Author: "Pierre-François Perrigault" - Searchworks@Jio Institute Digital Library Search Results

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1. Body-weight support gait training in neurological intensive care: safety, feasibility, and delays before walking with or without suspension

Author: Claire Jourdan, Fanny Pradalier, Kevin Chalard, Margrit Ascher, Francisco Miron Duran, Frédérique Pavillard, Frédéric Greco, Myriam Mellouk, Stéphane Fournier, Flora Djanikian, Isabelle Laffont, Anthony Gelis, and Pierre-François Perrigault
Subjects: Early mobilization, Neurocritical care, Brain injury, Rehabilitation, Body weight support, Verticalization, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract: Abstract Background Early Mobilization in Intensive Care Units (ICUs) enhances patients’ evolution, but has been rarely studied in neurological ICUs. The aim of this study was to assess gait training with body-weight support (BWS) in neuroICU, and to report on its safety, feasibility and on delays before walking with and without BWS. Methods This study was an observational one-year single-center study. Inclusion criteria were adults with a neurological injury requiring mechanical ventilation. Exclusion criteria were early death or ICU transfer. After weaning from ventilation, patients were screened for indications of BWS walking using predefined criteria. Results Patients’ conditions were mostly brain injuries: 32% subarachnoid hemorrhages, 42% focal strokes, and 12% traumatic brain injuries. Out of 272 admissions, 136 patients were excluded, 78 were eligible, and 33 performed BWS walking. Among non-eligible patients, 36 walked unsuspended upon ventilation weaning, 17 presented too severe impairments. Among the 45 eligible patients who did not receive BWS training, main reasons were workload and weekends (31%), medical barriers (29%), and early ICU discharge (22%). 78 BWS sessions were performed on the 33 beneficiaries (median sessions per patient 2, max 10). Pre-session, most patients had inadequate response to pain, orders, or simple orientation questions. Sitting without support was impossible for 74%. Most pre-post changes in hemodynamic, respiratory, and pain parameters were small, and recovered spontaneously after the session. Eight sessions were interrupted; reasons were pain, fatigue or major imbalance (4), syncope (1), occurrence of stool (2), and battery failure (1). None of these adverse events required medical intervention, patients recovered upon session interruption. Median session duration was 31 min, patients walked on median 17 m. First BWS session occurred on median 3 days after ventilation weaning, and 11 days before patients were able to walk unsuspended. Conclusions Verticalization and walking using a suspension device in patients in neuroICU allows early gait training, despite challenging neurological impairments. It is safe and generally well tolerated. Trial registration: ClinicalTrials database (ID: NCT04300491).
Published: 2023
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2. Transcranial sonographic assessment of the third ventricle in neuro-ICU patients to detect hydrocephalus: a diagnostic reliability pilot study

Author: Rémy Widehem, Paul Bory, Frédéric Greco, Frédérique Pavillard, Kévin Chalard, Alexandre Mas, Flora Djanikian, Julie Carr, Nicolas Molinari, Samir Jaber, Pierre-François Perrigault, and Gerald Chanques
Subjects: Neurocritical care, Third ventricle, Sonography, Hydrocephalus, Point of care, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Transcranial sonography is a point-of-care tool recommended in intensive care units (ICU) to monitor brain injured patients. Objectives of the study was to assess feasibility and reliability of the third ventricle (V3) diameter measurement using transcranial sonography (TCS) compared to brain computed-tomography (CT), the gold standard measurement, and to measure the TCS learning curve. Design: prospective study, in a 16-bed neurological ICU in an academic hospital. Every consecutive brain injured adult patient, who required a brain CT and TCS monitoring were included. The V3 diameter was blindly measured by TCS and CT. Intraclass correlation coefficient (ICC) and Bland–Altman plot were used to assess the reliability and agreement between TCS and CT V3 measurements. Diagnosis performance of the V3 diameter using TCS to detect hydrocephalus was measured. Absolute difference between V3 measurement by residents and experts was measured consecutively to assess the learning curve. Results Among the 100 patients included in the study, V3 diameter could be assessed in 87 patients (87%) from at least one side of the skull. Both temporal windows were available in 70 patients (70%). The ICC between V3 diameter measured by TCS and CT was 0.90 [95% CI 0.84–0.93] on the right side, and 0.92 [0.88–0.95] on the left side. In Bland–Altman analysis, mean difference, standard deviation, 95% limits of agreement were 0.36, 1.52, − 2.7 to 3.3 mm, respectively, on the right side; 0.25, 1.47, − 2.7 to 3.1 mm, respectively, on the left side. Among the 35 patients with hydrocephalus, V3 diameters could be measured by TCS in 31 patients (89%) from at least one side. Hydrocephalus was, respectively, excluded, confirmed, or inconclusive using TCS in 35 (40%), 25 (29%) and 27 (31%) of the 87 assessable patients. After 5 measurements, every resident reached a satisfactory measurement compared to the expert operator. Conclusion TCS allows rapid, simple and reliable V3 diameter measurement compared with the gold standard in neuro-ICU patients. Aside from sparing irradiating procedures and transfers to the radiology department, it may especially increase close patient monitoring to detect clinically occult hydrocephalus earlier. Further studies are needed to measure the potential clinical benefit of this method. Trial registration: ClinicalTrials.gov ID: NCT02830269.
Published: 2021
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3. Le jour d’après ressemblera-t-il au jour d’avant ? Comment la pandémie COVID reconfigure l’éthique en réanimation ?

Author: Matthieu Le Dorze, Pierre Mora, Claire Dahyot-Fizelier, Pierre-Gildas Guitard, Olivier Langeron, Elodie Brunel, Laurent Heyer, Clément Gakuba, Olivier Joannes-Boyau, Pierre-François Perrigault, and Yoann Launey
Subjects: Anesthesiology and Pain Medicine
Published: 2023

4. Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review

Author: Karim Asehnoune, Sigismond Lasocki, Philippe Seguin, Thomas Geeraerts, Pierre François Perrigault, Claire Dahyot-Fizelier, Catherine Paugam Burtz, Fabrice Cook, Dominique Demeure dit latte, Raphael Cinotti, Pierre Joachim Mahe, Camille Fortuit, Romain Pirracchio, Fanny Feuillet, Véronique Sébille, Antoine Roquilly, For the ATLANREA group, and For the COBI group
Subjects: Trauma, Traumatic brain injury, Intracranial hypertension, Brain oedema, Hyperosmolar therapy, Saline solution, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared the mortality and outcomes in patients with TBI with ICH treated or not with CHT. Methods We included patients with TBI (Glasgow Coma Scale ≤ 12 and trauma-associated lesion on brain computed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI and ATLANREA. CHT consisted of an intravenous infusion of NaCl 20% for 24 hours or more. The primary outcome was the risk of survival at day 90, adjusted for predefined covariates and baseline differences, allowing us to reduce the bias resulting from confounding factors in observational studies. A systematic review was conducted including studies published from 1966 to December 2016. Results Among the 1086 included patients, 545 (51.7%) developed ICH (143 treated and 402 not treated with CHT). In patients with ICH, the relative risk of survival at day 90 with CHT was 1.43 (95% CI, 0.99–2.06, p = 0.05). The adjusted hazard ratio for survival was 1.74 (95% CI, 1.36–2.23, p
Published: 2017
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5. Convention citoyenne sur la fin de vie : eléments de réflexion des soignants du Comité éthique de la société française d’anesthésie-réanimation

Author: Matthieu Le Dorze, Elodie Brunel, Clément Gakuba, Mikhaël Giabicani, Marc Guilloux, Pierre-Gildas Guitard, Pierre Mora, Laurent Müller, Marie-Virginie Oré, Florence Plantet, Sylvaine Robin, Christelle Rosenstrauch, Pierre Kalfon, Claire Dahyot-Fizelier, Gérard Audibert, and Pierre-François Perrigault
Subjects: Anesthesiology and Pain Medicine
Published: 2023

6. Mobilisation précoce en réanimation

Author: Claire Jourdan, Jennifer Hernandez, and Pierre-François Perrigault
Subjects: Anesthesiology and Pain Medicine, Emergency Medicine, Emergency Nursing
Published: 2022

7. Conflit en situation de limitation ou d’arrêt de traitement en réanimation

Author: Fabrice Michel, Frédérique Claudot, Benoit Veber, Elodie Brunel, Valérie Gateau, Caroline Guibet Lafaye, Stanislas Kandelman, Florence Lallemant, Anne Le Boudec, Matthieu Ledorze, Laurent Muller, Karine Nouette-Gaulain, Pierre-François Perrigault, Nadège Rutter, Emmanuel Samain, Gérald Visquesnel, and Luca Zilberstein
Subjects: Anesthesiology and Pain Medicine
Published: 2022

8. Use of a body-weight support device to train gait in a neurological intensive care unit. Safety, Feasibility, Time to independent walking

Author: Claire Jourdan, Fanny Pradalier, Kevin Chalard, Margrit Ascher, Francisco Miron Duran, Frédérique Pavillard, Frédéric Greco, Myriam Mellouk, Stéphane Fournier, Flora Djanikian, Isabelle Laffont, Anthony Gelis, and Pierre-François Perrigault
Abstract: Background. Early Mobilization in Intensive Care Units (ICUs) enhances patients’ evolution, but its benefits and practical implementation have rarely been studied in neurological ICUs. To report on tolerance, feasibility and benefits of walking with a specific body-weight support (BWS) device for patients admitted to a neurological intensive care unit. Methods. Observational single-center one-year study. Inclusion criteria were adults with a neurological injury requiring mechanical ventilation. Exclusion criteria were early death or ICU transfer. After weaning from ventilation, patients were screened for indications of BWS walking using predefined criteria. Results. Patients’ conditions were mostly brain injuries: 32% subarachnoid hemorrhages, 42% focal strokes, 12% traumatic brain injuries. Out of 272 admissions, 136 patients were excluded, 78 were eligible, 33 performed BWS walking. Regarding non-eligible patients, 36 walked unsuspended upon ventilation weaning, 17 presented too severe impairments. Regarding the 45 eligible patients who did not receive BWS training, main reasons were workload and week-ends (31%), medical barriers (29%), early ICU discharge (22%). For the 33-patient study sample, 78 BWS sessions were performed. Pre-session, most patients had inadequate response to pain, orders, or simple orientation questions. Sitting without support was impossible for 74%. Most pre-post changes in hemodynamic, respiratory, and pain parameters were small. Eight sessions were interrupted; reasons were pain, fatigue or major imbalance (4), syncope (1), occurrence of stool (2), battery failure (1). All adverse events ended upon session interruption. Patients walked on median 17 meters. During 51% of sessions, patients showed a spontaneous smile. First BWS session occurred on median 3 days after ventilation weaning, and 11 days before patients were able to walk unsuspended. Conclusions. Verticalization and walking using a suspension device patients in neuroICU allows early gait training, despite challenging neurological impairments. It is safe and generally well tolerated. Trial registration. ClinicalTrials database (ID: NCT04300491)
Published: 2022

9. 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

10. CT perfusion-guided administration of IV milrinone is associated with a reduction in delayed cerebral infarction after subarachnoid hemorrhage

Author: Vivien Szabo, Sarah Baccialone, Florentin Kucharczak, Cyril Dargazanli, Oceane Garnier, Frederique Pavillard, Nicolas Molinari, Vincent Costalat, Pierre-Francois Perrigault, and Kevin Chalard
Subjects: Medicine, Science
Abstract: Abstract Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH) is a singular pathological entity necessitating early diagnostic approaches and both prophylactic and curative interventions. This retrospective before-after study investigates the effects of a management strategy integrating perfusion computed tomography (CTP), vigilant clinical monitoring and standardized systemic administration of milrinone on the occurrence of delayed cerebral infarction (DCIn). The $${\text{"before"}}$$ "before" period included 277 patients, and the $${\text{"after"}}$$ "after" one 453. There was a higher prevalence of Modified Fisher score III/IV and more frequent diagnosis of vasospasm in the $${\text{"after"}}$$ "after" period. Conversely, the occurrence of DCIn was reduced with the $${\text{"after"}}$$ "after" management strategy (adjusted OR 0.48, 95% CI [0.26; 0.84]). Notably, delayed ischemic neurologic deficits were less prevalent at the time of vasospasm diagnosis (24 vs 11%, $$p=0.001$$ p = 0.001 ), suggesting that CTP facilitated early detection. In patients diagnosed with vasospasm, intravenous milrinone was more frequently administered (80 vs 54%, $$p
Published: 2024
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11. Macintosh Videolaryngoscope for Intubation in the Operating Room: A Comparative Quality Improvement Project

Author: Daniel Verzilli, Amélie Rollé, Samir Jaber, Nicolas Molinari, Pierre-François Perrigault, Alexandre Laplace, Xavier Capdevila, Audrey De Jong, Pascal Colson, Marco Normanno, and Y. Pouzeratte
Subjects: Adult, Male, Operating Rooms, Quality management, medicine.medical_treatment, Laryngoscopy, Video Recording, Laryngoscopes, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Intubation, Intratracheal, Humans, Medicine, Intubation, Aged, Quality Indicators, Health Care, medicine.diagnostic_test, business.industry, Odds ratio, Middle Aged, Quality Improvement, Confidence interval, 3. Good health, Intubation procedure, Anesthesiology and Pain Medicine, Anesthesia, Female, Airway management, business, 030217 neurology & neurosurgery
Abstract: BACKGROUND: “Macintosh”-videolaryngoscopes (VLs) are VLs that allow both direct and indirect laryngoscopy for intubation. We describe the decision-making and implementation-processes that our hospital used regarding the choice of device. We compared the performances of 4 Macintosh-VLs both in direct and indirect laryngoscopy. METHODS: A quality-improvement-project for airway management aiming at implementing Macintosh-VL for all intubation procedures performed in the operating room, involving 4 Macintosh-VLs (McGrath-Mac, C-MAC-S, C-MAC-S-Pocket-Monitor [PM], and APA). Three consecutive steps were described: (1) direct laryngoscopy with Macintosh-VL, (2) indirect laryngoscopy with Macintosh-VL (intubation attempt with Macintosh-style blade in case of Cormack I or II), (3) intubation attempt with hyperangulated blade in case of Cormack III/IV or failure of Macintosh-style blade. The main end point was the need to move to step III and use a hyperangulated blade. A mixed-effects multivariable logistic regression analysis was performed to compare devices on the main end point while considering site as a random effect. Comparison of means was performed using analysis of variance and Tukey’s test for multiple comparisons (number of laryngoscopy attempts, numeric rate scale [NRS] difficulty of intubation and NRS user-friendliness). Comparison of percentages was performed using a χ2 test for the need to move to step III and a Kruskal-Wallis test for the quality of image (bad, passable, good, very good, excellent). A P value ≤.008 was considered statistically significant. RESULTS: From May to September 2017, 589 patients were included. Using the McGrath-Mac (22/180 [12%]) was associated with less use of hyperangulated blade than using the C-MAC-S (39/132 [30%], odds ratio [OR] [99.2% confidence interval {CI}] 0.34 [0.16–0.77], P = .0005), the APA (35/138 [25%], OR [99.2% CI] 0.42 [0.19–0.93]; P = .004), but not the C-MAC-S-PM (29/139 [21%], OR [99.2% CI] 0.53 [0.23–1.2]; P = .04). Overall, the number of intubation attempts was significantly lower using the McGrath Mac than the C-MAC-S or the C-MAC-S-PMVLs. Subjective appreciation of intubation difficulty and user-friendliness of the devices showed respectively lower and higher NRS scores for the McGrath-Mac compared to the other devices, whereas subjective assessment of image quality showed higher quality for the C-MAC-S and C-MAC-S-PM compared to the APA or McGrath-Mac. CONCLUSIONS: Among 4 single-use Macintosh-VLs, glottic visualization in direct and indirect laryngoscopy with the Macintosh-style blade was significantly improved with the McGrath-Mac compared to other Macintosh-VLs, leading to a less frequent need to resort to the hyperangulated blade and reduced overall number of intubation attempts.
Published: 2020

12. Guidelines: Anaesthesia in the context of COVID-19 pandemic

Author: Lionel Velly, Etienne Gayat, Hervé Quintard, Emmanuel Weiss, Audrey De Jong, Philippe Cuvillon, Gérard Audibert, Julien Amour, Marc Beaussier, Matthieu Biais, Sébastien Bloc, Marie Pierre Bonnet, Pierre Bouzat, Gilles Brezac, Claire Dahyot-Fizelier, Souhayl Dahmani, Mathilde de Queiroz, Sophie Di Maria, Claude Ecoffey, Emmanuel Futier, Thomas Geeraerts, Haithem Jaber, Laurent Heyer, Rim Hoteit, Olivier Joannes-Boyau, Delphine Kern, Olivier Langeron, Sigismond Lasocki, Yoan Launey, Frederic le Saché, Anne Claire Lukaszewicz, Axel Maurice-Szamburski, Nicolas Mayeur, Fabrice Michel, Vincent Minville, Sébastien Mirek, Philippe Montravers, Estelle Morau, Laurent Muller, Jane Muret, Karine Nouette-Gaulain, Jean Christophe Orban, Gilles Orliaguet, Pierre François Perrigault, Florence Plantet, Julien Pottecher, Christophe Quesnel, Vanessa Reubrecht, Bertrand Rozec, Benoit Tavernier, Benoit Veber, Francis Veyckmans, Hélène Charbonneau, Isabelle Constant, Denis Frasca, Marc-Olivier Fischer, Catherine Huraux, Alice Blet, Marc Garnier, Assistance Publique - Hôpitaux de Marseille (APHM), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de pharmacologie moléculaire et cellulaire (IPMC), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'Anesthésie et Réanimation [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHU Pitié-Salpêtrière], 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), Institut Mutualiste de Montsouris (IMM), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Nutrition, Métabolismes et Cancer (NuMeCan), 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)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, CHU Toulouse [Toulouse], Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Physiopathologie et Pharmacologie Clinique de la Douleur, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique Juge - Clinique du sport [Marseille], Pôle d'Anesthésie-Réanimation [CHU Rangueil], CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Hôpital de Rangueil, Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département d'Anesthésie Réanimation, 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), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Institut Curie [Paris], Réanimation Médico-Chirurgicale, Service d'Anesthésie Réanimation, CHU Necker - Enfants Malades [AP-HP], Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe d’Anesthésie-Réanimation Chirurgie cardio-thoracique et vasculaire [Toulouse], Clinique Pasteur [Toulouse], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Département d'anesthésiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-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 Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Pôle Anesthésie Réanimation [CHU de Toulouse], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), Histoire et Cultures de l'Antiquité et du Moyen Âge (HISCANT-MA), Université de Lorraine (UL), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Emergency Department, Université Bordeaux Segalen - Bordeaux 2-Hôpital Pellegrin - Bordeaux, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Anaesthesiology, Robert Debré Hospital, Service d'anesthésie réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie mitochondriale, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherches sur les Herbivores - UMR 1213 (UMRH), Institut National de la Recherche Agronomique (INRA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Anesthésiologie, Université Pierre et Marie Curie - Paris 6 (UPMC), and Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France.
Subjects: Infection prevention and control, [SDV]Life Sciences [q-bio], Psychological intervention, Airway management, Context (language use), Critical Care and Intensive Care Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030202 anesthesiology, Informed consent, Personal protective equipment, Pandemic, Health care, Medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Modalities, SARS-CoV-2, business.industry, COVID-19, 030208 emergency & critical care medicine, General Medicine, Guideline, 3. Good health, Anesthesiology and Pain Medicine, Universal precautions, Anesthesia, Viruses, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: Objectives The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. Results The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. Conclusion We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
Published: 2020

13. Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial

Author: Yassir Aarab, Severin Ramin, Audrey Boissin, Pierre-François Perrigault, Thomas Odonnat, Philippe Cuvillon, Océane Garnier, Grégory Marin, Nicolas Molinari, Gerald Chanques, 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), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, medicine.medical_specialty, Mammaplasty, Breast surgery, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Analgesic, Remifentanil, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Double-Blind Method, 030202 anesthesiology, medicine, Humans, Prospective Studies, Breast augmentation, Pain, Postoperative, Thoracic Nerves, business.industry, Perioperative, medicine.disease, 3. Good health, Surgery, Anesthesiology and Pain Medicine, Opioid, Nerve block, Female, business, 030217 neurology & neurosurgery, Autonomic Nerve Block, Follow-Up Studies, medicine.drug
Abstract: Background Pectoral nerve blocks have been proposed for analgesia during and after breast cancer surgery, but data are conflicted in aesthetic breast surgery. This trial tested the primary hypothesis that adding a preincisional pectoral nerve block is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that rescue opioid consumption would be decreased with a long-lasting effect for both outcomes during the following days. Methods Seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive a pectoral nerve block versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and nonsteroidal anti-inflammatory drugs. The primary outcome measure was the maximal numerical rating scale in the first 6 h after extubation. Secondary outcomes included intraoperative remifentanil consumption and from extubation to day 5: maximal numerical rating scale, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5. Results The maximal numerical rating scale score in the first 6 h was lower in the pectoral nerve block group compared with the control group (3.9 ± 2.5 vs. 5.2 ± 2.2; difference: –1.2 [95% CI, –2.3 to –0.1]; P = 0.036). The pectoral nerve block group had a lower maximal numerical rating scale between days 1 and 5 (2.2 ± 1.9 vs. 3.2 ± 1.7; P = 0.032). The cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for the pectoral nerve block group from hour 6 to day 1 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 31.5] mg, P = 0.006) and from days 1 to 5 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 51] mg, P = 0.002). Conclusions Pectoral nerve block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery and is associated with reduced opioid consumption over the first 5 postoperative days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Published: 2021

14. COVID-19 and ethics: We learn as we go. But where are we going?

Author: Matthieu Le Dorze, Stanislas Kandelman, Valérie Gateau, Fabrice Michel, Benoit Veber, Gérard Audibert, Elodie Brunel, Frédérique Claudot, Caroline Guidet-lafaye, Anne Le Boudec, Laurent Muller, Pierre-François Perrigault, Florence Plantet, Isabelle Rouquette-Vicenti, Emmanuel Samain, Paul Zetlaoui, Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Royal Victoria Hospital, McGill University Health Center [Montreal] (MUHC), Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Rouen, University of Rouen, Rouen, France, Société française d'anesthésie et de réanimation (SFAR), SFAR, Dubois Frid, Caroline, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), [SDV]Life Sciences [q-bio], Allocation, Decision Making, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Resource Allocation, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Medicine, Humans, 030212 general & internal medicine, Bioethical Issues, Pandemics, ComputingMilieux_MISCELLANEOUS, Ethics, business.industry, COVID-19, General Medicine, medicine.disease, Triage, [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, Editorial, Hospital Restructuring, Medical emergency, Seasons, business
Abstract: International audience
Published: 2021

15. Bienvenue en infectiologie dans un monde qui change…

Author: Pierre-François Perrigault and Philippe Montravers
Subjects: Anesthesiology and Pain Medicine, business.industry, Medicine, business
Published: 2020

16. Critères d’admission en unité de surveillance continue pour surveillance postopératoire

Author: Kevin Chalard, Flora Djanikian, Pierre-François Perrigault, and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, [SDV]Life Sciences [q-bio], Emergency Medicine, 030212 general & internal medicine, Emergency Nursing, 3. Good health
Abstract: Resume La prise en charge peroperatoire des patients a haut risque a fait des progres remarquables ces dernieres annees. L’accent est mis desormais sur la periode postoperatoire. Dans cette optique, les services d’unites de surveillance continue (USC) occupent une place grandissante. Cependant les lits d’USC sont des ressources couteuses et limitees qu’il convient de limiter aux patients qui en beneficieront reellement. La selection des patients susceptibles de beneficier d’une prise en charge en USC postoperatoire s’articule autour de 5 criteres : (1) l’âge et les comorbidites du patient ; (2) le type d’intervention chirurgicale ; (3) la survenue d’evenements peroperatoires impactant la suite ; (4) une charge en soins, importante ; (5) les specificites organisationnelles propres a chaque structure. Ces criteres ont ete quantifies a l’aide de scores (ASA-PS, APACHE II, Charlston, P-POSSUM). Ils constituent une aide mais ne doivent pas se substituer a la decision du clinicien.
Published: 2019

17. Long-term outcome in patients with aneurysmal subarachnoid hemorrhage requiring mechanical ventilation

Author: Kevin Chalard, Federico Manna, Gerald Chanques, Pierre-François Perrigault, Frederique Pavillard, Nicolas Molinari, Vivien Szabo, Cyril Dargazanli, Flora Djanikian, Vincent Costalat, Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Retiveau, Nolwenn, and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, Vascular Medicine, law.invention, Diagnostic Radiology, 0302 clinical medicine, Medical Conditions, Modified Rankin Scale, law, Medicine and Health Sciences, Brain Damage, Tomography, Cognitive Impairment, Cerebral Ischemia, Multidisciplinary, Cognitive Neurology, Radiology and Imaging, Vasospasm, Middle Aged, Intensive care unit, Hospitals, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Survival Rate, Intensive Care Units, Neurology, Medicine, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Female, France, Aneurysms, Research Article, Adult, medicine.medical_specialty, Subarachnoid hemorrhage, Imaging Techniques, Science, Disabilities, Cognitive Neuroscience, Hemorrhage, Neuroimaging, Research and Analysis Methods, 03 medical and health sciences, Signs and Symptoms, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Diagnostic Medicine, Internal medicine, Intensive care, medicine, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Vascular Diseases, Survival rate, Aged, Retrospective Studies, Mechanical ventilation, business.industry, Biology and Life Sciences, Retrospective cohort study, Subarachnoid Hemorrhage, medicine.disease, Respiration, Artificial, Computed Axial Tomography, Health Care, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Health Care Facilities, Cognitive Science, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Clinical Medicine, business, 030217 neurology & neurosurgery, Neuroscience
Abstract: Background Patients affected with aneurysmal subarachnoid hemorrhage (aSAH) often require intensive care, and then present distinctive outcome from less severe patients. We aimed to specify their long-term outcome and to identify factors associated with poor outcome. Methods We conducted a retrospective study in a French university hospital intensive care unit. Patients with aSAH requiring mechanical ventilation hospitalized between 2010 and 2015 were included. At least one year after initial bleeding, survival and degree of disability were assessed using the modified Rankin Scale (mRS) via telephone interviews. A multivariable logistic regression analysis was performed to determine independent factors associated with poor outcome defined as mRS≥3. Results Two-hundred thirty-six patients were included. Among them, 7 were lost to follow-up, and 229 were analyzed: 73 patients (32%) had a good outcome (mRS Conclusion Among aSAH patients requiring assisted ventilation, two-third of them survived at one year, and one-third showed good long-term outcome. As it appears as an independant factor associated with poor outcome, DCI shoud retain particular attention in future studies beyond angiographic vasospasm.
Published: 2021

18. Transcranial sonographic assessment of the third ventricle in neuro-ICU patients to detect hydrocephalus: a diagnostic reliability pilot study

Author: Paul Bory, Flora Djanikian, Kevin Chalard, Frédéric Greco, Pierre-François Perrigault, Rémy Widehem, Samir Jaber, Frederique Pavillard, Alexandre Mas, Gerald Chanques, Julie Carr, Nicolas Molinari, Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Saint-Eloi, Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Colombière, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Hôpital Gui de Chauliac [Montpellier], MORNET, Dominique, Hôpital Saint Eloi (CHRU Montpellier), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Remote patient monitoring, Intraclass correlation, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Neurocritical care, medicine, Prospective cohort study, Third ventricle, RC86-88.9, business.industry, Research, Neurointensive care, Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Gold standard (test), medicine.disease, Point of care, Hydrocephalus, [SDV] Life Sciences [q-bio], Sonography, medicine.anatomical_structure, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Nuclear medicine, business, 030217 neurology & neurosurgery
Abstract: Background Transcranial sonography is a point-of-care tool recommended in intensive care units (ICU) to monitor brain injured patients. Objectives of the study was to assess feasibility and reliability of the third ventricle (V3) diameter measurement using transcranial sonography (TCS) compared to brain computed-tomography (CT), the gold standard measurement, and to measure the TCS learning curve. Design: prospective study, in a 16-bed neurological ICU in an academic hospital. Every consecutive brain injured adult patient, who required a brain CT and TCS monitoring were included. The V3 diameter was blindly measured by TCS and CT. Intraclass correlation coefficient (ICC) and Bland–Altman plot were used to assess the reliability and agreement between TCS and CT V3 measurements. Diagnosis performance of the V3 diameter using TCS to detect hydrocephalus was measured. Absolute difference between V3 measurement by residents and experts was measured consecutively to assess the learning curve. Results Among the 100 patients included in the study, V3 diameter could be assessed in 87 patients (87%) from at least one side of the skull. Both temporal windows were available in 70 patients (70%). The ICC between V3 diameter measured by TCS and CT was 0.90 [95% CI 0.84–0.93] on the right side, and 0.92 [0.88–0.95] on the left side. In Bland–Altman analysis, mean difference, standard deviation, 95% limits of agreement were 0.36, 1.52, − 2.7 to 3.3 mm, respectively, on the right side; 0.25, 1.47, − 2.7 to 3.1 mm, respectively, on the left side. Among the 35 patients with hydrocephalus, V3 diameters could be measured by TCS in 31 patients (89%) from at least one side. Hydrocephalus was, respectively, excluded, confirmed, or inconclusive using TCS in 35 (40%), 25 (29%) and 27 (31%) of the 87 assessable patients. After 5 measurements, every resident reached a satisfactory measurement compared to the expert operator. Conclusion TCS allows rapid, simple and reliable V3 diameter measurement compared with the gold standard in neuro-ICU patients. Aside from sparing irradiating procedures and transfers to the radiology department, it may especially increase close patient monitoring to detect clinically occult hydrocephalus earlier. Further studies are needed to measure the potential clinical benefit of this method. Trial registration: ClinicalTrials.gov ID: NCT02830269.
Published: 2021

19. Additional file 1 of Transcranial sonographic assessment of the third ventricle in neuro-ICU patients to detect hydrocephalus: a diagnostic reliability pilot study

Author: Widehem, Rémy, Bory, Paul, Greco, Frédéric, Pavillard, Frédérique, Kévin Chalard, Mas, Alexandre, Djanikian, Flora, Carr, Julie, Molinari, Nicolas, Jaber, Samir, Pierre-François Perrigault, and Chanques, Gerald
Abstract: Additional file1: Table S1: Patient characteristics, Table S2: CT and TCS findings for the 100 patients included for analysis, Figure S1: Study design, Figure S2: Study flow chart, Figure S3: Right and left sides V3 diameters measured by TCS compared with CT, Figure S4: Comparison of V3 diameters measured by TCS, according to the hydrocephalus status, Figure S5: V3 diameters measured by TCS compared with the other side
Published: 2021
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20. Bilateral mandibular block improves pain relief and morphine consumption in mandibular osteotomies: a prospective, randomized, double-blind, placebo-controlled clinical trial

Author: Jérôme Ridolfo, Charlotte Vannucci, Habib Ly, Xavier Capdevila, Gerald Chanques, Marina Bertuit, Nicolas Molinari, Marie De Boutray, Francesca Rapido, Pierre-François Perrigault, Christophe Dadure, Sophie Galmiche, 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), Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Lapeyronie [Montpellier] (CHU), Institut des Neurosciences de Montpellier (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Saint Eloi (CHRU Montpellier), and MORNET, Dominique
Subjects: [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Mandibular nerve, Mandibular Osteotomy, Mandible, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Placebo, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, 030202 anesthesiology, Humans, Medicine, Prospective Studies, Anesthetics, Local, ComputingMilieux_MISCELLANEOUS, Pain Measurement, Trigeminal nerve, Pain, Postoperative, Morphine, business.industry, Ropivacaine, Nerve Block, 030206 dentistry, General Medicine, Analgesics, Opioid, Clinical trial, Treatment Outcome, Anesthesiology and Pain Medicine, Opioid, Anesthesia, Nerve block, medicine.symptom, business, Postoperative nausea and vomiting, medicine.drug
Abstract: BackgroundThe sensory innervation of the lower jaw mainly depends on the third root of the trigeminal nerve, the mandibular nerve (V3). The aim of this single-center, prospective, randomized, double-blind, placebo-controlled study was to evaluate the effectiveness of bilateral V3 block for postoperative analgesia management in mandibular osteotomies.Methods107 patients undergoing mandibular surgery (75 scheduled osteotomies and 32 mandible fractures) were randomized in two groups. A bilateral V3 block was performed in each group, either with ropivacaine 0.75% (block group, n=50) or with a placebo (placebo group, n=57). A postoperative multimodal analgesia was equally provided to both groups. The primary outcome was the cumulative morphine consumption at 24 hours. Secondary outcomes were the occurrence of severe pain and the incidence of postoperative nausea and vomiting (PONV) in the first 24 hours. Data were analyzed on an intention-to-treat basis.ResultsThe cumulative morphine consumption at 24 hours was significantly lower in the block group (median 8.0 mg (IQR 2.0–21.3) vs 12.0 mg (IQR 8.0–22.0), p=0.03), as well as the incidence of severe pain during the 24 hours of follow-up (4.0% vs 22.8%, pConclusionBilateral V3 block for mandibular osteotomies is an effective opioid-sparing procedure. It provided better postoperative analgesia in the first 24 hours, and it did not affect PONV incidence.Trial registration numberNCT02618993.
Published: 2021

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

Author: Achille Sossou, Rémy Bellier, Kevin Lagarde, Alexandre Mansour, Jean-Michel Constantin, Marc Leone, Céline Monard, Brice Fermier, Cedric Carrie, Sigismond Lasocki, Armine Rouhani, Alexy Tran Dinh, Pierre-François Perrigault, Antoine Roquilly, Jerôme Morel, Ghilain Beauplet, Sami Blidi, Claire Dahyot-Fizelier, Christian Isetta, Marie-Anne Vibet, Mathilde Holleville, Philippe Guerci, Clément Gakuba, Fanny Feuillet, Karim Asehnoune, Jeremy Bourenne, Marc Danguy des Déserts, Benjamin G. Chousterman, Karim Lakhal, Alexandru Cupaciu, Arnaud Foucrier, Gerald Chanques, Calypso Mathieu, Adrien Oudotte, Véronique Sébille, Hugues De Courson, Pauline Cailliez, Jonathan Au Duong, Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département Anesthésie Réanimation, CHU d'Angers, Université d'Angers, Angers, Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Beaujon (AP/HP), Beaujon, Intensive Care Unit, Simone Veil Hospital, Blois, Department of Neuro-Critical Care, Pellegrin Hospital, Bordeaux, Surgical and trauma Intensive Care, Pellegrin Hospital, Bordeaux, Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, Department of Anesthesiology and Critical Care, CHU Caen, Caen, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Department of neuro-critical care, AP/HP, Creteil, Intensive Care Unit, Eaubonne Hospital, Eaubonne, Department of Anesthesiology and Critical Care, Emile Roux Hospital, Le Puy en Velay, Intensive Care Unit, Lorient Hospital, Lorient, Department of Anesthesiology and Critical Care, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, Department of Neuro-Critical Care, Hospices Civils de Lyon, Lyon, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Emergency Intensive Care Unit, Hopital la Timone, Marseille, Department of Anesthesiology and Cardiothoracic Intensive Care, Pierre Zobda-Quitman, Martinique, Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, Severe Burn Intensive Care Unit, Hotel Dieu, CHU Nantes, Nantes, Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Nancy, Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Bichat (AP/ HP), Paris, Department of Anesthesiology and Critical Care, Severe Burn Unit, Centre Hospitalier Universitaire de Lariboisiere (AP/HP), Paris, Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Saint Louis (AP/ HP), Paris, Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, Neuro-Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, Intensive Care Unit, Department of Anesthesiology and Critical Care, Rangueil Hospital, Centre Hospitalier Universitaire, Toulouse, Department of Anesthesiology and Critical Care, Pontchaillou Hospital, CHU Rennes, Rennes, Department of Anesthesiology and Critical Care, CHU Saint Etienne, Saint Etienne, Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Université de Nantes, Nantes, DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), MORNET, Dominique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Pontchaillou [Rennes], Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Microbes évolution phylogénie et infections (MEPHI), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Microbiology (medical), medicine.medical_specialty, Critical Care, [SDV]Life Sciences [q-bio], Audit, Hospital-acquired pneumonia, law.invention, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, law, Intensive care, Humans, Medicine, 030212 general & internal medicine, Cluster randomised controlled trial, ComputingMilieux_MISCELLANEOUS, business.industry, Hazard ratio, Healthcare-Associated Pneumonia, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, Intensive care unit, Hospitals, 3. Good health, Clinical trial, [SDV] Life Sciences [q-bio], Intensive Care Units, Infectious Diseases, Emergency medicine, business
Abstract: Background We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) can improve the outcomes of patients in intensive care units (ICUs). Methods This study was conducted at 35 ICUs in 30 hospitals. We included consecutive, adult patients hospitalized in ICUs for 3 days or more. After a 3-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a 3-month cluster-randomized trial. We randomly assigned ICUs to either receive audit and feedback (intervention group) or participate in a national registry (control group). The primary outcome was the duration of ICU stay. Results Among 1856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measures of compliance were 47% (interquartile range [IQR], 38–56%) in the intervention group and 42% (IQR, 25–53%) in the control group (P = .001). As compared to the baseline period, the ICU lengths of stay were reduced by 3.2 days in the intervention period (P = .07) and by 2.8 days in the control period (P = .02). The durations of ICU stay were 7 days (IQR, 5–14 days) in the control group and 9 days (IQR, 5–20 days) in the intervention group (P = .10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from the ICU in the control group was 1.17 (95% confidence interval, .69–2.01; P = .10). Conclusions The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes. Clinical Trials Registration NCT03348579.
Published: 2020

22. L’épidémie du COVID-19, un immense défi organisationnel, médical et humain pour les équipes d’anesthésie-réanimation

Author: Fabrice Michel, Pierre-François Perrigault, Benoit Veber, Comité éthique de la Sfar, Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), and Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS)
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030504 nursing, [SDV]Life Sciences [q-bio], 0305 other medical science, 030217 neurology & neurosurgery, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2020

23. Early mobilization in intensive care for patients with brain injury: e-Survey of current practices in France

Author: Frederique Pavillard, C. Jourdan, Karolina Griffiths, Olivier Barber, Pierre-François Perrigault, Margrit Ascher, François Feuvrier, Paul Bory, Isabelle Laffont, and Kevin Chalard
Subjects: medicine.medical_specialty, Critical Care, business.industry, Rehabilitation, MEDLINE, Intensive Care Units, Intensive care, Brain Injuries, Surveys and Questionnaires, Medicine, Early mobilization, Humans, Orthopedics and Sports Medicine, France, Current (fluid), business, Intensive care medicine, Early Ambulation
Published: 2020

24. Optimal intracranial pressure in patients with aneurysmal subarachnoid hemorrhage treated with coiling and requiring external ventricular drainage

Author: Vincent Costalat, Frederique Pavillard, Cyril Dargazanli, Gregory Gascou, Pierre-Henri Lefevre, Carlos Riquelme, Pierre-François Perrigault, Federico Cagnazzo, Marine Le Corre, Ocean Garnier, Davide Tiziano Di Carlo, Imad Derraz, Paolo Perrini, Kevin Chalard, Riccardo Morganti, and Alain Bonafe
Subjects: Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Time Factors, Intracranial Pressure, Ischemia, Perfusion scanning, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Prospective Studies, Delayed cerebral ischemia, Intracranial pressure, Aged, medicine.diagnostic_test, Cerebral infarction, business.industry, External ventricular drainage, Endovascular Procedures, Vasospasm, General Medicine, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Angiography, Cardiology, Drainage, Surgery, Female, Neurology (clinical), business, Tomography, X-Ray Computed, Perfusion, 030217 neurology & neurosurgery
Abstract: Optimal management of intracranial pressure (ICP) among aneurysmal subarachnoid hemorrhage (aSAH) patients requiring external ventricular drainage (EVD) is controversial. To analyze predictors of delayed cerebral ischemia (DCI)-related cerebral infarction after aSAH and the influence of ICP values on DCI, we prospectively collected consecutive patients with aSAH receiving coiling and requiring EVD. Predictors of DCI-related cerebral infarction (new CT hypodensities developed within the first 3 weeks not related to other causes) were studied. Vasospasm and brain hypoperfusion were studied with CT angiography and CT perfusion (RAPID-software). Among 50 aSAH patients requiring EVD, 21 (42%) developed DCI-related cerebral infarction, while 27 (54%) presented vasospasm. Mean ICP ranged between 2 and 19 mmHg. On the multivariate analysis, the mean ICP (OR = 2, 95%CI = 1.01-3.9, p = 0.042) and the mean hypoperfusion volume on Tmax delay 6 (OR = 1.2, 95%CI = 1.01-1.3, p = 0.025) were independent predictors of DCI. To predict DCI-related cerebral infarction, Tmax delay 6 s presented the highest AUC (0.956, SE = 0.025), with a cutoff value of 18 ml showing sensitivity, specificity, PPV, NPV, and accuracy of 90.5% (95%CI = 69-98.8%), 86.2% (95%CI = 68.4-96%), 82.6% (95%CI = 65.4-92%), 92.5% (95%CI = 77-98%), and 88% (95%CI = 75-95%), respectively. The AUC of the mean ICP was 0.825 (SE = 0.057), and the best cutoff value was 6.7 mmHg providing sensitivity, specificity, PPV, NPV, and accuracy of 71.4% (95%CI = 48-89%), 62% (95%CI = 42-79%), 58% (95%CI = 44-70%), 75% (95%CI = 59-86%), and 66% (95%CI = 51-79%) for the prediction of DCI-related cerebral infarction, respectively. Among aSAH patients receiving coiling and EVD, lower ICP ( 6.7 mmHg in our study) could potentially be beneficial in decreasing DCI-related cerebral infarction. Brain hypoperfusion with a volume 18 ml at Tmax delay 6 s presents a high sensibility and specificity in prediction of DCI-related cerebral infarction.
Published: 2020

25. KMT2B-related disorders: expansion of the phenotypic spectrum and long-term efficacy of deep brain stimulation

Author: Nihr BioResource, F. Lucy Raymond, Shekeeb S. Mohammad, TD Graves, Susan J. Hayflick, Bert B.A. de Vries, Katy Barwick, Conor Fearon, Dora Steel, Mark Hallett, Asif Doja, Emilie Chan Seng, Camilo Toro, Fiona Stewart, Diane Demailly, Suh Young Jeong, Claudio M. de Gusmao, Frédérique Pavillard, Nutan Sharma, Fabienne Cyprien, Juan C Pallais, Brent L. Fogel, David R. FitzPatrick, Lucia Abela, Russell C. Dale, Bettina Balint, Natalie Trump, Michel Tchan, Sony Malhotra, Swasti Pal, Maya Topf, Manju A. Kurian, Michelle Sahagian, Julia Rankin, Laila Selim, Jeff L. Waugh, Sidney Krystal, Gustavo Polo, Caleb Rogers, Michel Mondain, Kailash P. Bhatia, Ishwar C. Verma, Marisela Dy-Hollins, Kelly A. Mills, Derek Wong, Laura Cif, William A. Gahl, Meredith W Allain, Sanaz Attaripour Isfahani, Agathe Roubertie, Jenny L. Wilson, Allison Gregory, Victoria Gonzalez, Carolyn D. Applegate, Nathalie Dorison, Jennifer A. Bassetti, Catherine Blanchet, Ada Hamosh, Deciphering Developmental Disorders Study, Hane Lee, Julien Baleine, Emma L. Baple, Gaetan Lesca, Anna Znaczko, Thomas Roujeau, Mario Sa, Laurence Lion François, Neil Mahant, Diane Doummar, Sandra Jansen, Marie Hully, Christine Coubes, Eva B. Forman, Victor S.C. Fung, Gaëtan Poulen, Raghda Zaitoun, Serena Galosi, Timothy Lynch, Xavier Vasques, Elise Schaefer, Richard Selway, Adeline Ngoh, Tuula Rinne, Philippe Coubes, Elizabeth L. Fieg, Rachel Fox, Jennifer Friedman, Andrea K. Petersen, Hugo Morales-Briceño, Rebecca Signer, Luis Rohena, Sandra Chantot Bastaraud, Chloé Laurencin, Kishore R. Kumar, Julian A. Martinez-Agosto, Ellyn Farrelly, Kathleen M. Gorman, Esther Meyer, Joel B. Krier, Ariane Soldatos, Lydie Burglen, Jean-Pierre Lin, Pierre-François Perrigault, Dolly Zhen, Harutomo Hasegawa, Mary D. King, Alba Sanchis-Juan, David A. Stevenson, Gilles Cambonie, Wui K. Chong, Christophe Milési, Vincent d'Hardemare, John R. Østergaard, Laboratoire de Recherche en Neurosciences Cliniques, IBM Systems Group, Service de Neurochirurgie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Gui de Chauliac [Montpellier], Evelina London Children's Hospital, Institute of Child Health [London], University College of London [London] (UCL), Birkbeck College [University of London], Great Ormond Street Hospital for Children [London] (GOSH), Cambridge University Hospitals - NHS (CUH), University of Cambridge [UK] (CAM), Royal Devon and Exeter NHS Foundation Trust [UK], and Stanford University
Subjects: 0301 basic medicine, Male, Pediatrics, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Deep Brain Stimulation, DYT1 DYSTONIA, GENERALIZED DYSTONIA, VARIANTS, Cohort Studies, 0302 clinical medicine, genetics, [MATH]Mathematics [math], Deep brain stimulation (DBS), Child, Laryngeal dystonia, ComputingMilieux_MISCELLANEOUS, Dystonia, Fetal Growth Retardation, neurodevelopment, Parkinsonism, KMT2B, 3. Good health, INSIGHTS, Phenotype, Treatment Outcome, Dystonic Disorders, Child, Preschool, Cohort, Disease Progression, deep brain stimulation (DBS), dystonia, Female, Chromosome Deletion, Adult, medicine.medical_specialty, Deep brain stimulation, Adolescent, DATABASE, Mutation, Missense, Endocrine System Diseases, Laryngeal Diseases, 03 medical and health sciences, Young Adult, All institutes and research themes of the Radboud University Medical Center, medicine, Genetics, Humans, Computer Simulation, Gait Disorders, Neurologic, Neurodevelopmental disorders Donders Center for Medical Neuroscience [Radboudumc 7], business.industry, MUTATIONS, Histone-Lysine N-Methyltransferase, Original Articles, medicine.disease, Status dystonicus, 030104 developmental biology, Disease Presentation, Brain stimulation, Mutation, Quality of Life, Neurology (clinical), business, FOLLOW-UP, GAIT, 030217 neurology & neurosurgery, SYSTEM
Abstract: Heterozygous mutations in KMT2B are associated with an early-onset, progressive and often complex dystonia (DYT28). Key characteristics of typical disease include focal motor features at disease presentation, evolving through a caudocranial pattern into generalized dystonia, with prominent oromandibular, laryngeal and cervical involvement. Although KMT2B-related disease is emerging as one of the most common causes of early-onset genetic dystonia, much remains to be understood about the full spectrum of the disease. We describe a cohort of 53 patients with KMT2B mutations, with detailed delineation of their clinical phenotype and molecular genetic features. We report new disease presentations, including atypical patterns of dystonia evolution and a subgroup of patients with a non-dystonic neurodevelopmental phenotype. In addition to the previously reported systemic features, our study has identified co-morbidities, including the risk of status dystonicus, intrauterine growth retardation, and endocrinopathies. Analysis of this study cohort (n = 53) in tandem with published cases (n = 80) revealed that patients with chromosomal deletions and protein truncating variants had a significantly higher burden of systemic disease (with earlier onset of dystonia) than those with missense variants. Eighteen individuals had detailed longitudinal data available after insertion of deep brain stimulation for medically refractory dystonia. Median age at deep brain stimulation was 11.5 years (range: 4.5–37.0 years). Follow-up after deep brain stimulation ranged from 0.25 to 22 years. Significant improvement of motor function and disability (as assessed by the Burke Fahn Marsden’s Dystonia Rating Scales, BFMDRS-M and BFMDRS-D) was evident at 6 months, 1 year and last follow-up (motor, P = 0.001, P = 0.004, and P = 0.012; disability, P = 0.009, P = 0.002 and P = 0.012). At 1 year post-deep brain stimulation, >50% of subjects showed BFMDRS-M and BFMDRS-D improvements of >30%. In the long-term deep brain stimulation cohort (deep brain stimulation inserted for >5 years, n = 8), improvement of >30% was maintained in 5/8 and 3/8 subjects for the BFMDRS-M and BFMDRS-D, respectively. The greatest BFMDRS-M improvements were observed for trunk (53.2%) and cervical (50.5%) dystonia, with less clinical impact on laryngeal dystonia. Improvements in gait dystonia decreased from 20.9% at 1 year to 16.2% at last assessment; no patient maintained a fully independent gait. Reduction of BFMDRS-D was maintained for swallowing (52.9%). Five patients developed mild parkinsonism following deep brain stimulation. KMT2B-related disease comprises an expanding continuum from infancy to adulthood, with early evidence of genotype-phenotype correlations. Except for laryngeal dysphonia, deep brain stimulation provides a significant improvement in quality of life and function with sustained clinical benefit depending on symptoms distribution.
Published: 2020

26. Recommandations pour le fonctionnement des unités de surveillance continue (USC) dans les établissements de santé, 2018

Author: Jean Reignier, Philippe Guiot, René Robert, Pierre-François Perrigault, Didier Honnart, Dominique Pateron, Marc Beaussier, Sébastien Kerever, Fanny Denys, Bertrand Guidet, Claude Ecoffey, Benoit Misset, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Institut Mutualiste de Montsouris (IMM), Service d'Urgences Adultes [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], CHU Rouen, Normandie Université (NU), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Roger Salengro [Lille], Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Nantes (CHU Nantes), Département de Médecine d'Urgence - Centre Régional Universitaire des Urgences (CRUU) (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé (CRESS - U1153), Université Paris Diderot - Paris 7 (UPD7)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Charleville-Mezières, Service d'Anesthésie Réanimation [Rennes], CHU Pontchaillou [Rennes], and Gestionnaire, Hal Sorbonne Université
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030208 emergency & critical care medicine, 030212 general & internal medicine, 3. Good health
Abstract: International audience; Près de 20 ans après la mise en place des premières unités de surveillance continue (USC), des réflexions sur la typologie de patients à y admettre (seuls 60 à 65 % des patients admis), la densité de personnels nécessaire et le dimensionnement de ces unités sont apparues. Les conseils professionnels de la Médecine Intensive Réanimation, de l’Anesthésie Réanimation et de la médecine d’urgence ont constitué un groupe de travail afin d’analyser les conditions de fonctionnement des USC et de proposer des recommandations pour un fonctionnement optimisé de ces unités en adéquation avec les nouvelles organisations du système de santé. En utilisant une méthodologie de type recommandations formalisées d’experts (RFE), cinq champs de réflexion ont été définis : rypologie de patients, structure des USC, organisation et management paramédical, organisation et management médical, USC et groupements hospitaliers de territoire (GHT). Vingt-six recommandations ont été proposées, toutes assorties d’un accord fort après cotation collective établie selon une méthodologie dérivée de la RAND/UCLA (deux tours de cotation).
Published: 2018

27. The Frontal Bone Window for Transcranial Doppler Ultrasonography in Critically Ill Patients: Validation of a New Approach in the ICU

Author: Xavier Capdevila, Geoffrey Dagod, Pierre Sentenac, Frédéric Greco, Pierre-François Perrigault, Jonathan Charbit, Paul Bory, Camille Maury, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Intensive Care Unit [Montpellier], Anaesthesiology and Intensive Care Department [Montpellier], Hôpital Lapeyronie [Montpellier] (CHU)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie [Montpellier] (CHU)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), CHU Montpellier, and MORNET, Dominique
Subjects: Male, Ultrasonography, Doppler, Transcranial, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Reliability and validity (D015203), 0302 clinical medicine, Brain Injuries, Traumatic, Medicine, Prospective Studies, Anterior cerebral artery (D020771), Prospective cohort study, Neurophysiological monitoring (D064926), Middle Aged, Frontal acoustic bone window, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, Cardiology, cardiovascular system, Female, Blood Flow Velocity, Original Work, Adult, medicine.medical_specialty, Anterior Cerebral Artery, Critical Illness, Diastole, Intensivist, 03 medical and health sciences, Cerebral vasospasm (D020301), medicine.artery, Internal medicine, Intensive care, Anterior cerebral artery, Humans, Glasgow Coma Scale, Aged, business.industry, Reproducibility of Results, Temporal Bone, Subarachnoid Hemorrhage, Transcranial Doppler, stomatognathic diseases, Frontal bone, Brain Injuries, Frontal Bone, Neurology (clinical), business, 030217 neurology & neurosurgery, Transcranial Doppler ultrasonography (D017585)
Abstract: Background and ObjectiveThe temporal bone window (TBW) for transcranial Doppler (TCD) often fails to insonate the anterior cerebral artery (ACA). The frontal bone window (FBW) has never been evaluated in intensive care units (ICU). The main objective was to determine the ability of the FBW to assess ACA velocities in critically ill patients.MethodsA prospective study was conducted in two ICUs of the Montpellier University Hospital (France), between November 2014 and September 2016. Adult patients admitted to ICU for brain injury, with a Glasgow Coma Scale score ≤ 13, were enrolled within 3 days after admission. A first TCD examination was carried out bilaterally through the TBW and FBW by an intensivist expert in TCD, repeated by the same examiner, and 15 min later by an intensivist certified in TCD, designated as non-expert, blinded. The success of the FBW examinations was defined by the ability to measure the ACA velocities. Intra- and interobserver agreements were analyzed according to the Bland and Altman method.ResultsA total of 147 patients were analyzed. The FBW succeeded in insonating the ACA in 66 patients [45%, CI (37–53)], 45 bilaterally and 21 unilaterally. For 16 patients (11%), the FBW was the only way to measure ACA velocities. By combining the two techniques, the ACA success rate increased from 62% CI (54–70) to 73% CI (65–79) (P = 0.05). Intra- and interobserver mean biases and 95% limits of agreement for ACA systolic velocity measurements through the FBW were 1 (− 33 to 35) and 2 (− 34 to 38) cm s−1, respectively. For paired TBW and FBW measures of ACA velocities, mean biases (± SD) for ACA systolic, and mean and diastolic velocities were relatively close to zero, but negatives (− 7 ± 33, − 2 ± 19, − 1 ± 15 cm s−1, respectively), highlighting that ACA velocities were lower with the FBW (A2 segment) than TBW (A1 segment). The correlation coefficient for ACA systolic velocities measured by the FBW and TBW wasR = 0.47, CI (0.28–0.62). No risk factors for failure of the FBW were identified.ConclusionsIn ICU, the FBW was able to insonate the ACA in 45% of patients admitted for brain injury, without the use of contrast agents. The FBW could improve the detection of ACA vasospasms.
Published: 2019

28. Deep brain stimulation treated dystonia-trajectory via status dystonicus

Author: Christophe Milési, Philippe Coubes, Diane Demailly, Emilie Chan Seng, Pierre-François Perrigault, Diane Ruge, Frédéric Greco, Agathe Roubertie, Thomas Roujeau, Laura Cif, Victoria Gonzalez, Alain Boularan, Elodie Nerrant, Gilles Cambonie, Xavier Vasques, Isabel De Antonio Rubio, and Fabienne Cyprien
Subjects: 0301 basic medicine, Dystonia, Pediatrics, medicine.medical_specialty, Deep brain stimulation, medicine.diagnostic_test, Pediatric onset, business.industry, medicine.medical_treatment, Magnetic resonance imaging, medicine.disease, Status dystonicus, 3. Good health, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Neurology, Cohort, medicine, Neurology (clinical), Young adult, business, 030217 neurology & neurosurgery, Cohort study
Abstract: BACKGROUND: Status dystonicus (SD) is a life-threatening condition. OBJECTIVE AND METHODS: In a dystonia cohort who developed status dystonicus, we analyzed demographics, background dystonia phenomenology and complexity, trajectory previous to-, via status dystonicus episodes, and evolution following them. RESULTS: Over 20 years, 40 of 328 dystonia patients who were receiving DBS developed 58 status dystonicus episodes. Dystonia was of pediatric onset (95%), frequently complex, and had additional cognitive and pyramidal impairment (62%) and MRI alterations (82.5%); 40% of episodes occured in adults. Mean disease duration preceding status dystonicus was 10.3 \textpm 8 years. Evolution time to status dystonicus varied from days to weeks; however, 37.5% of patients exhibited progressive worsening over years. Overall, DBS was efficient in resolving 90% of episodes. CONCLUSION: Status dystonicus is potentially reversible and a result of heterogeneous conditions with nonuniform underlying physiology. Recognition of the complex phenomenology, morphological alterations, and distinct patterns of evolution, before and after status dystonicus, will help our understanding of these conditions. \textcopyright 2018 International Parkinson and Movement Disorder Society.
Published: 2018

29. États généraux de la bioéthique : quelle est la position de la SFAR sur la fin de vie et le don d’organes ?

Author: Pierre-François Perrigault, Fabrice Michel, and Benoit Veber
Subjects: Anesthesiology and Pain Medicine
Published: 2019

30. Target intracranial pressure among patients with aneurysmal subarachnoid hemorrhage: A prospective single-center study

Author: Pierre-Henri Lefevre, Federico Cagnazzo, Pierre-François Perrigault, Cyril Dargazanli, Kevin Chalard, Imad Derraz, Alain Bonafe, Gregory Gascou, Paolo Perrini, Vincent Costalat, Carlos Riquelme, and Marine Le Corre
Subjects: medicine.medical_specialty, Subarachnoid hemorrhage, Radiological and Ultrasound Technology, Cerebral hypoperfusion, business.industry, Ventricular drainage, Vasospasm, Single Center, medicine.disease, Gastroenterology, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, Neurology (clinical), business, Intracranial pressure
Abstract: Background Management of external ventricular drainage (EVD) among aneurysmal subarachnoid hemorrhage (aSAH) patients remain controversial, and there are no consensus guidelines reporting optimal values of intracranial pressure (ICP). Objective To analyze predictors of delayed cerebral ischemia (DCI) after aSAH and the influence of ICP values on DCI. Methods We prospectively collected patients with aSAH requiring EVD. Predictors of DCI (new CT hypodensities developed within the first 3 weeks not related to others causes) were studied. Vasospasm and brain hypoperfusion were studied with CTA and CTP (RAPID software). Results Among 50 aSAH patients treated with EVD, 21 (42%) developed DCI, while 27 (54%) presented vasospasm. Mean ICP ranged between 2 mmHg and 19 mmHg. On the multivariate analysis, mean ICP (OR = 2, 95% CI = 1.01–3.9, P = 0.04) and mean volume of the hypoperfusion on Tmax delay > 6 (OR = 1.2, 95% CI = 1.01–1.3, P = 0.02) were the only independent predictors of DCI. To predict DCI, Tmax delay > 6 seconds presented the highest AUC (0.956), with a cutoff value of 18 mL showing sensitivity, specificity, PPV, NPV, and accuracy of 90.5% (95% CI = 69%–98.8%), 86.2% (95% CI = 68.4%–96%), 82.6% (95% CI = 65.4%–92%), 92.5% (95% CI = 77%–98%), 88% (95% CI = 75%–95%), respectively. The AUC of the mean ICP was 0.825, and the best cutoff value was 6.7 mmHg providing sensitivity, specificity, PPV, NPV, and accuracy of 71.4% (95% CI = 48%–89%), 62% (95% CI = 42%–79%), 58% (95% CI = 44%–70%), 75% (95% CI = 59%–86%), 66% (95% CI = 51%–79%) for the prediction of DCI, respectively. Conclusion ICP 6 seconds can predict more than 80% of DCI ( Fig. 1 , Fig. 2 ).
Published: 2020

31. Deep continuous sedation maintained until death, in French Intensive Care Units

Author: Matthieu Le Dorze, Stanislas Kandelman, Benoit Veber, Elodie Brunel, Houtin Baghdadi, Antoine Baumann, Frédérique Claudot, Caroline Guibet Lafaye, Valérie Gateau, Florence Lallemant, Anne Le Boudec, Fabrice Michel, Laurent Muller, Karine Nouette-Gaulain, Pierre-François Perrigault, Florence Plantet, Nadège Rutter, Emmanuel Samain, and Gérald Visquesnel
Subjects: Terminal Care, medicine.medical_specialty, business.industry, Clinical Decision-Making, Palliative Care, MEDLINE, General Medicine, Critical Care and Intensive Care Medicine, Palliative sedation, Death, Intensive Care Units, Anesthesiology and Pain Medicine, Intensive care, Continuous sedation, Humans, Medicine, France, Deep Sedation, business, Intensive care medicine, End-of-life care
Published: 2020

32. Ventilation mécanique en réanimation : ce qu’il faut savoir en 2017

Author: Jean-Christophe Orban, Arnaud Friggeri, Laurent Muller, Yazine Mahjoub, Jean-Michel Constantin, Christophe Quesnel, Oliver Langeron, Marc Leone, Antoine Roquilly, Sigismond Lasocki, Matthieu Legrand, Caroline Duracher Gout, Antoine Virat, Sébastien Mirek, Olivier Joannes Boyau, and Pierre-François Perrigault
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030212 general & internal medicine
Published: 2018

33. Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol

Author: Franck Verdonk, Bruno Pereira, Aurélie Masgrau, Anne-Claire Lukaszewicz, Serge Molliex, Samir Jaber, Ségolène Mrozek, Emmanuel Futier, Russell Chabanne, Lionel Velly, Elodie Caumon, Emmanuel Chabert, Charlotte Fernandez-Canal, Jean-Etienne Bazin, Anna Ferrier, Claire Dahyot-Fizelier, Pierre-François Perrigault, Marc Begard, Benoît Tavernier, Vincent Degos, CHU Clermont-Ferrand, Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques - EA 7426 (PI3), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Assistance Publique - Hôpitaux de Marseille (APHM), Département d'Anesthésie-Réanimation [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Gabriel Montpied [Clermont-Ferrand], 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), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Unité de Biostatistiques [CHU Clermont-Ferrand], Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), MORNET, Dominique, Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Assistance Publique Hôpitaux de Paris (AP-HP)Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France., Centre Hospitalier Universitaire de Clermont-Ferrand, Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), CHU Gabriel Montpied (CHU), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service de réanimation adulte, département d'anesthésie-réanimation, CHU Clermont-Ferrand-Hôtel Dieu, Unité de biostatistiques, CHU Clermont-Ferrand-Hôpital Montpied, Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression (PI3), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)
Subjects: Adult, Male, Mechanical Thrombolysis, Sedation, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Conscious Sedation, Anesthesia, General, Anaesthesia, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, medicine, Protocol, Humans, Multicenter Studies as Topic, General anaesthesia, 030212 general & internal medicine, Myocardial infarction, Stroke, Randomized Controlled Trials as Topic, business.industry, Endovascular Procedures, General Medicine, Thrombolysis, Perioperative, medicine.disease, stroke, 3. Good health, anaesthesia in neurology, [SDV] Life Sciences [q-bio], sedation, thrombectomy, Anesthesia, Observational study, Female, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: IntroductionEndovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.Methods and analysisAnesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0–2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.Ethics and disseminationThe AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.Trial registration numberNCT03229148.
Published: 2019

34. Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry

Author: Océane Garnier, Nicolas Molinari, Christine Bernard, Samir Jaber, Claire Duflos, Kevin Chalard, Pierre-François Perrigault, Valentine Delmas, and Gerald Chanques
Subjects: Adult, Male, medicine.medical_specialty, Psychometrics, Critical Illness, Pain, Richmond Agitation-Sedation Scale, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pain assessment, Clinical endpoint, Medicine, Humans, Aged, Pain Measurement, Critically ill, business.industry, Glasgow Coma Scale, Construct validity, Brain, Reproducibility of Results, Pain scale, Middle Aged, 3. Good health, Anesthesiology and Pain Medicine, Nociception, Neurology, Brain Injuries, Physical therapy, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Three clinical scales (the Nociception Coma Scale adapted for Intubated patients [NCS-I], its Revised version [NCS-R-I], and the Behavioral Pain Scale [BPS]) and videopupillometry were compared for measuring pain in intubated, noncommunicating, critically ill, brain-injured patients. Pain assessment was performed before, during, just after, and 5 minutes after 3 procedures: the reference non-nociceptive procedure (assessment of the Richmond Agitation Sedation Scale) and 2 nociceptive procedures (turning and tracheal suctioning). The primary endpoint was construct validity (discriminant and criterion validation), determined by comparing pain measurements between different times/procedures. Secondary endpoints were internal consistency, inter-rater reliability, and feasibility. Fifty patients (54% women, median age 63 years [56-68]) were included 13 [7-24] days after brain injury (76% hemorrhagic or ischemic strokes). All tools increased significantly more (P0.001) during the nociceptive procedures vs the non-nociceptive procedure. The BPS was the only pain tool that did not increase significantly during the non-nociceptive procedure (P = 0.41), suggesting that it was the most discriminant tool. The BPS, NCS-I, and NCS-R-I were good predictors of nociception with areas under the curves ≥0.96, contrary to videopupillometry (area under the curve = 0.67). The BPS, NCS-I, and NCS-I-R had high inter-rater reliabilities (weighted kappa = 0.86, 0.82 and 0.84, respectively). Internal consistency was moderate (0.60) for all pain scales. Factor analysis represented a majority of information on a first dimension, with motor domains represented on a second dimension. Scale feasibility was better for the NCS-I and NCS-R-I than for the BPS. In conclusion, the BPS, NCS-I, and NCS-R-I are valid, reliable, and acceptable pain scales for use in intubated critically ill, brain-injured patients, unlike videopupillometry. Future research requires tool design centered on domains of observation adapted to this very specific population.
Published: 2019

35. Limitation et arrêt des thérapeutiques en situation aiguë. Quel rôle pour le médecin anesthésiste-réanimateur dans une décision d’abstention d’un acte chirurgical urgent ?

Author: Matthieu Le Dorze, Vianney Mourman, Elodie Brunel, Benoît Veber, Arié Attias, Frédérique Claudot, Valérie Gateau, Marc Gentili, Caroline Guibet Lafaye, Stanislas Kandelman, Florence Lallemant, Anne Le Boudec, Fabrice Michel, Pierre-François Perrigault, Florence Plantet, Emmanuel Samain, Benoit Veber, Gerald Viquesnel, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Henri Mondor, Mathématiques Appliquées Paris 5 (MAP5 - UMR 8145), Université Paris Descartes - Paris 5 (UPD5)-Institut National des Sciences Mathématiques et de leurs Interactions (INSMI)-Centre National de la Recherche Scientifique (CNRS), Service de Médecine légale et de Droit de la Santé, Faculté de Médecine [Nancy], Université de Lorraine (UL)-Université de Lorraine (UL), Institut Curie, Direction de la recherche clinique et de l'enseignement, Institut Curie [Paris], Centre Maurice Halbwachs (CMH), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Beaujon [AP-HP], Réanimation Pédiatrique et Néonatale, Centre Hospitalier Universitaire Nord, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Henri Mondor [Créteil], École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS)-Département de Sciences sociales ENS-PSL, École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Hôpital Lariboisière, Institut Curie, École normale supérieure - Paris (ENS Paris)-École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Beaujon, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), and Service de réanimation médicale [Rouen]
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, [SDV]Life Sciences [q-bio], 030212 general & internal medicine, 030204 cardiovascular system & hematology, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2018

36. Deep brain stimulation is effective in pediatric patients with GNAO1 associated severe hyperkinesia

Author: Philippe Coubes, Friederike Körber, Laura Cif, Victoria Gonzalez, Claude Cances, Caroline Nava, Julien Baleine, Pierre-François Perrigault, Nathalie Dorison, Agathe Roubertie, Thomas Roujeau, Frédéric Greco, Sebahattin Cirak, Diane Doummar, Christophe Béroud, Cyril Mignot, Christophe Milési, Gilles Cambonie, Stephan Waltz, Mohammad Maarouf, Anne Koy, Burkhard Stüve, Kerstin Becker, Alain Boularan, CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de génétique médicale [Hôpital de la Timone - APHM], Institut National de la Santé et de la Recherche Médicale (INSERM)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, 0301 basic medicine, Pediatrics, medicine.medical_specialty, Deep brain stimulation, Movement disorders, Hyperkinetic movement disorder, medicine.medical_treatment, Choreoathetosis, GTP-Binding Protein alpha Subunits, Gi-Go, Hyperkinesis, Globus Pallidus, GNAO1, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Missense mutation, Child, Children, Dystonia, Splice site mutation, business.industry, Infant, medicine.disease, 3. Good health, Treatment Outcome, 030104 developmental biology, Neurology, [SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics, Child, Preschool, Mutation, Female, Neurology (clinical), medicine.symptom, Hyperkinesia, business, 030217 neurology & neurosurgery
Abstract: International audience; Background: Exacerbation of hyperkinesia is a life-threatening complication of dyskinetic movement disorders, which can lead to multi-organ failure and even to death. GNAO1 has been recently identified to be involved in the pathogenesis of early infantile epileptic encephalopathy and movement disorders. Patients with GNAO1 mutations can present with a severe, progressive hyperkinetic movement disorder with prolonged life-threatening exacerbations, which are refractory to most anti-dystonic medication. Objective: The objective was to investigate the evolution of symptoms and the response to deep brain stimulation of the globus pallidus internus (GPi-DBS) in patients with different GNAO1 mutations. Methods: We report six patients presenting with global motor retardation, reduced muscle tone and recurrent episodes of severe, life-threatening hyperkinesia with dystonia, choreoathetosis, and ballism since early childhood. Five of them underwent GPi-DBS. Results: The genetic workup revealed mutations in GNAO1 for all six patients. These encompass a new splice site mutation (c.723 + 1G > T) in patient 1, a new missense mutation (c.610G > C; p.Gly204Arg) in patient 2, a heterozygous mutation (c.625 > T; p.Arg209Cys) in patients 3 and 4, and a heterozygous mutation (c.709G > A; p.Glu237Lys) in patients 5 and 6. By intervention with GPi-DBS the severe paroxysmal hyperkinetic exacerbations could be stopped in five patients. One patient is still under evaluation for neuromodulation. Conclusion In complex movement disorders of unsolved etiology clinical WES can rapidly streamline pathogenic genes. We identified two novel GNAO1 mutations. GPi-DBS can be an effective and life-saving treatment option for patients with GNAO1 mutations and has to be considered early.
Published: 2018

37. Impact of echinocandin on prognosis of proven invasive candidiasis in ICU: a post-hoc causal inference model using the AMARCAND2 study

Author: Olivier Lortholary, Demory, Gouin, Tellier, Saliba, Cabaret, Karoubi, Diconne, Houissa, Carpentier, Hraiech, Mateu, Bretonnière, Cousson, Zogheib, Cinotti, Montcriol, Gally, Gette, Quinart, Lamhaut, Bonadona, Argaud, Jean-Pierre Gangneux, Angel, Thevenot, Ruiz, Van Grunderbeek, Chabanne, Ammenouche, Merle, Kherchache, Mira, Constantin, Guelon, Schmitt, Lepape, Brocas, Luyt, Elie Azoulay, Jung, Megarbane, Dubost, Grossmith, Gaudard, Hssain Aait, Kaidomar, Mootien, Perrigault, Badetti, Lemaire, Brua, Roquilly, Sejourne, Blasco, Allaouchiche, Bruder, Quintard, Seguin, Brunin, Lesieur, Wiramus, Lambiotte, Mahul, Vincent, Cerf, Delpierre, Tonnelier, Didier Guillemot, Bastien, Cheval, Dumenil, Mahe, Jean-Paul Mira, Plantefeve, Geffe, Guerin-Robardey, Navellou, Bollaert, Charles, Hervé Dupont, Lepoivre, Durand, D. du Cheyron, Forel, Jean-François Timsit, Gergaud, Lebreton, Baudin, Pierre-François Perrigault, Launoy, Hayl-Slayman, Baldesi, Foucher-Lezla, Ichai, Jean-Michel Constantin, Olivier Leroy, Girault, Goubaux, Sébastien Bailly, Barthet, Bellec, Duroy, Lefrant, Petitpas, Hilbert, Leroy, Guervilly, Samba, Adda, Philippe Montravers, Ragonnet, Fratea, Cohen, Ouattara, Grenot, Cartier, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Chatiliez, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Amiens-Picardie, Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Service de médecine d'urgence [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pontchaillou [Rennes], Hôpital Bichat - Claude Bernard, This work was supported by a grant from MSD France. The analysis was conducted independently by the AmarCAND2 Scientific Committee., Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Centre hospitalier universitaire d'Amiens ( CHU Amiens-Picardie ), Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses ( B2PHI ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire ( CNRMA ), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris], and Jonchère, Laurent
Subjects: 0301 basic medicine, Microbiology (medical), Azoles, Male, medicine.medical_specialty, Antifungal Agents, Echinocandin, 030106 microbiology, 03 medical and health sciences, Echinocandins, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, medicine, polycyclic compounds, Humans, Candidiasis, Invasive, 030212 general & internal medicine, Prospective Studies, Aged, Candida, Septic shock, business.industry, Confounding, Candidiasis, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Invasive candidiasis, Middle Aged, medicine.disease, Prognosis, bacterial infections and mycoses, 3. Good health, Surgery, Intensive Care Units, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Infectious Diseases, Causal inference, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Female, business, Fluconazole, medicine.drug
Abstract: International audience; Objective: guidelines recommend first-line systemic antifungal therapy (SAT) with echinocandins in invasive candidiasis (IC), especially in critically ill patients. This study aimed at assessing the impact of echinocandins compared to azoles as initial SAT on the 28-day prognosis in adult ICU patients.Methods: From the prospective multicenter AmarCAND2 cohort (835 patients), we selected those with documented IC and treated with echinocandins (ECH) or azoles (AZO). The average causal effect of echinocandins on 28-day mortality was assessed using an inverse probability of treatment weight (IPTW) estimator.Results: 397 patients were selected, treated with echinocandins (242 patients, 61%) or azoles (155 patients, 39%); septic shock: 179 patients (45%). The median SAPSII was higher in the ECH group (48 [35; 62] vs. 43 [31; 58], p = 0.01). Crude mortality was 34% (ECH group) vs. 25% (AZO group). After adjustment on baseline confounders, no significant association emerged between initial SAT with echinocandins and 28-day mortality (HR: 0.95; 95% CI: [0.60; 1.49]; p = 0.82). However, echinocandin tended to benefit patients with septic shock (HR: 0.46 [0.19; 1.07]; p = 0.07).Conclusion: Patients who received echinocandins were more severely ill. Echinocandin use was associated with a non-significant 7% decrease of 28-day mortality and a trend to a beneficial effect for patient with septic shock.
Published: 2017

38. Antifungal therapy for patients with proven or suspected Candida peritonitis: Amarcand2, a prospective cohort study in French intensive care units

Author: Alexandre Ouattara, Lionel Lamhaut, Olivier Leroy, F. Thevenot, B. Goubaux, Franck Petitpas, Elie Azoulay, Cédric Bretonnière, P. Geffe, Jean-Marie Forel, Joel Cousson, G. Brunin, F. Bellec, Yves Cohen, A. Kherchache, C. Sejourne, R. Grenot, Bruno Mégarbane, A.L. Foucher-Lezla, Philippe Karoubi, M.C. Barthet, E. Duroy, Jean-Michel Constantin, S. Brua, F. Lebreton, Philippe Mateu, Anne Charlotte Tellier, Jean-Paul Mira, Didier Guillemot, T. Lepoivre, D. Guelon, Didier Demory, A.M. Guerin-Robardey, Elie Zogheib, D. Hayl-Slayman, Bernard Allaouchiche, Gilles Blasco, Pierre-François Perrigault, Bruno Levy, D. du Cheyron, Alain Lepape, J. F. Timsit, Nicolas Bruder, Michel Durand, N. Van Grunderbeek, Jean-Pierre Gangneux, H. Houissa, J.F. Vincent, E. Diconne, O. Lortholary, B Ragonnet, Christophe Lemaire, E. Brocas, Olivier Baldesi, E. Delpierre, Sébastien Bailly, J. Ruiz, Philippe Montravers, Hervé Dupont, Anne-Sylvie Dumenil, Olivier Lesieur, Agnès Bonadona, P. Cabaret, Philippe Gaudard, Ambroise Montcriol, P. Ichai, Z. Schmitt, C. Bensoussan, P. Gouin, Laurent Argaud, C. Dubost, Florent Baudin, Sami Hraiech, Christophe Guervilly, Pierre-Emmanuel Charles, Fabien Lambiotte, S. Gette, N. Ammenouche, M. Adda, Jean-Marie Tonnelier, D. Samba, Russel Chabanne, Pierre-Joachim Mahe, B. Page, P. Mahul, Dorothée Carpentier, Philippe Seguin, C. Badetti, J. Gally, Jean-Charles Cartier, Christophe Girault, S. Fratea, G. Angel, Olivier Bastien, Raphaël Cinotti, Charles-Edouard Luyt, Soizic Gergaud, Boris Jung, G. Grossmith, F. Saliba, Antoine Roquilly, C. Cheval, J.Y. Lefrant, A. Launoy, A. Aait Hssain, Gilles Hilbert, Sandrine Wiramus, Pierre-Edouard Bollaert, Hervé Quintard, Gaëtan Plantefève, Jean-Christophe Navellou, M. Kaidomar, A. Quinart, Charles Cerf, J.C. Merle, Y. Mootien, Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-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), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université Paris Diderot - Paris 7 (UPD7), Hôpital Cochin [AP-HP], Université Paris Descartes - Paris 5 (UPD5), Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris], Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Hôpital Chatiliez, Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CHU Clermont-Ferrand, CHU Amiens-Picardie, Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Université Paris Diderot - Paris 7 ( UPD7 ), CHU Cochin [AP-HP], Université Paris Descartes - Paris 5 ( UPD5 ), Centre d'infectiologie Necker-Pasteur, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire ( CNRMA ), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses ( B2PHI ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris], and Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)
Subjects: 0301 basic medicine, Comorbidity, Severity of Illness Index, 0302 clinical medicine, Critically ill patients, Risk Factors, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Peritonitis score, Odds Ratio, Prospective Studies, 030212 general & internal medicine, Simplified Acute Physiology Score, Prospective cohort study, Candida, biology, Candidiasis, General Medicine, Middle Aged, 3. Good health, Invasive candidiasis, Intensive Care Units, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Treatment Outcome, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, SAPS II, France, medicine.drug, Microbiology (medical), medicine.medical_specialty, Echinocandin, 030106 microbiology, Peritonitis, Empiric antifungal therapy, 03 medical and health sciences, Candida score, Internal medicine, Intensive care, medicine, Humans, Targeted antifungal therapy, Antifungal agents, Aged, Candida glabrata, business.industry, biology.organism_classification, medicine.disease, Surgery, Candida peritonitis, ROC Curve, business, Fluconazole
Abstract: International audience; OBJECTIVE:The clinical characteristics and prognosis of patients treated for Candida peritonitis (CP) were compared according to the type of systemic antifungal therapy (SAT), empiric (EAF) or targeted (TAF) therapies, and the final diagnosis of infection.METHODS:Patients in intensive care units (ICU) treated for CP were selected among the AmarCAND2 cohort, to compare patients receiving EAF for unconfirmed suspicion of CP (EAF/nonCP), to those with suspected secondarily confirmed CP (EAF/CP), or with primarily proven CP receiving TAF.RESULTS:In all, 279 patients were evaluated (43.4% EAF/nonCP, 29.7% EAF/CP and 25.8% TAF patients). At SAT initiation, the severity of illness was similar among EAF/nonCP and EAF/CP patients, lower among TAF patients (median Simplified Acute Physiology Score II (SAPS II) 49 and 51 versus 35, respectively; p 0.001). Candida albicans was involved in 67%, Candida glabrata in 15.6%. All strains were susceptible to echinocandin; 84% to fluconazole. Echinocandin was administered to 51.2% EAF/nonCP, 49% EAF/CP and 40% TAF patients. At day 28, 72%, 76% and 75% of EAF/nonCP, EAF/CP and TAF patients, respectively, were alive. An increased mortality was observed in patients with a Sequential Organ Failure Assessment (SOFA) score
Published: 2017

39. Les USC et la médecine périopératoire

Author: Marc Beaussier, Francis Bonnet, Claude Ecoffey, Xavier Capdevila, Laurent Heyer, Sébastien Kerever, Pierre-François Perrigault, and Marc Leone
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, business.industry, Medicine, 030208 emergency & critical care medicine, 030212 general & internal medicine, business
Published: 2018

40. Systemic antifungal therapy for proven or suspected invasive candidiasis: the AmarCAND 2 study

Author: Patrick Devos, Caroline Bensoussan, Elie Azoulay, Didier Guillemot, Philippe Montravers, Hervé Dupont, Jean-Michel Constantin, Jean-Pierre Gangneux, Jean-Paul Mira, Pierre-François Perrigault, Olivier Leroy, Jean-François Timsit, Sébastien Bailly, Olivier Lortholary, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Département de biostatistiques, Université de Lille, Droit et Santé, CHU Amiens-Picardie, Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-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), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Pharmacoépidémiologie et maladies infectieuses (PhEMI), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Raymond Poincaré [AP-HP], Hopital Saint-Louis [AP-HP] (AP-HP), Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Soins Intensifs et de Maladies Infectieuses, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Hospitalier Tourcoing, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hôpital Cochin [AP-HP], CHU Lille, AP-HP - Hôpital Bichat - Claude Bernard [Paris], CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Clermont-Ferrand, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), MSD France, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Institut d'oncologie/développement Albert Bonniot de Grenoble ( INSERM U823 ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de recherche, santé, environnement et travail ( Irset ), Université d'Angers ( UA ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -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 ) -Université des Antilles ( UA ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ), Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Pharmacoépidémiologie et maladies infectieuses ( PhEMI ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), AP-HP Hôpital Raymond Poincaré [Garches], Hopital Saint Louis Paris, CHU Saint Louis [APHP], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ), and Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]
Subjects: 0301 basic medicine, Pediatrics, medicine.medical_specialty, [SDV]Life Sciences [q-bio], 030106 microbiology, Population, Context (language use), Critical Care and Intensive Care Medicine, 03 medical and health sciences, Candidaemia, Internal medicine, Intensive care, medicine, Critically ill, education, Candida, education.field_of_study, [ SDV ] Life Sciences [q-bio], Septic shock, business.industry, Research, Mortality rate, Candidiasis, Odds ratio, medicine.disease, 3. Good health, SAPS II, Cohort study, business, Fluconazole, medicine.drug
Abstract: Background In the context of recent guidelines on invasive candidiasis (IC), how French intensive care units (ICUs) are managing IC? Methods This is a prospective observational multicenter cohort study. During 1 year (2012–2013), 87 French ICUs enrolled consecutive patients with suspected or proven IC (SIC or PIC) and receiving systemic antifungal therapy (SAT). Data were collected up to 28 days after inclusion. Results We studied 835 patients, 291 with PIC and 544 with SIC. At SAT initiation, patients with SIC were significantly more severe (SAPS II 50.1 ± 18.7 vs. 46.2 ± 18.0). Severe sepsis or septic shock prompted to initiate empiric SAT in 70 % of SIC. Within 4 days in median, the initial SAT was modified in 49 % of patients with PIC vs. 33 % patients with SIC. Modifications were most often motivated by mycological results, and de-escalation was the most frequent change. Regarding compliance to IC management guidelines, echinocandin was used for 182 (62.5 %) patients with PIC, and 287 (52.7 %) of those with SIC; central venous catheter was removed in 87 (54.3 %) of patients with candidaemia, and 43 of the remaining patients received echinocandin; and de-escalation was undertaken after 5 days of SAT in 142 patients, after 10 days in 13 patients. As 20.6 % of SIC were secondarily documented, 403/835 (48 %) patients had finally a proven IC. Candida albicans was the main pathogen (65.3 %), then Candida glabrata (15.9 %). The 28-day mortality rates were 40.0 % in candidaemia, 25.4 % in cIAI, and 26.7 % in deep-seated candidiasis. In the overall population of patients with proven IC, four independent prognostic factors were identified: immunosuppression (Odds Ratio (OR) = 1.977: 1.03–3.794 95 % confidence interval (CI), p = 0.04), age (OR = 1.035; 1.017–1.053 95 % CI; p 46 on ICU admission (OR = 2.894; 1.81–4.626 95 % CI; p
Published: 2016

41. MOESM1 of Systemic antifungal therapy for proven or suspected invasive candidiasis: the AmarCAND 2 study

Author: Leroy, Olivier, Bailly, Sébastien, Gangneux, Jean-Pierre, Mira, Jean-Paul, Devos, Patrick, Dupont, Hervé, Montravers, Philippe, Pierre-François Perrigault, Jean-Michel Constantin, Guillemot, Didier, Azoulay, Elie, Lortholary, Olivier, Bensoussan, Caroline, and Jean-François Timsit
Abstract: Additional file 1. Table E1. Characteristics of patients with proven and suspected invasive candidiasis at ICU admission. Table E2. Rate of proven versus suspected invasive candidiasis enrolled by center according to center characteristics. Table E3. Among the 544 ICU patients with SAT for suspicion of invasive candidiasis, characteristics of patient reported as having triggered the decision to initiate a systemic antifungal therapy. Table E4. Factors in favor of the prescription of echinocandin agent at SAT initiation (multivariate analysis). Table E5. Comparison of patients with initially vs. ultimately proven invasive candidiasis. Table E6. Comparison of patients with invasive candidiasis vs. without invasive candidiasis.
Published: 2016
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42. Antifungal de-escalation was not associated with adverse outcome in critically ill patients treated for invasive candidiasis: post hoc analyses of the AmarCAND2 study data

Author: Elie Azoulay, Sébastien Bailly, Jean-François Timsit, Olivier Lortholary, Olivier Leroy, Jean-Pierre Gangneux, Pierre-François Perrigault, Didier Guillemot, Philippe Montravers, Jean-Paul Mira, Jean-Michel Constantin, Hervé Dupont, Université Joseph Fourier - Grenoble 1 (UJF), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Chatiliez, Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-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), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Amiens-Picardie, Pharmacoépidémiologie et maladies infectieuses (PhEMI), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation polyvalente, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hôpital Saint-Louis, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Bichat - Claude Bernard, 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 Diderot - Paris 7 (UPD7), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Centre hospitalier universitaire d'Amiens (CHU Amiens-Picardie), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 (UPD5), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Joseph Fourier - Grenoble 1 ( UJF ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Centre hospitalier universitaire d'Amiens ( CHU Amiens-Picardie ), Pharmacoépidémiologie et maladies infectieuses ( PhEMI ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire ( CNRMA ), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], and Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 )
Subjects: Male, medicine.medical_specialty, Antifungal Agents, Critical Illness, [SDV]Life Sciences [q-bio], Observation, Comorbidity, Critical Care and Intensive Care Medicine, Severity of Illness Index, Time-to-Treatment, law.invention, Echinocandins, law, Anesthesiology, Internal medicine, Severity of illness, Humans, Multicenter Studies as Topic, Medicine, Candidiasis, Invasive, Hospital Mortality, Prospective Studies, Prospective cohort study, Intensive care medicine, Fluconazole, Survival analysis, Aged, [ SDV ] Life Sciences [q-bio], business.industry, Middle Aged, medicine.disease, Survival Analysis, Intensive care unit, 3. Good health, Intensive Care Units, Logistic Models, Outcome and Process Assessment, Health Care, Disease Progression, Female, France, business, De-escalation, medicine.drug
Abstract: International audience; PURPOSE: Systemic antifungal therapy (SAT) of invasive candidiasis needs to be initiated immediately upon clinical suspicion. Controversies exist about adequate time and potential harm of antifungal de-escalation (DE) in documented and suspected candidiasis in ICU patients. Our objective was to investigate whether de-escalation within 5 days of antifungal initiation is associated with an increase of the 28-day mortality in SAT-treated non-neutropenic adult ICU patients. METHODS: From the 835 non-neutropenic adults recruited in the multicenter prospective observational AmarCAND2 study, we selected the patients receiving systemic antifungal therapy for a documented or suspected invasive candidiasis in the ICU and who were still alive 5 days after SAT initiation. They were included into two groups according to the occurrence of observed SAT de-escalation before day 6. The average causal SAT de-escalation effect on 28-day mortality was evaluated by using a double robust estimation. RESULTS: Among the 647 included patients, early de-escalation at day 5 after antifungal initiation occurred in 142 patients (22 %), including 48 (34 %) patients whose SAT was stopped before day 6. After adjustment for the baseline confounders, early SAT de-escalation was the solely factor not associated with increased 28-day mortality (RR 1.12, 95 % CI 0.76-1.66). CONCLUSION: In non-neutropenic critically ill adult patients with documented or suspected invasive candidiasis, SAT de-escalation within 5 days was not related to increased day-28 mortality but it was associated with decreased SAT consumption. These results suggest for the first time that SAT de-escalation may be safe in these patients
Published: 2015

43. Polyarteritis Nodosa Associated with Essential Mixed Cryglobulinemia Revealed by Subarachnoid Hemorrhage

Author: Guillaume Taieb, Alain Bonafe, Pierre-François Perrigault, Benjamin Conte, Pierre Labauge, Valérie Rigau, Mathieu Briere, and Dimitri Renard
Subjects: Male, Pathology, medicine.medical_specialty, Subarachnoid hemorrhage, Cyclophosphamide, Polyarteritis nodosa, business.industry, Posterior reversible encephalopathy syndrome, General Medicine, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Pathophysiology, Polyarteritis Nodosa, Cryoglobulin, Cryoglobulinemia, hemic and lymphatic diseases, Necrotizing Vasculitis, Internal Medicine, medicine, Humans, business, Vasculitis, medicine.drug
Abstract: Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis mediated by intravascular deposition of immune complexes. We report a 55-year-old man with PAN revealed by CNS vasculitis with subarachnoid hemorrhage and brainstem vasogenic oedema, associated with essential mixed cryoglobulinemia. In spite of aggressive treatment (steroids and cyclophosphamide), the patient became tetraplegic. A pathophysiological relationship between cryoglobulin and PAN can be suspected. Mixed cryoglobulinemia may trigger vasculitis with PAN features, possibly explaining the lack of treatment response.
Published: 2011

44. Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia

Author: Jean-Jacques Eledjam, Samir Jaber, Mustapha Sebbane, Daniel Verzilli, Boris Jung, Pierre-François Perrigault, Patricia Courouble, Gerald Chanques, and Hélène Jean-Pierre
Subjects: Male, medicine.medical_specialty, Concordance, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, Hospitals, University, Predictive Value of Tests, law, Internal medicine, Intensive care, Anesthesiology, Gram-Negative Bacteria, medicine, Humans, Intensive care medicine, Aged, Retrospective Studies, Mechanical ventilation, business.industry, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Retrospective cohort study, Middle Aged, medicine.disease, Intensive care unit, Anti-Bacterial Agents, respiratory tract diseases, Gram-Positive Cocci, Trachea, Intensive Care Units, Pneumonia, Female, business, Bronchoalveolar Lavage Fluid
Abstract: Any delay in adequate antibiotic treatment compromises the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. We assessed the potential impact of using results of routine weekly endotracheal aspirate (EA) cultures to guide initial antibiotic treatment for VAP. Retrospective analysis of prospectively collected data in a medical–surgical intensive care unit (ICU) of a university hospital. We studied 113 VAP episodes and evaluated the concordance between the latest EA and the broncho-alveolar lavage (BAL). We stratified patients into three groups: concordant EA–BAL (concordant group), discordant EA–BAL (discordant group) and EA not performed group. We then compared the adequacy of the antibiotic prescribed initially and outcomes between the three groups. Ninety assessable EA–BAL samples were evaluated. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior (P
Published: 2008

45. Successful rescue thrombolysis in massive pulmonary embolism with intracerebral hemorrhage

Author: Alain Boularan, Frédéric Greco, Pierre-François Perrigault, Audrey De Jong, and Kifah Khouri
Subjects: Intracerebral hemorrhage, medicine.medical_specialty, business.industry, medicine.medical_treatment, MEDLINE, General Medicine, Thrombolysis, medicine.disease, Intensive care unit, Surgery, Pulmonary embolism, law.invention, Aneurysm clipping, law, cardiovascular system, medicine, Compassionate Treatment, Cerebral Bleeding, business
Abstract: We report the case of a man with a massive pulmonary embolism, which lead to cardiac arrest. After ruptured aneurysm clipping, he was successfully treated by rescue thrombolysis administered as compassionate treatment despite the risk of cerebral bleeding. The patient was discharged from the intensive care unit; his initial neurological, cardiac, and pulmonary conditions restored. In case of life-threatening pulmonary embolism, the risk-benefit ratio of thrombolysis therapy should be systematically evaluated and the decision adapted to each patient.
Published: 2015

46. Suspicion de péritonite à Candida dans l’étude AMARCAND II : peut-on prédire les patients qui vont avoir une culture positive ?

Author: Jean-Paul Mira, Olivier Leroy, Jean-Michel Constantin, Hervé Dupont, Philippe Montravers, Elie Azoulay, Jean-François Timsit, Jean-Pierre Gangneux, Pierre-François Perrigault, Olivier Lortholary, CHU Amiens-Picardie, Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-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), Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hopital Saint-Louis [AP-HP] (AP-HP), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Unité de Soins Intensifs et de Maladies Infectieuses, 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 Diderot - Paris 7 (UPD7), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-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 ), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Jonchère, Laurent, Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Institut de recherche, santé, environnement et travail ( Irset ), Université d'Angers ( UA ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -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 ) -Université des Antilles ( UA ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Hopital Saint Louis Paris, CHU Saint Louis [APHP], Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut Cochin ( UM3 (UMR 8104 / U1016) ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ), and Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]
Subjects: [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, [ SDV ] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], 3. Good health
Abstract: National audience; Introduction Les péritonites secondaires à levures représentent une part importante des candidoses profondes et de leur traitement. Peu d’outils sont disponibles afin de prédire au mieux les patients susceptible d’avoir une culture du liquide péritonéal positive. L’étude AMARCAND II (10/202–09/2013) a analysé les patients de réanimation recevant un traitement antifongique pour un candidose invasive prouvée ou suspectée. L’analyse des patients ayant un traitement probabiliste pour péritonite à levure suspectée est présentée ici. Patients et méthodes Cent soixante-douze patients parmi les 835 inclus ont été analysés. Les patients ayant une documentation mycologique (groupe D) ont été comparés à ceux ayant une culture à levure négative (groupe ND). La performance du Candida score [1] et du Peritonitis score [2] ont été évalués dans cette population de candidose profonde suspectée. Résultats Parmi les 172 patients, 51 ont eu une péritonite documentée à levure et 121 un culture à levure négative. Les caractéristiques des groupes sont présentées dans le Tableau 1. L’AUC du Peritonitis score était de 0,63 [0,54–0,72] contre 0,40 [0,31–0,49] pour le Candida score, p = 0,005. Pour un Peritonitis score ≥ 3, la sensibilité était de 39,2 %, la spécificité de 81,8 %, la VPP de 47,6 % et la VPN de 76,2 %. Le Candida score ne permettait pas de classer les patients atteints de péritonite à levure. Discussion Peu d’éléments permettent de différencier les patients qui vont avoir une infection documentée des autres. La localisation sus-mésocolique de l’infection et l’antibiothérapie de plus de 48 heures sont les éléments les plus fiables retrouvés. Le Peritonitis score reste intéressant dans ce contexte mais le Candida score n’a aucune utilité
Published: 2015

47. Outcomes of Patients With Acute Respiratory Failure After Abdominal Surgery Treated With Noninvasive Positive Pressure Ventilation

Author: Jean-Jacques Eledjam, Gerald Chanques, Jean-Marc Delay, Eric Jacquet, Pierre-François Perrigault, Samir Jaber, Mustapha Sebbane, and Bruno Souche
Subjects: Male, Pulmonary and Respiratory Medicine, Artificial ventilation, Respiratory rate, medicine.medical_treatment, Pressure support ventilation, Critical Care and Intensive Care Medicine, Positive-Pressure Respiration, Pulmonary Disease, Chronic Obstructive, Postoperative Complications, Neoplasms, Fraction of inspired oxygen, Abdomen, Humans, Medicine, Prospective Studies, Continuous positive airway pressure, Digestive System Surgical Procedures, Mechanical ventilation, business.industry, Middle Aged, Treatment Outcome, Respiratory failure, Anesthesia, Acute Disease, Female, Intubation, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, business, Abdominal surgery
Abstract: Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation (NPPV) in patients who have acute respiratory failure (ARF) after abdominal surgery. We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery.We prospectively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital. We documented demographic and diagnostic data, gas exchange, and clinical outcomes. We compared patients who were not intubated to those who were intubated after a trial of NPPV.Of 72 patients with ARF after abdominal surgery who were treated with NPPV, 48 patients avoided intubation (67%). Patients in the intubated and nonintubated groups had similar demographic characteristics, and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission. The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen (Fi(O2)) ratio (123 +/- 62 mm Hg vs 194 +/- 76 mm Hg, p0.01) and more extended bilateral alveolar infiltrates (67% vs 31%, p0.01) than the non-intubated group. Within the first NPPV observation period, the Pa(O2)/Fi(O2) increased (+ 36 +/- 29% [+/- SD], p = 0.04) and the respiratory rate decreased (28.2 +/- 3.4 breaths/min vs 23.1 +/- 3.8 breaths/min, p0.01) significantly only in the non-intubated group. The non-intubated group had significantly lower length of ICU stay (17.3 +/- 10.9 days vs 34.1 +/- 28.5 days, p0.01) and mortality rate (6% vs 29%, p0.01).NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support.
Published: 2005

48. A Prospective Study of Agitation in a Medical-Surgical ICU

Author: Claire Altairac, Samir Jaber, Jean-Jacques Eledjam, Mustapha Sebbane, Gerald Chanques, Pierre-François Perrigault, and Christine Vergne
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Psychomotor agitation, business.industry, Sedation, Incidence (epidemiology), Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, law, Anesthesia, Emergency medicine, medicine, Delirium, medicine.symptom, Risk factor, Simplified Acute Physiology Score, Cardiology and Cardiovascular Medicine, business, Prospective cohort study
Abstract: Study objectives Although agitation is thought to be common in the ICU, it has been poorly studied. We evaluated the incidence, risks factors, and outcomes of agitation in ICU. Design Prospective observational study. Interventions None. Method All consecutive ICU admissions over an 8-month period were analyzed. Measurements and results Two hundred eleven patients were admitted a total of 216 times during the period of the study. Twenty-nine patients were excluded from the study because their pathology findings did not allow an evaluation of their level of consciousness; 182 patients were actually enrolled. Agitation developed in 95 of 182 patients (52%). Agitation began 4.4 ± 5.6 days (± SD) after admission to the ICU and lasted 3.9 ± 4.1 days. Patients with agitation had a higher Simplified Acute Physiology Score II on ICU admission than those who did not have agitation (40 ± 16 vs 33 ± 13, p Conclusions Agitation is a common event in a mixed medical-surgical ICU. It is associated with adverse outcomes including prolonged stay, nosocomial infections, and unplanned extubations. A better knowledge of incidence and risk factors should facilitate identification of patients at risk and decrease the incidence of agitation.
Published: 2005

49. Post-extubation stridor in intensive care unit patients

Author: Samir Jaber, Michèle Ramonatxo, Bruno Souche, Stefan Matecki, Jean-Jacques Eledjam, Gerald Chanques, Christine Vergne, and Pierre-François Perrigault
Subjects: Male, Manometry, medicine.medical_treatment, Stridor, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Statistics, Nonparametric, law.invention, Risk Factors, law, Intensive care, Intubation, Intratracheal, Humans, Medicine, Intubation, Prospective Studies, Respiratory sounds, Simplified Acute Physiology Score, Respiratory Sounds, medicine.diagnostic_test, business.industry, Laryngeal Edema, Middle Aged, Intensive care unit, Airway Obstruction, Intensive Care Units, ROC Curve, SAPS II, Anesthesia, Cuff, Female, France, medicine.symptom, business
Abstract: Objective. To evaluate the incidence and identify factors associated with the occurrence of post-extubation stridor and to evaluate the performance of the cuff-leak test in detecting this complication. Design. Prospective, clinical investigation. Setting. Intensive care unit of a university hospital. Patients. Hundred twelve extubations were analyzed in 112 patients during a 14-month period. Intervention. A cuff-leak test before each extubation. Measurements and results.The incidence of stridor was 12%. When we chose the thresholds of 130 ml and 12% to quantify the cuff-leak volume, the sensitivity and the specificity of the test were, respectively, 85% and 95%. The patients who developed stridor had a cuff leak significantly lower than the others, expressed in absolute values (372±170 vs 59±92 ml, p
Published: 2003

50. Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy

Author: Carlos Riquelme, Igor Lima Maldonado, Vincent Costalat, Jean François Vendrell, Kyriakos Lobotesis, Alain Bonafe, Chérif Heroum, Caroline Arquizan, Pierre-François Perrigault, D. Milhaud, Isabelle Mourand, and Paolo Machi
Subjects: Male, medicine.medical_specialty, Solitaire Cryptographic Algorithm, Middle Cerebral Artery, medicine.medical_treatment, Cardiology, Single Center, Brain Ischemia, medicine, Humans, Prospective Studies, Prospective cohort study, Stroke, Aged, Thrombectomy, Advanced and Specialized Nursing, Vascular disease, business.industry, Cerebral infarction, Fibrinolysis, Angiography, Stent, Thrombolysis, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Surgery, Treatment Outcome, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed, Carotid Artery, Internal
Abstract: Background and Purpose— Large vessel occlusion in ischemic stroke is associated with a high degree of morbidity. When intravenous thrombolysis fails, mechanical thrombectomy can provide an alternative and synergistic method for flow restoration. In this study we evaluate the safety and efficacy of our stroke management protocol (RECOST study). Methods— Fifty consecutive ischemic stroke patients with large vessel occlusion were included. After clinical and MRI imaging assessment, 3 treatment strategies were selected according to time of symptom onset and location of vessel occlusion: rescue therapy; combined therapy; and stand-alone thrombectomy (RECOST study). MRI ASPECT score Results— Mean patient age was 67.6 years, mean NIHSS score was 14.7, and mean ASPECT score was 6 on presentation. Vessel occlusions were in the middle cerebral artery (40%), the internal carotid artery (28%), and the basilar artery (32%). Rescue treatment represented 24%, combined therapy represented 56%, and stand-alone thrombectomy represented 20%. Mean recanalization time from symptoms onset was 377 minutes, with overall recanalization rate TICI 3 of 84%. NIHSS score at discharge was 6.5, with 60% of patients demonstrating NIHSS score 0 to 1 or an improvement of >9 points. Symptomatic complication rate was 10%. At 3 months, 54% of patients had a modififed Rankin scale score of 0 to 2, with an overall mortality rate of 12%. Conclusions— The present integrated stroke management protocol (RECOST study) demonstrated rapid, safe, and effective recanalization. We postulate that the Solitaire device contributed to high recanalization and patient selection using MRI ASPECT score to low and complication rates, therefore avoiding futile and dangerous interventions.
Published: 2011

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