided, three-step support strategy significantly reduced prolonged grief symptoms.French Ministry of Health.
Published: 2022

21. Characteristics, management, and outcomes of patients with infectious encephalitis requiring intensive care: A prospective multicentre observational study

Author: Pierre Fillatre, Alexandra Mailles, Jean Paul Stahl, Pierre Tattevin, Sophie Abgrall, Laurent Argaud, Xavier Argemi, Guillaume Baille, Aurélie Baldolli, Sarah Benghanem, Kevin Bertrand, Julien Biberon, Charlotte Biron, Geneviève Blanchet Fourcade, Mathieu Blot, Elisabeth Bothelo-Nevers, Frédéric Bourdain, David Boutoille, Hélène Brasme, Cédric Bruel, Fabrice Bruneel, Rodolphe Buzele, Emmanuel Canet, Etienne Canoui, Philippe Casenave, Bernard Castan, Charles Cazanave, Céline Cazorla, Pascal Chavanet, Catherine Chirouze, Tomasz Chroboczek, Johan Courjon, Daniel Da Silva, Thomas De Broucker, Arnaud De La Blanchardiere, Etienne De Montmollin, Eric Denes, Colin Deschanvres, Aurélien Dinh, Olivier Epaulard, Emmanuel Forestier, Thibaut Fraisse, Benjamin Gaborit, Amandine Gagneux-Brunon, Nicolas Gaillard, Arnaud Galbois, Mathieu Godement, François Goehringer, Pascale Goubin, Simon Gravier, Valentin Greigert, Isabelle Gueit, Thomas Guimard, Carole Henry, Maxime Hentzien, Pierre Jaquet, Fanny Jomier, Snejana Jurici, Solen Kerneis, Morgane Le Bras, Marion Le Marechal, Gwenael Le Moal, Paul Le Turnier, Anne-Sophie Lecompte, Raphael Lecomte, Stéphanie Lejeune, François-Xavier Lescure, Olivier Lesieur, Philippe Lesprit, Guillaume Louis, Rafael Mahieu, Alain Makinson, Guillaume Marc, Alexandre Maria, Nathalie Marin, Guillaume Martin-Blondel, Martin Martinot, Alexandre Mas, Philippe Mateu, Morgan Matt, Laurence Maulin, Frédéric Mechai, Eugénie Mutez, Jérémie Orain, Anne Pachart, Nathalie Pansu, Solene Patrat-Delon, Patricia Pavese, Hélène Pelerin, Véronique Pelonde-Erimée, Isabelle Pierre, Emilie Piet, Diane Ponscarme, Dimitri Psimaras, Mathilde Puges, Jean Reignier, Mathilde Reveillon Istin, Sylvain Rheims, Aurélie Richard-Mornas, Vincent Roubeau, Yvon Ruch, Isabelle Runge, Hélène Savini, Romain Sonneville, Jean-Marie Turmel, Louise Tyvaert, Marc-Olivier Vareil, Magali Vidal-Roux, Virginie Vitrat, Adrien Wang, Heidi Wille, Mathieu Zuber, Laurent Almoyna-Martinez, Jean-Louis Herrmann, Jérome Honnorat, Patrice Morand, France Roblot, Jean-Paul Stahl, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Santé publique France - French National Public Health Agency [Saint-Maurice, France], Centre Hospitalier Universitaire [Grenoble] (CHU), ARN régulateurs bactériens et médecine (BRM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and This work was supported by the French Infectious Diseases Society (Société de pathologie infectieuse de langue française, SPILF).
Subjects: Frailty, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV]Life Sciences [q-bio], Encephalitis, Intensive care unit, Functional outcome, Herpes simplex virus, Critical Care and Intensive Care Medicine
Abstract: International audience; PURPOSE: Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. MATERIALS AND METHODS: Ancillary study focusing on patients with ICU admission within the ENCEIF cohort, a French prospective observational multicentre study. The primary criteria for outcome was the functional status at hospital discharge, categorized using the Glasgow outcome scale (GOS). Logistic regression model was used to identify risk factors for poor outcome, defined as a GOS ≤ 3. RESULTS: We enrolled 198 ICU patients with IE. HSV was the primary cause (n = 72, 36% of all IE, 53% of IE with microbiological documentation). Fifty-two patients (26%) had poor outcome at hospital discharge, including 22 deaths (11%). Immunodeficiency, supratentorial focal signs on admission, lower cerebrospinal fluid (CSF) white cells count (2 days were independent predictors of poor outcome. CONCLUSION: HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.
Published: 2023

22. Electrocardiographic Changes at the Early Stage of Status Epilepticus: First Insights From the ICTAL Registry

Author: Paul Chinardet, Floriane Gilles, Helene Cochet, Jonathan Chelly, Jean-Pierre Quenot, Gwenaelle Jacq, Pauline Soulier, Olivier Lesieur, Pascal Beuret, Mathilde Holleville, Cedric Bruel, Pierre Bailly, Bertrand Sauneuf, Caroline Sejourne, Arnaud Galbois, Candice Fontaine, François Perier, Nicolas Pichon, Marine Arrayago, Nicolas Mongardon, David Schnell, Jean-Baptiste Lascarrou, Raphaële Convers, and Stephane Legriel
Subjects: Critical Care and Intensive Care Medicine
Abstract: To describe early electrocardiogram (ECG) abnormalities after status epilepticus (SE) and evaluate their association with 90-day neurological outcomes.Retrospective analysis of a multicenter, national prospective registry between February 2018 and June 2020.Sixteen ICUs in France, IctalGroup Research Network.Adults with available ECG performed less than or equal to 24 hours after the onset of SE and less than or equal to 12 hours after its resolution.Double-blinded review of all ECGs was performed by two independent cardiologists. ECGs were categorized as normal/abnormal and then with minor/major early ECG abnormalities according to the Novacode ECG Classification system.Among 155 critically ill patients with SE, early ECG abnormalities were encountered in 145 (93.5%), categorized as major in 91 of 145 (62.8%). In addition to sinus tachycardia, the main abnormalities were in the ST segment (elevation [16.6%] or depression [17.9%]) or negative T waves (42.1%). Major early ECG abnormalities were significantly associated with respiratory distress and sinus tachycardia at the scene and hyperlactatemia at ICU admission. By multivariable analysis, three variables were significantly associated with 90-day poor outcome: age, preexisting ultimately fatal comorbidity, and cerebral insult as the cause of SE. Early major ECG abnormalities were not independently associated with 90-day functional outcome.In our study, early ECG abnormalities in the acute phase of SE were frequent, often unrecognized and were associated with clinical and biological stigma of hypoxemia. Although they were not independently associated with 90-day functional outcome, ECG changes at the early stage of SE should be systematically evaluated.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03457831.
Published: 2022

23. Sédation profonde et continue maintenue jusqu’au décès en réanimation : mise au point de la Commission d’Ethique de la SRLF

Author: Alexandra Laurent, Zoé Cohen-Solal, Jean-Pierre Quenot, Jean Reignier, CE de la Srlf, Raphaëlle David, Thierry Boulain, Régis Quéré, Emmanuelle Mercier, Lilia Soufir, Bertrand Quentin, Olivier Lesieur, Virginie Lemiale, Cyril Goulenok, Bénédicte Gaillard-Le Roux, Laure de Saint-Blanquat, Jean-Philippe Rigaud, Sylvain Lavoué, Mathieu Serie, Benoit Misset, Gwendolyn Penven, Chaouki Mezher, Anne-Laure Poujol, René Robert, and Maxime Elbaz
Subjects: Intensive care, Philosophy, Emergency Medicine, Emergency Nursing, Humanities
Abstract: La mise en œuvre de la sédation profonde et continue maintenue jusqu’au décès en réanimation peut s’avérer complexe car il faut tenir compte de la singularité de chaque patient et de son entourage. Cet aspect de la prise en charge devrait être évoqué autant que possible avec le patient et ses proches bien avant que la question de la fin de vie ne se pose. Formation des soignants, information des patients et des proches et adaptation de l’environnement en fin de vie représentent les pistes d’amélioration de la prise en charge de la fin de vie en réanimation.
Published: 2021

24. Clinical and microbiological features of drowning-associated pneumonia: a retrospective multicentre cohort study

Author: Florian Reizine, Agathe Delbove, Pierre Tattevin, Alexandre Dos Santos, Laetitia Bodenes, Pierre Bouju, Pierre Fillâtre, Aurélien Frérou, Guillaume Halley, Olivier Lesieur, Patricia Courouble, Florian Berteau, Jean Morin, Flora Delamaire, Rémy Marnai, Anthony Le Meur, Cécile Aubron, Jean Reignier, Arnaud Gacouin, Jean-Marc Tadié, CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Microbiology (medical), Drowning, [SDV]Life Sciences [q-bio], Microorganisms, General Medicine, Pneumonia, Cohort Studies, Hospitalization, Intensive Care Units, Critical care, Infectious Diseases, Humans, Hospital Mortality, Antimicrobial strategy, Retrospective Studies
Abstract: International audience; Objective: Pneumonia is the most frequent infectious complication in patients who have experienced drowning that requires intensive care unit (ICU) admission. We aimed to describe clinical, microbiological, and therapeutic data as well as predictors and impacts of such pneumonia on patients' outcomes.Methods: We conducted a retrospective, multicentre study (2013-2020) of 270 consecutive patients admitted for drowning to 14 ICUs in Western France. Their baseline characteristics and outcomes were compared according to the occurrence of drowning-associated pneumonia (DAP), defined as pneumonia diagnosed within 48 hours of ICU admission. A Cox regression model was used to compare survival on day 28, and logistic regression was used to identify risk factors for DAP. Microbiological characteristics and empirical antibacterial treatment were also analysed.Results: Among the 270 patients admitted to the ICU for drowning, 101 (37.4%) and 33 (12.2%) experienced pneumonia and microbiologically proven DAP, respectively. The occurrence of pneumonia was associated with higher severity scores at ICU admission (median Simplified Acute Physiology Score II, 34 [interquartile range {IQR}, 25-55] vs. 45 [IQR, 28-67]; p 0.006) and longer ICU length of stay (2 days [IQR, 1-3] vs. 4 days [IQR, 2-7]; p < 0.001). The 28-day mortality rate was higher among these patients (29/101 [28.7%] vs. 26/169 [15.4%]; p 0.013). Microbiologically proven DAP remained associated with higher 28-day mortality after adjustments for cardiac arrest and water salinity (adjusted hazard ratio, 1.86 [95% CI, 1.06-3.28]; p 0.03). A microbiological analysis of respiratory samples showed a high proportion of gram-negative bacilli (23/56; 41.1%), with a high prevalence of amoxicillin-clavulanate resistance (12/33; 36.4%).Conclusions: Pneumonia is a common complication in patients admitted in the ICU for drowning and is associated with increased mortality.
Published: 2022

25. La décision médicale en réanimation, un indispensable fardeau

Author: SRLF Commission d'Éthique, Cyril Goulenok, Zoé Cohen-Solal, Raphaëlle David, Laure De Saint Blanquat, Maxime Elbaz, Bénédicte Gaillard Le Roux, Sylvain Lavoué, Virginie Lemiale, Emmanuelle Mercier, Chaouki Mezher, Benoit Misset, Gwendolyn Penven, Anne-Laure Poujol, Régis Quéré, Jean-Philippe Rigaud, Mathieu Série, and Olivier Lesieur
Subjects: Emergency Medicine, Emergency Nursing
Abstract: La décision est au cœur du métier de réanimateur. Elle est partie intégrante de son activité au quotidien. Cet exercice s’avère d’autant plus difficile lorsque, en période de crise sanitaire, les médecins sont confrontés à une majoration du flux des patients en inadéquation avec la capacité d’accueil en réanimation. Il est nécessaire de s’interroger sur les mécanismes qui entrent en jeu dans cette démarche de décision. L’analyse étymologique aide à une meilleure compréhension de ces mécanismes. Décider n’est pas choisir. On ne peut réduire la décision à un calcul mathématique. L’angoisse, l’incertitude font partie intégrante de ce processus. Les récents travaux sur les biais cognitifs ainsi que la recherche en neurosciences ont mis l’accent sur sa profonde complexité. Le partage de décision, exercice bien développé en soins critiques, permet de soulager en partie du fardeau qu’elle représente. Si les avantages de ce partage sont indéniables, il ne faut pas en négliger ses inconvénients. Elle reste un fardeau indispensable car témoin de l’engagement du soignant envers le soigné et de l’expression de sa responsabilité morale. Le fardeau est une charge que l’on porte, que l’on assume. S’il pèse dans la décision, il lui apporte aussi toute sa valeur. Décider c’est soigner. L’avènement de nouvelles technologies pourrait considérablement modifier l’approche décisionnelle. Il est nécessaire, en amont, de définir ce que représente la décision en réanimation afin d’intégrer au mieux ces technologies sans se positionner comme technolâtre ou technophobe mais plutôt technosophe.
Published: 2022

26. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis

Author: David Hajage, Alain Combes, Christophe Guervilly, Guillaume Lebreton, Alain Mercat, Arthur Pavot, Saad Nseir, Armand Mekontso-Dessap, Nicolas Mongardon, Jean Paul Mira, Jean-Damien Ricard, Alexandra Beurton, Guillaume Tachon, Loay Kontar, Christophe Le Terrier, Jean Christophe Richard, Bruno Mégarbane, Ruth H. Keogh, Aurélien Belot, Camille Maringe, Clémence Leyrat, Matthieu Schmidt, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dres, Julien Mayaux, Cédric Daubin, Richard Descamps, Aurélie Joret, Damien Du Cheyron, Frédéric Pene, Jean-Daniel Chiche, Mathieu Jozwiak, Paul Jaubert, Guillaume Voiriot, Muriel Fartoukh, Marion Teulier, Clarisse Blayau, Erwen L'Her, Cécile Aubron, Laetitia Bodenes, Nicolas Ferriere, Johann Auchabie, Anthony Le Meur, Sylvain Pignal, Thierry Mazzoni, Jean-Pierre Quenot, Pascal Andreu, Jean-Baptiste Roudau, Marie Labruyère, Sébastien Preau, Julien Poissy, Daniel Mathieu, Sarah Benhamida, Rémi Paulet, Nicolas Roucaud, Martial Thyrault, Florence Daviet, Sami Hraiech, Gabriel Parzy, Aude Sylvestre, Sébastien Jochmans, Anne-Laure Bouilland, Mehran Monchi, Marc Danguy des Déserts, Quentin Mathais, Gwendoline Rager, Pierre Pasquier, Jean Reignier, Amélie Seguin, Charlotte Garret, Emmanuel Canet, Jean Dellamonica, Clément Saccheri, Romain Lombardi, Yanis Kouchit, Sophie Jacquier, Armelle Mathonnet, Mai-Ahn Nay, Isabelle Runge, Frédéric Martino, Laure Flurin, Amélie Rolle, Michel Carles, Rémi Coudroy, Arnaud W. Thille, Jean-Pierre Frat, Maeva Rodriguez, Pascal Beuret, Audrey Tientcheu, Arthur Vincent, Florian Michelin, Fabienne Tamion, Dorothée Carpentier, Déborah Boyer, Gaetan Beduneau, Valérie Gissot, Stéphan Ehrmann, Charlotte Salmon Gandonniere, Djlali Elaroussi, Agathe Delbove, Yannick Fedun, Julien Huntzinger, Eddy Lebas, Grâce Kisoka, Céline Grégoire, Stella Marchetta, Bernard Lambermont, Laurent Argaud, Thomas Baudry, Pierre-Jean Bertrand, Auguste Dargent, Christophe Guitton, Nicolas Chudeau, Mickaël Landais, Cédric Darreau, Alexis Ferre, Antoine Gros, Guillaume Lacave, Fabrice Bruneel, Mathilde Neuville, Jérôme Devaquet, Richard Gallot, Riad Chelha, Arnaud Galbois, Anne Jallot, Ludivine Chalumeau Lemoine, Khaldoun Kuteifan, Valentin Pointurier, Louise-Marie Jandeaux, Joy Mootien, Charles Damoisel, Benjamin Sztrymf, Juliette Chommeloux, Charles Edouard Luyt, Frédérique Schortgen, Leon Rusel, Camille Jung, Florent Gobert, Damien Vimpere, Lionel Lamhaut, Bertrand Sauneuf, Liliane Charrrier, Julien Calus, Isabelle Desmeules, Benoît Painvin, Jean-Marc Tadie, Vincent Castelain, Baptiste Michard, Jean-Etienne Herbrecht, Mathieu Baldacini, Nicolas Weiss, Sophie Demeret, Clémence Marois, Benjamin Rohaut, Pierre-Henri Moury, Anne-Charlotte Savida, Emmanuel Couadau, Mathieu Série, Nica Alexandru, Cédric Bruel, Candice Fontaine, Sonia Garrigou, Juliette Courtiade Mahler, Maxime Leclerc, Michel Ramakers, Pierre Garçon, Nicole Massou, Ly Van Vong, Juliane Sen, Nolwenn Lucas, Franck Chemouni, Annabelle Stoclin, Alexandre Avenel, Henri Faure, Angélie Gentilhomme, Sylvie Ricome, Paul Abraham, Céline Monard, Julien Textoris, Thomas Rimmele, Florent Montini, Gabriel Lejour, Thierry Lazard, Isabelle Etienney, Younes Kerroumi, Claire Dupuis, Marine Bereiziat, Elisabeth Coupez, François Thouy, Clément Hoffmann, Nicolas Donat, Anne Chrisment, Rose-Marie Blot, Antoine Kimmoun, Audrey Jacquot, Matthieu Mattei, Bruno Levy, Ramin Ravan, Loïc Dopeux, Jean-Mathias Liteaudon, Delphine Roux, Brice Rey, Radu Anghel, Deborah Schenesse, Vincent Gevrey, Jermy Castanera, Philippe Petua, Benjamin Madeux, Otto Hartman, Michael Piagnerelli, Anne Joosten, Cinderella Noel, Patrick Biston, Thibaut Noel, Gurvan LE Bouar, Messabi Boukhanza, Elsa Demarest, Marie-France Bajolet, Nathanaël Charrier, Audrey Quenet, Cécile Zylberfajn, Nicolas Dufour, Buno Mégarbane, Sébastian Voicu, Nicolas Deye, Isabelle Malissin, François Legay, Matthieu Debarre, Nicolas Barbarot, Pierre Fillatre, Bertrand Delord, Thomas Laterrade, Tahar Saghi, Wilfried Pujol, Pierre Julien Cungi, Pierre Esnault, Mickael Cardinale, Vivien Hong Tuan Ha, Grégory Fleury, Marie-Ange Brou, Daniel Zafimahazo, David Tran-Van, Patrick Avargues, Lisa Carenco, Nicolas Robin, Alexandre Ouali, Lucie Houdou, Noémie Suh, Steve Primmaz, Jérome Pugin, Emmanuel Weiss, Tobias Gauss, Jean-Denis Moyer, Catherine Paugam Burtz, Béatrice La Combe, Rolland Smonig, Jade Violleau, Pauline Cailliez, Jonathan Chelly, Antoine Marchalot, Cécile Saladin, Christelle Bigot, Pierre-Marie Fayolle, Jules Fatséas, Amr Ibrahim, Dabor Resiere, Rabih Hage, Clémentine Cholet, Marie Cantier, Pierre Trouiler, Philippe Montravers, Brice Lortat-Jacob, Sebastien Tanaka, Alexy Tran Dinh, Jacques Duranteau, Anatole Harrois, Guillaume Dubreuil, Marie Werner, Anne Godier, Sophie Hamada, Diane Zlotnik, Hélène Nougue, Guillaume Carteaux, Keyvan Razazi, Nicolas De Prost, Meriam Lamraoui, Claire Alessandri, Quentin de Roux, Charles de Roquetaillade, Benjamin G. Chousterman, Alexandre Mebazaa, Etienne Gayat, Marc Garnier, Emmanuel Pardo, Lea Satre-Buisson, Christophe Gutton, Elise Yvin, Clémence Marcault, Elie Azoulay, Michael Darmon, Hafid Ait Oufella, Geoffroy Hariri, Tomas Urbina, Sandie Mazerand, Nicholas Heming, Francesca Santi, Pierre Moine, Djillali Annane, Adrien Bouglé, Edris Omar, Aymeric Lancelot, Emmanuelle Begot, Gaétan Plantefeve, Damien Contou, Hervé Mentec, Olivier Pajot, Stanislas Faguer, Olivier Cointault, Laurence Lavayssiere, Marie-Béatrice Nogier, Matthieu Jamme, Claire Pichereau, Jan Hayon, Hervé Outin, François Dépret, Maxime Coutrot, Maité Chaussard, Lucie Guillemet, Pierre Goffin, Romain Thouny, Julien Guntz, Laurent Jadot, Romain Persichini, Vanessa Jean-Michel, Hugues Georges, Thomas Caulier, Gaël Pradel, Marie-Hélène Hausermann, Thi My Hue Nguyen-Valat, Michel Boudinaud, Emmanuel Vivier, Sylvène Rosseli, Gaël Bourdin, Christian Pommier, Marc Vinclair, Simon Poignant, Sandrine Mons, Wulfran Bougouin, Franklin Bruna, Quentin Maestraggi, Christian Roth, Laurent Bitker, François Dhelft, Justine Bonnet-Chateau, Mathilde Filippelli, Tristan Morichau-Beauchant, Stéphane Thierry, Charlotte Le Roy, Mélanie Saint Jouan, Bruno Goncalves, Aurélien Mazeraud, Matthieu Daniel, Tarek Sharshar, Cyril Cadoz, Rostane Gaci, Sébastien Gette, Guillaune Louis, Sophe-Caroline Sacleux, Marie-Amélie Ordan, Aurélie Cravoisy, Marie Conrad, Guilhem Courte, Sébastien Gibot, Younès Benzidi, Claudia Casella, Laurent Serpin, Jean-Lou Setti, Marie-Catherine Besse, Anna Bourreau, Jérôme Pillot, Caroline Rivera, Camille Vinclair, Marie-Aline Robaux, Chloé Achino, Marie-Charlotte Delignette, Tessa Mazard, Frédéric Aubrun, Bruno Bouchet, Aurélien Frérou, Laura Muller, Charlotte Quentin, Samuel Degoul, Xavier Stihle, Claude Sumian, Nicoletta Bergero, Bernard Lanaspre, Hervé Quintard, Eve Marie Maiziere, Pierre-Yves Egreteau, Guillaume Leloup, Florin Berteau, Marjolaine Cottrel, Marie Bouteloup, Matthieu Jeannot, Quentin Blanc, Julien Saison, Isabelle Geneau, Romaric Grenot, Abdel Ouchike, Pascal Hazera, Anne-Lyse Masse, Suela Demiri, Corinne Vezinet, Elodie Baron, Deborah Benchetrit, Antoine Monsel, Grégoire Trebbia, Emmanuelle Schaack, Raphaël Lepecq, Mathieu Bobet, Christophe Vinsonneau, Thibault Dekeyser, Quentin Delforge, Imen Rahmani, Bérengère Vivet, Jonathan Paillot, Lucie Hierle, Claire Chaignat, Sarah Valette, Benoït Her, Jennifier Brunet, Mathieu Page, Fabienne Boiste, Anthony Collin, Florent Bavozet, Aude Garin, Mohamed Dlala, Kais Mhamdi, Bassem Beilouny, Alexandra Lavalard, Severine Perez, Benoit Veber, Pierre-Gildas Guitard, Philippe Gouin, Anna Lamacz, Fabienne Plouvier, Bertrand P Delaborde, Aïssa Kherchache, Amina Chaalal, Marc Amouretti, Santiago Freita-Ramos, Damien Roux, Jean-Michel Constantin, Mona Assefi, Marine Lecore, Agathe Selves, Florian Prevost, Christian Lamer, Ruiying Shi, Lyes Knani, Sébastien Pili Floury, Lucie Vettoretti, Michael Levy, Lucile Marsac, Stéphane Dauger, Sophie Guilmin-Crépon, Hadrien Winiszewski, Gael Piton, Thibaud Soumagne, Gilles Capellier, Jean-Baptiste Putegnat, Frédérique Bayle, Maya Perrou, Ghyslaine Thao, Guillaume Géri, Cyril Charron, Xavier Repessé, Antoine Vieillard-Baron, Mathieu Guilbart, Pierre-Alexandre Roger, Sébastien Hinard, Pierre-Yves Macq, Kevin Chaulier, Sylvie Goutte, Patrick Chillet, Anaïs Pitta, Barbara Darjent, Amandine Bruneau, Sigismond Lasocki, Maxime Leger, Soizic Gergaud, Pierre Lemarie, Nicolas Terzi, Carole Schwebel, Anaïs Dartevel, Louis-Marie Galerneau, Jean-Luc Diehl, Caroline Hauw-Berlemont, Nicolas Péron, Emmanuel Guérot, Abolfazl Mohebbi Amoli, Michel Benhamou, Jean-Pierre Deyme, Olivier Andremont, Diane Lena, Julien Cady, Arnaud Causeret, Arnaud De La Chapelle, Christophe Cracco, Stéphane Rouleau, David Schnell, Camille Foucault, Cécile Lory, Thibault Chapelle, Vincent Bruckert, Julie Garcia, Abdlazize Sahraoui, Nathalie Abbosh, Caroline Bornstain, Pierre Pernet, Florent Poirson, Ahmed Pasem, Philippe Karoubi, Virginie Poupinel, Caroline Gauthier, François Bouniol, Philippe Feuchere, Anne Heron, Serge Carreira, Malo Emery, Anne Sophie Le Floch, Luana Giovannangeli, Nicolas Herzog, Christophe Giacardi, Thibaut Baudic, Chloé Thill, Said Lebbah, Jessica Palmyre, Florence Tubach, Nicolas Bonnet, Nathan Ebstein, Stéphane Gaudry, Yves Cohen, Julie Noublanche, Olivier Lesieur, Arnaud Sément, Isabel Roca-Cerezo, Michel Pascal, Nesrine Sma, Gwenhaël Colin, Jean-Claude Lacherade, Gauthier Bionz, Natacha Maquigneau, Pierre Bouzat, Michel Durand, Marie-Christine Hérault, Jean-Francois Payen, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Nord [CHU - APHM], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Université Paris-Saclay, CHU Lille, Hôpital Henri Mondor, Groupe de recherche clinique CARMAS [Créteil] (UPEC/Faculté de Médecine de Créteil), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Hôpital Louis Mourier - AP-HP [Colombes], Hôpital Foch [Suresnes], CHU Amiens-Picardie, Geneva University Hospital (HUG), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), 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)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Lariboisière-Fernand-Widal [APHP], London School of Hygiene and Tropical Medicine (LSHTM), RICHARD, Jean-Christophe, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Pulmonary and Respiratory Medicine, Adult, Respiratory Distress Syndrome, SARS-CoV-2, [SDV]Life Sciences [q-bio], acute respiratory distress syndrome (ARDS), COVID-19, extracorporeal membrane oxygenation, Critical Care and Intensive Care Medicine, Cohort Studies, [SDV] Life Sciences [q-bio], emulated target trial, acute respiratory distress syndrome, Treatment Outcome, surgical procedures, operative, Humans, Retrospective Studies
Abstract: International audience; Rationale: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown.Objectives: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2
Published: 2022

27. Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial*

Author: Soizic Gergaud, Olivier Lesieur, Gael Pradel, Marie Conrad, Jean-Louis Teboul, Jean-Paul Mira, Jean-Pierre Bedos, Fabien Hervé, Julie Helms, Eric Mariotte, Julien Demiselle, Damien du Cheyron, Pierre Asfar, René Robert, Christophe Guitton, Fabien Grelon, Jean-Marie Tonnelier, Pierre-François Dequin, Yves Le Tulzo, Antoine Vieillard-Baron, Fabienne Tamion, Marie Lemerle, Nicolas Weiss, Valérie Seegers, Thierry Van Der Linden, Francçois Legay, Bruno Mégarbane, Nadia Anguel, Ferhat Meziani, Peter Radermacher, Frédéric Gonzalez, Claude Guérin, and Jean-Damien Ricard
Subjects: Male, Mean arterial pressure, medicine.medical_specialty, Angiotensin receptor, Resuscitation, Critical Care and Intensive Care Medicine, Sepsis, Angiotensin Receptor Antagonists, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Internal medicine, Post-hoc analysis, medicine, Humans, Arterial Pressure, Antihypertensive Agents, Randomized Controlled Trials as Topic, Septic shock, business.industry, Acute kidney injury, 030208 emergency & critical care medicine, Acute Kidney Injury, Middle Aged, medicine.disease, Shock, Septic, Treatment Outcome, 030228 respiratory system, Cardiology, Female, business, Kidney disease
Abstract: Objectives Individualizing a target mean arterial pressure is challenging during the initial resuscitation of patients with septic shock. The Sepsis and Mean Arterial Pressure (SEPSISPAM) trial suggested that targeting high mean arterial pressure might reduce the occurrence of acute kidney injury among those included patients with a past history of chronic hypertension. We investigated whether the class of antihypertensive medications used before the ICU stay in chronic hypertensive patients was associated with the severity of acute kidney injury occurring after inclusion, according to mean arterial pressure target. Design Post hoc analysis of the SEPSISPAM trial. Setting The primary outcome was the occurrence of severe acute kidney injury during the ICU stay defined as kidney disease improving global outcome stage 2 or higher. Secondary outcomes were mortality at day 28 and mortality at day 90. Patients All patients with chronic hypertension included in SEPSISPAM with available antihypertensive medications data in the hospitalization report were included. Measurements and main results We analyzed 297 patients. Severe acute kidney injury occurred in 184 patients, without difference according to pre-ICU exposure to antihypertensive medications. Patients with pre-ICU exposure to angiotensin II receptor blockers had significantly less severe acute kidney injury in the high mean arterial pressure target group (adjusted odd ratio 0.24 with 95% CI [0.09-0.66]; p = 0.006). No statistically significant association was found after adjustment for pre-ICU exposure to antihypertensive medications and survival. Conclusions Our results suggest that patients with septic shock and chronic hypertension treated with angiotensin II receptor blocker may benefit from a high mean arterial pressure target to reduce the risk of acute kidney injury occurrence.
Published: 2021

28. Transferring an ICU Patient at the End of His Life for the Purpose of Organ Donation: Could It Be Considered?

Author: Matthieu Le Dorze, Bénédicte Gaillard Le Roux, Gérard Audibert, Régis Quéré, Laurent Muller, Sylvain Lavoué, Jean-Christophe Venhard, Pierre-François Perrigault, and Olivier Lesieur
Subjects: Death, Transplantation, Intensive Care Units, Tissue and Organ Procurement, Humans, Organ Transplantation
Published: 2022

29. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study

Author: Philippe PETUA, Xavier MONNET, Michael Levy, Alexy Tran Dinh, Rabih Hage, Marie Cantier, Nicolas WEISS, Marc Danguy des Déserts, Nicolas DUFOUR, Adrien Bouglé, Anne Godier, MICHEL CARLES, Laurent Bitker, Benjamin Glenn Chousterman, Olivier Lesieur, Céline Grégoire, Mathieu Page, Christophe LE TERRIER, Stephane Dauger, Hafid Ait-Oufella, Matthieu Daniel, Lionel Lamhaut, Martin Dres, Anatole Harrois, Jean-Pierre QUENOT, Sebastien Preau, Guillaume Louis, Valentin Pointurier, Pierre-Henri Moury, Alexandre Mebazaa, Thibault MARTINEZ, Maxime Léger, Sebastien Gette, Frank Chemouni, Benjamin Rohaut, GUILLAUME VOIRIOT, Nicolas TERZI, David Hajage, Tristan Morichau-Beauchant, International Network (INet), and Mégarbane, Bruno
Subjects: Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Original, medicine.medical_treatment, Critical Illness, Kaplan-Meier Estimate, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Mechanical ventilation, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Belgium, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Risk Factors, Mortality risk factor, medicine, Humans, Hospital Mortality, Prospective Studies, Prospective cohort study, Outcome, Aged, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Respiratory Distress Syndrome, Acute respiratory distress syndrome, business.industry, SARS-CoV-2, Patient Acuity, COVID-19, Middle Aged, Respiration, Artificial, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Intensive Care Units, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Emergency medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Female, France, business
Abstract: Purpose To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission. Methods COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected. Results From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54–71] years and SAPS II 37 [28–50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10–14) cmH2O, and 24 (21–27) cmH2O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6–34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO2 ratio and a shorter time between first symptoms and ICU admission. Conclusion Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients. Electronic supplementary material The online version of this article (10.1007/s00134-020-06294-x) contains supplementary material, which is available to authorized users.
Published: 2020

30. Type 1 Diabetes in People Hospitalized for COVID-19: New Insights From the CORONADO Study

Author: Sandrine Lablanche, Florence Galtier, Pierre Leroy, Vincent Dubée, Dominique Bonnefont-Rousselot, Patrick Saulnier, Matthieu Wargny, Manuel Etienne, Patrice Darmon, Anne-Laure Borel, Jean-Louis LAPLANCHE, Olivier Lesieur, Bertrand Cariou, Malak Taher, Lydia GUITTET, Vincent Minville, BRUNO MOURVILLIER, Jean-Pierre QUENOT, Bernard Bonnotte, Lucien Marchand, Team2 Carmen, Veronique Kerlan, Pascal Reynier, Nadia Sabbah, Matthieu PICHELIN, Jean-Charles Aurégan, Guillaume Martin-Blondel, Olivier Bourron, Blandine Rammaert, Pierre-Edouard Fournier, Coralie Amadou, Giulia Chinetti, Jean-Christophe Lagier, Didier Raoult, Centre hospitalier universitaire de Nantes (CHU Nantes), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Sud Francilien, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service d'endocrinologie, diabétologie et nutrition [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), 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)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), 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), Pathogénèse et contrôle des infections chroniques (PCCI), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Diabétologie [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CH Evry-Corbeil, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), 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), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Service de diabétologie [CHU Pitié-Salpétrière], Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Paris (UP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Gestionnaire, Hal Sorbonne Université
Subjects: Male, Pediatrics, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Endocrinology, Diabetes and Metabolism, Pneumonia, Viral, Population, 030209 endocrinology & metabolism, law.invention, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, law, Diabetes mellitus, Internal Medicine, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, education, Pandemics, Case report form, ComputingMilieux_MISCELLANEOUS, Aged, Aged, 80 and over, Glycated Hemoglobin, Advanced and Specialized Nursing, Inpatients, Type 1 diabetes, education.field_of_study, business.industry, e-Letters: Observations, COVID-19, Middle Aged, Prognosis, medicine.disease, Respiration, Artificial, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Diabetes Mellitus, Type 2, Hypertension, Etiology, Female, Observational study, Coronavirus Infections, business
Abstract: Since the start of the coronavirus disease 2019 (COVID-19) pandemic, patients with diabetes were rapidly recognized as a high-risk population for severe disease. Indeed, a high prevalence of diabetes among patients with COVID-19 who required hospitalization has been consistently reported, reaching 33.8% in 5,700 people hospitalized for COVID-19 in the New York City area (1). In addition, diabetes was associated with more than a doubled risk of intensive care unit (ICU) admission and more than a tripled risk of death (2). However, precise data regarding the type of diabetes are scarce. We report here the clinical characteristics and early prognosis of patients with type 1 diabetes (T1D) hospitalized for COVID-19 in the nationwide multicenter observational CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study (3). The aim of the CORONADO study was to describe the phenotypic characteristics and prognosis of patients with diabetes admitted with COVID-19 between 10 March and 10 April 2020 in 68 French hospitals. The protocol (ClinicalTrials.gov reg. no. NCT04324736) obtained all regulatory approvals as recently described (3). Inclusion criteria were 1 ) hospitalization for biologically and/or clinically/radiologically attested COVID-19 and 2 ) personal history of diabetes or newly diagnosed diabetes on admission. The composite primary end point combined tracheal intubation for mechanical ventilation and/or death on day 7 (D7). Secondary outcomes included death, tracheal intubation, and discharge on D7. Classification of diabetes was recorded in the electronic case report form as noted in the medical file by the physician in charge of the patient. In the present subanalysis, patients in whom diabetes was diagnosed on admission were excluded since the etiological diagnosis had not been formally established. All cases noted as T1D were carefully reviewed by local investigators and the steering committee …
Published: 2020

31. Evolution du capacitaire et des ressources humaines en réanimation après la première vague de la pandémie COVID-19 : une enquête du Syndicat des Médecins Réanimateurs

Author: Syndicat des Médecins Réanimateurs SMR, Laura Federici, Olivier Lesieur, Arnaud Sement, Jean-Luc Chagnon, Jean-Philippe Rigaud, Jean-Luc Diehl, Didier Dreyfuss, Philippe Guiot, Nicolas Joram, Hervé Outin, Chantal Sevens, Didier Thévenin, Samia Touati, Djillali Annane, and Nicolas Terzi
Subjects: Emergency Medicine, Emergency Nursing
Abstract: La France a connu au printemps 2020 une crise sanitaire sans précédent sur les plans sanitaire et sociétal due à la pandémie de COVID-19. Lors de cette première vague les hôpitaux ont fait face à un afflux important de patients dans les secteurs de Réanimation. Des mesures exceptionnelles ont été mises en place, pour permettre au système de soins de tenir. Au sortir de cette première vague des propositions ont été faites afin d’optimiser l’organisation des Soins Critiques. Dans ce contexte, nous avons mené une enquête auprès des services de Réanimation français en Janvier 2021, destinée à produire un état des lieux. L’objectif principal de cette enquête était de déterminer si les mesures revendiquées par les soignants et affichées par l’exécutif étaient effectives. Nous avons mené une enquête déclarative visant à établir l’état des lieux des lits de Réanimation et des effectifs soignants avant et après la première vague de la pandémie à COVID-19 en France. Nous avons ainsi pu démontré qu’aucun des lits supplémentaires ouverts pendant la première vague épidémique n’a été pérennisé. Plus inquiétant, 13% des 114 services répondeurs soulignent que le ratio d’une infirmière pour 2,5 patients n’est pas respecté par manque de personnels formés et disponibles. Ces éléments confirment qu’à l’heure actuelle, aucune mesure n’a été prise pour améliorer un capacitaire historiquement et conjoncturellement déficitaire. Cette indispensable correction ne pourra s’opérer qu’avec le recrutement, la formation et la stabilisation d’équipes soignantes spécialisées, médicales et paramédicales.
Published: 2022

32. Effects of Mean Arterial Pressure Target on Mottling and Arterial Lactate Normalization in Patients with Septic Shock: A Post-Hoc Analysis of the SEPSISPAM Trial

Author: Nicolas Fage, Julien DEMISELLE, Valérie SEEGERS, Hamid MERDJI, Fabien GRELON, Bruno Megarbane, Nadia ANGUEL, Jean-Paul Mira, Pierre-François DEQUIN, Soizic GERGAUD, Nicolas WEISS, François LEGAY, Yves Le Tulzo, Marie Conrad, Rémi Coudroy, Frédéric GONZALEZ, Christophe Guitton, Fabienne Tamion, Jean-Marie TONNELIER, Jean Pierre BEDOS, Thierry VAN DER LINDEN, Antoine Vieillard-Baron, Eric MARIOTTE, Gaël PRADEL, Olivier LESIEUR, Jean-Damien Ricard, Fabien HERVE, Damien DU CHEYRON, Claude Guerin, Alain MERCAT, Jean-Louis Teboul, Peter RADERMACHER, and Pierre Asfar
Published: 2022

33. Multicentre observational status-epilepticus registry: Protocol for ICTAL

Author: Gwenaelle Jacq, Jonathan Chelly, Jean-Pierre Quenot, Pauline Soulier, Olivier Lesieur, Pascal Beuret, Mathilde Holleville, Cedric Bruel, Pierre Bailly, Bertrand Sauneuf, Caroline Sejourne, Jean Philippe Rigaud, Arnaud Galbois, Marine Arrayago, Gaetan Plantefeve, Annabelle Stoclin, David Schnell, Candice Fontaine, François Perier, Wulfran Bougouin, Nicolas Pichon, Nicolas Mongardon, Didier Ledoux, Jean-Baptiste Lascarrou, Stephane Legriel, Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupe Hospitalier Sud, Groupe hospitalier de La Rochelle, Centre Hospitalier de Roanne, Hôpitaux Universitaires Paris Nord Val de Seine (HUPNVS), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier Saint-Joseph [Paris], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Réanimation Polyvalente [CHPC - Site Louis Pasteur], Site Louis Pasteur [CHPC], CH Centre Hospitalier Public du Cotentin (CHPC)-CH Centre Hospitalier Public du Cotentin (CHPC), Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Centre hospitalier de Dieppe, Centre Hospitalier Privé Claude Galien - Ramsay Santé, Centre Hospitalier de Cannes, Centre hospitalier Argenteuil (CH Argenteuil), Institut Gustave Roussy (IGR), Département de soins aigus [Gustave Roussy] (DSA), Centre Hospitalier d'Angoulême (CH Angoulême), Hôpital Privé Jacques Cartier [Massy], Hôpital de Brive, Hôpital Henri Mondor, Centre Hospitalier Universitaire de Liège (CHU-Liège), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Acknowledgements We thank A Wolfe MD (Chaumont, France) for helping to prepare the manuscript. The study was supported by the French public funding agency Délégation à la Recherche Clinique et à l’Innovation (DRCI), Versailles, France., and HAL UVSQ, Équipe
Subjects: Critical Care, adult neurology, General Medicine, Cross-Sectional Studies, Status Epilepticus, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Humans, Multicenter Studies as Topic, Medicine, epidemiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Registries, adult intensive & critical care, Retrospective Studies
Abstract: IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can cause long-term impairments. Overall outcomes remain poor. Major efforts are required to clarify the epidemiology of SE and the determinants of outcomes, thereby identifying targets for improved management.Methods and analysisICTAL Registry is a multicentre open cohort of critically ill patients with convulsive, non-convulsive or psychogenic non-epileptic SE. Observational methods are applied to collect uniform data. The goal of the ICTAL Registry is to collect high-quality information on a large number of patients, thereby allowing elucidation of the pathophysiological mechanisms involved in mortality and morbidity. The registry structure is modular, with a large core data set and the opportunity for research teams to create satellite data sets for observational or interventional studies (eg, cohort multiple randomised controlled trials, cross-sectional studies and short-term and long-term longitudinal outcome studies). The availability of core data will hasten patient recruitment to studies, while also decreasing costs. Importantly, the vast amount of data from a large number of patients will allow valid subgroup analyses, which are expected to identify patient populations requiring specific treatment strategies. The results of the studies will have a broad spectrum of application, particularly given the multidisciplinary approach used by the IctalGroup research network.Ethics and disseminationThe ICTAL Registry protocol was approved by the ethics committee of the French Intensive Care Society (#CE_SRLF 19-68 and 19-68a). Patients or their relatives/proxies received written information to the use of the retrospectively collected and pseudonymised data, in compliance with French law. Prospectively included patients receive written consent form as soon as they recover decision-making competency; if they refuse consent, they are excluded from the registry. Data from the registry will be disseminated via conference presentations and peer-reviewed publications.Trial registration numberNCT03457831.
Published: 2022

34. Respiratory management of drowning-associated acute respiratory failure: a multicentre retrospective cohort study

Author: Florian Reizine, Yannick Fedun, Laetitia Bodenes, Pierre Bouju, Pierre Fillâtre, Aurélien Frérou, Olivier Lesieur, Arnaud Gacouin, and Agathe Delbove
Subjects: Pulmonary and Respiratory Medicine
Published: 2023

35. [Resuscitation in the post-Covid-19 era: scalable, connected and personalised]

Author: Olivier, Lesieur
Subjects: SARS-CoV-2, COVID-19, Humans
Published: 2021

36. [From Florence Nightingale to Resuscitation 4.0]

Author: Olivier, Lesieur
Subjects: Humanities, Critical Care, Humans, History of Nursing
Abstract: Complex, rough, trying, work and care in intensive care must be rethought and reorganised to reconcile the concern for the well-being of the patient, his relatives and the carers. A configuration where new technologies, the ethical dimension, prevention and training would contribute significantly to the efficiency and humanity of the premises.
Published: 2021

37. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

Author: Kenneth Ekpe, Damien Roux, Olivier Lesieur, Nicolas Pichon, Cédric Bruel, Stéphane Legriel, Olga Cosic, Bertrand Sauneuf, Nathalie Zappella, Laura Crosby, Baptiste Claude, Marc Garnier, Pierrick Cronier, Maxime Mallet, Carole Ruault, Sofia Ortuno, Arnaud Galbois, Julien Labreuche, Antoine Vieillard-Baron, Centre Hospitalier de Versailles André Mignot (CHV), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupe de recherche clinique en anesthésie réanimation médecine périopératoire [CHU Pitié-Salpétrière] (GRC ARPE), CHU Pitié-Salpêtrière [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), Service d'Anesthésie réanimation [CHU Tenon], CHU Tenon [AP-HP], Hôpital Ambroise Paré [AP-HP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Hôpital Saint-Louis de La Rochelle (CH La Rochelle), CHU Limoges, Ramsay Générale de Santé - Hôpital Privé La Louvière, Centre hospitalier Saint-Joseph [Paris], Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Public du Cotentin (CHPC), Hôpital Louis Mourier - AP-HP [Colombes], Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire (GRC 29 - ARPE), Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CH Centre Hospitalier Public du Cotentin (CHPC), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Service de Pneumologie - R3S [CHU Pitié-Salpêtrière] (SPMIR-R3S)
Subjects: Liver Cirrhosis, Male, medicine.medical_specialty, Multivariate analysis, Cirrhosis, Science, Peritonitis, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Ascitic Fluid, Humans, In patient, 030304 developmental biology, Aged, Retrospective Studies, 0303 health sciences, Multidisciplinary, Critically ill, business.industry, Mortality rate, Retrospective cohort study, Digestive signs and symptoms, Bacterial Infections, Middle Aged, medicine.disease, 3. Good health, Mycoses, Liver, 030211 gastroenterology & hepatology, Female, business, Secondary Peritonitis, Complication, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38–9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
Published: 2021

38. Place du psychologue en réanimation

Author: Olivier Lesieur, Gwendoline Penven, Alexandra Laurent, Benoit Misset, CE de la Srlf, Zoé Cohen Solal, Bénédicte Gaillard Le Roux, Cyril Goulenok, Raphaëlle David, Sylvain Lavoué, Emmanuelle Mercier, Virginie Lemiale, Régis Quéré, Chaouki Mezher, Laure de Saint Blanquat, Maxime El Baz, Jean-Philippe Rigaud, and Anne-Laure Poujol
Subjects: Nursing, law, Intensive care, Emergency Medicine, Psychological support, Clinical case, Triangulation (psychology), Emergency Nursing, Psychology, Intensive care unit, law.invention
Abstract: Dans les services de soins aigus, comme en réanimation, où l’intégrité physique et psychique des patients est atteinte, le somatique prime mais il est inéluctablement imprégné de la dimension émotionnelle. Les études actuelles témoignent d’ailleurs d’un vécu émotionnel intense et souvent bouleversant, tant pour les patients et leurs proches, que pour les soignants. Le psychologue prend donc place dans cette triangulation patient-famille-soignant afin de préserver la place de la dimension émotionnelle au sein des services de réanimation, et de proposer un accompagnement psychologique adapté. A partir d’un cas clinique, cet article a pour objectif de clarifier, pour les soignants de réanimation, le rôle du psychologue : les demandes implicites/explicites du patient, de ses proches, et des soignants sont identifiées ; des axes de travail du psychologue sont proposés et expliqués ; il est montré comment le psychologue se saisit de ces demandes pour accompagner patient, famille et soignants.
Published: 2021

39. Author response for 'Influenza vaccination and prognosis of COVID ‐19 in hospitalized patients with diabetes: Results from the CORONADO study'

Author: null A Diallo, null M Pichelin, null M Wargny, null P Gourdy, null JB Bonnet, null S Hadjadj, null B Cariou, null A Sultan, null F Galtier, null Matthieu Wargny, null Pascale Mahot, null Bertrand Cariou, null Samy Hadjadj, null Matthieu Pichelin, null Anne‐Laure Fournier‐Guilloux, null Nicolas Mauduit, null Edith Bigot‐Corbel, null Anne‐Sophie Boureau, null Laure Dekcer, null Audrey Ernould, null Claire Primot, null Anne Seguin, null Marielle Joliveau, null Sonia Pouvreau, null Chloé FOURNIER, null Jeremy Thureau, null Edith Fonteneau, null Pamela Hublain, null Chu Nantes, null Carole Agasse, null Mathilde DE Kergaradec, null Vincent Minville, null Fanny Vardon‐Bounes, null Guillaume Martin‐Blondel, null Pierre Gourdy, null Blandine Tramunt, null Marie‐Christine Turnin, null Hélène Hanaire, null Jean‐Michel Mansuy, null Didier Fabre, null Marie‐Blanche Arhainx, null Laurent Cazals, null Laure Combes, null Emmanuelle Lami, null Mallory Cianferani, null Bruno Megarbane, null Pierre Leroy, null Jean‐François Gautier, null Tiphaine Vidal‐Trecan, null Jean‐Pierre Riveline, null Jean‐Louis Laplanche, null Stéphane Mouly, null Louis Potier, null Ronan Roussel, null Malak Taher, null Yawa Abouleka, null Fetta Yaker, null Aurelie Carlier, null Anne Boutten, null Marilyne Hallot‐Feron, null Fadila Mourah, null Charles Thivolet, null Emilie Blond, null Muriel Rolland, null Josep Verdecho Mendez, null Marine Alexandre, null Julien Pottecher, null Emilie Richer, null Laurent Meyer, null Florina Luca, null Jean‐Marc Lessinger, null Thibault Bahougne, null Bruno Guerci, null Lisa Ludwig, null Siham Benzirar, null Catherine Malaplate, null Thierry Matton, null Julien Poissy, null Karine Faure, null Pierre Fontaine, null Florence Baudoux, null Anne Vambergue, null Jean David Pekar, null Marc Lambert, null Cécile Yelnik, null Amélie Bruandet, null Laurent Petit, null Didier Neau, null Vincent Rigalleau, null Annie Berard, null Amandine Galioot, null Remy Coudroy, null Arnaud Thille, null René Robert, null France Roblot‐Cazenave, null Blandine Rammaert, null Pierre Jean Saulnier, null Xavier Piguel, null Nesrine Benhenda, null Camille Husson, null Celine Olivier, null Florence Torremocha, null Mathilde Fraty, null Marie Flamen d'assigny, null Aurelie Miot, null Valentin Bossard, null Kada Klouche, null Alain Makinson, null Ariane Sultan, null Jean‐Baptiste Bonnet, null Vincent Foulongne, null Florence Galtier, null Cécile Aubron, null Séverine Ansart, null Véronique Kerlan, null Pascale Quiniou, null Jean‐Luc Carre, null Stéphane Quesnot, null Bruno Laviolle, null Carole Schwebel, null Olivier Epaulard, null Pierre‐Yves Benhamou, null Cécile Betry, null Anne‐Laure Borel, null Sandrine Lablanche, null Dorra Guergour, null Catherine Duclos, null Emmanuel Cosson, null Erwan Guyot, null Aurore Deniau, null Phucthutrang Nguyen, null Yves Reznik, null Michael Joubert, null Stéphane Allouche, null Lydia Guittet, null Steven Grange, null Manuel Etienne, null Gaëtan Prévost, null Valéry Brunel, null Jean‐Christophe Lagier, null Didier Raoult, null Anne Dutour, null Bénédicte Gaborit, null Sandrine Boulllu, null Patrice Darmon, null Adèle Lasbleiz, null Mathieu Cerino, null Fanny Romain, null Marie Houssays, null Jean Pierre Quenot, null Lionel Piroth, null Bruno Vergès, null Laurence Duvillard, null Bernard Bonnotte, null Alain Mercat, null Vincent Dubee, null Ingrid Allix, null Patrice Rodien, null Robin Dhersin, null Maylis Lebeault, null Wojciech Trzepizur, null Jocelyne Loison, null Antoine Brangier, null Pierre Asfar, null Pascal Reynier, null Françoise Larcher, null Françoise Joubaud, null Marie‐Rita Andreu, null Geoffrey Urbanski, null Laurent Hubert, null Cedric Annweiler, null Jean Dellamonica, null Johan Courjon, null Nicolas Chevalier, null Giulia Chinetti, null Magda Chafai, null Bruno Mourvillier, null Firouze Bani‐Sadr, null Sarra Barraud, null Brigitte Delemer, null Philippe Gillery, null Pascale Labedade, null Amélie Chabrol, null Alfred Penfornis, null Catherine Petit, null Coralie Amadou, null Maxime Adler, null Clément Dubost, null Pierre‐Louis Conan, null Lyse Bordier, null Franck Ceppa, null Cyril Garcia, null Mathilde Sollier, null Olivier Dupuy, null Sophie Laplance, null Olivier Billuart, null Marie Joseph Aroulanda, null Frédérique Olivier, null Florence Ayon, null Nathalie Wilhelm, null Loic Epelboin, null Nadia Sabbah, null Aurelie Charpin, null Pierre Squara, null Olivier Belliard, null Claude Dubois, null Michel Marre, null Johann Auchabie, null Roxane Courtois, null Thierry Duriez, null Tiphaine Mergey, null Laura Vallee, null Laetitia Seguin, null Abdallah Al‐Salameh, null Jean‐Philippe Lanoix, null Sandrine Soriot‐Thomas, null Anne‐Marie Bourgeois‐Descouls, null Rachel Desailloud, null Natacha Germain, null Bogdan Galusca, null Gwenaelle Belleton, null Nesrine Marouani, null Delia Palaghiu, null Amira Hammour, null Fernando Berdaguer, null Thimothée Klopfenstein, null Hajer Zayet, null Patrice Winiszewski, null Marie Zanusso, null Pauline Garnier, null Ingrid Julier, null Karim Hamzaoui, null Sophie Marty‐Gres, null Tarik Sadki, null Lucile Cadot, null Jean‐Louis Dubost, null Céline Gonfroy, null Catherine Campinos, null Pascale Martres, null Marie Pierre Coulhon, null Nicolas Allou, null Marwa Bachir, null Stella Hoang, null Candice Kembellec, null Olivia Suply, null Fatima Kharcha, null Anne‐Claire Devouge, null Anna Flaus‐Furmanuk, null Isabelle Madeline, null Vincent Ehinger, null Sophie Bastard, null Loic Raffray, null Frederic Renou, null Aude Bojarski, null Caroline Paul, null Karine Borsu, null Angelique Gorlin, null Servane Bernardo, null Carole Truong Ut, null Stephane Renaud, null Antoine Vignoles, null Emilie Foch, null Laurie Masse, null Hubert Grand, null Helene Ferrand, null Christelle Raffaitin‐Cardin, null Hadjer Zellagui, null Celine Castang‐Brachet, null Frederique Boury, null Ana Alvarez Tena, null Isabelle Moura, null Pierre Kalfon, null Juliana Darasteanu, null Arnaud Monier, null Pascal Foucault, null Alexandra Depuille, null Stéphanie Laugier‐Robiolle, null Patrick Caneiro, null Maud Basso, null Etienne Larger, null Samir Bouam, null Wahiba Benzenati, null Leila Ait Bachir, null Camille Cussac Pillegand, null Marc Vasse, null Christophe Michard, null Nathanaëlle Montanier, null Luc Millot, null Françoise Crepet, null Danielle Ratsimba, null Kevin Bouiller, null Sophie Borot, null Isabelle Bruckert, null Annie Clergeot, null Franck Schillo, null Dorothée Vignes, null Muriel Bourgeon‐Ghittori, null Hamoud Lachgar, null Claire Lambert DE Cursay, null Stéphane Levante, null Jean Charles Auregan, null Antoine Merlet, null Cécile Zaragoza, null Gwénaëlle Arnault, null Anne‐Gaëlle Loupp, null Olivier Lesieur, null Mariam Roncato‐Saberan, null Didier Gouet, null Romain Lemarie, null Hong_an Allano, null Emmanuel Vivier, null Caroline Pariset, null Cédric Luyton, null Lucien Marchand, null Fanny Doroszewski, null Matthieu Pecquet, null Laurent Perard, null Sylvie Vuillermoz‐Blas, null Nicolas Kacki, null Patricia Charrier, null Amélie Ducet‐Boiffard, null Françoise Desroys Roure, null Olivier Bourron, null Dominique Bonnefont‐Rousselot, null Suzanne Laroche, null Franck Phan, null Agnès Hartemann, null Cyrielle Caussy, null Emmanuel Disse, null Claude Guerin, null Thomas Perpoint, null Philippe Moulin, null Régine Cartier, null Geoffroy Hariri, null Dorothée Chopin, null Camille Vatier, null Nathalie Bourcigaux, null Emmanuelle Chaigneau, null Sophie Christin‐Maitre, null Bruno Donadille, null Bruno Feve, null Sophie Lamothe, null Julie Sarfati, null Pascal Pernet, null Anne Chambon, null Delphine Demarsy, null Hugo Campagne, null Françoise Latil‐Plat, null Monica Berne, null Marilyne Grinand, null Marion Touzet, null Aydrey Zabulon, null Jocelyne Craspag, null Catherine Ledoux, null Cedric Contaret, null Blandine Janand‐Delenne, null Anaïs Giraud, null Marie Lou Lacrimini, null Joëlle Arrivie, null Deborah Ancelle, null Carine Guillois, null Bénédicte Fremy, null Amina Chaalal, null Gaëlle Barrande, null Anne Dorange, null Eglantine Rouanet, null Dominique Seret‐Begue, null Audrey Saoud, null Anne‐Marie Guedj, null Nathalie Bedos, null Fritz‐Line Velayoudom, null Marie Dumas, null Benoite Gonda, null Christine Coffin, null Stéphanie Gibiat, null Myriam Lungo, null Chantal Bully, null Pierre Serusclat, null Stella Bully, null Patricia Carre, null Jean‐Philippe Leberre, null Carlos Elkhoury, null Marine Thieux, null Laetitia Paradisi‐Prieur, and null CORONADO investigators
Subjects: Vaccination, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Hospitalized patients, Diabetes mellitus, Medicine, business, medicine.disease
Published: 2021

40. A Prospective Cohort Study to Identify Clinical, Biological, and Imaging Features That Predict the Etiology of Acute Encephalitis

Author: Daniel Da Silva, Vincent Roubeau, Patricia Pavese, Jean-Paul Mira, Rafael Mahieu, Heidi Wille, Lydie Khatchatourian, Charlotte Biron, Geneviève Blanchet-Fourcade, Romain Lefaucheur, Laurent Argaud, Arnaud Seigneurin, Guillaume Baille, Eugénie Mutez, Hélène Brasme, Morgan Matt, Amandine Gagneux-Brunon, Alexandra Mailles, Thibaut Fraisse, Morgane Le Bras, Céline Cazorla, Isabelle Pierre, Anne Bonnetain, Hélène Savini, Nathalie Marin, Isabelle Runge, Pierre Fillatre, Mathilde Reveillon-Istin, Mathieu Godement, Cédric Bruel, Martin Martinot, Xavier Argemi, Saber Touati, Emmanuel Forestier, M. Hentzien, Jérome Honnorat, Capucine Diard-Detoeuf, Nathalie Pansu, Yvon Ruch, Thècle Degroote, Alexandre Mas, Guillaume Louis, Bernard Castan, Thomas Guimard, Aurélien Dinh, Marc-Olivier Vareil, Pierre Jaquet, Aurélie Richard-Mornas, Thibault Challan-Belval, Paul Le Turnier, Aurélie Martin, Frédéric Bourdain, Catherine Chirouze, Pascal Chavanet, Carole Henry, François Goehringer, Alain Makinson, Fabrice Bruneel, Anne Pachart, Manuela Le Cam, Johan Courjon, Elisabeth Botelho-Nevers, Pierre Tattevin, Emilie Piet, Eric Denes, Jean-Louis Herrmann, Philippe Casenave, Rodolphe Buzele, Marion Le Maréchal, Laurence Maulin, Thomas De Broucker, Agnès Riché, Sylvain Rheims, Olivier Epaulard, Solene Patrat-Delon, Aurélie Baldolli, Valentin Greigert, Isabelle Gueit, Anne-Sophie Lecompte, Nicolas Gaillard, Marie Froidure, Guillaune Marc, Dimitri Psimaras, Nathalie Asseray, Charles Cazanave, Etienne Canouï, Jean-Etienne Herbrecht, Alexandre Thibault Jacques Maria, Romain Sonneville, Patrice Morand, Jessica Krause, Jean-Marie Turmel, Tomasz Tchroboczek, Kelly Tiercelet, Gwenael Le Moal, Arnaud de la Blanchardiere, Thomas Baudry, Jean-Paul Stahl, Simon Gravier, Frédéric Méchaï, Diane Ponscarme, Christelle Lucas, Laurent Almoyna-Martinez, Colin Deschanvres, Olivier Lesieur, Véronique Pelonde-Erimée, Raphaël Lecomte, David Boutoille, Sophie Abgrall, Jérémie Orain, Philippe Lesprit, François Raffi, Magalie Vidal-Roux, Mathieu Blot, Michael Bonnan, Arnaud Galbois, V. Vitrat, Olivier Bouchaud, Guillaume Martin-Blondel, Mathieu Zuber, Stéphanie Lejeune, Solen Kernéis, Hélène Pellerin, Isabelle Tyvaert, Mathilde Puges, Xavier Lescure, Philippe Mateu, Marine Delaroche, Fanny Jomier, Julien Biberon, Pascale Goubin, Benjamin Gaborit, Etienne De Montmollin, Centre Hospitalier Universitaire [Grenoble] (CHU), Santé publique France - French National Public Health Agency [Saint-Maurice, France], CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), French Infectious Diseases Society, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Infectious Encephalitis, 0301 basic medicine, Microbiology (medical), Herpesvirus 3, Human, Pediatrics, medicine.medical_specialty, Lymphocytosis, diagnosis, viruses, encephalitis, etiology, [SDV]Life Sciences [q-bio], 030106 microbiology, factor analysis, Context (language use), medicine.disease_cause, Virus, 03 medical and health sciences, 0302 clinical medicine, medicine, Infectious encephalitis, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, business.industry, medicine.disease, herpes simplex virus, 3. Good health, Infectious Diseases, Herpes simplex virus, Etiology, Encephalitis, Herpes Simplex, France, medicine.symptom, business, Encephalitis
Abstract: Background New diagnostic tools have been developed to improve the diagnosis of infectious encephalitis. Using a prospective cohort of encephalitis patients, our objective was to identify possible clusters of patients with similar patterns among encephalitis of unknown cause (EUC) and to describe to what extent a patient’s initial presentation may be predictive of encephalitis etiology, particularly herpes simplex virus (HSV) and varicella-zoster virus (VZV). Methods The National Cohort of Infectious Encephalitis in France is an ongoing prospective cohort study implemented in France in 2016. Patients who present with documented or suspected acute infectious encephalitis were included. Focusing on the variables that describe the initial presentation, we performed a factor analysis of mixed data (FAMD) to investigate a pattern of association between the initial presentation of a patient and the etiologic pathogen. Results As of 1 August 2018, data from 349 patients were analyzed. The most frequent pathogens were HSV (25%), VZV (11%), tick-borne encephalitis virus (6%), Listeria (5%), influenza virus (3%), and EUC (34%). Using the FAMD, it was not possible to identify a specific pattern related to the group of EUC. Age, temporal or hemorrhagic lesions, and cerebral spinal fluid lymphocytosis were significantly associated with HSV/VZV encephalitis. Conclusions No initial clinical/imaging/biology pattern was identified at admission among EUC, despite the improvement in diagnostic tools. In this context, the recommendation for a universal, early, probabilistic, initial treatment against HSV and VZV is still relevant, regardless of the initial clinical presentation of the encephalitis.
Published: 2021

41. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

Author: Gaëtan Plantefève, Pascal Beuret, Khaldoun Kuteifan, Olivier Lesieur, Saad Nseir, Nicholas Sedillot, Kada Klouche, Vincent Castelain, Cyrille Pichot, Jean-Claude Lacherade, Jean Dellamonica, Nicolas Meunier-Beillard, Florent Lheureux, Fiona Ecarnot, Bérengère Vivet, Pierre Bouju, Gilles Capellier, Grégoire Muller, Paul Michel Mertes, Nicolas Terzi, Eddy Lebas, Sébastien Gibot, PsyCOVID-ICU Trial Investigators, Jean-Philippe Rigaud, Diane Friedman, Julio Badie, Jean-Pierre Quenot, Pierre Asfar, Cyril Goulenok, Anne Renault, Anne-Laure Poujol, Irène François-Pursell, Philippe Mateu, David Schnell, Marjolaine Georges, Antoine Monsel, Belaid Bouhemad, Johanna Temime, Hamid Merdji, Christophe Vinsonneau, Thierry Vanderlinden, Alexandra Laurent, Mélanie Loiseau, Juliette Audibert, Alicia Fournier, Caroline Abdulmalak, Christine Binquet, Gwenaëlle Jacq, Stephan Ehrmann, Damien Roux, Bruno Levy, Saber Barbar, Julien Bohé, Guillaume Louis, Thomas Rimmelé, Laboratoire de psychologie : dynamiques relationnelles et processus identitaires [Dijon] (PSY-DREPI), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), UFR des Sciences de Santé (Université de Bourgogne), Université de Bourgogne (UB), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), CHU Lille, Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Ramsay Générale de Santé - Hôpital Privé La Louvière, Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Service de Pneumologie Soins Intensifs, Appareillage Respiratoire [CHU de Dijon], Les Hôpitaux Universitaires de Strasbourg (HUS), Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil de Strasbourg, Hôpital de Hautepierre [Strasbourg], Fédération de Médecine Translationnelle de Strasbourg (FMTS), Centre Hospitalier Chalon-sur-Saône William Morey, Centre Hospitalier de La Rochelle (CHR), Service de réanimation (CH d'Argenteuil), Centre Hospitalier Victor Dupouy, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service de Médecine Intensive Réanimation (CH Dieppe), Centre hospitalier de Dieppe, Espace régional de réflexion éthique de Normandie (EREN), Centre hospitalier de Bourg-en-Bresse / Fleyriat (CHBBF), Service des soins intensifs [Hôpital Louis Mourier], Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Centre Hospitalier de Roanne, Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière] (I3), CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'investigation clinique Biothérapie [CHU Pitié-Salpêtrière] (CIC-BTi), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Departement Hospitalo- Universitaire - Inflammation, Immunopathologie, Biothérapie [Paris] (DHU - I2B), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Adaptation, mesure et évaluation en santé. Approches interdisciplinaires (APEMAC), Université de Lorraine (UL), École de Psychologues Praticiens (EPP), Groupe hospitalier de la région de Mulhouse et Sud-Alsace, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL), CHRU Brest - Département d'Anesthésie Réanimation (CHU - BREST - DAR), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe Hospitalier de La Haute-Saône, Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Unité de réanimation médicale [CHU de Carémeau, Nîmes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Groupe Hospitalier Bretagne Sud (GHBS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Centre Hospitalier de Lens, Centre Hospitalier Louis Pasteur [Dole], Centre Hospitalier d'Angoulême (CH Angoulême), Hôpital Raymond Poincaré [AP-HP], CHU d'Angers [Département Urgences], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre Hospitalier de Charleville-Mezières, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente [Chartres], Hôpital Louis Pasteur [Chartres], Service de cardiologie [CHRU de Besançon], Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Délégation à la recherche clinique et à l'innovation [CHU Dijon] (DRCI), Service de médecine légale (Institut médico-légal et Unité médico-judiciaire) (CHU de Dijon), Cellule d'urgence médico-psychologique (CUMP), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer (LabEx LipSTIC), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC) (EREBFC)
Subjects: Mediation (statistics), [SDV]Life Sciences [q-bio], Context (language use), Critical Care and Intensive Care Medicine, law.invention, [SHS]Humanities and Social Sciences, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Environmental health, Intensive care, Healthcare professionals, Health care, Medicine, 030212 general & internal medicine, business.industry, RC86-88.9, Research, Stressor, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Intensive care unit, Mental health, 3. Good health, ICU, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], General Health Questionnaire, business, Stress factors, 030217 neurology & neurosurgery
Abstract: Background We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. Methods This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. Results In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p p B = 0.13; 95% confidence interval [CI] = 0.08–0.17), having a relative at risk of COVID-19 (B = 0.14; 95%-CI = 0.09–0.18) and working in high-intensity zones (B = 0.11; 95%-CI = 0.02–0.20). Perceived stress mediated the impact of the crisis context on mental health (B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = − 0.32, 95% CI = − 0.54, − 0.11. Conclusion COVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020).
Published: 2021

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

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

43. Being Convinced and Taking Responsibility

Author: Pascale Le Maguet, L Joseph, Anne Gaelle Si Larbi, Zoé Cohen-Solal, Olivier Lesieur, Nancy Kentish-Barnes, Marie Thuong, Chaouki Mezher, Virginie Souppart, Benjamin Zuber, Martial Ouendo, Sophie Marqué, Elie Azoulay, Gaëlle Cheisson, Nicolas Pichon, Stanislas Kandelman, Julien Charpentier, Gérald Viquesnel, Anne Renault, Stéphane Donati, Jacques Duranteau, Bernard Floccard, and Laurent Martin-Lefevre
Subjects: Adult, Male, Brain dead, Brain Death, medicine.medical_specialty, Tissue and Organ Procurement, genetic structures, business.industry, MEDLINE, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Family medicine, medicine, Humans, Family, Female, France, Organ donation, business, Qualitative Research, Bereavement, Qualitative research
Abstract: Family members of brain dead patients experience an unprecedented situation in which not only they are told that their loved one is dead but are also asked to consider organ donation. The objective of this qualitative study was to determine 1) what it means for family members to make the decision and to take responsibility, 2) how they interact with the deceased patient in the ICU, 3) how family members describe the impact of the process and of the decision on their bereavement process.Qualitative study using interviews with bereaved family members who were approached for organ donation after the death of their relative in the ICU (brain death).Family members from 13 ICUs in France.Bereaved family members who were approached for organ donation after the death of their relative in the ICU (brain death).None.Twenty-four interviews were conducted with 16 relatives of organ donor patients and with eight relatives of nonorgan donor patients. Three themes emerged: 1) taking responsibility-relatives explain how they endorse decisional responsibility but do not experience it as a burden, on the contrary; 2) ambiguous perceptions of death-two groups of relatives emerge: those for whom ambiguity hinders their acceptance of the patient's death; those for whom ambiguity is an opportunity to accept the death and say goodbye; and 3) donation as a comfort during bereavement.In spite of caregivers' efforts to focus organ donation discussions and decision on the patient, family members feel a strong decisional responsibility that is not experienced as a burden but a proof of their strong connection to the patient. Brain death however creates ambivalent experiences that some family members endure whereas others use as an opportunity to perform separation rituals. Last, organ donation can be experienced as a form of comfort during bereavement provided family members remain convinced their decision was right.
Published: 2019

44. De Florence Nightingale à la réanimation 4.0

Author: Olivier Lesieur
Subjects: General Medicine, General Nursing
Published: 2021

45. La réanimation de l’ère post-Covid-19 : modulable, connectée et personnalisée

Author: Olivier Lesieur
Subjects: General Medicine, General Nursing
Published: 2021

46. Admission criteria and management of critical care patients in a pandemic context: position of the Ethics Commission of the French Intensive Care Society, update of April 2021

Author: Zoé Cohen-Solal, Bénédicte Gaillard-Le Roux, Cyril Goulenok, Jean Pierre Quenot, Gwendolyn Penven, Emmanuelle Mercier, Virginie Lemiale, Raphaëlle David, Bertrand Quentin, Sylvain Lavoué, Thierry Van Der Linden, Chaouki Mezher, Olivier Lesieur, Laure de Saint Blanquat, Régis Quéré, Anne Laure Poujol, Maxime Elbaz, Benoit Misset, Jean Philippe Rigaud, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Brigade de sapeurs pompiers de Paris (BSPP), CHU Necker - Enfants Malades [AP-HP], Hôtel-Dieu, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Privé Jacques Cartier [Massy], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Centre Hospitalier Universitaire de Liège (CHU-Liège), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Gustave Eiffel, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Centre hospitalier de Dieppe, and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)
Subjects: [SDV]Life Sciences [q-bio], media_common.quotation_subject, education, Proportionality (mathematics), Context (language use), Review, Commission, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, Dignity, 0302 clinical medicine, Nursing, law, Intensive care, Health care, Medicine, health care economics and organizations, media_common, RC86-88.9, business.industry, Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, 16. Peace & justice, Intensive care unit, Solidarity, 3. Good health, 030228 respiratory system, business
Abstract: Intensive care unit professionals have experience in critical care and its proportionality, collegial decision-making, withholding or withdrawal of treatment deemed futile, and communication with patients’ relatives. These elements rely on ethical values from which we must not deviate in a pandemic situation. The recommendations made by the Ethics Commission of the French Intensive Care Society reflect an approach of responsibility and solidarity towards our citizens regarding the potential impact of a pandemic on critical care resources in France, with the fundamental requirement of respect for human dignity and equal access to health care for all.
Published: 2021

47. Intensive care units, the Achilles heel of France in the COVID-19 battle

Author: Etienne Javouhey, Djillali Annane, Jean-Luc Chagnon, Olivier Lesieur, Samia Touati, Laura Federici, Hervé Outin, Didier Thevenin, Nicolas Terzi, Philippe Guiot, Chantal Sevens, Nicolas Joram, Didier Dreyfuss, Jean Philippe Rigaud, Arnaud Sement, and Jean Luc Diehl
Subjects: 2019-20 coronavirus outbreak, Heel, Battle, Coronavirus disease 2019 (COVID-19), business.industry, Health Policy, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), media_common.quotation_subject, lcsh:Public aspects of medicine, lcsh:RA1-1270, medicine.disease, medicine.anatomical_structure, Oncology, Intensive care, Internal Medicine, medicine, Commentary, Medical emergency, business, media_common
Published: 2021

48. Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

Author: Gaël Piton, Arnaud W. Thille, Damien Contou, Laura Federici, Bertrand Guidet, Jean Reignier, Julie Badin, Erwan I'her, Dalila Benzekri-Llefevre, Pascal Beuret, Riad Chelha, Suela Demiri, Christophe Vinsonneau, Michel Djibré, Juliette Masse, Nicolas Terzi, Francois Thouy, Juliette Audibert, Olivier Lesieur, Stephan Ehrmann, Hassene Rahmani, Alexandre Boyer, Saad Nseir, Denis Frasca, Christophe Girault, Jean-Pierre Frat, René Robert, Martial Thyrault, Jean-Pierre Quenot, Laurent Argaud, Christophe Guitton, Didier Thevenin, Nadia Aissaoui, Khaldoune Kuteifan, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier de Blois (CH Blois), CHU Rouen, Normandie Université (NU), Centre Hospitalier Le Mans (CH Le Mans), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Roanne (CH Roanne), CH de Roanne, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional d'Orléans (CHRO), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Strasbourg (UNISTRA), CHU Strasbourg, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Lyon, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire de Traitement de l'Information Medicale (LaTIM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical Research in Intensive Care and Sepsis - TRIal Group for Global Evaluation and Research in SEPsis [CHU Limoges] (Réseau CRICS-TRIGGERSEP ), Hôpital Dupuytren [CHU Limoges], Hôpital Saint-Louis de La Rochelle (CH La Rochelle), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Lens, Centre Hospitalier Victor Dupouy, CHU Grenoble, Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Groupe Hospitalier Nord Essonne [Longjumeau], Centre Hospitalier de Béthune Beuvry (CH Béthune Beuvry), Hôpital Louis Pasteur [Chartres], Université catholique de Lille (UCL), Groupe hospitalier Pellegrin, CHU Saint-Antoine [AP-HP], Centre Hospitalier Privé Claude Galien - Ramsay Santé, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), 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), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Blois (CHB), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique (IMT Atlantique), and CarMeN, laboratoire
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], law.invention, 03 medical and health sciences, 0302 clinical medicine, Quality of life, law, Informed consent, Oxygen therapy, medicine, Humans, respiratory medicine (see thoracic medicine), 030212 general & internal medicine, Prospective Studies, Prospective cohort study, adult intensive & critical care, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, Intensive Care, General Medicine, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Oxygen, Intensive Care Units, 030228 respiratory system, medical ethics, Propensity score matching, Emergency medicine, Quality of Life, Observational study, business, Respiratory Insufficiency, Cohort study
Abstract: IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631
Published: 2021

49. Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study

Author: Alexandre Lautrette, Alberto Noto, Steven Ovu, Alexander Avidan, Alessandro Protti, Hans Pargger, Suzana Margareth Lobo, Andrej Michalsen, Gavin M. Joynt, Ulrich Jaschinski, Martin Posch, Cameron Green, Mario Filipe, Sudakshina Mullick, Spyros D. Mentzelopoulos, Olivier Lesieur, Manfred Weiss, Bara Ricou, Ivo W. Soliman, Alexandre Demoule, Orsolya Szűcs, Claudio Piras, Massimo Antonelli, Veronica de la Guardia, László Zubek, Steven Q. Simpson, Anastasiia Gruber, Kai Tisljar, Joerg C. Schefold, Belén Estebanez-Montiel, Christiane S. Hartog, Christopher Danbury, Alberto Giannini, Eliana B Caser, Hans-Henrik Bülow, Barbara Tamowicz, Annette Robertsen, Charles L. Sprung, Joseph L. Nates, Manuel Hache-Marliere, Charles Feldman, Philipp G. H. Metnitz, Freda DeKeyser Ganz, Roshni Sreedharan, Maria Grazia Bocci, Angel Estella, and Matthew Anstey
Subjects: Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Terminal Care, Withholding Treatment, business.industry, medicine.medical_treatment, Decision Making, Psychological intervention, MEDLINE, Death, Life Support Care, Intensive Care Units, Intensive care, Emergency medicine, medicine, Population study, Humans, Observational study, Cardiopulmonary resuscitation, Prospective Studies, Medical diagnosis, business, 610 Medicine & health
Abstract: BACKGROUND End-of-life practices vary among intensive care units (ICUs) worldwide. Differences can result in variable use of disproportionate or non-beneficial life-sustaining interventions across diverse world regions. This study investigated global disparities in end-of-life practices. METHODS In this prospective, multinational, observational study, consecutive adult ICU patients who died or had a limitation of life-sustaining treatment (withholding or withdrawing life-sustaining therapy and active shortening of the dying process) during a 6-month period between Sept 1, 2015, and Sept 30, 2016, were recruited from 199 ICUs in 36 countries. The primary outcome was the end-of-life practice as defined by the end-of-life categories: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, or failed cardiopulmonary resuscitation (CPR). Patients with brain death were included in a separate predefined end-of-life category. Data collection included patient characteristics, diagnoses, end-of-life decisions and their timing related to admission and discharge, or death, with comparisons across different regions. Patients were studied until death or 2 months from the first limitation decision. FINDINGS Of 87 951 patients admitted to ICU, 12 850 (14·6%) were included in the study population. The number of patients categorised into each of the different end-of-life categories were significantly different for each region (p
Published: 2021

50. Impact of targeted hypothermia in expanded-criteria organ donors on recipient kidney-graft function: study protocol for a multicentre randomised controlled trial (HYPOREME)

Author: Noëlle Brulé, Emmanuel Canet, Morgane Péré, Fanny Feuillet, Maryvonne Hourmant, Karim Asehnoune, Bertrand Rozec, Agnes Duveau, Laurent Dube, Marc Pierrot, Stanislas Humbert, Patrice Tirot, Jean-Marc Boyer, Laurent Martin-Lefevre, François Labadie, René Robert, Thierry Benard, Thomas Kerforne, Antoine Thierry, Olivier Lesieur, Jean-François Vincent, Mathieu Lesouhaitier, Raphaelle Larmet, Cecile Vigneau, Angelique Goepp, Pierre Bouju, Charlotte Quentin, Pierre-Yves Egreteau, Olivier Huet, Anne Renault, Yannick Le Meur, Jean-Christophe Venhard, Mathias Buchler, Olivier Michel, Marie-Hélène Voellmy, Fabien Herve, David Schnell, Anne Courte, Denis Glotz, Lucile Amrouche, Marc Hazzan, Nassim Kamar, Valerie Moal, Jeremy Bourenne, Moglie Le Quintrec-Donnette, Emmanuel Morelon, Thierry Boulain, Philippe Grimbert, Anne Elisabeth Heng, Pierre Merville, Aude Garin, Christian Hiesse, Brice Fermier, Christiane Mousson, Charlotte Guyot-Colosio, Nicolas Bouvier, Jean-Philippe Rerolle, Antoine Durrbach, Sarah Drouin, Sophie Caillard, Luc Frimat, Sophie Girerd, Laetitia Albano, Lionel Rostaing, Dominique Bertrand, Alexandre Hertig, Pierre-Francois Westeel, Florent Montini, Eric Delpierre, Dider Dorez, Eric Alamartine, Carole Ouisse, Veronique Sebille, and Jean Reignier
Subjects: Graft Survival, Humans, Multicenter Studies as Topic, Transplants, Hypothermia, General Medicine, Kidney, Kidney Transplantation, Tissue Donors, Randomized Controlled Trials as Topic
Abstract: IntroductionExpanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and mortality. HYPOREME will be a multicentre randomised controlled trial (RCT) comparing targeted hypothermia to normothermia in ECDs, in a country where the use of machine perfusion for organ storage is the standard of care. We hypothesise that hypothermia will decrease the incidence of DGF.Methods and analysisHYPOREME is a multicentre RCT comparing the effect on kidney function in recipients of targeted hypothermia (34°C–35°C) and normothermia (36.5°C–37.5°C) in the ECDs. The temperature intervention starts from randomisation and is maintained until aortic clamping in the operating room. We aim to enrol 289 ECDs in order to analyse the kidney function of 516 recipients in the 53 participating centres. The primary outcome is the occurrence of DGF in kidney recipients, defined as a requirement for renal replacement therapy within 7 days after transplantation (not counting a single session for hyperkalemia during the first 24 hours). Secondary outcomes include the proportion of patients with individual organs transplanted in each group; the number of organs transplanted from each ECD and the vital status and kidney function of the recipients 7 days, 28 days, 3 months and 1 year after transplantation. An interim analysis is planned after the enrolment of 258 kidney recipients.Ethics and disseminationThe trial was approved by the ethics committee of the French Intensive Care Society (CE-SRLF-16-07) on 26 April 2016 and by the competent French authorities on 20 April 2016 (Comité de Protection des Personnes-TOURS-Région Centre-Ouest 1, registration #2016-S3). Findings will be published in peer-reviewed journals and presented during national and international scientific meetings.Trial registration numberNCT03098706.
Published: 2022

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