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1. Republication de : Impact d’un protocole d’examens pronostiques dans la prise en charge des arrêts cardio-respiratoires en réanimation

Author: Marc Leone, François Antonini, Guillaume Carpentier, Coralie Vigne, Emmanuelle Hammad, Gary Duclos, and Laurent Zieleskiewicz
Subjects: business.industry, Emergency Medicine, Medicine, Critical Care and Intensive Care Medicine, business
Published: 2020
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2. Impact d’un protocole d’examens pronostiques dans la prise en charge des arrêts cardio-respiratoires en réanimation

Author: Marc Leone, Coralie Vigne, François Antonini, Emmanuelle Hammad, Gary Duclos, Guillaume Carpentier, Laurent Zieleskiewicz, Hôpital Nord [CHU - APHM], Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Microbes évolution phylogénie et infections (MEPHI), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Gynecology, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, medicine.medical_specialty, business.industry, MEDLINE, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Hypoxia (medical), [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Organ Dysfunction Scores, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, medicine, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, medicine.symptom, business, ComputingMilieux_MISCELLANEOUS, 030217 neurology & neurosurgery
Abstract: International audience
Published: 2019
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3. Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

Author: Pierre Kalfon, Mohamed Boucekine, Philippe Estagnasie, Marie-Agnès Geantot, Audrey Berric, Georges Simon, Bernard Floccard, Thomas Signouret, Mélanie Fromentin, Martine Nyunga, Juliette Audibert, Adel Ben Salah, Bénédicte Mauchien, Achille Sossou, Marion Venot, René Robert, Arnaud Follin, Anne Renault, Maïté Garrouste-Orgeas, Olivier Collange, Quentin Levrat, Isabelle Villard, Didier Thevenin, Julien Pottecher, René-Gilles Patrigeon, Nathalie Revel, Coralie Vigne, Elie Azoulay, Olivier Mimoz, Pascal Auquier, Karine Baumstarck, IPREA Study Group, Hôpital Louis Pasteur [Chartres], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Hôpital Ambroise Paré [AP-HP], Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, CH de Troyes, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Européen de Marseille (HEM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Victor Provo, Centre Hospitalier Emile Roux [AP-HP], Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHRU Brest - Département d'Anesthésie Réanimation (CHU - BREST - DAR), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre hospitalier Saint-Joseph [Paris], CHU Strasbourg, service de réanimation, groupe hospitalier de la Rochelle-Ré-Aunis, Hôpital Beaujon [AP-HP], Centre Hospitalier de Lens, Hôpital de Hautepierre [Strasbourg], Centre Hospitalier d'Auxerre, Hôpital Pasteur [Nice] (CHU), Hôpital Nord [CHU - APHM], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), IPREA Study Group: Karine Vie, Gwenaëlle Lannuzel, Hélène Bout, Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Jean-Pierre Quenot, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, Alicia Richard, Claire Boulle, Benjamin Kowalski, Elisa Klusek, Tarek Sharshar, Andrea Polito, Caroline Duvallet, Sonia Krim, Nicolas Girard, Cécile Jourdain, Stéphane Techer, Corinne Chauvel, Corinne Bruchet, Johanna Temime, Stéphanie Beaussart, Fabienne Jarosz, Jullien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, Valérie Cerro, Déborah Levy, Sébastien Andre, Christophe Guervilly, Laurent Papazian, Myriam Moussa, Stéphanie Renoult, Delphine Biet, Steve Novak, Jean-Christophe Orban, Aminata Diop, Carole Ichai, Antoine Tesniere, Jean-Pascal Goupil, Frédérique Laville, Nadège Rutter, Sandie Brochon, Kelly Tiercelet, Julien Amour, Nora Ait-Hamou, Marjorie Leger, Virginie Souppart, Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, Sabrina Seguin, Christophe Hart, Kathy Dernivoix, Caroline Wuiot, Karine Sanches, Stéphane Hecketsweiler, Catherine Sylvestre-Marconville, Vincent Gardan, Stéphanie Deparis-Dusautois, Yana Chaban, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), and Centre hospitalier d'Auxerre (CHA)
Subjects: Male, Multivariate analysis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Risk Factors, law, Surveys and Questionnaires, Cluster Analysis, Generalized estimating equation, Patient-reported outcome, Pain Measurement, Aged, 80 and over, Univariate analysis, Chest drain, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Intensive care unit, 3. Good health, Intensive Care Units, Adult intensive care unit, Female, France, Central venous catheter, Discomfort, medicine.medical_specialty, Critical Illness, Pain, Statistics, Nonparametric, 03 medical and health sciences, medicine, Humans, Pain Management, Aged, business.industry, Research, IPREA, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Length of Stay, Critical care, 030228 respiratory system, Life support, Multivariate Analysis, Emergency medicine, Quality of Life, Self Report, business, Intra-hospital transport
Abstract: BackgroundThe short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay.MethodsThe study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the “Inconforts des Patients de REAnimation” (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed.ResultsPatients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0–5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores.ConclusionPatients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients’ perceptions of their ICU stay regarding recalled pain.Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015
Published: 2020
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4. Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: Impact on the management of 756 patients

Author: François Kerbaul, Coralie Vigne, Emmanuelle Hammad, Gary Duclos, Raphaelle Fresco, Pierre Bouzat, Marc Leone, François Antonini, Ugo Scemama, Xavier Flecher, Calypso Mathieu, Sophie Medam, Pascal Thomas, Thierry Bege, Pierre-Hugues Roche, Marion Poirier, Laurent Zieleskiewicz, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Département de neurochirurgie, Hôpital Nord [CHU - APHM], Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dysoxie, suractivité : aspects cellulaires et intégratifs thérapeutiques (DS-ACI / UMR MD2), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Biomécanique Appliquée (LBA UMR T24), Aix Marseille Université (AMU)-Université Gustave Eiffel, Aix Marseille Université (AMU), Institut du Mouvement et de l’appareil Locomoteur [Hôpital Sainte-Marguerite - APHM] (IML), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud )-Rhumatologie [Sainte- Marguerite - APHM] ( Hôpitaux Sud), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), pithioux, martine, Centre recherche en CardioVasculaire et Nutrition (C2VN), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Institut des Sciences du Mouvement Etienne Jules Marey (ISM), and Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)
Subjects: Adult, Male, Chest x-ray, medicine.medical_specialty, Thoracic Injuries, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, Abdominal Injuries, Focused assessment with sonography for trauma, Single Center, Sensitivity and Specificity, Diagnostic accuracy, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Trauma Centers, Laparotomy, medicine, Humans, Severe trauma, Whole Body Imaging, Point of care ultrasound, 030212 general & internal medicine, Prospective cohort study, Retrospective Studies, Ultrasonography, General Environmental Science, Multiple Trauma, business.industry, Ultrasound, Trauma center, Trauma bay, 030208 emergency & critical care medicine, medicine.disease, 3. Good health, Chest tube, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, Pneumothorax, Whole body computed tomography, General Earth and Planetary Sciences, Female, Radiology, Tomography, X-Ray Computed, business, Pelvic x-ray
Abstract: International audience; Background: Before total body computed tomography scan, an initial rapid imaging assessment should be conducted in the trauma bay. It generally includes a chest x-ray, pelvic x-ray, and an extended focused ultrasonography assessment for trauma. This initial imaging assessment has been poorly described since the increase in the use of ultrasound. Therefore, our study aimed to evaluate the diagnostic accuracy and therapeutic impact of this initial imaging work-up in severe trauma patients. A secondary aim was to assess the therapeutic impact of a chest x-ray according to the lung ultrasonography findings.Methods: Patients with severe trauma who were admitted directly to our level 1 trauma center were consecutively included in this retrospective single center study. The diagnostic accuracy, therapeutic impact, and appropriate decision rate were calculated according to the initial assessment results of the whole body computed tomography scan and surgery reports.Results: Among the 1315 trauma patients admitted, 756 were included in this research. Lung ultrasound showed a higher diagnostic accuracy for haemothorax and pneumothorax cases than the chest x-ray. Sensitivity and specificity of the abdominal ultrasound to detect intraperitoneal effusion were 70% and 96%, respectively. The initial assessment had a therapeutic impact in 76 (10%) of the patients, including 16 (2%) immediate laparotomies and 58 (7%) chest tube insertions. The pelvic x-ray had no therapeutic impact, and when the lung ultrasound was normal, the chest x-ray had a therapeutic impact of only 0.13%. Combining the chest x-ray and lung ultrasound allowed adequate management of all the pneumothorax and haemothorax cases. Only one of the 756 patients had initial management that was judged as inappropriate. This patient had a missed pelvic disjunction with active retroperitoneal bleeding, and Abbreviations: underwent an inappropriate immediate laparotomy.Conclusions: In our cohort, the initial imaging assessment allowed appropriate decisions in 755 of 756 patients, with a global therapeutic impact of 10%. The pelvic x-ray had a minimal therapeutic impact, and in the patients with normal lung ultrasounds, the chest x-ray marginally affected the management of our patients. The potential consequences of abandoning systematic chest and pelvic x-rays should be investigated in future randomized prospective studies. (C) 2018 Elsevier Ltd. All rights reserved.
Published: 2018
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5. Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Author: Coralie Vigne, Emmanuelle Hammad, Mohamed Boucekine, Benjamin Coiffard, Karine Baumstarck, Gary Duclos, Aurélien Culver, Jean-Louis Mege, Marc Leone, François Antonini, Laurent Zieleskiewicz, Aix-Marseille Université - Faculté de médecine (AMU MED), Aix Marseille Université (AMU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), and Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)
Subjects: medicine.medical_specialty, Mathematical computing, Critical Care and Intensive Care Medicine, Head trauma, law.invention, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, law, Internal medicine, medicine, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Body temperature, Circadian rhythm, Mortality, ComputingMilieux_MISCELLANEOUS, Survival analysis, 2. Zero hunger, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Research, Mortality rate, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Multiple trauma, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Intensive care unit, 3. Good health, Critical care, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, business, Body mass index, 030217 neurology & neurosurgery, Cohort study
Abstract: Background Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value p 0.6 °C (p p = 0.001 and HR = 4.73, 95% CI [1.38–16.22], p = 0.01). Conclusions Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.
Published: 2020
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6. Assessment of patients’ self-perceived intensive care unit discomforts: Validation of the 18-item version of the IPREA

Author: Karine Baumstarck, Mohamed Boucekine, Philippe Estagnasie, Marie-Agnès Geantot, Audrey Berric, Georges Simon, Bernard Floccard, Thomas Signouret, Mélanie Fromentin, Martine Nyunga, Achille Sossou, Marion Venot, René Robert, Arnaud Follin, Juliette Audibert, Anne Renault, Maïté Garrouste-Orgeas, Olivier Collange, Quentin Levrat, Isabelle Villard, Didier Thevenin, Julien Pottecher, René-Gilles Patrigeon, Nathalie Revel, Coralie Vigne, Elie Azoulay, Olivier Mimoz, Pascal Auquier, Pierre Kalfon, the IPREA Study group, Aix Marseille Université (AMU), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Clinique Ambroise Paré, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Intercommunal Toulon la Seyne sur mer, Centre hospitalier de Troyes, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Européen de Marseille (HEM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Roubaix, Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay, Hopital Saint-Louis [AP-HP] (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Louis Pasteur [Chartres], CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre hospitalier Saint-Joseph [Paris], CHU Strasbourg, Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CH La Rochelle, Hôpital Beaujon [AP-HP], Centre Hospitalier de Lens, Centre Hospitalier d'Auxerre, Hôpital Pasteur [Nice] (CHU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier d'Auxerre (CHA), and Chauzy, Alexia
Subjects: Male, medicine.medical_treatment, [SDV]Life Sciences [q-bio], law.invention, 0302 clinical medicine, Quality of life, law, Surveys and Questionnaires, Health care, Validation, Medicine, 030212 general & internal medicine, Simplified Acute Physiology Score, 10. No inequality, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, 030503 health policy & services, General Medicine, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Intensive care unit, Confirmatory factor analysis, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Intensive Care Units, lcsh:R858-859.7, Female, medicine.symptom, 0305 other medical science, Discomfort, Adult, medicine.medical_specialty, Psychometrics, Critical Illness, Short Report, lcsh:Computer applications to medicine. Medical informatics, Young Adult, 03 medical and health sciences, Humans, Renal replacement therapy, Aged, Retrospective Studies, Mechanical ventilation, business.industry, Questionnaire, IPREA, Public Health, Environmental and Occupational Health, Length of Stay, Respiration, Artificial, Self Concept, Sleep deprivation, Critical care, Quality of Life, Physical therapy, Self Report, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background and aims We reported the validation of the 18-item version of the ‘Inconforts des Patients de REAnimation (IPREA)’ questionnaire that includes 2 new items exploring feeling depressed and shortness of breath during an intensive care unit (ICU) stay. Methods The validation process was integrated in a multicenter, cluster-randomized, controlled, two-parallel group study built to assess the effectiveness of a tailored multicomponent program for reducing self-perceived discomfort in the ICU. All patients aged 18 years or older who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Data collection included demographics (sex, age), type of admission (medical and surgical), health status scores at admission (Knaus score and McCabe index, Simplified Acute Physiology Score (SAPS) II), specific ICU therapeutics such as mechanical ventilation (MV), noninvasive ventilation (NIV), use of vasopressors, or renal replacement therapy (RRT), and ICU stay duration. Results A total of 994 patients were included. The initial structure of IPREA was confirmed using confirmatory factor analysis showing satisfactory fit (RMSEA at 0.042, CFI at 0.912). No multidimensional structure was identified, allowing the calculation of an overall discomfort score. The three highest discomforts were sleep deprivation, thirst, and perfusion lines and other devices, and the 3 lowest discomforts were limited visiting hours, hunger, and isolation. The overall discomfort score of the 18-item version of IPREA did not differ between men and women. Higher age was significantly correlated with a lower overall discomfort score. While MV was not linked to self-reported discomfort, patients treated by NIV reported higher overall discomfort scores than patients not treated by NIV. Conclusion The 18-item version of IPREA is easy to use and possesses satisfactory psychometric properties. The availability of a reliable and valid French questionnaire asking about patients’ self-perceived ICU discomforts enables feedback from the health care team to be incorporated in a continuous quality health care improvement strategy. Trial registration clinicaltrial.gov NCT02442934 (registration date: May 18, 2015, retrospectively registered).
Published: 2019
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7. [Impact of a prognostic investigation protocol in post-resuscitation care set in intensive-care unit]

Author: Gary, Duclos, Guillaume, Carpentier, François, Antonini, Emmanuelle, Hammad, Coralie, Vigne, Marc, Leone, and Laurent, Zieleskiewicz
Subjects: Data Analysis, Male, Time Factors, Organ Dysfunction Scores, Resuscitation, Coronary Care Units, Diagnostic Techniques, Neurological, Middle Aged, Prognosis, Sensitivity and Specificity, Clinical Protocols, Practice Guidelines as Topic, Humans, Post-Cardiac Arrest Syndrome, Female, Guideline Adherence, Hypoxia, Brain, Out-of-Hospital Cardiac Arrest, Aged, Retrospective Studies
Published: 2019

8. Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit

Author: Laurent Zieleskiewicz, Marc Leone, François Antonini, Nadim Cassir, D. Boumaza, Julie Alingrin, Gary Duclos, A.-F. Dureau, Coralie Vigne, Emmanuelle Hammad, Physico-Chimie-Curie (PCC), Centre National de la Recherche Scientifique (CNRS)-Institut Curie [Paris]-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Chimie du CNRS (INC), ORL et Chirurgie cervico-faciale pédiatrique - [Hôpitaux Timone et Nord - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Aix Marseille Université (AMU)- Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)- Hôpital Nord [CHU - APHM], and Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Methicillin-Resistant Staphylococcus aureus, Microbiology (medical), medicine.medical_specialty, Pediatrics, Time Factors, medicine.drug_class, Antibiotics, Real-Time Polymerase Chain Reaction, Staphylococcal infections, medicine.disease_cause, law.invention, Hospitals, University, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, law, Internal medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Retrospective Studies, Rapid diagnostic test, business.industry, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, General Medicine, Staphylococcal Infections, bacterial infections and mycoses, medicine.disease, Methicillin-resistant Staphylococcus aureus, Intensive care unit, Drug Utilization, Anti-Bacterial Agents, respiratory tract diseases, 3. Good health, Intensive Care Units, Infectious Diseases, Molecular Diagnostic Techniques, chemistry, Linezolid, Vancomycin, Sputum, medicine.symptom, business, medicine.drug
Abstract: International audience; Ventilator-associated pneumonia (VAP) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with excess mortality and costs. Molecular biology test allows rapid identification of MRSA in sputum with high negative predictive value. We hypothesized that use of a rapid diagnostic test in patients with suspected VAP was associated with reduced use of antibiotics directed against MRSA. This retrospective, observational study was conducted in a polyvalent intensive care unit (ICU) of a university hospital. We compared two periods: before (2007-2010) and after (2010-2015) the implementation of a rapid diagnostic test, which uses RT-PCR to detect pathogens in 60 minutes. The primary endpoint was the effect on the empirical use of anti-MRSA antibiotics. The second endpoint was the effect of this strategy on the cost regarding antibiotic treatment. The first group included 120 suspected VAP (88 patients) and the second group 121 suspected VAP (89 patients). Empirical use of vancomycin and linezolid decreased by 50 % between the two periods. Twenty-seven VAP (22 %) were treated with an anti-MRSA treatment between 2007 and 2010, and 13 (11 %) between 2010 and 2015 (p = 0.04). The mean cost of anti-MRSA treatment by patients in the first group was 63 +/- 223 a,notsign, and 13 +/- 52 a,notsign in the second group (p < 0.001). This study shows that a rapid diagnostic test was associated with reduced use and cost of anti-MRSA antibiotics in patients with suspected VAP. These results should be confirmed by further multicenter prospective studies.
Published: 2016
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9. Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year

Author: Pierre, Kalfon, Marine, Alessandrini, Mohamed, Boucekine, Stéphanie, Renoult, Marie-Agnès, Geantot, Stéphanie, Deparis-Dusautois, Audrey, Berric, Olivier, Collange, Bernard, Floccard, Olivier, Mimoz, Amour, Julien, René, Robert, Juliette, Audibert, Anne, Renault, Arnaud, Follin, Didier, Thevenin, Nathalie, Revel, Marion, Venot, René-Gilles, Patrigeon, Thomas, Signouret, Mélanie, Fromentin, Tarek, Sharshar, Coralie, Vigne, Julien, Pottecher, Quentin, Levrat, Achille, Sossou, Maïté, Garrouste-Orgeas, Jean-Pierre, Quenot, Claire, Boulle, Elie, Azoulay, Karine, Baumstarck, Pascal, Auquier, Yana, Chaban, Hôpital Louis Pasteur [Chartres], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Hôpital Ambroise Paré [AP-HP], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre hospitalier de Troyes, Centre Hospitalier Intercommunal Toulon la Seyne sur mer, CHU Strasbourg, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier de Lens, Hôpital Pasteur [Nice] (CHU), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier d'Auxerre (CHA), Hôpital Européen de Marseille (HEM), Hôpital Cochin [AP-HP], Service médical des soins intensifs [CHU Raymond Poincaré], Hôpital Raymond Poincaré [AP-HP], Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hôpital de Hautepierre [Strasbourg], Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CH La Rochelle, Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay, Centre hospitalier Saint-Joseph [Paris], Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier [Douai, Nord], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Centre Hospitalier d'Auxerre
Subjects: Male, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, Stress Disorders, Post-Traumatic, 0302 clinical medicine, Randomized controlled trial, law, Patient-Centered Care, Surveys and Questionnaires, Health care, Medicine, Prospective Studies, Survivors, Patient Comfort, Patient-reported outcome, Aged, 80 and over, Simplified Acute Physiology Score, Traumatic stress, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Middle Aged, Intensive care unit, 3. Good health, Hospitalization, Intensive Care Units, Tailored interventions, Female, Discomfort, Cohort study, Adult, medicine.medical_specialty, Tailored program, Critical Illness, Statistics, Nonparametric, 03 medical and health sciences, Humans, Aged, Post-traumatic stress disorder, business.industry, Critically ill, 030208 emergency & critical care medicine, Critical care, 030228 respiratory system, Emergency medicine, ICU, Quality of Life, Observational study, business, Program Evaluation
Abstract: International audience; Purpose: Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors.Methods: This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1 year was assessed based on the Impact of Event Scale-Revised (IES-R).Results: Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1 year (p = 0.015).Conclusions: Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1 year.
Published: 2018
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10. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction

Author: Bruno Levy, Raphael Clere-Jehl, Annick Legras, Tristan Morichau-Beauchant, Marc Leone, Ganster Frederique, Jean-Pierre Quenot, Antoine Kimmoun, Alain Cariou, Johan Lassus, Veli-Pekka Harjola, Ferhat Meziani, Guillaume Louis, Patrick Rossignol, Kevin Duarte, Nicolas Girerd, Alexandre Mebazaa, Philippe Vignon, Mathieu Mattei, Carine Thivilier, Pierre Perez, Thomas Auchet, Caroline Fritz, Julie Boisrame-Helme, Emmanuelle Mercier, Denis Garot, Jessica Perny, Sebastien Gette, Emmanuelle Hammad, Coralie Vigne, Auguste Dargent, Pascal Andreu, Philippe Guiot, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer (LabEx LipSTIC), Institut National de la Recherche Agronomique (INRA)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université Paris-Sud - Paris 11 (UP11)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université de Montpellier (UM), University of Helsinki, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Limoges, Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Institut National de la Recherche Agronomique (INRA)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université Paris-Sud - Paris 11 (UP11)-École pratique des hautes études (EPHE)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc (CRLCC - CGFL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-France-Comté] (EFS [Bourgogne-France-Comté])-Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC)-Université de Montpellier (UM), HUS Heart and Lung Center, Clinicum, Department of Medicine, Kardiologian yksikkö, HUS Emergency Medicine and Services, Institut National de la Recherche Agronomique (INRA)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université Paris-Sud - Paris 11 (UP11)-École Pratique des Hautes Études (EPHE), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord
Subjects: Male, Inotrope, ILL PATIENTS, Cardiac index, 030204 cardiovascular system & hematology, LACTATE, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, SUPPORT, TISSUE OXYGENATION, Vasoconstrictor Agents, Prospective Studies, Myocardial infarction, Cardiogenic shock, cardiogenic shock, Middle Aged, 3. Good health, Epinephrine, Cardiology, HEART, Female, TRIAL, France, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, Shock, Cardiogenic, acute myocardial infarction, vasopressor, norepinephrine, EXTRACORPOREAL MEMBRANE-OXYGENATION, Norepinephrine (medication), 03 medical and health sciences, Double-Blind Method, Internal medicine, Heart rate, MANAGEMENT, medicine, Humans, epinephrine, Aged, business.industry, Septic shock, MORTALITY, SEPTIC SHOCK, Hemodynamics, 030208 emergency & critical care medicine, medicine.disease, 3121 General medicine, internal medicine and other clinical medicine, business
Abstract: IF 16.834 (2017); International audience; BACKGROUND Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking. OBJECTIVES The goal of this paper was to compare in a prospective, double-blind, multicenter, randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction. METHODS The primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses. RESULTS Fifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p < 0.0001). Several metabolic changes were unfavorable to epinephrine compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001). CONCLUSIONS In patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743) (J AmColl Cardiol 2018; 72: 173-82) (C) 2018 by the American College of Cardiology Foundation.
Published: 2018
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11. Implementation of an electronic checklist in the ICU: Association with improved outcomes

Author: Claude Martin, Coralie Vigne, Djamel Mokart, Sophie Medam, Marc Leone, Emmanuelle Hammad, François Antonini, Gary Duclos, Laurent Zieleskiewicz, Marie Hélène Po, Frederic Potie, Véronique Paone, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre d'Investigation Clinique [Hôpital de la Conception - APHM] (CIC), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Microbes évolution phylogénie et infections (MEPHI), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, Male, medicine.medical_specialty, Critical Care, Critical Care and Intensive Care Medicine, law.invention, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective cohort study, Propensity Score, Aged, Retrospective Studies, business.industry, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, General Medicine, Odds ratio, Middle Aged, University hospital, Intensive care unit, Respiration, Artificial, Confidence interval, Checklist, 3. Good health, Surgery, Anesthesiology and Pain Medicine, Treatment Outcome, Conditional logistic regression, Female, Guideline Adherence, Electronics, business, Morning Rounds
Abstract: International audience; Objective: To assess the impact of an electronic checklist during the morning rounds on ventilatorassociated pneumonia (VAP) in the intensive care unit (ICU). Patients and methods: We conducted a retrospective, before/after study in a single ICU of a university hospital. A systematic electronic checklist focusing on guidelines adherence was introduced in January 2012. From January 2008 to June 2014, we screened patients with ICU stay durations of at least 48 hours. Propensity score-matched analysis with conditional logistic regression was used to compare the rate of VAP and number of days free of invasive devices before and after implementation of the electronic checklist. Results: We analysed 1711 patients (before group, n = 761; after group, n = 950). The rates of VAP were 21% and 11% in the before and after groups, respectively (p < 0.001). In propensity-score matched analysis (n = 742 in each group), VAP occurred in 151 patients (21%) during the before period compared with 72 patients (10%) during the after period (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.27-0.53). The after group showed increases in ICU-free days (OR = 1.05; 95% CI = 1.04-1.07) and mechanical ventilation-free days (OR = 1.03; 95% CI = 1.01-1.04). Conclusion: In this matched before/after study, implementation of an electronic checklist was associated with positive effects on patient outcomes, especially on VAP. Further prospective studies are needed to confirm these observations. (C) 2017 Societefrancaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Published: 2018
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12. Risk factors for death in septic shock A retrospective cohort study comparing trauma and non-trauma patients

Author: Coralie Vigne, Karine Baumstarck, Anderson Loundou, Emmanuelle Hammad, Marc Leone, Julie Alingrin, Laurent Zieleskiewicz, François Antonini, Gary Duclos, Sophie Medam, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Aix Marseille Université (AMU), Unité d'Aide Méthodologique, Assistance Publique - Hôpitaux de Marseille (APHM)-CHU Marseille, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), and COMBE, Isabelle
Subjects: Adult, Male, medicine.medical_specialty, mouse model, efficacy, Observational Study, 030204 cardiovascular system & hematology, comorbidities, law.invention, mosquito-borne diseases, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, law, death, Internal medicine, Humans, Medicine, severe trauma, Retrospective Studies, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Septic shock, Mortality rate, Area under the curve, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Odds ratio, Middle Aged, medicine.disease, Shock, Septic, Intensive care unit, 3. Good health, age, Shock (circulatory), Cohort, Wounds and Injuries, septic shock, ectoparasiticide, Female, France, medicine.symptom, Stegomyia albopicta (= Aedes albopictus), business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Research Article
Abstract: International audience; The aim of this study was to compare septic shock directly associated-mortality between severe trauma patients and nontrauma patients to assess the role of comorbidities and age. We conducted a retrospective study in an intensive care unit (ICU) (15 beds) of a university hospital (928 beds). From January 2009 to May 2015, we reviewed 2 anonymized databases including severe trauma patients and nontrauma patients. We selected the patients with a septic shock episode. Among 385 patients (318 nontrauma patients and 67 severe trauma patients), the ICU death rate was 43%. Septic shock was directly responsible for death among 35% of our cohort, representing 123 (39%) nontrauma patients and 10 (15%) trauma patients (P
Published: 2017
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13. A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial

Author: Pierre, Kalfon, Karine, Baumstarck, Philippe, Estagnasie, Marie-Agnès, Geantot, Audrey, Berric, Georges, Simon, Bernard, Floccard, Thomas, Signouret, Mohamed, Boucekine, Mélanie, Fromentin, Martine, Nyunga, Achille, Sossou, Marion, Venot, René, Robert, Arnaud, Follin, Juliette, Audibert, Anne, Renault, Maïté, Garrouste-Orgeas, Olivier, Collange, Quentin, Levrat, Isabelle, Villard, Didier, Thevenin, Julien, Pottecher, René-Gilles, Patrigeon, Nathalie, Revel, Coralie, Vigne, Elie, Azoulay, Olivier, Mimoz, Pascal, Auquier, Yana, Chaban, Hôpital Louis Pasteur [Chartres], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Clinique Ambroise Paré, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Intercommunal Toulon la Seyne sur mer, Centre hospitalier de Troyes, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Européen de Marseille (HEM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Roubaix, Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay, Hopital Saint-Louis [AP-HP] (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre hospitalier Saint-Joseph [Paris], CHU Strasbourg, Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CH La Rochelle, Hôpital Beaujon [AP-HP], Centre Hospitalier de Lens, Centre hospitalier d'Auxerre (CHA), Hôpital Pasteur [Nice] (CHU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier d'Auxerre
Subjects: Male, medicine.medical_specialty, Tailored program, medicine.medical_treatment, Critical Illness, [SDV]Life Sciences [q-bio], Psychological intervention, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, Intensive care, Anesthesiology, Health care, Medicine, Humans, 030212 general & internal medicine, Patient-reported outcome, Aged, Pain Measurement, Mechanical ventilation, Aged, 80 and over, business.industry, 030208 emergency & critical care medicine, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, 3. Good health, Intensive Care Units, Critical care, ICU, Physical therapy, Quality of Life, Female, Perception, Self Report, business, Cluster-randomized controlled trial, Discomfort, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort. In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge. During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was − 7.00 (95% CI − 9.89 to − 4.11, p
Published: 2017
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14. Analytical interference during cefepime therapeutic drug monitoring in intensive care patient: About a case report

Author: Laurie Toullec, Olivier Blin, Amélie Marsot, Coralie Vigne, Julien Dupouey, Romain Guilhaumou, Marc Leone, Laurent Allanioux, Service de Pharmacologie Clinique [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Assistance Publique - Hôpitaux de Marseille (APHM), Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, and INSB-INSB-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, 0301 basic medicine, medicine.medical_specialty, Cefepime, 030106 microbiology, Physical examination, law.invention, 03 medical and health sciences, law, Intensive care, medicine, Humans, Pharmacology (medical), Intensive care medicine, Chromatography, High Pressure Liquid, medicine.diagnostic_test, business.industry, Middle Aged, Intensive care unit, Anti-Bacterial Agents, Cephalosporins, 3. Good health, Intensive Care Units, Therapeutic drug monitoring, Plasma concentration, Drug Monitoring, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: International audience; beta-lactams therapeutic drug monitoring (TDM) appears as an essential tool to ensure the achievement of pharmacokinetic-pharmacodynamic targets and prevent induced toxicity in intensive care unit patients. Indeed, those patients exhibit important pharmacokinetic variabilities that could lead to unpredictable plasma concentrations, potentially associated with poor clinical outcome, development of antibiotic resistance or increased side effects. Here, we report the case of a 48-year-old-patient admitted to intensive care unit and treated by cefepime using TDM. Due to inconsistency between observed cefepime plasma concentrations and patient clinical examination, investigations were started. After analytical tests, we highlighted an underlying analytical interference that overestimated cefepime plasma concentration with our in-house high performance liquid chromatography with ultraviolet detection (HPLC-UV) method. Only the inadequacy between plasmatic concentration and patient situation alerted pharmacologists and clinicians. As we found no previous case in literature, we believe this report must serve as an example of analytical limits that required pharmacologist awareness and expertise in TDM realization. Copyright (C) 2017 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.
Published: 2017
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15. Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Author: Coralie Vigne, Jean-Jacques Rouby, Emmanuelle Hammad, Sébastien Perbet, Olivier Langeron, Alexandre Noel, Qin Lu, Eric Peytel, Laurent Papazian, Laurent Muller, Claude Martin, Belaid Bouhemad, Alice Baldovini, Marc Leone, Laurent Zieleskiewicz, Malik Haddam, Jean-Michel Constantin, François Antonini, Jean-Louis Golmard, Christophe Guervilly, Charlotte Arbelot, Samuel Lehingue, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital Nord [CHU - APHM], Unité Générale de Soins Intensifs, Hôpital d'Estaing, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), CHU Pitié-Salpêtrière [APHP], Université Pierre et Marie Curie - Paris 6 ( UPMC ), Hôpital d'Instruction des Armées Laveran, Hôpital d'instruction des armées Laveran, Multidisciplinary intensive care unit, UFR des Sciences de Santé (Université de Bourgogne), Université de Bourgogne ( UB ), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Département de Biostatistiques [Paris], Assistance publique - Hôpitaux de Paris (AP-HP), Études des Structures, des Processus d’Adaptation et des Changements de l’Espace ( ESPACE ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ) -Université d'Avignon et des Pays de Vaucluse ( UAPV ) -Aix Marseille Université ( AMU ) -Centre National de la Recherche Scientifique ( CNRS ), Centre interdisciplinaire de recherche en biologie ( CIRB ), Collège de France ( CdF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Université de Bourgogne (UB), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Études des Structures, des Processus d’Adaptation et des Changements de l’Espace (ESPACE), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Avignon Université (AU)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), and Université Nice Sophia Antipolis (1965 - 2019) (UNS)
Subjects: ARDS, Supine position, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Prone position, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Prospective cohort study, Lung, Lung ultrasound, Acute respiratory distress syndrome, business.industry, 030208 emergency & critical care medicine, Oxygenation, medicine.disease, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Predictive value of tests, Breathing, Recruitment, business
Abstract: IF 12.015; International audience; Prone position (PP) improves oxygenation and outcome of acute respiratory distress syndrome (ARDS) patients with a PaO2/FiO(2) ratio < 150 mmHg. Regional changes in lung aeration can be assessed by lung ultrasound (LUS). Our aim was to predict the magnitude of oxygenation response after PP using bedside LUS. We conducted a prospective multicenter study that included adult patients with severe and moderate ARDS. LUS data were collected at four time points: 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. Overdistension was not assessed. Fifty-one patients were included. Oxygenation response after PP was not correlated with a specific LUS pattern. The patients with focal and non-focal ARDS showed no difference in global reaeration score. With regard to the entire PP session, the patients with non-focal ARDS had an improved aeration gain in the anterior areas. Oxygenation response was not associated with aeration changes. No difference in PaCO2 change was found according to oxygenation response or lung morphology. In ARDS patients with a PaO2/FiO(2) ratio aecurrency sign150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP.
Published: 2016
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16. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study

Author: Laurent, Zieleskiewicz, Laurent, Muller, Karim, Lakhal, Zoe, Meresse, Charlotte, Arbelot, Pierre-Marie, Bertrand, Belaid, Bouhemad, Bernard, Cholley, Didier, Demory, Serge, Duperret, Jacques, Duranteau, Christophe, Guervilly, Emmanuelle, Hammad, Carole, Ichai, Samir, Jaber, Olivier, Langeron, Jean-Yves, Lefrant, Yazine, Mahjoub, Eric, Maury, Eric, Meaudre, Fabrice, Michel, Michel, Muller, Cyril, Nafati, Sébastien, Perbet, Hervé, Quintard, Béatrice, Riu, Coralie, Vigne, Kathia, Chaumoitre, François, Antonini, Bernard, Allaouchiche, Claude, Martin, Jean-Michel, Constantin, Daniel, De Backer, Marc, Leone, Mathias, Castanier, Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Pôle d'anesthésie-réanimation-urgences, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Intensive Care Unit, Cannes general hospital, Cannes, Université Bourgogne Franche-Comté [COMUE] (UBFC), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, Département de Recherche en Ethique, Université Paris-Sud - Paris 11 (UP11), Service d'anesthésie et réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Bioénergétique fondamentale et appliquée, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Unité Générale de Soins Intensifs, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de dermatologie [CHU d'Amiens-Picardie], CHU Amiens-Picardie, CHU Saint-Antoine [AP-HP], département d'anesthésie, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Service d'anesthésie et de réanimation, Institut de pharmacologie moléculaire et cellulaire (IPMC), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de Réanimation, Hospices Civils de Lyon (HCL)-Hôpital E. Herriot, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], Service des Soins Intensifs, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], CHU Toulouse [Toulouse], Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital Nord [CHU - APHM], Laboratoire d'Economie Appliquée de Grenoble ( GAEL ), Université Pierre Mendès France - Grenoble 2 ( UPMF ) -Institut National de la Recherche Agronomique ( INRA ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), CHU Pitié-Salpêtrière [APHP], Université Bourgogne Franche-Comté ( UBFC ), Service de réanimation médicale [HEGP], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Hôpital Sainte-Musse, Université Paris-Sud - Paris 11 ( UP11 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ) -Hôpital Universitaire Carémeau [Nîmes], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Hôpital d'Estaing, Institut de pharmacologie moléculaire et cellulaire ( IPMC ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE), Anthropologie bio-culturelle, Droit, Ethique et Santé ( ADES ), Aix Marseille Université ( AMU ) -EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique ( CNRS ), Hospices Civils de Lyon ( HCL ) -Hôpital E. Herriot, Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Erasme Hospital, Centre hospitalier universitaire de Nantes (CHU Nantes), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), and COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)
Subjects: medicine.medical_specialty, Point-of-Care Systems, Ultrasonic Therapy, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], education, MEDLINE, Critical Care and Intensive Care Medicine, law.invention, law, Intensive care, Anesthesiology, Medicine, Humans, Prospective Studies, Prospective cohort study, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, Point of care, Ultrasonography, [ SDV ] Life Sciences [q-bio], business.industry, Intensive care unit, 3. Good health, Transcranial Doppler, Intensive Care Units, Observational study, business
Abstract: To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU). POCUS is of growing importance in the ICU. Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown. Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified. Among 1954 patients hospitalized during the study period, 1073 (55 %) POCUS/day were performed in 709 (36 %) patients. POCUS served for diagnostic assessment in 932 (87 %) cases and procedural guidance in 141 (13 %) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16 % of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69 %, respectively. Ultrasound guidance was used in 54 and 15 % of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts. With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.
Published: 2015
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17. NOREPINEPHRINE: NOT TOO MUCH, TOO LONG

Author: Claude Martin, B. Meyssignac, Julie Alingrin, Sophie Medam, Marc Leone, François Antonini, Coralie Vigne, Laurent Zieleskiewicz, Malik Haddam, and Emmanuelle Hammad
Subjects: Male, medicine.medical_specialty, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, Norepinephrine (medication), Norepinephrine, law, Risk Factors, medicine, Humans, Vasoconstrictor Agents, Hospital Mortality, Aged, Retrospective Studies, Dose-Response Relationship, Drug, Septic shock, business.industry, Mortality rate, Retrospective cohort study, Odds ratio, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, Shock, Septic, Survival Analysis, Thrombocytopenia, Confidence interval, Surgery, Intensive Care Units, Shock (circulatory), Anesthesia, Emergency Medicine, Female, France, medicine.symptom, business, medicine.drug
Abstract: The study was designed to assess whether high dosages of norepinephrine are associated with increased death rate and to determine the dosage of norepinephrine associated with an intensive care unit (ICU) death rate greater than 90%. We conducted a retrospective, noninterventional, observational study in a single ICU (15 beds) of an academic hospital. From January 2009 to May 2013, data of all patients with a diagnosis of septic shock were extracted from our database. Data were collected at the time of the admission in ICU, at the onset of septic shock, and when the maximal posology of norepinephrine was reached. Mortality was assessed in ICU, in hospital, and at day 90. Among the 324 patients with septic shock, the death rate was 48%. The death rate reached 90% for the quantile of patients receiving more than 1 μg/kg per minute of norepinephrine. In our cohort, four independent factors associated with mortality were identified: age (odds ratio, 1.02 [95% confidence interval, 1.00-1.04]; P = 0.02), thrombocytopenia (odds ratio, 3.8 [95% confidence interval, 1.8-8.5]; P < 0.001), urine output less than 500 mL (odds ratio, 8.7 [95% confidence interval, 3.6-25]; P < 0.001), and dosage of norepinephrine greater than 1 μg/kg per minute (odds ratio, 9.7 [95% confidence interval, 4.5-23]; P < 0.001). However, because of the study's design, unmeasured confounding factors should be taken into account in our findings.
Published: 2015

18. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost

Author: Kathia Chaumoitre, Clément Brun, A. Remacle, Coralie Vigne, Claude Martin, Emmanuelle Hammad, B. Meyssignac, Laurent Zieleskiewicz, A. Cornesse, Marc Leone, Malik Haddam, and François Antonini
Subjects: Adult, Male, medicine.medical_specialty, Radiography, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, law, Medicine, Humans, Hospital Mortality, Lung, Aged, Retrospective Studies, Ultrasonography, Icu mortality, business.industry, Ultrasound, Retrospective cohort study, General Medicine, Length of Stay, Middle Aged, Intensive care unit, Respiration, Artificial, Lung ultrasound, Radiation exposure, Intensive Care Units, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Treatment Outcome, Female, Radiography, Thoracic, Radiology, business, Tomography, X-Ray Computed
Abstract: To determine the effect of implementing a daily lung ultrasound round on the number of chest radiographs and chest computed tomography (CT) scans in a polyvalent intensive care unit (ICU).Retrospective study comparing two consecutive periods.All patients hospitalized for longer than 48 hours in a polyvalent ICU.Implementation of a daily lung ultrasound round after a short educational program. The number of chest radiographs and chest CT scans and the patient outcome were measured before (group PRE) and after (group POST) the implementation of a daily lung ultrasound round.No demographic difference was found between the two groups, with the exception of a higher severity score in the group POST. For each ICU stay, the number of chest radiographs was 10.3 ± 12.4 in the group PRE and 7.7 ± 10.3 in the group POST, respectively (P0.005) The number of chest CT scans was not reduced in the group POST, as compared with the group PRE (0.5 ± 0.7 CT scan/patient/ICU stay versus 0.4 ± 0.6 CT scan/patient/ICU stay, P=0.01). The ICU mortality was similar in both groups (21% versus 22%, P=0.75) CONCLUSION: The implementation of a daily lung ultrasound round was associated with a reduction in radiation exposure and medical cost without altering patient outcome.
Published: 2015

19. Sepsis postopératoire en chirurgie thoracique : facteurs de risques de BMR et impact d’une antibiothérapie adaptée

Author: Camille Pouliquen, Simon Schonne, Nadim Cassir, Claude Martin, Xavier Benoit D’Journo, Coralie Vigne, Marc Leone, and François Antonini
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction Les pneumonies postoperatoires et les infections de site operatoire sont des complications frequentes et graves en chirurgie thoracique. Actuellement le choix de l’antibiotherapie repose sur les donnees publiees dans le cadre du traitement des pneumonies communautaires, nosocomiales et acquises sous ventilation mecanique. L’objectif de notre etude est d’apporter au clinicien des elements pour argumenter le choix d’une antibiotherapie probabiliste a large spectre dans cette situation clinique. Premierement nous avons recherche des facteurs de risque d’infection a bacteries multi-resistantes (BMR) dans cette population. Dans un second temps, nous avons etudie l’impact d’une antibiotherapie adaptee sur le pronostic. Patients et methodes Il s’agit d’une etude retrospective conduite dans une reanimation polyvalente de 15 lits. Notre etude a recu l’autorisation du Correspondant Informatique et Libertes (CIL) local. Tous les patients operes en chirurgie thoracique pris en charge en reanimation en postoperatoire ont ete eligibles. L’epidemiologie analytique a porte sur l’ensemble des patients ayant presente une pneumonie postoperatoire ou une infection de site operatoire documentees. Resultats Entre juin 2010 et decembre 2013, 272 patients ont ete admis en reanimation dans les suites d’une intervention de chirurgie thoracique. Parmi les 111 patients ayant developpe un sepsis postoperatoire, 74 ont ete documentes dont 31 pneumonies postoperatoires (42 %), 39 infections de site operatoire (53 %) et 4 sepsis d’autre origine (5 %). Les facteurs de risque de BMR retrouves en analyse multivariee etaient : un antecedent de broncho-pneumopathie chronique obstructive (BPCO), OR = 5,4, IC [1,4 ; 25,0], p = 0,02 et la presence d’au moins un des facteurs de risque de pneumonie liee aux soins a germes multi-resistants selon l’American Thoracic Society [1] (hospitalisation d’au moins deux jours au cours des 90 derniers jours, antibiotherapie dans les 90 jours, immunodepression, vie en institution medicalisee), OR = 6,8, IC[1,9–30,0], p = 0,05. L’antibiotherapie probabiliste initiale etait adaptee chez 60 (81 %) patients. La mortalite en reanimation etait de 64 % dans le groupe des patients ayant recu une antibiotherapie inadaptee contre 34 % chez ceux ayant recu une antibiotherapie adaptee, p = 0,04. Discussion Ces resultats suggerent qu’un antecedent de BPCO est un facteur de risque d’infection a BMR dans les sepsis postoperatoires en chirurgie thoracique. Les facteurs de risque d’infection a BMR decrits dans le cadre des pneumonies nosocomiales et acquises sous ventilation mecanique semblent applicables aux pneumonies postoperatoires et infection de site operatoire. Une antibiotherapie inadaptee est associee a une augmentation de 30 % de mortalite en reanimation.
Published: 2015
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20. Facteurs prédictifs de ventilation prolongée en chirurgie thoracique

Author: Camille Pouliquen, Malik Haddam, Marc Leone, François Antonini, Xavier D’Journo, Coralie Vigne, Emmanuelle Hammad, Laurent Zieleskiewicz, and Claude Martin
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction En reanimation, la ventilation mecanique peut etre prolongee avec une morbi-mortalite elevee notamment en cas de pneumonies acquises sous ventilation mecanique. La tracheotomie peut alors etre proposee bien que ces avantages sur la morbi-mortalite ne soient pas demontres [1] . Or la litterature actuelle ne permet pas de predire la duree de ventilation et le moment ideal de la tracheotomie [2] . L’objectif de cette etude etait de rechercher des criteres predictifs de ventilation mecanique prolongee chez les patients en postoperatoire de chirurgie thoracique. Patients et methodes Nous avons realise une etude retrospective sur 3 ans dans une reanimation polyvalente : 221 patients analyses repartis en 2 populations. Population A patients ventiles plus et moins de 48 h et population B : patients ventiles plus et moins de 14 jours. L’objectif etait de determiner si des criteres cliniques, biologiques ou des scores de gravite, a l’admission et pendant le sejour pouvaient predire une ventilation superieure a 48 heures et a 14 jours. Resultats L’analyse statistique unie variee a montre pour la population A, que l’index de masse corporelle (IMC), l’albuminemie preoperatoire, les scores SOFA et IGS2 sont correles de facon significative avec une duree de ventilation longue. Ces resultats sont confirmes dans la population B pour le SOFA et l’IGS2. Pour les populations A et B, les patients ventiles plus longtemps ont presente significativement plus de complications a type de pneumonies, syndrome de detresse respiratoire (SDRA), fistules, pleuresie, fibrillation auriculaire (FA), et echec d’extubation. Les analyses multivariees ont montre pour la population A que les facteurs predictifs de ventilation superieure a 48 h sont le score SOFA et la survenue d’une FA avec des odds ratio respectifs de 1,6 [1,3–2] et 7 [2,7–19], p p Tableau 1 . Discussion L’impact de l’ALR sur la prise en charge postoperatoire permet une rehabilitation precoce et est retrouve dans notre etude comme un facteur protecteur de ventilation prolongee. A l’inverse : le score IGS2, la survenue d’une complication a type de FA, de pneumonie ou de SDRA sont des facteurs de risque. Isolement ces facteurs ne peuvent predire une duree de ventilation superieure a 14 jours mais ensemble ils peuvent aider a definir un groupe a risque chez qui la tracheotomie peut etre discutee precocement.
Published: 2015
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21. Parcours intrahospitalier et délais de prise en charge du patient traumatisé grave

Author: B. Meyssignac, R. Bardin, François Antonini, Marion Poirier, Laurent Zieleskiewicz, Malik Haddam, C. Martin, Clément Brun, M. Leone, Coralie Vigne, and Emmanuelle Hammad
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Introduction La prise en charge des patients apres un traumatisme grave represente un enjeu sanitaire et economique. Le temps est un element important du pronostic et l’imagerie est indispensable pour decider de l’orientation de ces patients [1] . L’objectif de cette etude etait l’analyse du parcours intrahospitalier et des delais de prise en charge de ces patients au cours des 24 heures suivant le traumatisme. Materiel et methodes Etude observationnelle retrospective monocentrique conduite dans un service de reanimation traumatologique et polyvalente au CHU Nord de Marseille entre juillet 2011 et juillet 2013. Nous avons analyses les dossiers des 343 patients traumatises graves admis directement en reanimation (Les 191 patients admis via le service des urgences ou un autre centre hospitalier ont ete exclus). L’analyse a porte sur : profil demographique, mecanisme et bilan lesionnel, lieu d’admission, transfert au scanner et/ou bloc operatoire ou arterioembolisation), et sur les delais de prise en charge : obtention du bilan radiologique initial (radiographie thorax + bassin + FAST echographie), du scanner corps entier et delai avant chirurgie urgente. Resultats L’âge moyen des patients etait de 39 ans (± 18 ans), l’IGS median etait a 33 [24–36]. Le mecanisme lesionnel etait dans 61 % des cas un accident de la voie publique, 14 % des patients presentaient un traumatisme penetrant, parmi eux 5 patients (1,5 %) ont ete admis directement au bloc operatoire devant une instabilite hemodynamique majeure. Apres une admission en reanimation et la realisation du bilan radiologique initial (delai median : 14 min [10–22]), 300 patients (87 %) ont ete conduits au scanner (IGS median 35 [6–102], mortalite 16 %) pour un bilan lesionnel exhaustif (delai median : 41 min [24–59]). Seuls 20 patients (6 %) etaient transferes directement au bloc operatoire (IGS median 54 [28–80], mortalite 30 %, p Fig. 1 ). Discussion L’analyse du parcours de soins, dans le cadre de l’evaluation des pratiques professionnelles, met en evidence la place cruciale de l’imagerie dans la strategie diagnostique et decisionnelle des l’admission du patient traumatise. La chirurgie urgente des l’admission concerne tres peu de patients et est associee a une mortalite elevee. La tres grande majorite des patients (87 %) est concernee par la realisation en premiere intention d’une tomodensitometrie pour bilan lesionnel exhaustif. L’optimisation de la prise en charge doit permettre l’obtention de ce bilan dans le delai le plus court possible.
Published: 2014
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22. Apport de l’échographie pleuro-pulmonaire à l’accueil des patients traumatisés graves. Peut-on se passer de la radiographie du thorax ?

Author: R. Bardin, B. Pastene, B. Meyssignac, François Antonini, M. Leone, Malik Haddam, Laurent Zieleskiewicz, R. Fresco, C. Martin, Coralie Vigne, and Emmanuelle Hammad
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Introduction L’echographie pleuro-pulmonaire (EP) et la radiographie pulmonaire (RP) sont recommandees dans la prise en charge du traumatise grave. La puissance diagnostique de l’echographie est superieure a celle de la radiographie pour les epanchements pleuraux. L’impact therapeutique des deux techniques en association est peu etudie. L’objectif principal etait de comparer la puissance diagnostique de l’EP et de la RP pour le diagnostic du pneumothorax (PNO) et de l’hemothorax. L’objectif secondaire etait d’evaluer l’impact therapeutique respectif de ces procedures. Materiel et methodes Etude retrospective monocentrique (CHU Nord, Marseille) avec collecte prospective des donnees. Pour chaque patient traumatise primaire, une RP, une EP et une TDM corps entier etaient realisees. Selon les protocoles de service, une fiche de recueil des resultats des imageries et des traitements etait remplie avec une analyse retrospective. Les dossiers des patients etaient ensuite relus (un seul relecteur) pour determiner si les decisions etaient appropriees. La puissance diagnostique de la RP et de l’EP etaient definies par rapport a la TDM. L’impact therapeutique etait defini par le nombre de modifications induites par les examens d’imagerie (RP, EP ou RP + EP) avant TDM rapportes au nombre d’examens realises. Resultats En 30 mois, 146 patients traumatises primaires ont ete inclus dans l’etude. Les puissances diagnostiques et impacts therapeutiques des deux examens sont resumes dans le Tableau 1 . En cas d’EP anormale, l’impact therapeutique de la RP etait de 28 %. En cas d’EP normale, il etait nul. Les PNO n’etaient draines que sur une positivite des deux examens (EP + RP). Trois hemothorax non detectes a la RP ont ete draines sur les donnees de l’EP. Aucun drainage inapproprie n’etait detecte a la relecture des dossiers. Trois abstentions de drainage ont ete analyses comme inappropriees (PNO draines secondairement non detectes a l’EP et a la RP). Discussion L’EP a une puissance diagnostique et un impact therapeutique superieurs a la RP sans toutefois etre parfaite dans le contexte de l’urgence. L’association des deux techniques evite de drainer a tort des PNO minimes detectes par l’EP. Cependant, si l’EP est normale, la RP n’apportait aucune modification therapeutique. Les consequences d’une prescription de RP basee sur les resultats de l’EP en termes de qualite de prise en charge initiale restent a evaluer par de futures etudes.
Published: 2014
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23. Définir la dose réfractaire de noradrénaline

Author: Coralie Vigne, Claude Martin, Leone Marc, Emmanuelle Hammad, Sophie Medam, Laurent Zieleskiewicz, Julie Alingrin, Malik Haddam, François Antonini, and B. Meyssignac
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction Dans le choc septique, l’utilisation de la noradrenaline est recommandee en premiere intention. L’impact des hautes doses de noradrenaline sur la survie des patients reste meconnu. L’objectif de cette etude etait de determiner la dose de noradrenaline pour laquelle le pourcentage de deces excede 90 % et de determiner si la dose maximale de noradrenaline administree est un facteur de risque independant de mortalite. Materiel et methodes Nous avons conduit une etude retrospective, observationnelle et monocentrique de janvier 2009 a mai 2013. Tous les patients ayant presente un choc septique ont ete inclus. Nous avons recueilli les donnees demographiques, le score SOFA et SAPS 2, le site infectieux, la presence d’une defaillance d’organe, la dose maximale en μg/kg/min de noradrenaline et sa duree d’administration. Nous avons recueilli au premier jour du choc septique et le jour ou la dose maximale de noradrenaline a ete atteinte les parametres hemodynamiques. A la sortie de reanimation nous avons egalement releve la duree de ventilation mecanique, la duree totale du sejour en reanimation, ainsi que le recours a l’adrenaline, la dobutamine, l’isoprenaline, la terlipressine et l’hemisuccinate d’hydrocortisone. Nous avons recherche la survenue du deces, en reanimation, en hospitalisation ou dans les 28 premiers jours. Resultats Sur les 324 patients inclus le taux de mortalite etait de 48 %. Le taux de mortalite atteint 90 % pour les patients qui depassent la dose de 1 μg/kg/min de noradrenaline. Nous avons identifie quatre facteurs de risque independants de mortalite : l’âge (1,02 [1,0–1,04], p = 0,019), la thrombopenie (3,8 [1,7–8,5], p Discussion Au cours du choc septique, une dose de noradrenaline superieure a 1 μg/kg/min constitue un facteur de risque independant de mortalite. Une dose maximale de noradrenaline superieure a 1ug/kg/min est associee a un risque de mortalite superieur a 90 %. Ce resultat peut aider a definir une dose dite « refractaire » dans de futures etudes.
Published: 2015
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24. Procédure mini-invasive ne signifie pas sans complications

Author: Coralie Vigne, Marc Leone, A. Melot, Zoe Meresse, and Calypso Mathieu
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Tissue adhesives, medicine, General Medicine, Radiology, medicine.disease, Adverse effect, business, Minimally invasive procedures, Pulmonary embolism, Surgery
Published: 2013
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25. Impact de l’introduction de l’échographie pleuro-pulmonaire dans une unité de réanimation sur le nombre de radiographies et scanners thoraciques prescrits

Author: C. Martin, M. Leone, Kathia Chaumoitre, Coralie Vigne, Clément Brun, François Antonini, Emmanuelle Hammad, A. Remacle, Laurent Zieleskiewicz, A. Cornesse, B. Meyssignac, and Charlotte Arbelot
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Introduction L’acces a une imagerie pulmonaire performante est necessaire en reanimation, exposant aux radiations ionisantes et aux transferts dangereux [1] . L’echographie pulmonaire (EP) est une technique non irradiante et disponible aux performances diagnostiques superieures a la radiographie thoracique (RT) [2] . Elle represente une alternative aux examens ionisants [3] . L’objectif de notre etude etait de determiner l’impact de l’echographie pleuro-pulmonaire en reanimation sur le nombre de RT et de scanners thoraciques (ST) prescrits. Une analyse en sous-groupe excluant les patients ayant eu une chirurgie thoracique (prescription de radios et de scanner par les chirurgiens) etait realisee. Materiel et methodes Etude retrospective comparant deux periodes consecutives dans une reanimation de 15 lits d’un hopital universitaire. Inclusion des patients hospitalises plus de 48 h. Mise en place d’un examen d’EP a la demande quotidien apres courte periode de formation du personnel medical a la technique. Le nombre de RT, de ST ainsi que les caracteristiques des patients etaient mesures avant (groupe PRE) et apres (groupe POST) l’introduction de l’echographie, le personnel medical n’etait pas informe de la realisation d’une etude. Resultats Les donnees epidemiologiques des deux groupes etaient comparables, seul le score de gravite IGS II etait plus eleve dans le groupe POST 35 ± 16 vs. 39 ± 17 ( p = 0,005). Pour chaque sejour en reanimation, le nombre de RT et de ST etait significativement reduit dans le groupe POST (10,3 ± 12 RT dans le groupe PRE vs. 7,7 ± 10 dans le groupe POST ( p vs. 0,4 ± 1 dans le groupe POST ( p = 0,01)). Apres exclusion des patients ayant eu une chirurgie thoracique, la reduction de prescription etait plus importante (9,4 ± 11 vs. 6,4 ± 8 ( p = 0,0001)). La mortalite en reanimation etait similaire dans les deux groupes (21 % vs. 22 %, ( p = 0,75)) ( Tableau 1 ). Discussion L’introduction de l’echographie pleuro-pulmonaire etait associee a une reduction significative du nombre de RT et de ST reduisant l’exposition des patients aux radiations ionisantes et les depenses de sante sans consequence pronostique. L’economie realisee sur un an dans notre structure est evaluee a 1000 mGy et 30 000 euros. Ce resultat a ete obtenu sans protocole dictant les indications respectives des examens d’imagerie thoracique de reanimation. L’impact d’un tel protocole pourrait accentuer la tendance constatee et reste a evaluer dans de futurs travaux prospectifs.
Published: 2014
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25 results on '"Coralie Vigne"'

1. Republication de : Impact d’un protocole d’examens pronostiques dans la prise en charge des arrêts cardio-respiratoires en réanimation

2. Impact d’un protocole d’examens pronostiques dans la prise en charge des arrêts cardio-respiratoires en réanimation

3. Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

4. Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: Impact on the management of 756 patients

5. Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

6. Assessment of patients’ self-perceived intensive care unit discomforts: Validation of the 18-item version of the IPREA

7. [Impact of a prognostic investigation protocol in post-resuscitation care set in intensive-care unit]

8. Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit

9. Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year

10. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction

11. Implementation of an electronic checklist in the ICU: Association with improved outcomes

12. Risk factors for death in septic shock A retrospective cohort study comparing trauma and non-trauma patients

13. A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial

14. Analytical interference during cefepime therapeutic drug monitoring in intensive care patient: About a case report

15. Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

16. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study

17. NOREPINEPHRINE: NOT TOO MUCH, TOO LONG

18. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost

19. Sepsis postopératoire en chirurgie thoracique : facteurs de risques de BMR et impact d’une antibiothérapie adaptée

20. Facteurs prédictifs de ventilation prolongée en chirurgie thoracique

21. Parcours intrahospitalier et délais de prise en charge du patient traumatisé grave

22. Apport de l’échographie pleuro-pulmonaire à l’accueil des patients traumatisés graves. Peut-on se passer de la radiographie du thorax ?

23. Définir la dose réfractaire de noradrénaline

24. Procédure mini-invasive ne signifie pas sans complications

25. Impact de l’introduction de l’échographie pleuro-pulmonaire dans une unité de réanimation sur le nombre de radiographies et scanners thoraciques prescrits

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25 results on '"Coralie Vigne"'

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