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2. Outcomes of mild-to-moderate postresuscitation shock after non-shockable cardiac arrest and association with temperature management: a post hoc analysis of HYPERION trial data

Author

Ines Ziriat, Aurélie Le Thuaut, Gwenhael Colin, Hamid Merdji, Guillaume Grillet, Patrick Girardie, Bertrand Souweine, Pierre-François Dequin, Thierry Boulain, Jean-Pierre Frat, Pierre Asfar, Bruno Francois, Mickael Landais, Gaëtan Plantefeve, Jean-Pierre Quenot, Jean-Charles Chakarian, Michel Sirodot, Stéphane Legriel, Nicolas Massart, Didier Thevenin, Arnaud Desachy, Arnaud Delahaye, Vlad Botoc, Sylvie Vimeux, Frederic Martino, Jean Reignier, Alain Cariou, and Jean Baptiste Lascarrou

Subjects
Cardiac arrest, Targeted temperature management, Therapeutic hypothermia, In-hospital, Postresuscitation shock, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Outcomes of postresuscitation shock after cardiac arrest can be affected by targeted temperature management (TTM). A post hoc analysis of the “TTM1 trial” suggested higher mortality with hypothermia at 33 °C. We performed a post hoc analysis of HYPERION trial data to assess potential associations linking postresuscitation shock after non-shockable cardiac arrest to hypothermia at 33 °C on favourable functional outcome. Methods We divided the patients into groups with vs. without postresuscitation (defined as the need for vasoactive drugs) shock then assessed the proportion of patients with a favourable functional outcome (day-90 Cerebral Performance Category [CPC] 1 or 2) after hypothermia (33 °C) vs. controlled normothermia (37 °C) in each group. Patients with norepinephrine or epinephrine > 1 µg/kg/min were not included. Results Of the 581 patients included in 25 ICUs in France and who did not withdraw consent, 339 had a postresuscitation shock and 242 did not. In the postresuscitation-shock group, 159 received hypothermia, including 14 with a day-90 CPC of 1–2, and 180 normothermia, including 10 with a day-90 CPC of 1–2 (8.81% vs. 5.56%, respectively; P = 0.24). After adjustment, the proportion of patients with CPC 1–2 also did not differ significantly between the hypothermia and normothermia groups (adjusted hazards ratio, 1.99; 95% confidence interval, 0.72–5.50; P = 0.18). Day-90 mortality was comparable in these two groups (83% vs. 86%, respectively; P = 0.43). Conclusions After non-shockable cardiac arrest, mild-to-moderate postresuscitation shock at intensive-care-unit admission did not seem associated with day-90 functional outcome or survival. Therapeutic hypothermia at 33 °C was not associated with worse outcomes compared to controlled normothermia in patients with postresuscitation shock. Trial registration ClinicalTrials.gov, NCT01994772

Published
2022
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3. Insights from patients screened but not randomised in the HYPERION trial

Author

J. B. Lascarrou, Gregoire Muller, Jean-Pierre Quenot, Nicolas Massart, Mickael Landais, Pierre Asfar, Jean-Pierre Frat, Jean-Charles Chakarian, Michel Sirodot, Bruno Francois, Guillaume Grillet, Sylvie Vimeux, Arnaud Delahaye, Stéphane Legriel, Didier Thevenin, Jean Reignier, Gwenhael Colin, and for the AfterROSC Network

Subjects
Cardiac arrest, Targeted temperature management, Therapeutic hypothermia, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Few data are available about outcomes of patients screened for, but not enrolled in, randomised clinical trials. Methods We retrospectively reviewed patients who had non-inclusion criteria for the HYPERION trial comparing 33 °C to 37 °C in patients comatose after cardiac arrest in non-shockable rhythm, due to any cause. A good neurological outcome was defined as a day-90 Cerebral Performance Category score of 1 or 2. Results Of the 1144 patients with non-inclusion criteria, 1130 had day-90 information and, among these, 158 (14%) had good functional outcomes, compared to 7.9% overall in the HYPERION trial (10.2% with and 5.7% without hypothermia). Considerable centre-to-centre variability was found in the proportion of non-included patients who received hypothermia (0% to 83.8%) and who had good day-90 functional outcomes (0% to 31.3%). The proportion of patients with a good day-90 functional outcome was significantly higher with than without hypothermia (18.5% vs. 11.9%, P = 0.003). Conclusion Our finding of better functional outcomes without than with inclusion in the HYPERION trial, despite most non-inclusion criteria being of adverse prognostic significance (e.g., long no-flow and low-flow times and haemodynamic instability), raises important questions about the choice of patient selection criteria and the applicability of trial results to everyday practice. At present, reserving hypothermia for patients without predictors of poor prognosis seems open to criticism.

Published
2021
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4. Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Konstantinos Bachoumas, Albrice Levrat, Aurélie Le Thuaut, Stéphane Rouleau, Samuel Groyer, Hervé Dupont, Paul Rooze, Nathanael Eisenmann, Timothée Trampont, Julien Bohé, Benjamin Rieu, Jean-Charles Chakarian, Aurélie Godard, Laura Frederici, Stephanie Gélinotte, Aurélie Joret, Pascale Roques, Benoit Painvin, Christophe Leroy, Marcel Benedit, Loic Dopeux, Edouard Soum, Vlad Botoc, Muriel Fartoukh, Marie-Hélène Hausermann, Toufik Kamel, Jean Morin, Roland De Varax, Gaetan Plantefève, Alexandre Herbland, Matthieu Jabaudon, Thibault Duburcq, Christelle Simon, Russell Chabanne, Francis Schneider, Frederique Ganster, Cedric Bruel, Ahmed-Saïd Laggoune, Delphine Bregeaud, Bertrand Souweine, Jean Reignier, and Jean-Baptiste Lascarrou

Subjects
Epidural analgesia, Chest trauma, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P

Published
2020
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5. Targeted Temperature Management After In-Hospital Cardiac Arrest

Author

Alexiane Blanc, Gwenhael Colin, Alain Cariou, Hamid Merdji, Guillaume Grillet, Patrick Girardie, Elisabeth Coupez, Pierre-François Dequin, Thierry Boulain, Jean-Pierre Frat, Pierre Asfar, Nicolas Pichon, Mickael Landais, Gaëtan Plantefeve, Jean-Pierre Quenot, Jean-Charles Chakarian, Michel Sirodot, Stéphane Legriel, Nicolas Massart, Didier Thevenin, Arnaud Desachy, Arnaud Delahaye, Vlad Botoc, Sylvie Vimeux, Frederic Martino, Jean Reignier, F.S. Taccone, and J.B. Lascarrou

Subjects
Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine
Published
2022
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6. Prevalence, Intensity, and Clinical Impact of Dyspnea in Critically Ill Patients Receiving Invasive Ventilation

Author

Alexandre Demoule, David Hajage, Jonathan Messika, Samir Jaber, Hassimiou Diallo, Maxime Coutrot, Achille Kouatchet, Elie Azoulay, Muriel Fartoukh, Sami Hraiech, Pascal Beuret, Michael Darmon, Maxens Decavèle, Jean-Damien Ricard, Gerald Chanques, Alain Mercat, Matthieu Schmidt, Thomas Similowski, Morgane Faure, Suela Demiri, Marie-Amelie Ordan, Maxime Mallet, Guillaume Berquier, Béatrice La Combe, Malo Emery, Abirami Thiagarajah, Fouad Belafia, Mathieu Capdevila, Yassir Aarab, Alain Combes, Guillaume Hekimian, Loic Le Gunnec, Cherifa Gouanne, Clementine Taconet, Laurent Papazian, Jean-Marie Forel, Christophe Guervilly, Mélanie Adda, Xavier Fabre, Jean-Charles Chakarian, Bénédicte Philippon-Jouve, Florian Michelin, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hopital Saint-Louis [AP-HP] (AP-HP), CHU Tenon [AP-HP], Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre Hospitalier de Roanne, Département d'anesthésie-réanimation[Montpellier], and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier]

Subjects
Pulmonary and Respiratory Medicine, acute respiratory failure, Noninvasive Ventilation, Critical Illness, Respiration, Critical Care and Intensive Care Medicine, Respiration, Artificial, Intensive Care Units, Mechanical ventilation, Dyspnea, Prevalence, post-traumatic stress disorder, Humans, Prospective Studies, intensive care unit burden, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background: Dyspnea is a traumatic experience. Only limited information is available on dyspnea in intubated critically ill patients. Our objectives were 1) To quantify the prevalence and severity of dyspnea, 2) To evaluate the impact of dyspnea on intensive care unit (ICU) length of stay and post-traumatic stress disorder (PTSD) 90 days after ICU discharge.Methods: Prospective cohort study in 10 ICUs in France. In patients intubated for more than 24 hours, dyspnea was quantified with a visual analog scale (from zero to 10) as soon as they were able to communicate, the following day and prior spontaneous breathing trials. PTSD was defined by an Impact of Event Scale-Revised score ≥ 22.Results: Among the 612 patients assessed, 34% reported dyspnea, with a median dyspnea rating of 5 (interquartile range, 4-7). ICU length of stay was not significantly different between dyspneic and non-dyspneic patients (6 [3-12] and 6 [3-13] days, respectively; P=0.781). Mortality was not different between groups. Of the 153 patients interviewed on day 90, a higher proportion of individuals with probable PTSD was observed among patients who were dyspneic on enrolment (29% vs. 13%, P=0.017). The density of dyspnea (number of dyspneic episodes divided by time from enrolment to extubation) were independently associated with post-traumatic stress disorder (odds ratio: 1.07, 95% confidence interval: 1.01-1.13, P=0.031).Conclusion: Dyspnea was frequent and intense in intubated critically ill patients. ICU length of stay was not significantly different among patients reporting dyspnea, but PTSD was more frequent at day 90.

Published
2022
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7. Targeted Temperature Management After In-Hospital Cardiac Arrest: An Ancillary Analysis of Targeted Temperature Management for Cardiac Arrest With Nonshockable Rhythm Trial Data

Author

Alexiane, Blanc, Gwenhael, Colin, Alain, Cariou, Hamid, Merdji, Guillaume, Grillet, Patrick, Girardie, Elisabeth, Coupez, Pierre-François, Dequin, Thierry, Boulain, Jean-Pierre, Frat, Pierre, Asfar, Nicolas, Pichon, Mickael, Landais, Gaëtan, Plantefeve, Jean-Pierre, Quenot, Jean-Charles, Chakarian, Michel, Sirodot, Stéphane, Legriel, Nicolas, Massart, Didier, Thevenin, Arnaud, Desachy, Arnaud, Delahaye, Vlad, Botoc, Sylvie, Vimeux, Frederic, Martino, Jean, Reignier, F S, Taccone, and J B, Lascarrou

Subjects
Treatment Outcome, Hypothermia, Induced, Humans, Hypothermia, Cardiopulmonary Resuscitation, Hospitals, Out-of-Hospital Cardiac Arrest
Abstract

Targeted temperature management (TTM) currently is the only treatment with demonstrated efficacy in attenuating the harmful effects on the brain of ischemia-reperfusion injury after cardiac arrest. However, whether TTM is beneficial in the subset of patients with in-hospital cardiac arrest (IHCA) remains unclear.Is TTM at 33 °C associated with better neurological outcomes after IHCA in a nonshockable rhythm compared with targeted normothermia (TN; 37 °C)?We performed a post hoc analysis of data from the published Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm randomized controlled trial in 584 patients. We included the 159 patients with IHCA; 73 were randomized to 33 °C treatment and 86 were randomized to 37 °C treatment. The primary outcome was survival with a good neurologic outcome (cerebral performance category [CPC] score of 1 or 2) on day 90. Mixed multivariate adjusted logistic regression analysis was performed to determine whether survival with CPC score of 1 or 2 on day 90 was associated with type of temperature management after adjustment on baseline characteristics not balanced by randomization.Compared with TN for 48 h, hypothermia at 33 °C for 24 h was associated with a higher percentage of patients who were alive with good neurologic outcomes on day 90 (16.4% vs 5.8%; P = .03). Day 90 mortality was not significantly different between the two groups (68.5% vs 76.7%; P = .24). By mixed multivariate analysis adjusted by Cardiac Arrest Hospital Prognosis score and circulatory shock status, hypothermia was associated significantly with good day 90 neurologic outcomes (OR, 2.40 [95% CI, 1.17-13.03]; P = .03).Hypothermia at 33 °C was associated with better day 90 neurologic outcomes after IHCA in a nonshockable rhythm compared with TN. However, the limited sample size resulted in wide CIs. Further studies of patients after cardiac arrest resulting from any cause, including IHCA, are needed.

Published
2021

8. Impact of a visual aid on discordance between physicians and family members about prognosis of critically ill patients

Author

Jean-Charles Chakarian, Pascal Beuret, Gabrielle Burelli, Bénédicte Philippon-Jouve, Mahmoud Kaaki, Xavier Fabre, Léonard Descaillot, Hélène Vanacker, Chloé Berthelier, and Alexandre Domine

Subjects
Counseling, Male, medicine.medical_specialty, Critical Care, Critical Illness, Medical information, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Professional-Family Relations, Physicians, Intensive care, Humans, Medicine, Family, Icu stay, Prospective Studies, 030212 general & internal medicine, Aged, Aged, 80 and over, Audiovisual Aids, business.industry, Critically ill, General Medicine, Middle Aged, Prognosis, Intensive Care Units, Anesthesiology and Pain Medicine, 030228 respiratory system, Patient Satisfaction, SAPS II, Emergency medicine, Female, SOFA score, business
Abstract

Objective This study aimed to evaluate the impact of a visual aid on the discordance about prognosis between physicians and family members. Methods The study was performed in a general intensive care department with two 6-bed units. In the unit A, family members could consult a visual aid depicting day by day the evolution of global, hemodynamic, respiratory, renal and neurological conditions of the patient on a 10-point scale. In the unit B, they only received oral medical information. On day 7 of the ICU stay, the physician and family members estimated the prognosis of the patient among four proposals (life threatened; steady state but may worsen; steady state, should heal; will heal). Then we compared the rate of discordance about prognosis between physicians and family members in the two units. Results Seventy-nine consecutive patients admitted in the intensive care department and still present at day 7, their family members and physicians, were enrolled. Patients in the two units were comparable in age, sex ratio, reason for admission, SAPS II at admission and SOFA score at day 7. In the unit A, physician-family members discordance about prognosis occurred for 12 out of 39 patients (31%) vs. 22 out of 40 patients (55%) in the unit B (P = 0.04). Conclusion In our study, adding a visual aid depicting the evolution of the condition of critically ill patients day by day to classic oral information allowed the family to have an estimate of the prognosis less discordant with the estimate of the physician.

Published
2018
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9. Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Loic Dopeux, Christelle Simon, Gaëtan Plantefève, Konstantinos Bachoumas, Bertrand Souweine, Roland De Varax, Thibault Duburcq, Julien Bohé, Francis Schneider, Jean-Baptiste Lascarrou, Alexandre Herbland, Pascale Roques, Marcel Benedit, Delphine Bregeaud, Matthieu Jabaudon, Marie-Hélène Hausermann, Aurélie Godard, Russell Chabanne, Samuel Groyer, Albrice Levrat, Frédérique Ganster, Christophe Leroy, Muriel Fartoukh, Laura Frederici, Benoit Painvin, Stephane Rouleau, Ahmed-Saïd Laggoune, Benjamin Rieu, Edouard Soum, Jean Morin, Paul Rooze, Jean-Charles Chakarian, Aurélie Joret, Hervé Dupont, Stéphanie Gelinotte, Vlad Botoc, Nathanael Eisenmann, Jean Reignier, Aurélie Le Thuaut, Toufik Kamel, Timothée Trampont, Cédric Bruel, CH de Saint-Malo [Broussais], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional d'Orléans (CHRO), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Victor Dupouy, Hôpital Saint-Louis de La Rochelle (CH La Rochelle), Vanderbilt University Medical Center [Nashville], Vanderbilt University [Nashville], Génétique, Reproduction et Développement (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier de Versailles André Mignot (CHV), Pôle de Médecine Périopératoire [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Les Hôpitaux Universitaires de Strasbourg (HUS), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Service de réanimation polyvalente, Groupe Hospitalier Paris Saint-Joseph (hpsj), Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, Hôtel-Dieu de Nantes, CHU La Roche sur Yon, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service d'Anesthésie - Réanimation, Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Amiens-Picardie, Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), Université de Picardie Jules Verne (UPJV), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Anesthésie Réanimation chirurgicale [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Service des urgences [CHU Limoges], CHU Limoges, Service de Réanimation Médicale Sud, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre hospitalier de Dieppe, Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Reanimation Hôpital de Moulins Yzeure, Moulins, France, Pôle Urgences [CHU Clermont-Ferrand], Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and DESSAIVRE, Louise

Subjects
medicine.medical_specialty, Flail chest, Epidural analgesia, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Chest trauma, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Medicine, Intubation, Mechanical ventilation, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Intensive care unit, [SDV] Life Sciences [q-bio], 030228 respiratory system, SAPS II, Anesthesia, Injury Severity Score, business
Abstract

Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. Conclusions EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.

Published
2020
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10. Additional file 2 of Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Bachoumas, Konstantinos, Albrice Levrat, Thuaut, Aurélie Le, Rouleau, Stéphane, Groyer, Samuel, Dupont, Hervé, Rooze, Paul, Eisenmann, Nathanael, Trampont, Timothée, Bohé, Julien, Rieu, Benjamin, Jean-Charles Chakarian, Godard, Aurélie, Frederici, Laura, Gélinotte, Stephanie, Joret, Aurélie, Roques, Pascale, Benoit Painvin, Leroy, Christophe, Benedit, Marcel, Loic Dopeux, Soum, Edouard, Botoc, Vlad, Fartoukh, Muriel, Marie-Hélène Hausermann, Kamel, Toufik, Morin, Jean, Varax, Roland De, Plantefève, Gaetan, Herbland, Alexandre, Jabaudon, Matthieu, Duburcq, Thibault, Simon, Christelle, Chabanne, Russell, Schneider, Francis, Ganster, Frederique, Bruel, Cedric, Ahmed-Saïd Laggoune, Bregeaud, Delphine, Souweine, Bertrand, Reignier, Jean, and Lascarrou, Jean-Baptiste

Abstract

Additional file 2: Figure S2. Proportions of patients given epidural analgesia in each study ICU.

Published
2020
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11. Additional file 4 of Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Bachoumas, Konstantinos, Albrice Levrat, Thuaut, Aurélie Le, Rouleau, Stéphane, Groyer, Samuel, Dupont, Hervé, Rooze, Paul, Eisenmann, Nathanael, Trampont, Timothée, Bohé, Julien, Rieu, Benjamin, Jean-Charles Chakarian, Godard, Aurélie, Frederici, Laura, Gélinotte, Stephanie, Joret, Aurélie, Roques, Pascale, Benoit Painvin, Leroy, Christophe, Benedit, Marcel, Loic Dopeux, Soum, Edouard, Botoc, Vlad, Fartoukh, Muriel, Marie-Hélène Hausermann, Kamel, Toufik, Morin, Jean, Varax, Roland De, Plantefève, Gaetan, Herbland, Alexandre, Jabaudon, Matthieu, Duburcq, Thibault, Simon, Christelle, Chabanne, Russell, Schneider, Francis, Ganster, Frederique, Bruel, Cedric, Ahmed-Saïd Laggoune, Bregeaud, Delphine, Souweine, Bertrand, Reignier, Jean, and Lascarrou, Jean-Baptiste

Subjects
human activities, humanities
Abstract

Additional file 4: Table S2. Sensitivity analysis restricted to the 327 patients with an NRS pain score > 3 on ICU day 1.

Published
2020
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12. Additional file 3 of Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Bachoumas, Konstantinos, Albrice Levrat, Thuaut, Aurélie Le, Rouleau, Stéphane, Groyer, Samuel, Dupont, Hervé, Rooze, Paul, Eisenmann, Nathanael, Trampont, Timothée, Bohé, Julien, Rieu, Benjamin, Jean-Charles Chakarian, Godard, Aurélie, Frederici, Laura, Gélinotte, Stephanie, Joret, Aurélie, Roques, Pascale, Benoit Painvin, Leroy, Christophe, Benedit, Marcel, Loic Dopeux, Soum, Edouard, Botoc, Vlad, Fartoukh, Muriel, Marie-Hélène Hausermann, Kamel, Toufik, Morin, Jean, Varax, Roland De, Plantefève, Gaetan, Herbland, Alexandre, Jabaudon, Matthieu, Duburcq, Thibault, Simon, Christelle, Chabanne, Russell, Schneider, Francis, Ganster, Frederique, Bruel, Cedric, Ahmed-Saïd Laggoune, Bregeaud, Delphine, Souweine, Bertrand, Reignier, Jean, and Lascarrou, Jean-Baptiste

Abstract

Additional file 3: Table S1. Sensitivity analysis restricted to the 526 patients in ICUs where at least 1 study patient received epidural analgesia.

Published
2020
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13. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm

Author

Jean-Baptiste, Lascarrou, Hamid, Merdji, Amélie, Le Gouge, Gwenhael, Colin, Guillaume, Grillet, Patrick, Girardie, Elisabeth, Coupez, Pierre-François, Dequin, Alain, Cariou, Thierry, Boulain, Noelle, Brule, Jean-Pierre, Frat, Pierre, Asfar, Nicolas, Pichon, Mickael, Landais, Gaëtan, Plantefeve, Jean-Pierre, Quenot, Jean-Charles, Chakarian, Michel, Sirodot, Stéphane, Legriel, Julien, Letheulle, Didier, Thevenin, Arnaud, Desachy, Arnaud, Delahaye, Vlad, Botoc, Sylvie, Vimeux, Frederic, Martino, Bruno, Giraudeau, Jean, Reignier, L C, Lacherade, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques

Subjects
Male, medicine.medical_treatment, [SDV]Life Sciences [q-bio], MEDLINE, Hypothermia, 030204 cardiovascular system & hematology, Targeted temperature management, law.invention, Body Temperature, 03 medical and health sciences, 0302 clinical medicine, Rhythm, Randomized controlled trial, law, Hypothermia, Induced, medicine, Humans, Single-Blind Method, 030212 general & internal medicine, Cardiopulmonary resuscitation, Coma, Aged, Brain Diseases, business.industry, Induced, Follow up studies, General Medicine, Middle Aged, Cardiopulmonary Resuscitation, 3. Good health, Heart Arrest, Intensive Care Units, Anesthesia, Female, medicine.symptom, business, Out-of-Hospital Cardiac Arrest, Follow-Up Studies
Abstract

International audience; BACKGROUND: Moderate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiac arrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated. METHODS: We performed an open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33° C during the first 24 hours) with targeted normothermia (37° C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiac arrest with nonshockable rhythm. The primary outcome was survival with a favorable neurologic outcome, assessed on day 90 after randomization with the use of the Cerebral Performance Category (CPC) scale (which ranges from 1 to 5, with higher scores indicating greater disability). We defined a favorable neurologic outcome as a CPC score of 1 or 2. Outcome assessment was blinded. Mortality and safety were also assessed. RESULTS: From January 2014 through January 2018, a total of 584 patients from 25 ICUs underwent randomization, and 581 were included in the analysis (3 patients withdrew consent). On day 90, a total of 29 of 284 patients (10.2%) in the hypothermia group were alive with a CPC score of 1 or 2, as compared with 17 of 297 (5.7%) in the normothermia group (difference, 4.5 percentage points; 95% confidence interval [CI], 0.1 to 8.9; P\,=\,0.04). Mortality at 90 days did not differ significantly between the hypothermia group and the normothermia group (81.3% and 83.2%, respectively; difference, -1.9 percentage points; 95% CI, -8.0 to 4.3). The incidence of prespecified adverse events did not differ significantly between groups. CONCLUSIONS: Among patients with coma who had been resuscitated from cardiac arrest with nonshockable rhythm, moderate therapeutic hypothermia at 33° C for 24 hours led to a higher percentage of patients who survived with a favorable neurologic outcome at day 90 than was observed with targeted normothermia. (Funded by the French Ministry of Health and others; HYPERION ClinicalTrials.gov number, NCT01994772.).

Published
2019
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14. Predictors of Intubation in Patients With Acute Hypoxemic Respiratory Failure Treated With a Noninvasive Oxygenation Strategy*

Author

Jérôme Devaquet, Gwenaël Prat, Keyvan Razazi, Jean-Paul Mira, Jean-Damien Ricard, Stéphanie Ragot, Laurent Argaud, Muriel Fartoukh, Arnaud W. Thille, Saad Nseir, Laurent Brochard, René Robert, Thierry Boulain, Christophe Girault, Jean-Michel Constantin, Alain Mercat, Jean-Charles Chakarian, Alexandre Demoule, Jean-Pierre Frat, Rémi Coudroy, Jean-Baptiste Lascarrou, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)

Subjects
Respiratory rate, high-flow nasal cannula, positive-pressure ventilation, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Lung injury, Critical Care and Intensive Care Medicine, medicine.disease_cause, outcomes, intubation, high-flow oxygen, 03 medical and health sciences, 0302 clinical medicine, Oxygen therapy, General & Internal Medicine, Medicine, Intubation, pneumonia, Respiratory system, lung injury, Tidal volume, distress-syndrome, therapy, acute respiratory failure, business.industry, lower tidal volumes, noninvasive ventilation, 030208 emergency & critical care medicine, 3. Good health, massachusetts, 030228 respiratory system, flow nasal cannula, Anesthesia, Breathing, business, Nasal cannula
Abstract

International audience; Objectives: In patients with acute hypoxemic respiratory failure, noninvasive ventilation and high-flow nasal cannula oxygen are alternative strategies to conventional oxygen therapy. Endotracheal intubation is frequently needed in these patients with a risk of delay, and early predictors of failure may help clinicians to decide early. We aimed to identify factors associated with intubation in patients with acute hypoxemic respiratory failure treated with different noninvasive oxygenation techniques. Design: Post hoc analysis of a randomized clinical trial. Setting: Twenty-three ICUs. Patients: Patients with a respiratory rate greater than 25 breaths/min and a Pao(2)/Fio(2) ratio less than or equal to 300mm Hg. Intervention: Patients were treated with standard oxygen, high-flow nasal cannula oxygen, or noninvasive ventilation. Measurement and Main Results: Respiratory variables one hour after treatment initiation. Under standard oxygen, patients with a respiratory rate greater than or equal to 30 breaths/min were more likely to need intubation (odds ratio, 2.76; 95% CI, 1.13-6.75; p = 0.03). One hour after high-flow nasal cannula oxygen initiation, increased heart rate was the only factor associated with intubation. One hour after noninvasive ventilation initiation, a Pao(2)/Fio(2) ratio less than or equal to 200 mm Hg and a tidal volume greater than 9 mL/kg of predicted body weight were independent predictors of intubation (adjusted odds ratio, 4.26; 95% CI, 1.62-11.16; p = 0.003 and adjusted odds ratio, 3.14; 95% CI, 1.22-8.06; p = 0.02, respectively). A tidal volume above 9 mL/kg during noninvasive ventilation remained independently associated with 90-day mortality. Conclusions: In patients with acute hypoxemic respiratory failure breathing spontaneously, the respiratory rate was a predictor of intubation under standard oxygen, but not under high-flow nasal cannula oxygen or noninvasive ventilation. A Pao(2)/Fio(2) below 200mm Hg and a high tidal volume greater than 9mL/kg were the two strong predictors of intubation under noninvasive ventilation.

Published
2018
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