262 results on '"Yazine Mahjoub"'
Search Results
2. Norepinephrine weaning guided by the Hypotension Prediction Index in vasoplegic shock after cardiac surgery: protocol for a single-centre, open-label randomised controlled trial – the NORAHPI study
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Osama Abou-Arab, Christophe Beyls, Yazine Mahjoub, Jonathan Meynier, Thomas Lefebvre, Nicolas Mollet, and Annabelle Boussault
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Medicine - Abstract
Introduction Norepinephrine (NE) is the first-line recommended vasopressor for restoring mean arterial pressure (MAP) in vasoplegic syndrome (vs) following cardiac surgery with cardiopulmonary bypass. However, solely focusing on target MAP values can lead to acute hypotension episodes during NE weaning. The Hypotension Prediction Index (HPI) is a machine learning algorithm embedded in the Acumen IQ device, capable of detecting hypotensive episodes before their clinical manifestation. This study evaluates the clinical benefits of an NE weaning strategy guided by the HPI.Material and analysis The Norahpi trial is a prospective, open-label, single-centre study that randomises 142 patients. Inclusion criteria encompass adult patients scheduled for on-pump cardiac surgery with postsurgical NE administration for vs patient randomisation occurs once they achieve haemodynamic stability (MAP>65 mm Hg) for at least 4 hours on NE. Patients will be allocated to the intervention group (n=71) or the control group (n=71). In the intervention group, the NE weaning protocol is based on MAP>65 mmHg and HPI65 mm Hg in the control group. Successful NE weaning is defined as achieving NE weaning within 72 hours of inclusion. An intention-to-treat analysis will be performed. The primary endpoint will compare the duration of NE administration between the two groups. The secondary endpoints will include the prevalence, frequency and time of arterial hypotensive events monitored by the Acumen IQ device. Additionally, we will assess cumulative diuresis, the total dose of NE, and the number of protocol weaning failures. We also aim to evaluate the occurrence of postoperative complications, the length of stay and all-cause mortality at 30 days.Ethics and dissemination Ethical approval has been secured from the Institutional Review Board (IRB) at the University Hospital of Amiens (IRB-ID:2023-A01058-37). The findings will be shared through peer-reviewed publications and presentations at national and international conferences.Trial registration number NCT05922982.
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- 2024
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3. Left atrial strain: an operator and software-dependent tool
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Christophe Beyls, Osama Abou-Arab, and Yazine Mahjoub
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2024
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4. Comparison of landiolol and amiodarone for the treatment of new-onset atrial fibrillation after cardiac surgery (FAAC) trial: study protocol for a randomized controlled trial
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Edouard Caspersen, Pierre-Grégoire Guinot, Bertrand Rozec, Jean-Ferréol Oilleau, Jean-Luc Fellahi, Philippe Gaudard, Emmanuel Lorne, Yazine Mahjoub, Emmanuel Besnier, Mouhamed Djahoum Moussa, Nicolas Mongardon, Jean-Luc Hanouz, Anaïs R. Briant, Laure Peyro Saint Paul, Clémence Tomadesso, Jean-Jacques Parienti, Richard Descamps, Alina Denisenko, Marc-Olivier Fischer, and for the ARCOTHOVA Group
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Anti-arrhythmic drugs ,Anti-coagulation ,Amiodarone ,Atrial fibrillation ,Beta-blockers ,Cardiac surgery ,Medicine (General) ,R5-920 - Abstract
Abstract Background Postoperative atrial fibrillation (PoAF) after cardiac surgery has a high incidence of 30%, but its management is controversial. Two strategies are recommended without evidence of a superiority of one against the other: rate control with beta-blocker or rhythm control with amiodarone. Landiolol is a new-generation beta-blocker with fast onset and short half-life. One retrospective, single-center study compared landiolol to amiodarone for PoAF after cardiac surgery with a better hemodynamic stability and a higher rate of reduction to sinus rhythm with landiolol, justifying the need for a multicenter randomized controlled trial. Our aim is to compare landiolol to amiodarone in the setting of PoAF after cardiac surgery with the hypothesis of a higher rate of reduction to sinus rhythm with landiolol during the 48 h after the first episode of POAF. Methods The FAAC trial is a multicenter single-blind two parallel-arm randomized study, which planned to include 350 patients with a first episode of PoAF following cardiac surgery. The duration of the study is 2 years. The patients are randomized in two arms: a landiolol group and an amiodarone group. Randomization (Ennov Clinical®) is performed by the anesthesiologist in charge of the patient if PoAF is persistent for at least 30 min after correction of hypovolemia, dyskalemia, and absence of pericardial effusion on a transthoracic echocardiography done at bedside. Our hypothesis is an increase of the percentage of patients in sinus rhythm from 70 to 85% with landiolol in less than 48 h after onset of PoAF (alpha risk = 5%, power = 90%, bilateral test). Discussion The FAAC trial was approved by the Ethics Committee of EST III with approval number 19.05.08. The FAAC trial is the first randomized controlled trial comparing landiolol to amiodarone for PoAF after cardiac surgery. In case of higher rate of reduction with landiolol, this beta-blocker could be the drug of choice used in this context as to reduce the need for anticoagulant therapy and reduce the risk of complications of anticoagulant therapy for patients with a first episode of postoperative atrial fibrillation after cardiac surgery. Trial registration ClinicalTrials.gov NCT04223739. Registered on January 10, 2020.
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- 2023
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5. Prognostic Value of a New Right Ventricular-to-Pulmonary Artery Coupling Parameter Using Right Ventricular Longitudinal Shortening Fraction in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prospective Echocardiography Study
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Christophe Beyls, Mathilde Yakoub-Agha, Alexis Hermida, Nicolas Martin, Maxime Crombet, Thomas Hanquiez, Alexandre Fournier, Geneviève Jarry, Dorothée Malaquin, Audrey Michaud, Osama Abou-Arab, Laurent Leborgne, and Yazine Mahjoub
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right ventricular ,coupling ,longitudinal shortening fraction ,speckle tracking ,Medicine - Abstract
Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58–0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49–0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg−1 was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38–74]) for patients with RV-LSF/PASP < 0.30%.mmHg−1 and 17% (95%CI = [12–23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg−1; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg−1 was associated with MACE at 6 months.
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- 2024
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6. Commentary: Impact of COVID-19 pneumonia on pulmonary vascular volume
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Vincent Jounieaux, Daniel O. Rodenstein, and Yazine Mahjoub
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COVID-19 ,SARS-CoV-2 ,intrapulmonary shunt ,happy hypoxia ,AVDS ,pulmonary vasculature ,Medicine (General) ,R5-920 - Published
- 2023
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7. Editorial: COVID-19 related acute vascular distress syndrome: from physiopathology to treatment
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Yazine Mahjoub, Daniel Rodenstein, and Vincent Jounieaux
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COVID-19 ,SARS-CoV ,AVDS ,ARDS ,intrapulmonary shunt ,right ventricular function ,Medicine (General) ,R5-920 - Published
- 2023
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8. Early hyperoxia and 28-day mortality in patients on venoarterial ECMO support for refractory cardiogenic shock: a bicenter retrospective propensity score-weighted analysis
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Mouhamed Djahoum Moussa, Christophe Beyls, Antoine Lamer, Stefan Roksic, Francis Juthier, Guillaume Leroy, Vincent Petitgand, Natacha Rousse, Christophe Decoene, Céline Dupré, Thierry Caus, Pierre Huette, Mathieu Guilbart, Pierre-Grégoire Guinot, Patricia Besserve, Yazine Mahjoub, Hervé Dupont, Emmanuel Robin, Jonathan Meynier, André Vincentelli, and Osama Abou-Arab
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Cardiogenic shock ,ECMO ,Hyperoxia ,Mortality ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The mortality rate for a patient with a refractory cardiogenic shock on venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains high, and hyperoxia might worsen this prognosis. The objective of the present study was to evaluate the association between hyperoxia and 28-day mortality in this setting. Methods We conducted a retrospective bicenter study in two French academic centers. The study population comprised adult patients admitted for refractory cardiogenic shock. The following arterial partial pressure of oxygen (PaO2) variables were recorded for 48 h following admission: the absolute peak PaO2 (the single highest value measured during the 48 h), the mean daily peak PaO2 (the mean of each day’s peak values), the overall mean PaO2 (the mean of all values over 48 h), and the severity of hyperoxia (mild: PaO2
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- 2022
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9. Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia
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Christophe Beyls, Jeremie Vial, Thomas Lefebvre, Charlotte Muller, Thomas Hanquiez, Patricia Besserve, Mathieu Guilbart, Guillaume Haye, Michael Bernasinski, Pierre Huette, Hervé Dupont, Osama Abou-Arab, Vincent Jounieaux, and Yazine Mahjoub
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right ventricle dilatation ,AVDS ,computed tomography ,angiogram ,COVID-19 ,pneumonia ,Medicine (General) ,R5-920 - Abstract
BackgroundRight ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events.ObjectiveThe aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients.MethodsBetween February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 h of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission).ResultsAmong 181 patients, 62% (n = 112/181) presented RVD. The RV/LV ratio was 1.10 [1.05–1.18] in the RVD group and 0.88 [0.84–0.96] in the non-RVD group (p = 0.001). Adverse clinical events were 30% and identical in the two groups (p = 0.73). In Receiving operative curves (ROC) analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio = 1.70, 95% CI [1.03–2.94]; p = 0.04) and cardiovascular component (> 2) of the SOFA score (HR = 2.93, 95% CI [1.44–5.95], p = 0.003).ConclusionRight ventricle (RV) dilatation assessed by RV/LV ratio was a common CTPA finding in non-intubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events.
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- 2023
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10. Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
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Pierre Huette, Mouhamed Djahoum Moussa, Christophe Beyls, Pierre-Grégoire Guinot, Mathieu Guilbart, Patricia Besserve, Mehdi Bouhlal, Sarah Mounjid, Hervé Dupont, Yazine Mahjoub, Audrey Michaud, and Osama Abou-Arab
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Acute kidney injury ,Mortality ,Cardiac surgery ,Norepinephrine ,Propensity analysis ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery. Methods This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics. Results Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63–2.34%; P
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- 2022
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11. Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study
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Christophe Beyls, Alexis Hermida, Yohann Bohbot, Nicolas Martin, Christophe Viart, Solenne Boisgard, Camille Daumin, Pierre Huette, Hervé Dupont, Osama Abou-Arab, and Yazine Mahjoub
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Left atrial strain ,Atrial fibrillation ,COVID-19 ,Pneumonia ,Intensive care unit ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain (LAS) analysis, a marker of LA contractility, have been associated with the development of AF in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict AF in patients with severe hypoxemic COVID-19 pneumonia. We conducted a prospective single center study in Amiens University Hospital intensive care unit (ICU) (France). Adult patients with severe or critical COVID-19 pneumonia according to the World Health Organization definition and in sinus rhythm were included. Transthoracic echocardiography was performed within 48 h of ICU admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of AF during ICU stay. Results From March 2020 to February of 2021, 79 patients were included. Sixteen patients (20%) developed AF in ICU. Patients of the AF group were significantly older with a higher SAPS II score than those without AF. LAScd and LASr were significantly more impaired in the AF group compared to the other group (− 8.1 [− 6.3; − 10.9] vs. − 17.2 [− 5.0; − 10.2] %; P − 11% and 8 ± 4% with LAScd ≤ − 11% (log rank test P value
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- 2021
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12. Interchangeability of right ventricular longitudinal shortening fraction assessed by transthoracic and transoesophageal echocardiography in the perioperative setting: A prospective study
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Christophe Beyls, Pierre Huette, Paul Vangreveninge, Florent Leviel, Camille Daumin, BenAmmar Ammar, Gilles Touati, Bouzerar Roger, Thierry Caus, Hervé Dupont, Osama Abou-Arab, Diouf Momar, and Yazine Mahjoub
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right ventricular shortening fraction ,speckle tracking ,interchangeability ,right ventricle ,tricuspid ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundConventional transthoracic (TTE) and transoesophageal echocardiography (TEE) parameters assessing right ventricle (RV) systolic function are daily used assuming their clinical interchangeability. RV longitudinal shortening fraction (RV-LSF) is a two-dimensional speckle tracking parameter used to assess RV systolic function. RV-LSF is based on tricuspid annular displacement analysis and could be measured with TTE or TEE.ObjectiveThe aim of the study was to determine if RV-LSFTTE and RV-LSFTEE measurements were interchangeable in the perioperative setting.MethodsProspective perioperative TTE and TEE echocardiography were performed under general anesthesia during scheduled cardiac surgery in 90 patients. RV-LSF was measured by semi-automatic software. Comparisons were performed using Pearson correlation and Bland-Altman plots. RV-LSF clinical agreement was determined as a range of −5 to 5%.ResultsOf the 114 patients who met the inclusion criteria, 90 were included. The mean preoperative RV-LSFTTE was 20.4 ± 4.3 and 21.1 ± 4.1% for RV-LSFTEE. The agreement between RV-LSF measurements was excellent, with a bias at −0.61 and limits of agreement of −4.18 to 2.97 %. All measurements fell within the determined clinical agreement interval in the Bland-Altman plot. Linear regression analysis showed a high correlation between RV-LSFTTE and RV-LSFTEE measurement (r = 0.9; confidence interval [CI] 95%: [0.87–0.94], p < 0.001).ConclusionRV-LSFTTE and RV-LSFTEE measurements are interchangeable, allowing RV-LSF to be a helpful parameter for assessing perioperative changes in RV systolic function.NCTNCT05404737. https://www.clinicaltrials.gov/ct2/show/NCT05404737.
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- 2022
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13. Prognostic value of acute cor pulmonale in COVID-19-related pneumonia: A prospective study
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Christophe Beyls, Nicolas Martin, Thomas Booz, Christophe Viart, Solenne Boisgard, Camille Daumin, Maxime Crombet, Julien Epailly, Pierre Huette, Hervé Dupont, Osama Abou-Arab, and Yazine Mahjoub
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acute cor pulmonale (ACP) ,COVID-19 ,AVDS ,speckle tracking ,ARDS ,Medicine (General) ,R5-920 - Abstract
BackgroundIt is known that acute cor pulmonale (ACP) worsens the prognosis of non-coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (NC-ARDS). The ACP risk score evaluates the risk of ACP occurrence in mechanically ventilated patients with NC-ARDS. There is less data on the risk factors and prognosis of ACP induced by COVID-19-related pneumonia.ObjectiveThe objective of this study was to evaluate the prognostic value of ACP, assessed by transthoracic echocardiography (TTE) and clinical factors associated with ACP in a cohort of patients with COVID-19-related pneumonia.Materials and methodsBetween February 2020 and June 2021, patients admitted to intensive care unit (ICU) at Amiens University Hospital for COVID-19-related pneumonia were assessed by TTE within 48 h of admission. ACP was defined as a right ventricle/left ventricle area ratio of >0.6 associated with septal dyskinesia. The primary outcome was mortality at 30 days.ResultsAmong 146 patients included, 36% (n = 52/156) developed ACP of which 38% (n = 20/52) were non-intubated patients. The classical risk factors of ACP (found in NC-ARDS) such as PaCO2 >48 mmHg, driving pressure >18 mmHg, and PaO2/FiO2 < 150 mmHg were not associated with ACP (all P-values > 0.1). The primary outcome occurred in 32 (22%) patients. More patients died in the ACP group (n = 20/52 (38%) vs. n = 12/94 (13%), P = 0.001). ACP [hazards ratio (HR) = 3.35, 95%CI [1.56–7.18], P = 0.002] and age >65 years (HR = 2.92, 95%CI [1.50–5.66], P = 0.002) were independent risk factors of 30-day mortality.ConclusionACP was a frequent complication in ICU patients admitted for COVID-19-related pneumonia. The 30-day-mortality was 38% in these patients. In COVID-19-related pneumonia, the classical risk factors of ACP did not seem relevant. These results need confirmation in further studies.
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- 2022
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14. Pure SARS-CoV-2 related AVDS (Acute Vascular Distress Syndrome)
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Vincent Jounieaux, Damien Basille, Osama Abou-Arab, Marie-Pierre Guillaumont, Claire Andrejak, Yazine Mahjoub, and Daniel Oscar Rodenstein
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SARS-CoV-2 ,Intrapulmonary shunt ,Contrast-enhanced echocardiography ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS). Case presentation A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt. Conclusions This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19 patients.
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- 2021
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15. Portal Vein Pulsatility Index as a Potential Risk of Venous Congestion Assessed by Magnetic Resonance Imaging: A Prospective Study on Healthy Volunteers
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Osama Abou-Arab, Christophe Beyls, Mouhamed Djahoum Moussa, Pierre Huette, Elodie Beaudelot, Mathieu Guilbart, Bruno De Broca, Thierry Yzet, Hervé Dupont, Roger Bouzerar, and Yazine Mahjoub
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fluid responsiveness ,portal vein pulsatility ,fluid challenge ,venous congestion ,magnetic resonance imaging ,Physiology ,QP1-981 - Abstract
High values of the portal vein pulsatility index (PI) have been associated with adverse outcomes in perioperative or critically ill patients. However, data on dynamic changes of PI related to fluid infusion are scarce. We aimed to determine if dynamic changes in PI are associated with the fluid challenge (FC). To address this challenge, we conducted a prospective single-center study. The population study included healthy subjects. FC consisted in the administration of 500 ml of Ringer lactate infusion over 5 min. The portal blood flow and PI were assessed by magnetic resonance imaging. The responsiveness to FC was defined as an increase in the cardiac stroke volume of at least 10% as assessed by echocardiography. We included 24 healthy volunteers. A total of fourteen (58%) subjects were responders, and 10 (42%) were non-responders. In the responder group, FC induced a significant increase in portal blood flow from 881 (762–1,001) at the baseline to 1,010 (778–1,106) ml min−1 (p = 0.005), whilst PI remained stable (from 31 [25–41] to 35 (25–42) %; p = 0.12). In the non-responder group, portal blood flow remained stable after FC (from 1,042 to 1,034 ml min−1; p = 0.084), whereas PI significantly increased from 32 (22–40) to 48% *(25–85) after FC (p = 0.027). PI was negatively correlated to portal blood flow (Rho coefficient = −0.611; p = 0.002). To conclude, PI might be a sensitive marker of early congestion in healthy subjects that did not respond to FC. This finding requires further validation in clinical settings with a larger sample size.
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- 2022
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16. Acute Cor Pulmonale in COVID-19-Related ARDS
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Pierre Huette, MD, Christophe Beyls, MD, Mathieu Guilbart, MD, Guillaume Haye, MD, Fatim-Zahra Najid, MD, Benjamin Mestan, MD, Pierre-Alexandre Roger, MD, Hervé Dupont, MD, PhD, Osama Abou-Arab, MD, PhD, and Yazine Mahjoub, MD, PhD
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acute cor pulmonale ,almitrine ,ARDS ,COVID-19 ,SARS-CoV-2 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Coronavirus disease-19 (COVID-19)-related severe acute respiratory distress syndrome can lead to acute cor pulmonale. We report a case of acute cor pulmonale secondary to severe COVID-19 acute respiratory distress syndrome diagnosed with transesophageal echocardiography. Almitrine infusion allowed rapid enhancement of right ventricular function as well as improvement in oxygenation. (Level of Difficulty: Intermediate.)
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- 2020
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17. Case Reports: Bronchial Mucosal Vasculature Is Also Involved in the Acute Vascular Distress Syndrome of COVID-19
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Vincent Jounieaux, Damien Basille, Bénédicte Toublanc, Claire Andrejak, Daniel Oscar Rodenstein, and Yazine Mahjoub
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SARS-CoV-2 ,bronchovideoscopy ,NBI (narrow band imaging) ,intrapulmonary shunt ,AVDS ,Medicine (General) ,R5-920 - Abstract
Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. We report here what may be, to the best of our knowledge, the first videoendoscopic descriptions of an hypervascularization of the bronchial mucosa in two patients hospitalized for coronavirus disease 2019 (COVID-19) pneumonia.Cases Presentation: Two patients, 27- and 37-year-old, were addressed to our Pneumology department for suspicion of COVID-19 pneumonia. Their symptoms (fever, dry cough, and dyspnoea), associated to pulmonary ground glass opacities on thoracic CT, were highly suggestive of a COVID-19 disease despite repeated negative pharyngeal swabs RT-PCR. In both patients, bronchoscopy examination using white light was unremarkable but NBI bronchoscopy revealed a diffuse hypervascularization of the mucosa from the trachea to the sub-segmental bronchi, associated with dilated submucosal vessels. RT-PCR performed in bronchoalveolar lavage (BAL) confirmed the presence of Sars-CoV-2.Conclusions: These two case reports highlight the crucial importance of the vascular component of the viral disease. We suggest that such bronchial hypervascularization with dilated vessels contributes, at least in part, to the intrapulmonary right to left shunt that characterizes the COVID-19 related Acute Vascular Distress Syndrome (AVDS). The presence of diffuse bronchial hypervascularization in the context of COVID-19 pandemic should prompt the search for Sars-CoV-2 in BAL samples.
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- 2021
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18. Comments on 'Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness': which parameter to assess right ventricular failure and venous congestion?
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Osama Abou-Arab, Mouhamed D. Moussa, Christophe Beyls, and Yazine Mahjoub
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2021
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19. Perioperative individualized hemodynamic optimization according to baseline mean arterial pressure in cardiac surgery patients: Rationale and design of the OPTIPAM randomized trial
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Richard Descamps, Julien Amour, Emmanuel Besnier, Adrien Bougle, Hélène Charbonneau, Martin Charvin, Bernard Cholley, Olivier Desebbe, Jean-Luc Fellahi, Denis Frasca, François Labaste, Diane Lena, Yazine Mahjoub, Paul-Michel Mertes, Serge Molliex, Pierre-Henri Moury, Mouhamed Djahoum Moussa, Jean-Ferreol Oilleau, Alexandre Ouattara, Sophie Provenchere, Bertand Rozec, Jean-Jacques Parienti, and Marc-Olivier Fischer
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Cardiology and Cardiovascular Medicine - Published
- 2023
20. Two-year prognosis of acute coronary syndrome during the first wave of the coronavirus disease 2019 pandemic
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Paul Gabrion, Christophe Beyls, Nicolas Martin, Genevieve Jarry, Arthur Facq, Alexandre Fournier, Dorothée Malaquin, Yazine Mahjoub, Hervé Dupont, Momar Diouf, Helene Duquenne, Julien Maizel, Yohann Bohbot, Laurent Leborgne, and Alexis Hermida
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
21. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study
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Osama Abou-Arab, Pierre Huette, Fanny Debouvries, Hervé Dupont, Vincent Jounieaux, and Yazine Mahjoub
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2020
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22. Effect of the oXiris membrane on microcirculation after cardiac surgery under cardiopulmonary bypass: study protocol for a randomised controlled trial (OXICARD Study)
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Osama Abou-Arab, Pierre Huette, Guillaume Haye, Mathieu Guilbart, Gilles Touati, Momar Diouf, Christophe Beyls, Herve Dupont, and Yazine Mahjoub
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Medicine - Abstract
Introduction Cytokine storm and endotoxin release during cardiac surgery with cardiopulmonary bypass (CPB) have been related to vasoplegic shock and organ dysfunction. We hypothesised that early (during CPB) cytokine adsorption with oXiris membrane for patients at high risk of inflammatory syndrome following cardiac surgery may improve microcirculation, endothelial function and outcomes.Methods and analysis The Oxicard trial is a prospective, monocentric trial, randomising 70 patients scheduled for cardiac surgery. The inclusion criterion is patients aged more than 18 years old undergoing elective cardiac surgery under CPB with an expected CPB time >90 min (double valve replacement or valve replacement plus coronary arterial bypass graft). Patients will be allocated to the intervention group (n=35) or the control group (n=35). In the intervention group, oXiris membrane will be used on the Prismaflex device (Baxter) at blood pump flow of 450 mL/min during cardiac surgery under CPB. In the control group, cardiac surgery under CPB will be conducted as usual without oXiris membrane. An intention-to-treat analysis will be performed. The primary endpoint will be the microcirculatory flow index measured by sublingual microcirculation device at day 1 following cardiac surgery. The secondary endpoints will be other microcirculation variables at CPB end, 6 hours after CPB, at day 1 and at day 2. We also aim to evaluate the occurrence of major cardiovascular and cerebral events (eg, myocardial infarction, stroke, ischaemic mesenteric, resuscitated cardiac arrest, acute kidney injury) within the first 30 days. Cumulative catecholamine use, intensive care unit length of stay, endothelium glycocalyx shedding parameters (syndecan-1, heparan-sulfate and hyaluronic acid), inflammatory cytokines (tumour necrosis factor (TNF) alpha, interleukin 1 (IL1) beta, IL 10, IL 6, lipopolysaccharide, endothelin) and endothelial permeability biomarkers (angiopoietin 1, angiopoietin 2, Tie2 soluble receptor and Vascular Endothelial Growth Factor (VEGF) will also be evaluated.Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board of the University Hospital of Amiens (registration number ID RDB: 2019-A02437-50 in February 2020). Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.Trial registration number NCT04201119.
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- 2021
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23. Time course of fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study
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Claire Roger, Laurent Zieleskiewicz, Christophe Demattei, Karim Lakhal, Gael Piton, Benjamin Louart, Jean-Michel Constantin, Russell Chabanne, Jean-Sébastien Faure, Yazine Mahjoub, Isabelle Desmeulles, Hervé Quintard, Jean-Yves Lefrant, Laurent Muller, and AzuRea Group
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Fluid responsiveness ,Fluid challenge ,ICU ,Shock ,Echocardiography ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC. Methods This is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T 0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC. Results From May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43–63], median SOFA score 10 [8–12]). Among the 76/143 (53%) patient responders to FC at T 10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T 30 (49%, 95%CI = [37–60]), and 39 (51%, 95%CI = [38–62]) patients were persistent responders (PR), i.e., remained responders at T 30. Among the 67 NR at T 10, 4 became responders at T30, (6%, 95%CI = [1.9–15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups. Conclusions This study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent. Trial registration ClinicalTrials.gov, NCT02116413. Registered on April 16, 2014
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- 2019
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24. AVDS should not dethrone ARDS
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Yazine Mahjoub, Daniel Rodenstein, and Vincent Jounieaux
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2021
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25. Feasibility, Prediction and Association of Right Ventricular Free Wall Longitudinal Strain with 30-Day Mortality in Severe COVID-19 Pneumonia: A Prospective Study
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Christophe Beyls, Tristan Ghesquières, Alexis Hermida, Thomas Booz, Maxime Crombet, Nicolas Martin, Pierre Huette, Vincent Jounieaux, Hervé Dupont, Osama Abou-Arab, and Yazine Mahjoub
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right ventricle dysfunction ,strain ,COVID-19 ,speckle tracking ,pneumonia ,Medicine - Abstract
Introduction: Right ventricular (RV) systolic dysfunction (RVsD) is a common complication of coronavirus infection 2019 disease (COVID-19). The right ventricular free wall longitudinal strain parameter (RV-FWLS) is a powerful predictor of mortality. We explored the performance of RVsD parameters for predicting 30-day mortality and the association between RV-FWLS and 30-day mortality. Methods: COVID-19 patients hospitalized at Amiens University Hospital in the critical care unit with transthoracic echocardiography were included. We measured tricuspid annular plane systolic excursion (TAPSE), the RV S’ wave, RV fractional area change (RV-FAC), and RV-FWLS. The diagnostic performance of RVsD parameters as predictors for 30-day mortality was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). RVsD was defined by an RV-FWLS < 21% to explore the association between RVsD and 30-day mortality. Results: Of the 116 patients included, 20% (n = 23/116) died and 47 had a RVsD. ROC curve analysis showed that RV-FWLS failed to predict 30-day mortality, as did conventional RV parameters (all p > 0.05). TAPSE (21 (19–26) mm vs. 24 (21–27) mm; p = 0.024) and RV-FAC (40 (35–47)% vs. 47 (41–55)%; p = 0.006) were lowered in the RVsD group. In Cox analysis, RVsD was not associated with 30-day mortality (hazard ratio = 1.12, CI 95% (0.49–2.55), p = 0.78). Conclusion: In severe COVID-19 pneumonia, RV-FWLS was not associated with 30-day mortality.
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- 2022
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26. Association between the Right Ventricular Longitudinal Shortening Fraction and Mortality in Acute Respiratory Distress Syndrome Related to COVID-19 Infection: A Prospective Study
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Christophe Beyls, Camille Daumin, Alexis Hermida, Thomas Booz, Tristan Ghesquieres, Maxime Crombet, Nicolas Martin, Pierre Huette, Vincent Jounieaux, Hervé Dupont, Osama Abou-Arab, and Yazine Mahjoub
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RV-LSF ,right ventricle ,speckle-tracking ,ARDS ,COVID-19 ,Medicine - Abstract
Introduction: Right ventricular systolic dysfunction (RVsD) increases acute respiratory distress syndrome mortality in COVID-19 infection (CARDS). The RV longitudinal shortening fraction (RV-LSF) is an angle-independent and automatically calculated speckle-tracking parameter. We explored the association between RV-LSF and 30-day mortality in CARDS patients. Methods: Moderate-to-severe CARDS patients hospitalized at Amiens University Hospital with transesophageal echocardiography performed within 48 h of intensive care unit admission were included. RVsD was defined by an RV-LSF of n = 37/86) of the patients showed RVsD and 22% (n = 19/86) of the patients died. RV-LSF was observed in 26 (23.1–29.7)% of the no-RVsD function group and 16.5 (13.7–19.4)% (p < 0.001) of the RVsD group. Cardiogenic shock (n = 7/37 vs. 2/49, p = 0.03) and acute cor pulmonale (n = 18/37 vs. 10/49, p = 0.009) were more frequent in the RVsD group. The 30-day mortality was higher in the RVsD group (15/37 vs. 4/49, p = 0.001). In a multivariable Cox model, RV-LSF was an independent mortality factor (HR 4.45, 95%CI (1.43–13.8), p = 0.01). Conclusion: in a cohort of moderate-to-severe CARDS patients under mechanical ventilation, RVsD defined by the RV-LSF was associated with higher 30-day mortalities.
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- 2022
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27. Microvascular flow alterations in critically ill COVID-19 patients: A prospective study.
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Osama Abou-Arab, Christophe Beyls, Abdelilah Khalipha, Mathieu Guilbart, Pierre Huette, Stéphanie Malaquin, Benoit Lecat, Pierre-Yves Macq, Pierre Alexandre Roger, Guillaume Haye, Michaël Bernasinski, Patricia Besserve, Sandrine Soriot-Thomas, Vincent Jounieaux, Hervé Dupont, and Yazine Mahjoub
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Medicine ,Science - Abstract
BackgroundData on microcirculatory pattern of COVID-19 critically ill patients are scarce. The objective was to compare sublingual microcirculation parameters of critically ill patients according to the severity of the disease.MethodsThe study is a single-center prospective study with critically ill COVID-19 patients admitted in ICU. Sublingual microcirculation was assessed by IDF microscopy within 48 hours of ICU admission. Microcirculatory flow index (MFI), proportion of perfused vessel (PPV), total vessel density (TVD), De Backer score (DBS), perfused vessel density (PVD) and heterogeneity index (HI) were assessed. Patients were divided in 2 groups (severe and critical) according to the World health organization definition.FindingsFrom 19th of March to 7th of April 2020, 43 patients were included. Fourteen patients (33%) were in the severe group and twenty-nine patients (67%) in the critical group. Patients in the critical group were all mechanically ventilated. The critical group had significantly higher values of MFI, DBS and PVD in comparison to severe group (respectively, PaCO2: 49 [44-45] vs 36 [33-37] mmHg; pConclusionCritical COVID-19 patients under mechanical ventilation seem to have higher red blood cell velocity than severe non-ventilated patients.
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- 2021
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28. Tracheotomy in the intensive care unit: guidelines from a French expert panel
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Jean Louis Trouillet, Olivier Collange, Fouad Belafia, François Blot, Gilles Capellier, Eric Cesareo, Jean-Michel Constantin, Alexandre Demoule, Jean-Luc Diehl, Pierre-Grégoire Guinot, Franck Jegoux, Erwan L’Her, Charles-Edouard Luyt, Yazine Mahjoub, Julien Mayaux, Hervé Quintard, François Ravat, Sebastien Vergez, Julien Amour, and Max Guillot
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/−) and 6 a low level of proof (Grade 2+/−). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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- 2018
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29. Portal Vein Pulsatility as a Dynamic Marker of Venous Congestion Following Cardiac Surgery: An Interventional Study Using Positive End-Expiratory Pressure
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Pierre Huette, Pierre-Grégoire Guinot, Guillaume Haye, Mouhamed Djahoum Moussa, Christophe Beyls, Mathieu Guilbart, Lucie Martineau, Hervé Dupont, Yazine Mahjoub, and Osama Abou-Arab
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echography ,venous congestion ,portal vein pulsatility ,cardiac surgery ,mechanical ventilation ,Medicine - Abstract
We aimed to assess variations in the portal vein pulsatility index (PI) during mechanical ventilation following cardiac surgery. Method. After ethical approval, we conducted a prospective monocentric study at Amiens University Hospital. Patients under mechanical ventilation following cardiac surgery were enrolled. Doppler evaluation of the portal vein (PV) was performed by transthoracic echography. The maximum velocity (VMAX) and minimum velocity (VMIN) of the PV were measured in pulsed Doppler mode. The PI was calculated using the following formula (VMAX − VMIN)/(VMax). A positive end-expiratory pressure (PEEP) incremental trial was performed from 0 to 15 cmH2O, with increments of 5 cmH2O. The PI (%) was assessed at baseline and PEEP 5, 10, and 15 cmH2O. Echocardiographic and hemodynamic parameters were recorded. Results. In total, 144 patients were screened from February 2018 to March 2019 and 29 were enrolled. Central venous pressure significantly increased for each PEEP increment. Stroke volumes were significantly lower after PEEP incrementation, with 52 mL (50–55) at PEEP 0 cmH2O and 30 mL (25–45) at PEEP 15 cmH2O, (p < 0.0001). The PI significantly increased with PEEP incrementation, from 9% (5–15) at PEEP 0 cmH2O to 15% (5–22) at PEEP 5 cmH2O, 34% (23–44) at PEEP 10 cmH2O, and 45% (25–49) at PEEP 15 cmH2O (p < 0.001). Conclusion. In the present study, PI appears to be a dynamic marker of the interaction between mechanical ventilation and right heart pressure after cardiac surgery. The PI could be a useful noninvasive tool to monitor venous congestion associated with mechanical ventilation.
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- 2021
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30. Preload Dependency of 2D Right Ventricle Speckle Tracking Echocardiography Parameters in Healthy Volunteers: A Prospective Pilot Study
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Christophe Beyls, Yohann Bohbot, Matthieu Caboche, Pierre Huette, Guillaume Haye, Hervé Dupont, Yazine Mahjoub, and Abou-Arab Osama
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right ventricle ,speckle tracking ,strain ,preload ,fluid challenge ,Medicine - Abstract
(1) Background: Right ventricular (RV) strain parameters derived from the analysis of the tricuspid annular displacement (TAD) are emergent two-dimensional speckle tracking echocardiography (2D-STE) parameter used for the quantitative assessment of RV systolic function. Few data are available regarding 2D-STE parameters and their dependency on RV preload. Our aim was to evaluate the effect of an acute change in RV preload on 2D-STE parameters in healthy volunteers. (2) Methods: Acute modification of RV preload was performed by a fluid challenge (FC): an infusion of 500 mL of 0.9% sodium chloride was given over 5 min in supine position. Preload dependency (responder group) was confirmed by a stroke volume increase of at least 10% measured by echocardiography. (3) Results: Among 32 healthy volunteers, 19 (59%) subjects were classified as non-responders and 13 (41%) as responders. In the responder group, the tricuspid annular plane systolic excursion (TAPSE) significantly increased (20 (20–23.5) mm to 24 (20.5–26.5) mm; p = 0.018), while RV strain parameters significantly decreased after FC: −23.5 ((−22.3)–(−27.3))% to −25 ((−24)–(29.6))%; p = 0.03) for RV free wall longitudinal strain and −22.8 ((−20.4)–(−30.7))% to −23.7 ((−21.2)–(−27))%; p = 0.02) for RV four-chamber longitudinal strain. 2D-STE parameters derived from the TAD analysis were not influenced by the FC (all p > 0.05). (4) Conclusions: In young, healthy volunteers, RV strain parameters and TAPSE are preload dependent, while TAD parameters were not. The loading conditions must be accounted for when evaluating RV systolic function by 2D-STE parameters.
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- 2021
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31. Mortality of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation During the Three Epidemic Waves
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Christophe, Beyls, Pierre, Huette, Christophe, Viart, Benjamin, Mestan, Guillaume, Haye, Mathieu, Guilbart, Michael, Bernasinski, Patricia, Besserve, Florent, Leviel, Alejandro, Witte Pfister, Florence, De Dominicis, Vincent, Jounieaux, Pascal, Berna, Hervé, Dupont, Osama, Abou-Arab, and Yazine, Mahjoub
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Respiratory Distress Syndrome ,Biomedical Engineering ,Biophysics ,COVID-19 ,Bioengineering ,General Medicine ,Middle Aged ,Biomaterials ,Extracorporeal Membrane Oxygenation ,Treatment Outcome ,Humans ,Hospital Mortality ,Aged ,Retrospective Studies - Abstract
Clinical presentation and mortality of patients treated with extracorporeal membrane oxygenation (ECMO) for COVID-19 acute respiratory distress syndrome (CARDS) were different during the French epidemic waves. The management of COVID-19 patients evolved through waves as much as knowledge on that new viral disease progressed. We aimed to compare the mortality rate through the first three waves of CARDS patients on ECMO and identify associated risk factors. Fifty-four consecutive ECMO for CARDS hospitalized at Amiens University Hospital during the three waves were included. Patients were divided into three groups according to their hospitalization date. Clinical characteristics and outcomes were compared between groups. Pre-ECMO risk factors predicting 90 day mortality were evaluated using multivariate Cox regression. Among 54 ECMO (median age of 61[48-65] years), 26% were hospitalized during the first wave (n = 14/54), 26% (n = 14/54) during the second wave, and 48% (n = 26/54) during the third wave. Time from first symptoms to ECMO was higher during the second wave than the first wave. (17 [12-23] days vs. 11 [9-15]; p0.05). Ninety day mortality was higher during the second wave (85% vs. 43%; p0.05) but less during the third wave (38% vs. 85%; P0.05). Respiratory ECMO survival prediction score and time from symptoms onset to ECMO (HR 1.12; 95% confidence interval [CI]: 1.05-1.20; p0.001) were independent factors of mortality. After adjustment, time from symptoms onset to ECMO was an independent factor of 90 day mortality. Changes in CARDS management from first to second wave-induced a later ECMO cannulation from symptoms onset with higher mortality during that wave. The duration of COVID-19 disease progression could be selection criteria for initiating ECMO.
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- 2022
32. The Right Ventricular Systolic Function Assessment in Adult Respiratory Distress Syndrome: Simple. Basic. Complex
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Christophe Beyls, Osama Abou-Arab, and Yazine Mahjoub
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2023
33. Severe Covid-19 disease: rather AVDS than ARDS?
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Yazine Mahjoub, Daniel Oscar Rodenstein, and Vincent Jounieaux
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2020
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34. Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial
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Karim Asehnoune, Sebastien Pease, Philippine Eloy, Alexandre Mignon, Marina Esposito-Farèse, Pascal Raclot, Sami Jaber, Joel Cousson, Soizic Gergaud, Hervé Dupont, Marc Beaussier, Josette Gally, Claude Girard, Melanie Levrard, Claude Meistelman, Gilles Blasco, Jean-Francois Payen, Philippe Gouin, Nathalie Grall, Olivier Collanges, Paer Abback, Thomas Lescot, Sigismond Lasocki, Thomas Gaillard, Sebastien Pily-Floury, Antoine Tesniere, Gaëtan Plantefève, Jean-François Georger, Benoit Veber, Philippe Montravers, Christian Auboyer, Marie-Christine Herault, Florent Wallet, Jean-François Perrier, Regis Bronchard, Yazine Mahjoub, Alain Lepape, Vincent Piriou, Thierry Floch, Emmanuel Samain, Emmanuel Weiss, Thomas Clavier, Mathieu Desmard, Philippe Seguin, Candice Tassin, Yoann Launey, Nouria Belhadj-Tahar, Raphaël Cinotti, Olivier Pajot, Guillaume Besch, Catherine Paugam, Boris Jung, Jean-Marc Delay, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique (CIC 1425), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, CHU Rouen, Normandie Université (NU), CHU Pontchaillou [Rennes], Hôpital Beaujon [AP-HP], Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), CHU Amiens-Picardie, Université de Picardie Jules Verne (UPJV), DURAPOP trial group: Philippe Montravers, Regis Bronchard, Mathieu Desmard, Herve Dupont, Melanie Levrard, Yazine Mahjoub, Sigismond Lasocki, Soizic Gergaud, Thomas Gaillard, Gaetan Plantefeve, Olivier Pajot, Gilles Blasco, Emmanuel Samain, Guillaume Besch, Sebastien Pily-Floury, Catherine Paugam, Sebastien Pease, Paer Abback, Claude Girard, Jean-Francois Payen, Marie-Christine Herault, Sami Jaber, Boris Jung, Jean-Marc Delay, Josette Gally, Claude Meistelman, Jean-François Perrier, Karim Asehnoune, Raphael Cinotti, Antoine Tesniere, Alexandre Mignon, Thomas Lescot, Nouria Belhadj-Tahar, Marc Beaussier, Alain Lepape, Vincent Piriou, Florent Wallet, Candice Tassin, Joel Cousson, Pascal Raclot, Thierry Floch, Philippe Seguin, Yoann Launey, Benoit Veber, Philippe Gouin, Thomas Clavier, Christian Auboyer, Olivier Collanges, Jean-François Georger, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), 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), and MORNET, Dominique
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medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Penicillanic Acid ,Logistic regression ,0302 clinical medicine ,MESH: Risk Factors ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Risk Factors ,Pharmacology (medical) ,030212 general & internal medicine ,MESH: Penicillanic Acid ,Prospective Studies ,Original Research ,3. Good health ,Anti-Bacterial Agents ,Infectious Diseases ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,AcademicSubjects/MED00290 ,Piperacillin, Tazobactam Drug Combination ,[SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology ,Piperacillin/tazobactam ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,medicine.drug ,Microbiology (medical) ,MESH: Piperacillin ,medicine.medical_specialty ,MESH: Peritonitis ,Peritonitis ,Tazobactam ,03 medical and health sciences ,Internal medicine ,MESH: Anti-Bacterial Agents ,Post-hoc analysis ,medicine ,AcademicSubjects/MED00740 ,Humans ,Renal replacement therapy ,[SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology ,Pharmacology ,Piperacillin ,MESH: Humans ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Comorbidity ,MESH: Prospective Studies ,[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology ,business ,AcademicSubjects/MED00230 - Abstract
Background Therapeutic failure is a frequent issue in the management of post-operative peritonitis. Objectives A post hoc analysis of the prospective, multicentre DURAPOP trial analysed the risk factors for failures in post-operative peritonitis following adequate source control and empirical antibiotic therapy in critically ill patients. Patients and methods Overall failures assessed post-operatively between Day 8 and Day 45 were defined as a composite of death and/or surgical and/or microbiological failures. Risk factors for failures were assessed using logistic regression analyses. Results Among the 236 analysed patients, overall failures were reported in 141 (59.7%) patients, including 30 (12.7%) deaths, 81 (34.3%) surgical and 95 (40.2%) microbiological failures. In the multivariate analysis, the risk factors associated with overall failures were documented piperacillin/tazobactam therapy [adjusted OR (aOR) 2.10; 95% CI 1.17–3.75] and renal replacement therapy on the day of reoperation (aOR 2.96; 95% CI 1.05–8.34). The risk factors for death were age (aOR 1.08 per year; 95% CI 1.03–1.12), renal replacement therapy on reoperation (aOR 3.95; 95% CI 1.36–11.49) and diabetes (OR 6.95; 95% CI 1.34–36.03). The risk factors associated with surgical failure were documented piperacillin/tazobactam therapy (aOR 1.99; 95% CI 1.13–3.51), peritoneal cultures containing Klebsiella spp. (aOR 2.45; 95% CI 1.02–5.88) and pancreatic source of infection (aOR 2.91; 95% CI 1.21–7.01). No specific risk factors were identified for microbiological failure. Conclusions Our data suggest a predominant role of comorbidities, the severity of post-operative peritonitis and possibly of documented piperacillin/tazobactam treatment on the occurrence of therapeutic failures, regardless of their type.
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- 2021
35. Almitrine for COVID-19 critically ill patients – a vascular therapy for a pulmonary vascular disease: Three case reports
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Vincent Jounieaux, Mohamed Belhout, Hervé Dupont, Mathieu Guilbart, Osama Abou Arab, Christophe Beyls, Pierre Huette, Yazine Mahjoub, and Guillaume Haye
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Almitrine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Case report ,medicine ,Intensive care unit ,Intensive care medicine ,Acute vascular distress syndrome ,Critically ill ,Vascular disease ,business.industry ,COVID-19 ,General Medicine ,medicine.disease ,Treatment ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Safety ,business ,medicine.drug - Abstract
BACKGROUND Several reports with clinical, histological and imaging data have observed the involvement of lung vascular function to explain the severe hypoxemia in coronavirus disease 2019 (COVID-19) patients. It has been hypothesized that an increased pulmonary blood flow associated with an impairment of hypoxic pulmonary vasoconstriction is responsible for an intrapulmonary shunt. COVID-19 may lead to refractory hypoxemia (PaO2/FiO2 ratio below 100 mmHg) despite mechanical ventilation and prone positioning. We hypothesized that the use of a pulmonary vasoconstrictor may help decrease the shunt and thus enhance oxygenation. CASE SUMMARY We report our experience with three patients with refractory hypoxemia treated with almitrine to enhance oxygenation. Low dose almitrine (Vectarion®; Servier, Suresnes, France) was started at an infusion rate of 4 μg × kg/min on a central line. The PaO2/FiO2 ratio and total respiratory system compliance during almitrine infusion were measured. For the three patients, the PaO2/FiO2 ratio time-course showed a dramatic increase whereas total respiratory system compliance was unchanged. The three patients were discharged from the intensive care unit. The intensive care unit length of stay for patient 1, patient 2 and patient 3 was 30 d, 32 d and 31 d, respectively. Weaning from mechanical ventilation was performed 13 d, 18 d and 15 d after almitrine infusion for patient 1, 2 and 3, respectively. We found no deleterious effects on the right ventricular function, which was similar to previous studies on almitrine safety. CONCLUSION Almitrine may be effective and safe to enhance oxygenation in coronavirus disease 2019 patients. Further controlled studies are required.
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- 2021
36. Association between inflammation, angiopoietins, and disease severity in critically ill COVID-19 patients: a prospective study
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Youssef Bennis, Saïd Kamel, Pierre Gauthier, Gwladys Bourdenet, Osama Abou-Arab, Brigitte Gubler, Hervé Dupont, Yazine Mahjoub, Cédric Boudot, Christophe Beyls, Université d'Amiens, CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Université de Picardie Jules Verne (UPJV), Physiopathologie, Autoimmunité, maladies Neuromusculaires et THErapies Régénératrices (PANTHER), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de dermatologie [CHU d'Amiens-Picardie], and DESSAIVRE, Louise
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Male ,medicine.medical_specialty ,ARDS ,Coronavirus disease 2019 (COVID-19) ,[SDV]Life Sciences [q-bio] ,Critical Illness ,Inflammation ,Severity of Illness Index ,Angiopoietin ,Internal medicine ,Correspondence ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Interleukin 6 ,ComputingMilieux_MISCELLANEOUS ,Aged ,biology ,business.industry ,angiopoietin ,interleukin-6 ,COVID-19 ,Angiopoietins ,Middle Aged ,medicine.disease ,cytokines ,[SDV] Life Sciences [q-bio] ,Anesthesiology and Pain Medicine ,inflammation ,biology.protein ,biomarker ,Biomarker (medicine) ,Female ,Inflammation Mediators ,medicine.symptom ,business ,Biomarkers - Abstract
International audience
- Published
- 2021
37. Central venous-to-arterial CO2 difference is a poor tool to predict adverse outcomes after cardiac surgery: a retrospective study
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Pierre-Grégoire Guinot, Guillaume Haye, Lucie Martineau, Hervé Dupont, Momar Diouf, Mathieu Guilbart, Osama Abou-Arab, Pierre Huette, Jihad Mallat, Yazine Mahjoub, Christophe Beyls, and Patricia Besserve
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medicine.medical_specialty ,Cardiac output ,arterial lactate ,030204 cardiovascular system & hematology ,outcomes ,Hemopericardium ,Reports of Original Investigations ,Veins ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Anesthesiology ,medicine ,Cardiopulmonary bypass ,Humans ,Cardiac Surgical Procedures ,Retrospective Studies ,business.industry ,tissue perfusion ,030208 emergency & critical care medicine ,Retrospective cohort study ,Central venous-to-arterial CO2 difference ,General Medicine ,Carbon Dioxide ,medicine.disease ,Intensive care unit ,Cardiac surgery ,Oxygen ,Anesthesiology and Pain Medicine ,Mesenteric ischemia ,Anesthesia ,Blood Gas Analysis ,cardiopulmonary bypass ,business ,cardiac surgery - Abstract
Purpose The venous-to-arterial carbon dioxide partial pressure difference (CO2 gap) has been reported to be a sensitive indicator of cardiac output adequacy. We aimed to assess whether the CO2 gap can predict postoperative adverse outcomes after cardiac surgery. Methods A retrospective study was conducted of 5,151 patients from our departmental database who underwent cardiac surgery from 1 January 2008 to 31 December 2018. Lactate level (mmol·L−1), central venous oxygen saturation (ScVO2) (%), and the venous-to-arterial carbon dioxide difference (CO2 gap) were measured at intensive care unit (ICU) admission and on days 1 and 2 after cardiac surgery. The following postoperative adverse outcomes were collected: ICU mortality, hemopericardium or tamponade, resuscitated cardiac arrest, acute kidney injury, major bleeding, acute hepatic failure, mesenteric ischemia, and pneumonia. The primary outcome was the presence of at least one postoperative adverse outcome. Logistic regression was used to assess the association between ScVO2, lactate, and the CO2 gap with adverse outcomes. Their diagnostic performance was compared using a receiver operating characteristic (ROC) curve. Results There were 1,933 patients (38%) with an adverse outcome. Cardiopulmonary bypass (CPB) parameters were similar between groups. The CO2 gap was slightly higher for the “adverse outcomes” group than for the “no adverse outcomes” group. Arterial lactate at admission, day 1, and day 2 was also slightly higher in patients with adverse outcomes. Central venous oxygen saturation was not significantly different between patients with and without adverse outcomes. The area under the ROC curve to predict outcomes after CPB for the CO2 gap at admission, day 1, and day 2 were 0.52, 0.55, and 0.53, respectively. Conclusion After cardiac surgery with CPB, the CO2 gap at ICU admission, day 1, and day 2 was associated with postoperative adverse outcomes but showed poor diagnostic performance.
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- 2021
38. Pure SARS-CoV-2 related AVDS (Acute Vascular Distress Syndrome)
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Osama Abou-Arab, Damien Basille, Daniel Rodenstein, Marie Pierre Guillaumont, Vincent Jounieaux, Yazine Mahjoub, Claire Andrejak, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, and UCL - (SLuc) Service de pneumologie
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Adult ,Male ,medicine.medical_specialty ,Right-to-left shunt ,Case Report ,Disease ,030204 cardiovascular system & hematology ,Lung injury ,Pulmonary function testing ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,lcsh:RC109-216 ,Lung ,Respiratory Distress Syndrome ,business.industry ,SARS-CoV-2 ,COVID-19 ,030208 emergency & critical care medicine ,medicine.disease ,Pathophysiology ,Pulmonary embolism ,Shunt (medical) ,Infectious Diseases ,Dyspnea ,Echocardiography ,Concomitant ,Intrapulmonary shunt ,Cardiology ,business ,Contrast-enhanced echocardiography - Abstract
Background SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS). Case presentation A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt. Conclusions This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19 patients.
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- 2021
39. Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study
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Jihad Mallat, Marc-Olivier Fischer, Maxime Granier, Christophe Vinsonneau, Marie Jonard, Yazine Mahjoub, Fawzi Ali Baghdadi, Sébastien Préau, Fabien Poher, Olivier Rebet, Belaid Bouhemad, Malcolm Lemyze, Mehdi Marzouk, Emmanuel Besnier, Fadi Hamed, Nadeem Rahman, Osama Abou-Arab, and Pierre-Grégoire Guinot
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Leg ,Anesthesiology and Pain Medicine ,Critical Illness ,Hemodynamics ,Fluid Therapy ,Humans ,Blood Pressure ,Stroke Volume ,Prospective Studies ,Cardiac Output ,Respiration, Artificial - Abstract
Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVIn this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of15% defined fluid responsiveness. To investigate whether ΔPPVOf the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6-7.6) ml kgPassive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation.NCT03225378.
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- 2022
40. Aortic root dilatation in PFO‐related cryptogenic stroke: A propensity score–matched analysis
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Bourgain Marion, Alexandre Fournier, Dorothée Malaquin, Yohann Bohbot, Christophe Beyls, Christophe Tribouilloy, Laurent Leborgne, Osama Abou-Arab, Geneviève Jarry, Sandrine Canaple, Yazine Mahjoub, and Marie-Pierre Guillaumont
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medicine.medical_specialty ,Foramen Ovale, Patent ,Aortic root dilatation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Propensity Score ,Ischemic Stroke ,Retrospective Studies ,Aorta ,business.industry ,medicine.disease ,Dilatation ,Stroke ,Cryptogenic stroke ,medicine.anatomical_structure ,Cohort ,Propensity score matching ,Patent foramen ovale ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
BACKGROUND Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO-related cryptogenic stroke in a cohort of cryptogenic strokes. METHODS It is a retrospective, single-center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences. RESULTS Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P = .004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P
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- 2020
41. Fluid Challenge : de la théorie à la pratique
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Christophe Beyls, Pierre Huette, Yazine Mahjoub, and Osama Abou Arab
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03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,030208 emergency & critical care medicine - Abstract
Resume Le remplissage vasculaire a des effets secondaires prouves lies a la toxicite des molecules utilisees et a la quantite de liquide perfuse. Pour eviter ces effets secondaires le concept du « Fluid Challenge » (FC) ou epreuve de remplissage a ete developpe. Le FC permet de tester la capacite du systeme cardiocirculatoire a augmenter le debit cardiaque apres un remplissage vasculaire a minima. Ainsi, Le FC ne doit pas etre utilise quand l’hypovolemie est cliniquement evidente, notamment a la phase precoce des etats de choc. La reponse a un FC doit se faire en monitorant la variation du volume d’ejection ventriculaire apres le FC. Une variation de 10 a 15 % est consideree comme significative. Les outils qui semblent les plus fiables pour mesurer le volume d’ejection ventriculaire sont la thermodilution pulmonaire, la thermodilution transpulmonaire et l’echographie Doppler cardiaque. Il n’y a pas de consensus pour les modalites du FC. En se basant sur la litterature, est preconisee l’utilisation de cristalloides a la dose de 200–250 mL a perfuser en 5 a 10 minutes, et l’on propose d’evaluer l’effet du remplissage au bout de 20 a 30 minutes. Il convient de verifier les signes de mauvaise tolerance (œdeme pulmonaire, congestion veineuse) du remplissage vasculaire avant de poursuivre les FC iteratifs.
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- 2019
42. Case Reports: Bronchial Mucosal Vasculature Is Also Involved in the Acute Vascular Distress Syndrome of COVID-19
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Damien Basille, Yazine Mahjoub, Bénédicte Toublanc, Daniel Rodenstein, Vincent Jounieaux, and Claire Andrejak
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bronchovideoscopy ,Medicine (General) ,Pathology ,medicine.medical_specialty ,NBI (narrow band imaging) ,Right-to-left shunt ,Case Report ,Context (language use) ,Disease ,R5-920 ,Bronchoscopy ,medicine.artery ,Medicine ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,intrapulmonary shunt ,General Medicine ,respiratory system ,medicine.disease ,respiratory tract diseases ,Pneumonia ,Distress ,Bronchoalveolar lavage ,Viral disease ,business ,AVDS - Abstract
Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. We report here what may be, to the best of our knowledge, the first videoendoscopic descriptions of an hypervascularization of the bronchial mucosa in two patients hospitalized for coronavirus disease 2019 (COVID-19) pneumonia.Cases Presentation: Two patients, 27- and 37-year-old, were addressed to our Pneumology department for suspicion of COVID-19 pneumonia. Their symptoms (fever, dry cough, and dyspnoea), associated to pulmonary ground glass opacities on thoracic CT, were highly suggestive of a COVID-19 disease despite repeated negative pharyngeal swabs RT-PCR. In both patients, bronchoscopy examination using white light was unremarkable but NBI bronchoscopy revealed a diffuse hypervascularization of the mucosa from the trachea to the sub-segmental bronchi, associated with dilated submucosal vessels. RT-PCR performed in bronchoalveolar lavage (BAL) confirmed the presence of Sars-CoV-2.Conclusions: These two case reports highlight the crucial importance of the vascular component of the viral disease. We suggest that such bronchial hypervascularization with dilated vessels contributes, at least in part, to the intrapulmonary right to left shunt that characterizes the COVID-19 related Acute Vascular Distress Syndrome (AVDS). The presence of diffuse bronchial hypervascularization in the context of COVID-19 pandemic should prompt the search for Sars-CoV-2 in BAL samples.
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- 2021
43. Prognostic value of acute cor pulmonale in COVID-19-related pneumonia: A prospective study
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Christophe Beyls, Nicolas Martin, Thomas Booz, Christophe Viart, Solenne Boisgard, Camille Daumin, Maxime Crombet, Julien Epailly, Pierre Huette, Hervé Dupont, Osama Abou-Arab, and Yazine Mahjoub
- Subjects
General Medicine - Abstract
BackgroundIt is known that acute cor pulmonale (ACP) worsens the prognosis of non-coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (NC-ARDS). The ACP risk score evaluates the risk of ACP occurrence in mechanically ventilated patients with NC-ARDS. There is less data on the risk factors and prognosis of ACP induced by COVID-19-related pneumonia.ObjectiveThe objective of this study was to evaluate the prognostic value of ACP, assessed by transthoracic echocardiography (TTE) and clinical factors associated with ACP in a cohort of patients with COVID-19-related pneumonia.Materials and methodsBetween February 2020 and June 2021, patients admitted to intensive care unit (ICU) at Amiens University Hospital for COVID-19-related pneumonia were assessed by TTE within 48 h of admission. ACP was defined as a right ventricle/left ventricle area ratio of >0.6 associated with septal dyskinesia. The primary outcome was mortality at 30 days.ResultsAmong 146 patients included, 36% (n = 52/156) developed ACP of which 38% (n = 20/52) were non-intubated patients. The classical risk factors of ACP (found in NC-ARDS) such as PaCO2 >48 mmHg, driving pressure >18 mmHg, and PaO2/FiO2 < 150 mmHg were not associated with ACP (all P-values > 0.1). The primary outcome occurred in 32 (22%) patients. More patients died in the ACP group (n = 20/52 (38%) vs. n = 12/94 (13%), P = 0.001). ACP [hazards ratio (HR) = 3.35, 95%CI [1.56–7.18], P = 0.002] and age >65 years (HR = 2.92, 95%CI [1.50–5.66], P = 0.002) were independent risk factors of 30-day mortality.ConclusionACP was a frequent complication in ICU patients admitted for COVID-19-related pneumonia. The 30-day-mortality was 38% in these patients. In COVID-19-related pneumonia, the classical risk factors of ACP did not seem relevant. These results need confirmation in further studies.
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- 2021
44. AVDS should not dethrone ARDS
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Daniel Rodenstein, Vincent Jounieaux, and Yazine Mahjoub
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Respiratory Distress Syndrome ,2019-20 coronavirus outbreak ,ARDS ,Coronavirus disease 2019 (COVID-19) ,RC86-88.9 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Medical emergencies. Critical care. Intensive care. First aid ,Critical Care and Intensive Care Medicine ,medicine.disease ,Virology ,Commentary ,Humans ,Medicine ,business - Published
- 2021
45. Norepinephrine exposure and acute kidney injury after cardiac surgery under cardiopulmonary bypass: A post-hoc cardiox trial analysis
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Pierre, Huette, Pierre-Grégoire, Guinot, Christophe, Beyls, Eliza, Goldberg, Mathieu, Guilbart, Hervé, Dupont, Yazine, Mahjoub, Jonathan, Meynier, and Osama, Abou-Arab
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Norepinephrine ,Cardiopulmonary Bypass ,Postoperative Complications ,Anesthesiology and Pain Medicine ,Humans ,Cardiac Surgical Procedures ,Acute Kidney Injury - Published
- 2022
46. Short- versus Long-Sarafotoxins: Two Structurally Related Snake Toxins with Very Different in vivo Haemodynamic Effects.
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Yazine Mahjoub, Stéphanie Malaquin, Gilles Mourier, Emmanuel Lorne, Osama Abou Arab, Ziad A Massy, Hervé Dupont, and Frédéric Ducancel
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Medicine ,Science - Abstract
Sarafotoxin-m (24 amino acids) from the venom of Atractaspis microlepidota microlepidota was the first long-sarafotoxin to be identified, while sarafotoxin-b (21 aa) is a short-sarafotoxin from Atractaspis engaddensis. Despite the presence of three additional C-terminus residues in sarafotoxin-m, these two peptides display a high sequence homology and share similar three-dimensional structures. However, unlike sarafotoxin-b, sarafotoxin-m shows a very low in vitro affinity for endothelin receptors, but still has a very high in vivo toxicity in mammals, similar to that of sarafotoxin-b. We have previously demonstrated, in vitro, the crucial role of the C-terminus extension in terms of pharmacological profiles and receptor affinities of long- versus short-sarafotoxins. One possible hypothesis to explain the high in vivo toxicity of sarafotoxin-m could be that its C-terminus extension is processed in vivo, resulting in short-like sarafotoxin. To address this possibility, we investigated, in the present study, the in vivo cardiovascular effects of sarafotoxin-b, sarafotoxin-m and sarafotoxin-m-Cter (sarafotoxin-m without the C -terminus extension). Male Wistar rats were anaesthetised and mechanically ventilated. Invasive haemodynamic measurements and echocardiographic measurements of left and right ventricular function were performed. The rats were divided into four groups that respectively received intravenous injections of: saline, sarafotoxin-b (one LD50), sarafotoxin-m (one LD50) or sarafotoxin-m-Cter (one LD50). All measurements were performed at baseline, at 1 minute (+1) and at 6 minutes (+6) after injection.Sarafotoxin-b and sarafotoxin-m-Cter decreased cardiac output and impaired left ventricle systolic and diastolic function, whilst sarafotoxin-m decreased cardiac output, increased airway pressures and led to acute right ventricular dilatation associated with a decreased tricuspid annulus peak systolic velocity. Sarafotoxin-b and sarafotoxin-m-Cter appear to exert toxic effects via impairment of left ventricular function, whilst sarafotoxin-m increases airway pressures and impairs right ventricular function. These results do not support the hypothesis of an in vivo processing of long sarafotoxins.
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- 2015
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47. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study
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Vincent Jounieaux, Pierre Huette, Hervé Dupont, Osama Abou-Arab, Yazine Mahjoub, and Fanny Debouvries
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Adult ,Male ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Critical Illness ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Nitric Oxide ,Critical Care and Intensive Care Medicine ,Nitric oxide ,Betacoronavirus ,chemistry.chemical_compound ,Administration, Inhalation ,Research Letter ,medicine ,Humans ,Prospective Studies ,Intensive care medicine ,Prospective cohort study ,Pandemics ,Inhalation ,SARS-CoV-2 ,business.industry ,Critically ill ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,COVID-19 ,lcsh:RC86-88.9 ,Bronchodilator Agents ,Clinical trial ,chemistry ,Female ,Coronavirus Infections ,business - Published
- 2020
48. French ICUs fight back: An example of regional ICU organisation to tackle the SARS-CoV-2 outbreak
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Mathieu Guilbart, Benjamin Terrasi, Patricia Besserve, Yazine Mahjoub, and Emilien Arnaud
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Patient Transfer ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Critical Care and Intensive Care Medicine ,Article ,Hospitals, University ,Betacoronavirus ,Extracorporeal Membrane Oxygenation ,Anesthesiology ,Picardy ,Hotlines ,Pandemic ,medicine ,Hospital Planning ,Humans ,Bed Conversion ,ICU organisation ,Pandemics ,Covid-19 app ,SARS-CoV-2 ,business.industry ,Emergency Medical Service Communication Systems ,COVID-19 ,Outbreak ,General Medicine ,medicine.disease ,Mobile Applications ,Intensive Care Units ,Anesthesiology and Pain Medicine ,Hospital Bed Capacity ,Medicine ,France ,Hospital Communication Systems ,Medical emergency ,Coronavirus Infections ,business ,Mobile Health Units ,Software - Published
- 2020
49. Les réanimations françaises se mobilisent : un exemple d’organisation régionale contre l’épidémie de COVID-19
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Osama Abou-Arab, Patricia Bessserve, Benjamin Terrasi, Yazine Mahjoub, and Emilien Arnaud
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Anesthesiology and Pain Medicine - Abstract
Au debut du mois d’avril, l’epidemie de SARS-Cov-2 aura touche pres d’un million de personnes dans le monde, faisant ainsi plus de 400 000 morts. En Europe, la France est le troisieme pays le plus touche apres l’Italie et l’Espagne, avec plus de 50 000 cas confirmes et pres de 4000 deces [1]. L’une des zones les plus touchees en France est l’ex-region Picardie, regroupant les departements de la Somme, de l’Oise et de l’Aisne. Le premier cas en Picardie a ete diagnostique le 26 fevrier 2020 en Reanimation Cardiaque Thoracique Vasculaire et Respiratoire du CHU Amiens-Picardie. Le nombre de patients admis en reanimation a ensuite rapidement augmente d’abord dans l’Oise puis dans toute la Picardie. Pour faire face a cette augmentation rapide, une organisation a l’echelle regionale s’est mise en place pour coordonner l’ensemble des lits de reanimation et faciliter l’admission et la prise en charge des patients infectes. Nous exposons ici les elements principaux d’organisation regionale.
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- 2020
50. An urgent open surgical approach for left ventricle venting during peripheral veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: case report
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Christophe Beyls, Yazine Mahjoub, Alphonse Nzonzuma, Osama Abou Arab, Pierre Huette, and Mathieu Guilbart
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medicine.medical_specialty ,Myocarditis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Extracorporeal ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Advanced and Specialized Nursing ,business.industry ,General Medicine ,medicine.disease ,Peripheral ,Cardiac surgery ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Life support ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Safety Research - Abstract
The objective of the study is to describe an emergency procedure for left ventricle venting during veno-arterial extracorporeal life support for refractory cardiac arrest. Veno-arterial extracorporeal membrane oxygenation is widely used in refractory cardiac arrest but is characterized by an increase in left ventricle afterload, which may impair cardiac contractility improvement. Different left ventricle venting techniques are available. We report the use of a surgical approach with sternotomy for left ventricle venting in a 21-year-old patient who was placed under veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest with severe pulmonary edema, respiratory failure, and left ventricle stasis. A 21-year-old woman was admitted for laparoscopic sleeve gastrectomy. In the recovery room, she developed a refractory circulatory shock. Transthoracic echocardiography revealed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (left ventricle ejection fraction at 20%). Coronary angiogram was normal. On day 2, she underwent laparotomy for sepsis and she presented cardiac arrest secondary to ventricular tachycardia. We proceeded to peripheral veno-arterial extracorporeal membrane oxygenation as the cardiac arrest was refractory. A miniaturized veno-arterial extracorporeal membrane oxygenation system was implanted into the right femoral vessels onsite .The low flow duration was 40 minutes. Veno-arterial extracorporeal membrane oxygenation blood flow was set to 3 L min−1, resulting in a closed aortic valve and a massive pulmonary edema. Transesophageal echocardiography showed left ventricular ejection fraction at 5% without aortic valve opening. We first implanted an intra-aortic balloon pump without clinical improvement. Transesophageal echocardiography revealed massive thrombus formation into the aortic root. We decided to perform an open surgical approach for left ventricle unload using a transmitral cannula (22 Fr) via the right superior pulmonary vein connected to the inflow tube of the veno-arterial extracorporeal membrane oxygenation with Y connection. Transesophageal echocardiography showed a full opening of aortic valve and elimination of valve aortic thrombus. Chest radiography showed a significant decrease of pulmonary congestion. We were able to withdraw extracorporeal life support organization on day 10 and discharged on day 54. Clinical explorations reveal a fulminant rocuronium-related hypersensitivity myocarditis. This salvage surgical technique using a modified central veno-arterial extracorporeal membrane oxygenation cannulation technique has efficiently decreased blood stasis and permitted rapid recovery.
- Published
- 2019
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