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1. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The PRESSURE study

Author

François Allaert, Laurent Poiroux, David Grimaldi, Nadia Aissaoui, Sabine Valera, Brigitte Barrois, Gaël Piton, Philippe Michel, Grégoire Muller, Gwenaëlle Jacq, Saber Barbar, David Huard, Atika Youssoufa, Guillaume Decormeille, Sami Hraiech, Florence Boissier, Paulo Ferreira, Florian Rigaudier, Nicholas Heming, and Jean-Baptiste Lascarrou

Subjects
medicine.medical_specialty, Critical Illness, Beds, Neurological disorder, Emergency Nursing, Critical Care Nursing, Body weight, law.invention, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, law, Severity of illness, Prevalence, medicine, Humans, Multiple logistic regression analysis, 030212 general & internal medicine, Simplified Acute Physiology Score, Critically ill, business.industry, 030208 emergency & critical care medicine, medicine.disease, Intensive care unit, Confidence interval, Intensive Care Units, Emergency medicine, business
Abstract

Background The prevalence of pressure injuries (PIs) in critically ill patients has been extensively studied, but there is uncertainty regarding the risk factors. The main objective of this study was to describe the prevalence of PIs in critically ill patients. Secondary objectives were to describe PI, use of preventive measures for PI, and factors associated with occurrence of PI in the intensive care unit (ICU). Material and methods This was a 1-day point-prevalence study performed on a weekday in June 2017 in ICUs in France. On the same day, we noted the presence or absence of PI in all hospitalised patients of the participating ICUs, data on the ICUs, and the characteristics of patients and of PI. Results Eighty-six participating ICUs allowed the inclusion of 1228 patients. The prevalence of PI on the study day was 18.7% (95% confidence interval: 16.6–21.0). PIs acquired in the ICU were observed in 12.5% (95% confidence interval: 10.6–14.3) of critically ill patients on the study day. The most frequent locations of PI were the sacrum (57.4%), heel (35.2%), and face (8.7%). Severe forms of PI accounted for 40.8% of all PIs. Antiulcer mattresses were used in 91.5% of the patients, and active and/or passive mobilisation was performed for all the patients. Multiple logistic regression analysis identified longer length of stay in the ICU, a higher Simplified Acute Physiology Score, higher body weight, motor neurological disorder, high-dose steroids, and absence of oral nutrition on the study day as factors independently associated with occurrence of PI in the ICU. Conclusion This large point-prevalence study shows that PIs are found in about one of five critically ill patients despite extensive use of devices for preventing PI. Acquisition of PI in the ICU is strongly related to the patient's severity of illness on admission to the ICU and length of stay in the ICU.

Published
2021
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2. Relationship Between Obesity and Ventilator-Associated Pneumonia

Author

Saad Nseir, Amélie Le Gouge, Olivier Pouly, Jean-Baptiste Lascarrou, Jean-Claude Lacherade, Jean-Paul Mira, Emmanuelle Mercier, Pierre-Louis Declercq, Michel Sirodot, Gaël Piton, François Tinturier, Elisabeth Coupez, Stéphane Gaudry, Michel Djibré, Didier Thevenin, Malika Balduyck, Jean Reignier, Hoang-Nam Bui, Olivier Gontier, Jean-Pierre Quenot, Carole Schwebel, Véronique Leray, Nathalie Rolin, Frédéric Bellec, Vincent Das, Antoine Roquilly, Laurent Brisard, Thierry Boulain, Nadia Anguel, Jérôme Devaquet, Virginie Maxime, Daniel Da Silva, Emmanuel Canet, Bertrand Guidet, Charles Grégoire, Frédéric Martino, Delphine Chatelier, Vlad Botoc, Guillaume Thiery, Christine Kummerlen, J-Etienne Herbrecht, Philippe Letocart, Pierre Asfar, Frederique Ganster, Richecoeur Jack, Argaud Laurent, Zerimech Farid, and Maboudou Patrice

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, medicine.medical_specialty, business.industry, Incidence (epidemiology), medicine.medical_treatment, Hazard ratio, Ventilator-associated pneumonia, Critical Care and Intensive Care Medicine, medicine.disease, Intensive care unit, Enteral administration, law.invention, 03 medical and health sciences, 0302 clinical medicine, Parenteral nutrition, 030228 respiratory system, Interquartile range, law, Internal medicine, medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Background Patients with obesity are at higher risk for community-acquired and nosocomial infections. However, no study has specifically evaluated the relationship between obesity and ventilator-associated pneumonia (VAP). Research Question Is obesity associated with an increased incidence of VAP? Study Design and Methods This study was a post hoc analysis of the Impact of Early Enteral vs Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA2) open-label, randomized controlled trial performed in 44 French ICUs. Adults receiving invasive mechanical ventilation and vasopressor support for shock and parenteral nutrition or enteral nutrition were included. Obesity was defined as BMI ≥ 30 kg/m2 at ICU admission. VAP diagnosis was adjudicated by an independent blinded committee, based on all available clinical, radiologic, and microbiologic data. Only first VAP episodes were taken into account. Incidence of VAP was analyzed by using the Fine and Gray model, with extubation and death as competing risks. Results A total of 699 (30%) of the 2,325 included patients had obesity; 224 first VAP episodes were diagnosed (60 and 164 in obese and nonobese groups, respectively). The incidence of VAP at day 28 was 8.6% vs 10.1% in the two groups (hazard ratio, 0.85; 95% CI 0.63-1.14; P = .26). After adjustment on sex, McCabe score, age, antiulcer treatment, and Sequential Organ Failure Assessment at randomization, the incidence of VAP remained nonsignificant between obese and nonobese patients (hazard ratio, 0.893; 95% CI, 0.66-1.2; P = .46). Although no significant difference was found in duration of mechanical ventilation and ICU length of stay, 90-day mortality was significantly lower in obese than in nonobese patients (272 of 692 [39.3%] patients vs 718 of 1,605 [44.7%]; P = .02). In a subgroup of patients (n = 123) with available pepsin and alpha-amylase measurements, no significant difference was found in rate of abundant microaspiration of gastric contents, or oropharyngeal secretions between obese and nonobese patients. Interpretation Our results suggest that obesity has no significant impact on the incidence of VAP.

Published
2021
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3. Serum phosphate is associated with mortality among patients admitted to ICU for acute pancreatitis

Author

Gaël Piton, Sophie Grabar, Chérifa Cheurfa, Abdellah Hedjoudje, Emmanuel Weiss, Dilhana Badurdeen, Philippe Lévy, Frédéric Prat, Vivek Kumbhari, Jad Farha, Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Johns Hopkins Hospital, Hôpital Cochin [AP-HP], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), HAL-SU, Gestionnaire, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)

Subjects
Male, Multivariate analysis, pancreatitis, Anion gap, law.invention, Leukocyte Count, Patient Admission, 0302 clinical medicine, Reference Values, law, risk factors, Prospective cohort study, Acid-Base Equilibrium, Hazard ratio, Gastroenterology, Middle Aged, Intensive care unit, 3. Good health, Intensive Care Units, Oncology, 030220 oncology & carcinogenesis, Acute Disease, Acute pancreatitis, Female, Original Article, 030211 gastroenterology & hepatology, Adult, medicine.medical_specialty, Sensitivity and Specificity, Phosphates, 03 medical and health sciences, Internal medicine, medicine, Humans, serum phosphate, Pancreas, Aged, Proportional Hazards Models, Retrospective Studies, business.industry, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Bilirubin, Serum phosphate, Alkaline Phosphatase, medicine.disease, mortality, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, ROC Curve, Potassium, serum phospahte, Pancreatitis, Calcium, business, Biomarkers
Abstract

Background and Aims Routine laboratory tests can be useful predictors in the early assessment of the severity and mortality of acute pancreatitis (AP). The aim of this study was to evaluate the accuracy of clinical and laboratory parameters for the prediction of mortality among patients admitted to the intensive care unit (ICU) for AP. Methods We conducted a retrospective analysis of prospectively collected data from Beth Israel Deaconess Hospital made publicly available to examine the relationship between routine clinical and laboratory parameters with respect to mortality for AP. Cox proportional hazard ratio was used to evaluate the impact of several routine laboratory markers on mortality. Receiver operation characteristic (ROC) curve was performed to determine the accuracy of diagnosis of laboratory tests by using area under curve (AUC) for the respective analysis. Results In total, 499 patients were admitted to the ICU for AP. Several factors for predicting mortality in AP at admission were identified in the multivariate analysis: alkaline phosphatase hazard ratio (HR) = 1.00 (1.00–1.00, p = 0.024), anion gap HR = 1.09 (1.00–1.20, p = 0.047), bilirubin total HR = 1.11 (1.06–1.17, p, Key Points This is the first study that evaluates the role of serum phosphate at baseline for predicting the mortality of acute pancreatitis (AP) in intensive care unit (ICU).This study found that serum phosphate is a useful laboratory marker for predicting the mortality of AP independently of other known factors.This study found that serum phosphate value greater than 3.78 mg/dl within the first 24 h after admission in the ICU could predict mortality (area under curve = 0.7, p

Published
2021
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4. Evaluating the Risk of Irreversible Intestinal Necrosis Among Critically Ill Patients With Nonocclusive Mesenteric Ischemia

Author

Alexandre Malakhia, Maxime Ronot, Lucine Vuitton, Gaël Piton, Alexandre Doussot, Paul Calame, Pierre Verdot, Bruno Heyd, Franck Grillet, Hadrien Winiszewski, Eric Delabrousse, and Sebastien Pili-Floury

Subjects
Adult, Male, medicine.medical_specialty, Exploratory laparotomy, Critical Illness, medicine.medical_treatment, Context (language use), Risk Assessment, Gastroenterology, law.invention, Necrosis, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, law, Sepsis, Laparotomy, Internal medicine, Intestine, Small, parasitic diseases, medicine, Humans, Aged, Proportional Hazards Models, Aged, 80 and over, Prothrombin time, Hepatology, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Proportional hazards model, Middle Aged, Intensive care unit, Confidence interval, Bicarbonates, Mesenteric Ischemia, 030220 oncology & carcinogenesis, Multivariate Analysis, Prothrombin Time, Female, 030211 gastroenterology & hepatology, Tomography, X-Ray Computed, business
Abstract

INTRODUCTION To identify factors associated with irreversible transmural necrosis (ITN) among critically ill patients experiencing nonocclusive mesenteric ischemia (NOMI) and to compare the predictive value regarding ITN risk stratification with that of the previously described Clichy score. METHODS All consecutive patients admitted to the intensive care unit between 2009 and 2019 who underwent exploratory laparotomy for NOMI and who had an available contrast-enhanced computed tomography with at least 1 portal venous phase were evaluated for inclusion. Clinical, laboratory, and radiological variables were collected. ITN was assessed on pathological reports of surgical specimens and/or on laparotomy findings in cases of open-close surgery. Factors associated with ITN were identified by univariate and multivariate analysis to derive a NOMI-ITN score. This score was further compared with the Clichy score. RESULTS We identified 4 factors associated with ITN in the context of NOMI: absence of bowel enhancement, bowel thinning, plasma bicarbonate concentration ≤15 mmol/L, and prothrombin rate

Published
2021
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5. Diagnostic performance of CT for the detection of transmural bowel necrosis in non-occlusive mesenteric ischemia

Author

Gaël Piton, Alexandre Malakhia, Paul Calame, Pierre Verdot, Hadrien Winiszewski, Maxime Ronot, Zaher Lakkis, Sebastien Pili-Floury, Franck Grillet, and Eric Delabrousse

Subjects
medicine.medical_specialty, Necrosis, medicine.medical_treatment, Ischemia, Ileum, Gastroenterology, 030218 nuclear medicine & medical imaging, Jejunum, 03 medical and health sciences, 0302 clinical medicine, Laparotomy, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Retrospective Studies, medicine.diagnostic_test, business.industry, Stomach, digestive, oral, and skin physiology, Interventional radiology, General Medicine, medicine.disease, digestive system diseases, Intestinal Diseases, medicine.anatomical_structure, Mesenteric ischemia, Mesenteric Ischemia, 030220 oncology & carcinogenesis, Radiology, medicine.symptom, Tomography, X-Ray Computed, business
Abstract

To evaluate the diagnostic performance of CT for transmural necrosis (TN) in non-occlusive mesenteric ischemia (NOMI) according to the bowel segment involved. From January 2009 to December 2019, all patients admitted to the intensive care unit (ICU) and requiring laparotomy for NOMI were retrospectively studied. CT had to have been performed within 24 h prior to laparotomy and were reviewed by two abdominal radiologists, with a consensus reading in case of disagreement. A set of CT features of mesenteric ischemia were assessed, separating the stomach, jejunum, ileum, and right (RC) and left colon (LC). Univariate and multivariate analyses were performed to identify features associated with TN. Its influence on overall survival (OS) was assessed. Among 145 patients, 95 (66%) had ≥ 1 bowel segment with TN, including 7 (5%), 31 (21%), 43 (29%), 45 (31%), and 52 (35%) in the stomach, jejunum, ileum, RC, and LC, respectively. Overall inter-reader agreement of CT features was significantly lower in the colon than in the small bowel (0.59 [0.52–0.65] vs 0.74 [0.70–0.77] respectively). The absence of bowel wall enhancement was the only CT feature associated with TN by multivariate analysis, whatever the bowel segment involved. Proximal TN was associated with poorer OS (p < 0.001). The absence of bowel wall enhancement remains the most consistent CT feature of transmural necrosis, whatever the bowel segment involved in NOMI. Inter-reader agreement of CT features is lower in the colon than in the small bowel. Proximal TN seems to be associated with poorer OS. • The absence of bowel wall enhancement is the most consistent CT feature associated with transmural necrosis in NOMI, whatever is the bowel segment involved. • Inter-reader agreement is lower in the colon than in the small bowel in NOMI. • In NOMI, the more proximal the bowel necrosis, the worse the prognosis.

Published
2021
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6. Increased susceptibility to intensive care unit-acquired pneumonia in severe COVID-19 patients: a multicentre retrospective cohort study

Author

Thibaud Soumagne, Jean François Llitjos, Maxime Leclerc, Frédéric Pène, Jean-Baptiste Lascarrou, Matthieu Faron, Swann Bredin, Julien Charpentier, Arnaud Lepetit, Albin Gouhier, Gaël Piton, Annabelle Stoclin, and Mariana Cojocaru

Subjects
medicine.medical_specialty, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Septic shock, medicine, 030212 general & internal medicine, Risk factor, Mechanical ventilation, business.industry, Research, Bacterial pneumonia, lcsh:Medical emergencies. Critical care. Intensive care. First aid, COVID-19, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Intensive care unit, respiratory tract diseases, Pneumonia, Viral pneumonia, Ventilator-acquired pneumonia, business, Immunosuppression, Cohort study
Abstract

Background The aim of this study is to determine whether severe COVID-19 patients harbour a higher risk of ICU-acquired pneumonia. Methods This retrospective multicentre cohort study comprised all consecutive patients admitted to seven ICUs for severe COVID-19 pneumonia during the first COVID-19 surge in France. Inclusion criteria were laboratory-confirmed SARS-CoV-2 infection and requirement for invasive mechanical ventilation for 48 h or more. Control groups were two historical cohorts of mechanically ventilated patients admitted to the ICU for bacterial or non-SARS-CoV-2 viral pneumonia. The outcome of interest was the development of ICU-acquired pneumonia. The determinants of ICU-acquired pneumonia were investigated in a multivariate competing risk analysis. Result One hundred and seventy-six patients with severe SARS-CoV-2 pneumonia admitted to the ICU between March 1st and 30th June of 2020 were included into the study. Historical control groups comprised 435 patients with bacterial pneumonia and 48 ones with viral pneumonia. ICU-acquired pneumonia occurred in 52% of COVID-19 patients, whereas in 26% and 23% of patients with bacterial or viral pneumonia, respectively (p p = 0.011). Conclusion COVID-19 appears an independent risk factor of ICU-acquired pneumonia in mechanically ventilated patients with pneumonia. Whether this is driven by immunomodulatory properties by the SARS-CoV-2 or this is related to particular processes of care remains to be investigated.

Published
2021

7. Adverse Events in Intensive Care and Continuing Care Units During Bed-Bath Procedures: The Prospective Observational NURSIng during critical carE (NURSIE) Study

Author

Gwenaëlle Jacq, Catherine Tuaillon, Kristell Pedrono, Anne Lise Faure, Gwennaelle Mercier, Elodie Martinez, Celina Morand, Grégoire Muller, Sylvie L'Hotellier, Gaël Piton, Francoise De Freitas Pereira, Sami Hraiech, Cindy Lebrun, Philippe Michel, Guillaume Decormeille, Florence Boissier, Atika Youssouf, Nadia Aissaoui, Jean-Baptiste Lascarrou, David Grimaldi, Julie Negrel, Valerie Maurer-Maouchi, Julien Duviver, Sylvie Debock, Brice Sauvage, Samia Hultet-Midelton, Nadine Robquin, Virginie Dauve, Maud Rouhier, Gregoire Demont, Francoise Nicolas, Lea Soulisse, and Saber Barbar

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Critical Care Nursing, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Nursing care, 0302 clinical medicine, Risk Factors, Intensive care, Oxygen therapy, medicine, Nursing Interventions Classification, Humans, Prospective Studies, Simplified Acute Physiology Score, Adverse effect, Prospective cohort study, business.industry, Baths, 030208 emergency & critical care medicine, Middle Aged, Intensive Care Units, 030228 respiratory system, Emergency medicine, Female, Observational study, business
Abstract

Objectives Standard nursing interventions, especially bed-baths, in ICUs can lead to complications or adverse events defined as a physiologic change that can be life-threatening or that prolongs hospitalization. However, the frequency and type of these adverse events are rarely reported in the literature. The primary objective of our study was to describe the proportion of patients experiencing at least one serious adverse event during bed-bath. The secondary objectives were to determine the incidence of each type of serious adverse event and identify risk factors for these serious adverse events. Design Prospective multicenter observational study. Setting Twenty-four ICUs in France, Belgium, and Luxembourg. Patients The patients included in this study had been admitted to an ICU for less than 72 hours and required at least one of the following treatments: invasive ventilation, vasopressors, noninvasive ventilation, high-flow oxygen therapy. Serious adverse events were defined as cardiac arrest, accidental extubation, desaturation and/or mucus plugging/inhalation, hypotension and/or arrhythmia and/or agitation requiring therapeutic intervention, acute pain, accidental disconnection or dysfunction of equipment, and patient fall requiring additional assistance. Interventions None. Measurements and main results The study included 253 patients from May 1, 2018, to July 31, 2018 in 24 ICUs, representing 1,529 nursing procedures. The mean Simplified Acute Physiology Score II was 54 ± 19. Nursing care was administered by an average of 2 ± 1 caregivers and lasted between 11 and 20 minutes. Of the 253 patients included, 142 (56%) experienced at least one serious adverse event. Of the 1,529 nursing procedures, 295 (19%) were complicated by at least one serious adverse event. In multivariate analysis, the factors associated with serious adverse event were as follows: presence of a specific protocol (p = 0.011); tracheostomy (p = 0.032); administration of opioids (p = 0.007); presence of a physician (p = 0.0004); duration of nursing care between 6 and 10 minutes (p = 0.003), duration of nursing care between 11 and 20 minutes (p = 0.005), duration of nursing care greater than 40 minutes (p = 0.04) with a reference duration of nursing care between 20 and 40 minutes. Conclusions Serious adverse events were observed in one-half of patients and concerned one-fifth of nurses, confirming the need for caution. Further studies are needed to test systematic serious adverse event prevention strategies.

Published
2020
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8. Transmural Bowel Necrosis From Acute Mesenteric Ischemia and Strangulated Small-Bowel Obstruction: Distinctive CT Features

Author

Franck Grillet, Gaël Piton, Alexandre Malakhia, Eric Delabrousse, Paul Calame, and Celia Turco

Subjects
medicine.medical_specialty, Necrosis, Bowel infarction, business.industry, Bowel necrosis, Retrospective cohort study, General Medicine, medicine.disease, 030218 nuclear medicine & medical imaging, Bowel obstruction, 03 medical and health sciences, 0302 clinical medicine, Acute mesenteric ischemia, Mesenteric ischemia, 030220 oncology & carcinogenesis, medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Radiology, medicine.symptom, Pneumatosis intestinalis, business
Abstract

OBJECTIVE. The purpose of this study was to assess whether transmural bowel necrosis has distinct CT features based on the three main causes: occlusive acute mesenteric ischemia (AMI), nonocclusive AMI, and strangulated small-bowel obstruction (SBO). MATERIALS AND METHODS. From January 2010 to December 2017, the records of all patients with a pathologic diagnosis of transmural bowel necrosis were extracted from the pathology department database of a university hospital. The inclusion criteria for the study were presence of transmural bowel necrosis at pathologic examination and available contrast-enhanced CT images obtained within the 24 hours before surgery. Seventy-seven patients were finally included. The CT scans were retrospectively independently reviewed by two abdominal radiologists to identify the classic CT findings of transmural bowel necrosis. Statistical analyses were performed. RESULTS. Pneumatosis intestinalis was statistically more frequent in nonocclusive AMI (59%) than in occlusive AMI (29%) and strangulated SBO (7%) (p < 0.01), as were superior mesenteric venous gas (55%, 29%, and 0%; p < 0.01) and portal venous gas (48%, 10%, and 0%; p < 0.01). Decreased or absent bowel wall enhancement was more frequent in AMI than in SBO (nonocclusive AMI, 83%; occlusive AMI, 81%; SBO, 56%; p = 0.02), as was thinned bowel wall (nonocclusive AMI, 52%; occlusive AMI, 48%; SBO, 18%; p = 0.02). Spontaneous hyperattenuation of the bowel wall was more frequent in strangulated SBO (41%) than in nonocclusive AMI (10%) and occlusive AMI (14%) (p < 0.01). CONCLUSION. Transmural bowel necrosis has distinct CT findings according to its three main causes. Occlusive AMI is characterized by an absence of bowel wall enhancement and less mesenteric fat stranding, nonocclusive AMI by a high prevalence of pneumatosis intestinalis and portal venous gas, and strangulated SBO by spontaneous hyperattenuation of the bowel wall and an absence of pneumatosis intestinalis and portal venous gas.

Published
2020
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9. Trisodium citrate 4% versus heparin as a catheter lock for non-tunneled hemodialysis catheters in critically ill patients: a multicenter, randomized clinical trial

Author

Jean-Pierre Quenot, Julie Helms, Abderrahmane Bourredjem, Auguste Dargent, Ferhat Meziani, Julio Badie, Gilles Blasco, Gaël Piton, Gilles Capellier, Chaouki Mezher, Jean-Michel Rebibou, Abdelouaid Nadji, Thomas Crepin, Saber Davide Barbar, Camille Fleck, Amélie Cransac, Mathieu Boulin, Christine Binquet, Agnès Soudry-Faure, Rémi Bruyère, and for the VERROU-REA Trial Investigators and the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)

Subjects
Catheters, medicine.medical_treatment, Hemodialysis Catheter, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, Acute renal failure, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, medicine, Renal replacement therapy, business.industry, Heparin, Research, Acute kidney injury, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Intensive care unit, Catheter, 030228 respiratory system, Anesthesia, Hemodialysis, business, Citra-Lock, Critical illness
Abstract

Background Non-tunneled hemodialysis catheters are currently used for critically ill patients with acute kidney injury requiring extracorporeal renal replacement therapy. Strategies to prevent catheter dysfunction and infection with catheter locks remain controversial. Methods In a multicenter, randomized, controlled, double-blind trial, we compared two strategies for catheter locking of non-tunneled hemodialysis catheters, namely trisodium citrate at 4% (intervention group) versus unfractionated heparin (control group), in patients aged 18 years or older admitted to the intensive care unit and in whom a first non-tunneled hemodialysis catheter was to be inserted by the jugular or femoral vein. The primary endpoint was length of event-free survival of the first non-tunneled hemodialysis catheter. Secondary endpoints were: rate of fibrinolysis, incidence of catheter dysfunction and incidence of catheter-related bloodstream infection (CRBSI), all per 1000 catheter-days; number of hemorrhagic events requiring transfusion, length of stay in intensive care and in hospital; 28-day mortality. Results Overall, 396 randomized patients completed the trial: 199 in the citrate group and 197 in the heparin group. There was no significant difference in baseline characteristics between groups. The duration of event-free survival of the first non-tunneled hemodialysis catheter was not significantly different between groups: 7 days (IQR 3–10) in the citrate group and 5 days (IQR 3–11) in the heparin group (p = 0.51). Rates of catheter thrombosis, CRBSI, and adverse events were not statistically different between groups. Conclusions In critically ill patients, there was no significant difference in the duration of event-free survival of the first non-tunneled hemodialysis catheter between trisodium citrate 4% and heparin as a locking solution. Catheter thrombosis, catheter-related infection, and adverse events were not statistically different between the two groups. Trial registration Registered with Clinicaltrials.gov under the number NCT01962116. Registered 14 October 2013.

Published
2019
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10. Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial

Author

Jean Reignier, Emmanuelle Mercier, Jean-Philippe Rigaud, Jean-Paul Mira, Gaël Piton, Didier Thevenin, Saad Nseir, Michel Sirodot, Edouard Soum, Jean-Claude Lacherade, Amélie Le Gouge, Noelle Brule, Benoit Cypriani, Michel Djibré, Stéphane Gaudry, and Stéphanie Malaquin

Subjects
Male, Parenteral Nutrition, medicine.medical_specialty, Enterocyte, Fatty Acid-Binding Proteins, Critical Care and Intensive Care Medicine, Artificial respiration, Gastroenterology, Enteral administration, 03 medical and health sciences, chemistry.chemical_compound, Enteral Nutrition, 0302 clinical medicine, Internal medicine, Anesthesiology, Blood plasma, medicine, Citrulline, Humans, Intestinal Mucosa, Aged, business.industry, Shock, 030208 emergency & critical care medicine, Middle Aged, Respiration, Artificial, Intensive Care Units, Enterocytes, Parenteral nutrition, medicine.anatomical_structure, 030228 respiratory system, chemistry, Shock (circulatory), Female, medicine.symptom, business, Biomarkers
Abstract

The effects of the route of nutrition on the gut mucosa of patients with shock are unclear. Plasma citrulline concentration is a marker of enterocyte mass, and plasma intestinal fatty acid binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to study the effect of the route of nutrition on plasma citrulline concentration measured at day 3 of nutrition. Ancillary study of the NUTRIREA-2 trial. Ventilated adults with shock were randomly assigned to receive enteral or parenteral nutrition. Enterocyte biomarkers were measured at baseline, day 3, and day 8 of nutrition. A total of 165 patients from 13 French ICUs were included in the study: 85 patients in the enteral group and 80 patients in the parenteral group. At baseline, plasma citrulline was low without difference between groups (12.2 µmol L−1 vs 13.3 µmol L−1). At day 3, plasma citrulline concentration was higher in the enteral group than in the parenteral group (18.7 µmol L−1 vs 15.3 µmol L−1, p = 0.01). Plasma I-FABP concentration was increased at baseline, without difference between groups (245 pg mL−1 vs 244 pg mL−1). Plasma I-FABP concentration was higher in the enteral group than in the parenteral group at day 3 and day 8 (158 pg mL−1 vs 50 pg mL−1, p = 0.005 and 225 pg mL−1 vs 50 pg mL−1, p = 0.03). Plasma citrulline concentration was higher after 3 days of enteral nutrition than after 3 days of parenteral nutrition. This result raises the question of the possibility that enteral nutrition is associated with a more rapid restoration of enterocyte mass than parenteral nutrition.

Published
2019
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11. Impact of early low-calorie low-protein versus standard-calorie standard-protein feeding on outcomes of ventilated adults with shock: design and conduct of a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3)

Author

Christophe Leroy, Agathe Delbove, Guillaume Thiery, Gaëtan Plantefève, Patrice Tirot, Louis Chauvelot, Didier Thevenin, Julien Maizel, Vincent Das, Michael Darmon, Nathalie Thieulot-Rolin, Laurent Guérin, Philippe Letocart, Delphine Chatellier, Francis Schneider, Jérôme Devaquet, Fabien Lambiotte, Jean-Baptiste Lascarrou, Olivier Gontier, Walter Picard, Samir Jaber, Gaël Piton, Isabelle Vinatier, Bruno Giraudeau, Christophe Cracco, Amélie Le Gouge, Jean Pierre Quenot, Nicolas Terzi, Jack Richecoeur, Jean Philippe Rigaud, Sebastian Voicu, Yannick Hourmant, Laurent Brisard, Mai Anh Nay, Jean Reignier, François Tinturier, Djillali Annane, Louis Marie Dumont, Nicolae Vlad Botoc, Thierry Vanderlinden, Florian Reizine, Benjamin Madeux, Pierre Asfar, Samuel Groyer, Fabienne Tamion, Jean Paul Mira, Bertrand Souweine, Saad Nseir, Jean-François Timsit, Bertrand Guidet, Julio Badie, Johanna Oziel, Olivier Martinet, Anne Renault, Frédéric Martino, Christophe Vinsonneau, Diane Maugars, Nadia Aissaoui-Balanant, Michel Sirodot, Laurent Argaud, Hoang Nam Bui, Matthieu Debarre, Alain Combes, Emmanuelle Mercier, Daniel da Silva, 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), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, medicine.medical_specialty, Calorie, Low protein, Critical Illness, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Informed consent, law, Internal medicine, Diet, Protein-Restricted, Humans, Medicine, 030212 general & internal medicine, adult intensive & critical care, nutrition & dietetics, 2. Zero hunger, Mechanical ventilation, clinical trials, Protein feeding, SARS-CoV-2, business.industry, Intensive Care, COVID-19, General Medicine, Respiration, Artificial, Intensive care unit, 3. Good health, Clinical trial, Shock (circulatory), medicine.symptom, business
Abstract

IntroductionInternational guidelines include early nutritional support (≤48 hour after admission), 20–25 kcal/kg/day, and 1.2–2 g/kg/day protein at the acute phase of critical illness. Recent data challenge the appropriateness of providing standard amounts of calories and protein during acute critical illness. Restricting calorie and protein intakes seemed beneficial, suggesting a role for metabolic pathways such as autophagy, a potential key mechanism in safeguarding cellular integrity, notably in the muscle, during critical illness. However, the optimal calorie and protein supply at the acute phase of severe critical illness remains unknown. NUTRIREA-3 will be the first trial to compare standard calorie and protein feeding complying with guidelines to low-calorie low-protein feeding. We hypothesised that nutritional support with calorie and protein restriction during acute critical illness decreased day 90 mortality and/or dependency on intensive care unit (ICU) management in mechanically ventilated patients receiving vasoactive amine therapy for shock, compared with standard calorie and protein targets.Methods and analysisNUTRIREA-3 is a randomised, controlled, multicentre, open-label trial comparing two parallel groups of patients receiving invasive mechanical ventilation and vasoactive amine therapy for shock and given early nutritional support according to one of two strategies: early calorie-protein restriction (6 kcal/kg/day-0.2–0.4 g/kg/day) or standard calorie-protein targets (25 kcal/kg/day, 1.0–1.3 g/kg/day) at the acute phase defined as the first 7 days in the ICU. We will include 3044 patients in 61 French ICUs. Two primary end-points will be evaluated: day 90 mortality and time to ICU discharge readiness. The trial will be considered positive if significant between-group differences are found for one or both alternative primary endpoints. Secondary outcomes include hospital-acquired infections and nutritional, clinical and functional outcomes.Ethics and disseminationThe NUTRIREA-3 study has been approved by the appropriate ethics committee. Patients are included after informed consent. Results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03573739.

Published
2021
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12. New clinical algorithm including fungal biomarkers to better diagnose probable invasive pulmonary aspergillosis in ICU

Author

Jean-Christophe Navellou, Stéphane Bretagne, Gaël Piton, Laurence Millon, Joffrey Hamam, Emeline Scherer, Anne-Pauline Bellanger, Hadrien Winiszewski, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Libourne, Service de parasitologie et mycologie [CHRU de Besançon], Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Mycologie moléculaire - Molecular Mycology, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), None, Members of the Collaborative RESSIF group: Eric Bailly (CHU de Tours, Tours, France), Anne Isabelle Bertozi (CHU de Toulouse, Toulouse, France), Julie Bonhomme (CHU Caen, Caen, France), Bernard Bouteille (CHU de Limoges, Limoges, France), Cedric Bretonnière (CHU de Nantes, Nantes, France), Sophie Cassaing (CHU de Toulouse, Toulouse, France), Taieb Chouaki (CHU Amiens, Amiens, France), Olivier Cointault (CHU de Toulouse, Toulouse, France), Pierre Delobel (CHU de Toulouse, Toulouse, France), Odile Eloy (CH de Versailles, Versailles, France), Stanislas Faguer (CHU de Toulouse, Toulouse, France), Jerome Guinard (CH Orléans, Orléans, France), Thierry Lepoivre (CHU de Nantes, Nantes, France), Valerie Letscher-Bru (CHU de Strasbourg, Strasbourg, France), Bertrand Marcheix (CHU de Toulouse, Toulouse, France), Alida Minoza (CHU de Poitiers, Poitiers, France), Florent Morio (CHU de Nantes, Nantes, France), Celine Nourisson (CHU Clermont-Ferrand, Clermont-Ferrand, France), André Paugam (CHU Cochin, Paris, France), Hélène Raberin (CHU St-Etienne, St Etienne, France), Beatrice Riu (CHU de Toulouse, Toulouse, France)., Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), and Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, Population, Critical Care and Intensive Care Medicine, Aspergillosis, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Anesthesiology, Internal medicine, medicine, Aspergillus qPCR, Intensive care unit, 030212 general & internal medicine, Prospective cohort study, education, skin and connective tissue diseases, Mycosis, Fungal biomarkers, education.field_of_study, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Cancer, lcsh:RC86-88.9, medicine.disease, 3. Good health, respiratory tract diseases, Clinical algorithm, 030228 respiratory system, Biomarker (medicine), Invasive aspergillosis, Galactomannan antigen, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business
Abstract

Background The classification of invasive pulmonary aspergillosis (IPA) issued by the European Organization for the Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) is used for immunocompromised patients. An alternative algorithm adapted to the intensive care unit (ICU) population has been proposed (AspICU), but this algorithm did not include microbial biomarkers such as the galactomannan antigen and the Aspergillus quantitative PCR. The objective of the present pilot study was to evaluate a new algorithm that includes fungal biomarkers (BM-AspICU) for the diagnosis of probable IPA in an ICU population. Patients and methods Data from 35 patients with pathology-proven IPA according to European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSGERC)-2008 criteria were extracted from the French multicenter database of the Invasive Fungal Infections Surveillance Network (RESSIF). The patients were investigated according to the AspICU algorithm, and the BM-AspICU algorithm in analyzing the clinical, imaging, and biomarker data available in the records, without taking into account the pathology findings. Results Eight patients had to be excluded because no imaging data were recorded in the database. Among the 27 proven IPAs with complete data, 16 would have been considered as putative IPA with the AspICU algorithm and 24 would have been considered as probable IPA using the new algorithm BM-AspICU. Seven out of the 8 patients with probable BM-AspICU IPA (and not classified with the AspICU algorithm) had no host factors and no Aspergillus-positive broncho-alveolar lavage fluid (BALF) culture. Three patients were non-classifiable with any of the two algorithms, because they did not have any microbial criteria during the course of the infection, and diagnosis of proven aspergillosis was done using autopsy samples. Conclusion Inclusion of biomarkers could be effective to identify probable IPA in the ICU population. A prospective study is needed to validate the routine application of the BM-AspICU algorithm in the ICU population.

Published
2021
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13. Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Author

Jean Reignier, Gaël Piton, Marine Camus, Damien Contou, Raphael Favory, Frédéric Pène, Chloé Molliere, Idriss Abdallah, Elodie Baron, Sebastien Preau, Bertrand Guidet, Emmanuelle Mercier-Des-Rochettes, Hafid Ait-Oufella, Thibault Vieille, Jean-Rémi Lavillegrand, Mehran Monchi, Sara Thietart, Arnaud Galbois, Eric Maury, Guillaume Dumas, Gabriel Preda, Claire Pichereau, Arnaud-Felix Miailhe, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Roger Salengro [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Privé Claude Galien - Ramsay Santé, Centre hospitalier universitaire de Nantes (CHU Nantes), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier Sud Seine-et-Marne, Service d'Endocrinologie, diabétologie et endocrinologie de la reproduction [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Gestionnaire, HAL Sorbonne Université 5, and Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Organ Dysfunction Scores, Bilirubin, Cholangitis, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Microbiology, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, law, Intensive care, Internal medicine, Odds Ratio, Humans, Medicine, Intensive care unit, Mortality, Aged, Retrospective Studies, Outcome, Aged, 80 and over, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Cancer, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, medicine.disease, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, chemistry, Multicenter study, Multivariate Analysis, Female, 030211 gastroenterology & hepatology, SOFA score, business
Abstract

Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Results Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p p p p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02). Conclusions In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.

Published
2021
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14. Timing and causes of death in severe COVID-19 patients

Author

Maxime Leclerc, Benjamin G. Chousterman, Jean François Llitjos, Albin Gouhier, Mariana Cojocaru, Swann Bredin, Annabelle Stoclin, Charles de Roquetaillade, Thibaud Soumagne, Gaël Piton, Jean-Baptiste Lascarrou, and Frédéric Pène

Subjects
Adult, Male, medicine.medical_specialty, Secondary infection, Multiple Organ Failure, Pulmonary Fibrosis, Pneumonia, Viral, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Hypoxemia, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Ischemia, Cause of Death, Medicine, Humans, Intensive care unit, Hospital Mortality, Mortality, Hypoxia, Causes of death, Cause of death, Retrospective Studies, business.industry, RC86-88.9, SARS-CoV-2, Medical record, Research, COVID-19, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, Retrospective cohort study, Medical emergencies. Critical care. Intensive care. First aid, medicine.disease, Pneumonia, Intensive Care Units, Emergency medicine, Female, medicine.symptom, business, Multiple organ dysfunction syndrome
Abstract

Background Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU). Methods We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records. Results From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th–75th IQR, 7–27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th–75th IQR: 7–19 days), while only one death had occurred during the first 3 days since ICU admission. Conclusions In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.

Published
2021

15. Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia

Author

Célia Turco, Eric Delabrousse, Arnaud Juif, Paul Calame, Sebastien Pili-Floury, Hadrien Winiszewski, Gaël Piton, Pierre Verdot, Service de radiologie [CHRU Besancon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), GDS Bourgogne - Franche-Comté (GDS 71), Fédération nationale des Groupements de Défense Sanitaire (GDS France), Service de Chirurgie Digestive [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Ischemia, Mesenteric Artery, Superior, Laparotomy, medicine.artery, medicine, Humans, Radiology, Nuclear Medicine and imaging, Superior mesenteric artery, Risk factor, Retrospective Studies, Univariate analysis, business.industry, Abdominal aorta, General Medicine, medicine.disease, Atherosclerosis, Intensive care unit, 3. Good health, Mesenteric ischemia, 030220 oncology & carcinogenesis, Mesenteric Ischemia, Radiology, business, Tomography, X-Ray Computed, Calcification
Abstract

Purpose To evaluate whether abdominal atherosclerosis was associated with poorer outcome in a single-centre cohort of patients suffering from nonocclusive mesenteric ischemia (NOMI). Methods From January 2009 to December 2019, 121 consecutive patients from the critical care unit who underwent laparotomy for suspected NOMI and with available unenhanced and contrast-enhanced CT were included. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. Unenhanced CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA) and common iliac arteries according to the Agatston method. Univariate and multivariate analysis were performed. Results Among the 121 patients with NOMI and calcium score calculation, only 4 patients had no aortic calcifications (3 %) and 32 had no superior mesenteric artery calcification (26 %). 35 patients (29 %) died within 24 h after the abdominal CT scan. Univariate analysis showed that a total abdominal calcium score greater than 15 000 (last quartile) was significantly associated with death within 24 h (14 (40 %) vs 17 (20 %) patients, p = 0.035). By multivariate analysis, a total abdominal calcium score greater than 15 000 was an independent risk factor for death (HR = 1.94, 95 %CI [1.02–3.73], p = 0.044). Regarding separate calcium scores, only a SMA calcium score greater than 50 was a risk factor for death (HR 2.46, 95 %CI [1.14–3.93], p = 0.019). Conclusion Our results show that abdominal atherosclerosis, especially in the SMA, is associated with poorer outcome in NOMI.

Published
2021
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16. Semi-elemental versus polymeric formula for enteral nutrition in brain-injured critically ill patients: a randomized trial

Author

Camille Gilli, Anne Sophie Balon, Emmanuel Samain, Gilles Blasco, Hadrien Winiszewski, Sebastien Pili-Floury, Guillaume Besch, Gilles Capellier, Gaël Piton, and Laurent Carteron

Subjects
Adult, Male, medicine.medical_specialty, Critical Illness, Critical Care and Intensive Care Medicine, Gastroenterology, Enteral administration, Statistics, Nonparametric, law.invention, 03 medical and health sciences, Enteral Nutrition, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Humans, Prospective Studies, 030212 general & internal medicine, Gastroparesis, Brain injury, Critically ill, Aged, Nutrition, Food, Formulated, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Glasgow Coma Scale, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, medicine.disease, Semi-elemental, Intensive care unit, Parenteral nutrition, Brain Injuries, Vomiting, Female, France, medicine.symptom, business
Abstract

Background The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis. The purpose of this study was to compare the efficacy and tolerance of a semi-elemental versus a polymeric formula for enteral nutrition (EN) in brain-injured critically ill patients. Methods Prospective, randomized study including brain-injured adult patients [Glasgow Coma Scale (GCS) ≤ 8] with an expected duration of mechanical ventilation > 48 h. Intervention: an enteral semi-elemental (SE group) or polymeric (P group) formula. EN was started within 36 h after admission to the intensive care unit and was delivered according to a standardized nurse-driven protocol. The primary endpoint was the percentage of patients who received both 60% of the daily energy goal at 3 days and 100% of the daily energy goal at 5 days after inclusion. Tolerance of EN was assessed by the rate of gastroparesis, vomiting and diarrhea. Results Respectively, 100 and 95 patients were analyzed in the SE and P groups: Age (57[44–65] versus 55[40–65] years) and GCS (6[3–7] versus 5[3–7]) did not differ between groups. The percentage of patients achieving the primary endpoint was similar (46% and 48%, respectively; relative risk (RR) [95% confidence interval (CI)] = 1.05 (0.78–1.42); p = 0.73). The mean daily energy intake was, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (p = 0.42). Protein intakes were 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day (p p = 0.21), and 16% versus 8% patients suffered from diarrhea (p = 0.11). No patient presented vomiting in either group. Conclusion Semi-elemental compared to polymeric formula did not improve daily energy intake or gastrointestinal tolerance of enteral nutrition. Trial registration EudraCT/ID-RCB 2012-A00078-35 (registered January 17, 2012).

Published
2021
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17. Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

Author

Gaël Piton, Arnaud W. Thille, Damien Contou, Laura Federici, Bertrand Guidet, Jean Reignier, Julie Badin, Erwan I'her, Dalila Benzekri-Llefevre, Pascal Beuret, Riad Chelha, Suela Demiri, Christophe Vinsonneau, Michel Djibré, Juliette Masse, Nicolas Terzi, Francois Thouy, Juliette Audibert, Olivier Lesieur, Stephan Ehrmann, Hassene Rahmani, Alexandre Boyer, Saad Nseir, Denis Frasca, Christophe Girault, Jean-Pierre Frat, René Robert, Martial Thyrault, Jean-Pierre Quenot, Laurent Argaud, Christophe Guitton, Didier Thevenin, Nadia Aissaoui, Khaldoune Kuteifan, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier de Blois (CH Blois), CHU Rouen, Normandie Université (NU), Centre Hospitalier Le Mans (CH Le Mans), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Roanne (CH Roanne), CH de Roanne, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional d'Orléans (CHRO), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Strasbourg (UNISTRA), CHU Strasbourg, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Lyon, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire de Traitement de l'Information Medicale (LaTIM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical Research in Intensive Care and Sepsis - TRIal Group for Global Evaluation and Research in SEPsis [CHU Limoges] (Réseau CRICS-TRIGGERSEP ), Hôpital Dupuytren [CHU Limoges], Hôpital Saint-Louis de La Rochelle (CH La Rochelle), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Lens, Centre Hospitalier Victor Dupouy, CHU Grenoble, Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Groupe Hospitalier Nord Essonne [Longjumeau], Centre Hospitalier de Béthune Beuvry (CH Béthune Beuvry), Hôpital Louis Pasteur [Chartres], Université catholique de Lille (UCL), Groupe hospitalier Pellegrin, CHU Saint-Antoine [AP-HP], Centre Hospitalier Privé Claude Galien - Ramsay Santé, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Blois (CHB), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique (IMT Atlantique), and CarMeN, laboratoire

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], law.invention, 03 medical and health sciences, 0302 clinical medicine, Quality of life, law, Informed consent, Oxygen therapy, medicine, Humans, respiratory medicine (see thoracic medicine), 030212 general & internal medicine, Prospective Studies, Prospective cohort study, adult intensive & critical care, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, Intensive Care, General Medicine, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Oxygen, Intensive Care Units, 030228 respiratory system, medical ethics, Propensity score matching, Emergency medicine, Quality of Life, Observational study, business, Respiratory Insufficiency, Cohort study
Abstract

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

Published
2021
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18. The prognostic value of the neutrophil-to-lymphocyte ratio in critically ill cirrhotic patients

Author

Steven Grangé, Caroline Lemaitre, Fabienne Tamion, Audrey De Jong, Richard Moreau, Emmanuel Weiss, Catherine Paugam-Burtz, Samir Jaber, Mikhael Giabicani, Gerald Chanques, Gaël Piton, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Liver Cirrhosis, medicine.medical_specialty, Neutrophils, Critical Illness, [SDV]Life Sciences [q-bio], Population, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Internal medicine, medicine, Risk of mortality, Humans, Lymphocytes, Neutrophil to lymphocyte ratio, education, Retrospective Studies, education.field_of_study, Univariate analysis, Hepatology, business.industry, Mortality rate, Gastroenterology, 030208 emergency & critical care medicine, Prognosis, 3. Good health, Cohort, 030211 gastroenterology & hepatology, SOFA score, business
Abstract

Background Hospital death rates following ICU admission of cirrhotic patients remain high. Identifying patients at high risk of mortality after few days of aggressive management is imperative for providing adequate interventions. Herein, we aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with usual organ failure scores in the outcome prediction of cirrhotic patients hospitalized more than 3 days in ICU. Methods We conducted a retrospective bicentric study in two cohorts of cirrhotic patients hospitalized more than 3 days in French university hospital ICUs. At admission and day 3, we calculated several clinico-biological scores grading liver disease and organ failure severity and calculated the NLR. The primary outcome was 28-day mortality. Results The test cohort included 116 patients. At day 28, 43 (37.1%) patients had died. Variations of MELD score (ΔMELD), SOFA score (ΔSOFA), CLIF-SOFA score (ΔCLIF-SOFA) and NLR (ΔNRL) between admission and day 3 were significantly associated with 28-day mortality in univariate analysis. When included in bivariate analysis ΔNLR remained a significant predictor of 28-day mortality independently of these severity scores. Kaplan-Meier curves and statistics using reclassification methods showed a better 28-day mortality risk prediction using ΔNRL in association with ΔSOFA in comparison to ΔSOFA alone. These results were confirmed in an external validation cohort, including 101 critically ill cirrhotic patients. Conclusions ΔNLR is an independent predictor of mortality in the critically ill cirrhotic patients' population who requires intensive care supportive treatment and should be used in association with ΔSOFA as a prognostic biomarker.

Published
2021
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19. Refractory ARDS with diffuse centrilobular nodules: did the patient smoke a tree?

Author

Gaël Piton, Estelle Dossot, Thibaud Soumagne, and Hadrien Winiszewski

Subjects
Male, ARDS, Marijuana Abuse, medicine.medical_treatment, 030204 cardiovascular system & hematology, Pulmonary compliance, law.invention, Diagnosis, Differential, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Refractory, law, Bronchoscopy, medicine, Extracorporeal membrane oxygenation, Intubation, Humans, Medical history, 030212 general & internal medicine, Respiratory Distress Syndrome, business.industry, Thoracic Surgery, Video-Assisted, General Medicine, medicine.disease, Intensive care unit, respiratory tract diseases, Pneumonia, Anesthesia, business, Tomography, X-Ray Computed
Abstract

A 22-year-old man with no relevant medical history except hashish use (10 joints a day) was admitted to the intensive care unit in December 2018 for refractory acute respiratory distress syndrome (ARDS). He presented dry cough and dyspnoea for 1 week. After intubation, veno-venous extracorporeal membrane oxygenation (VV-ECMO) was required because of severe hypoxemia and very low respiratory compliance (15 mL/cmH2O). Given the possibility of severe community-acquired pneumonia and influenza, urgent antibiotic therapy associating cephalosporin plus macrolid and …

Published
2020

20. Sarcopenia and visceral obesity assessed by computed tomography are associated with adverse outcomes in patients with Crohn's disease

Author

Julienne Grillot, Christelle D'Engremont, Anne-Laure Parmentier, Zaher Lakkis, Gaël Piton, Diane Cazaux, Claire Gay, Marjolaine De Billy, Stéphane Koch, Sophie Borot, Lucine Vuitton, Service de Gastro-Entérologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre d'Investigation Clinique de Besançon (Inserm CIC 1431), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service d'Oncologie Médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Service d'anesthésie et soins intensifs [CHRU Besançon], Service de radiologie [CHRU Besancon], Service de Diabétologie - Endocrinologie [CHRU Besançon], CCSD, Accord Elsevier, Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])

Subjects
0301 basic medicine, Male, Sarcopenia, [SDV]Life Sciences [q-bio], Disease, Overweight, Critical Care and Intensive Care Medicine, Gastroenterology, Severity of Illness Index, 0302 clinical medicine, Crohn Disease, Risk Factors, Prevalence, Adiposity, 2. Zero hunger, Crohn's disease, Nutrition and Dietetics, Middle Aged, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Cohort, Body Composition, Female, France, medicine.symptom, Adult, medicine.medical_specialty, Nutritional Status, 030209 endocrinology & metabolism, Intra-Abdominal Fat, Risk Assessment, 03 medical and health sciences, Young Adult, Predictive Value of Tests, Internal medicine, medicine, Humans, Obesity, Adverse effect, Muscle, Skeletal, Retrospective Studies, 030109 nutrition & dietetics, business.industry, Malnutrition, medicine.disease, business, Tomography, X-Ray Computed, human activities, Body mass index
Abstract

Summary Background Altered body composition may impact on the clinical course of Crohn's disease (CD) but is not detected by the simple body mass index (BMI) assessment. Aim To assess the prevalence of sarcopenia and visceral obesity by a single computed tomography (CT) slice, and its association with adverse events in an adult hospitalized CD cohort. Methods 88 CD patients who had abdominal CT scans during hospitalization were retrospectively enrolled. The skeletal muscle index (SMI) at the third lumbar vertebra level was used to assess sarcopenia. Sarcopenia was defined as a SMI Results The prevalence of sarcopenia was 58%, malnutrition 21.6%, and visceral obesity 19.3%. Among sarcopenic patients, 49% had a normal BMI, 13.7% were overweight, and 1(2%) was obese. Sarcopenic CD patients had significantly more abscesses (51% vs 16.7%, p = 0.001), hospitalizations (61.2% vs 36.1%, p = 0.022) and digestive surgery (63.3% vs 27.8%, p = 0.001) than non-sarcopenic patients during the follow-up, whereas usual malnutrition assessment was not correlated with disease outcomes. In multivariate analysis, both sarcopenia and visceral obesity were associated with further occurrence of digestive surgery. Conclusion Both sarcopenia and visceral obesity were associated with adverse outcomes in severe CD patients whereas usual nutritional assessment was not.

Published
2019
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21. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

Author

Suzanne Goursaud, Antoine Ausseur, Jérémie Lemarié, Philippe Michel, Gaël Piton, Maximilien Grall, Emmanuelle Mercier, Fabien Lambiotte, Arnaud-Félix Miailhe, Saad Nseir, Nicholas Sedillot, Philippe Guiot, Aurélie Le Thuaut, Maud Jonas, Sébastien Moschietto, Julien Charpentier, Leptorea, Aurelie Gaultier, Jean-Baptiste Lascarrou, Christophe Cracco, Pierre Asfar, Karim Chaoui, Lara Zafrani, Claire Lhommet, Adel Maamar, Nicolas de Prost, Jean Reignier, Marie-Line Eustache, Yoann Zerbib, Michel Sirodot, Laurent Argaud, Jean-Claude Lacherade, Yannick Monseau, Alexis Ferré, Olivier Lesieur, Pascale Bourhy, Vlad Botoc, Jérôme Pillot, Didier Thevenin, Mickael Landais, Adel Ben Salah, David Osman, Elena Gauvin, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service de Réanimation Médicale, CHU d'Angers, France, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), 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), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Cholet (CHC), Hôpitaux de Chartres [Chartres], Service de réanimation (CH Saint-Malo), Centre hospitalier de Saint-Malo, Centre Hospitalier Cahors, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier d'Angoulême (CH Angoulême), Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Georges Renon [Niort] (CH Georges Renon Niort), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier de Mulhouse, site du Hasenrain (Mulhouse), Centre hospitalier de Saint-Nazaire, Centre hospitalier [Valenciennes, Nord], Centre Hospitalier Le Mans (CH Le Mans), 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), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier de La Rochelle (CHR), CHU de Saint-Brieuc, Centre Hospitalier René Dubos [Pontoise], Hopital de Périgueux (CH Périgueux), Hopital de Périgueux, Centre Hospitalier Henri Duffaut (Avignon), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier de la Côte Basque (CHCB), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Fleyriat [Bourg en Bresse], Centre Hospitalier d'Annecy, Centre hospitalier d'Annecy, Centre Hospitalier de Lens, 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 Paris Cité (UPCité), CHU Amiens-Picardie, Biologie des Spirochètes / Biology of Spirochetes, Institut Pasteur [Paris] (IP), Centre hospitalier de Cahors, Le CHCB, Centre Hospitalier de la Côte Basque, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Institut Pasteur [Paris], Centre Hospitalier Départemental Vendée, 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), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP)

Subjects
Adult, Male, medicine.medical_specialty, Severe leptospirosis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Multiple Organ Failure, Population, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Risk Factors, Anesthesiology, medicine, Humans, Leptospirosis, Renal replacement therapy, Temperate zone, Hospital Mortality, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Intensive care unit, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, 3. Good health, Intensive Care Units, 030228 respiratory system, Emergency medicine, Outcome, SOFA score, Female, France, business, Mortality
Abstract

International audience; Purpose: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.Methods: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes.Results: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations.Conclusions: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.

Published
2019
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22. Impact of nutrition route on microaspiration in critically ill patients with shock: a planned ancillary study of the NUTRIREA-2 trial

Author

Pierre-Louis Declercq, François Tinturier, Gaël Piton, Emmanuelle Mercier, Jean Reignier, Jean-Paul Mira, Elisabeth Coupez, Jean-Claude Lacherade, Jeremy Pasco, Emmanuelle Jaillette, Stéphane Gaudry, Michel Sirodot, Didier Thevenin, Saad Nseir, Malika Balduyck, Michel Djibré, Jean-Baptiste Lascarrou, Amélie Le Gouge, Farid Zerimech, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Lille 2 - Faculté de Médecine, Université de Tours (UT), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Nantes (UN), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier de Dieppe, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), CHU Amiens-Picardie, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Avicenne [AP-HP], Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université de Tours

Subjects
Male, medicine.medical_specialty, Bodily Secretions, Constipation, Time Factors, medicine.medical_treatment, Critical Illness, Critical Care and Intensive Care Medicine, Artificial respiration, Enteral administration, Gastroenterology, Pathophysiology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, Microaspiration, Aged, Retrospective Studies, Mechanical ventilation, Gastric Juice, business.industry, Research, Oropharyngeal secretions, Drug Administration Routes, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Bacterial pneumonia, Ventilator-associated pneumonia, 030208 emergency & critical care medicine, Gastric contents, Shock, lcsh:RC86-88.9, Pneumonia, Middle Aged, medicine.disease, 3. Good health, Critical care, Intensive Care Units, Parenteral nutrition, Inhalation, Vomiting, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Nutrition Therapy, medicine.symptom, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Background Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions. Methods Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates. Results A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p = 0.016), constipation rate was significantly lower (6% vs 21%, p = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)). Conclusions Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition. Trial registration ClinicalTrials.gov, NCT03411447. Registered 18 July 2017. Retrospectively registered.

Published
2019
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23. Acute Mesenteric Ischemia Among Postcardiac Surgery Patients Presenting with Multiple Organ Failure

Author

Bénédicte De Parseval, Eric Delabrousse, Sebastien Pili-Floury, Stéphane Koch, Gilles Capellier, Emmanuel Samain, Alexis Guillaume, Gaël Piton, and Sidney Chocron

Subjects
Male, medicine.medical_specialty, Multiple Organ Failure, health care facilities, manpower, and services, 030204 cardiovascular system & hematology, Nonocclusive mesenteric ischemia, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Acute mesenteric ischemia, Risk Factors, law, medicine, Humans, cardiovascular diseases, Cardiac Surgical Procedures, Simplified Acute Physiology Score, health care economics and organizations, Severe complication, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, Intensive care unit, Surgery, Cardiac surgery, Intensive Care Units, Mesenteric Ischemia, Intestinal Fatty Acid-Binding Protein, Acute Disease, Emergency Medicine, Female, 030211 gastroenterology & hepatology, business
Abstract

Acute mesenteric ischemia (AMI) is a rare but severe complication after cardiac surgery. However, AMI is likely to be more frequent in the subgroup of patients presenting with multiple organ failure after a cardiac surgery. The primary objective of this study was to identify AMI risk factors among patients requiring intensive care unit (ICU) admission after cardiac surgery.Retrospective observational study of all the patients requiring admission to two ICUs in a large university hospital after a cardiac surgery procedure. AMI confirmation was based on abdominal computed tomography scan, digestive endoscopy, laparotomy, or postmortem examination. Univariate and multivariate analyses were done to compare pre- and in-ICU characteristics between patients with or without AMI.Between 2007 and 2013, a cardiac surgery was performed in 4,948 patients, of whom 320 patients (6%) required ICU admission for multiple organ failure. AMI was confirmed in 10% of the patients admitted to the ICU for multiple organ failure (33/320). The prognosis of these patients was extremely poor with 28- and 90-day mortality rates of 64% and 83%, respectively. Nonocclusive mesenteric ischemia (NOMI) was the main mechanism involved in 83% of the patients. Coronary artery bypass graft, need for blood transfusion during cardiopulmonary bypass, aspartate aminotransferase at least 100 UI/L, and Simplified Acute Physiology Score II at least 50 at ICU admission were independently associated with AMI. An AMI risk score based upon these four risk factors was able to identify three classes of risk: low risk (1%), intermediate risk (9%), and high risk (29%).AMI is a frequent condition among patients presenting with multiple organ failure after cardiac surgery, occurring in 10% of them. The prognosis of AMI is extremely poor. The main mechanism of AMI is NOMI, occurring in approximately 80% of patients. Further progress should be performed on prevention and earlier diagnosis.

Published
2017
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24. The pharmacokinetic challenge of treating invasive aspergillosis complicating severe influenzae assisted by extracorporeal membrane oxygenation

Author

Anne-Laure Clairet, Jennifer Lagoutte-Renosi, Hadrien Winiszewski, Laurence Millon, Gaël Piton, Jean-Christophe Navellou, Gilles Capellier, Anne-Claire Rougny, Réanimation Médicale CHRU Besançon, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Pôle pharmaceutique [CHRU Besançon], Laboratoire de Pharmacologie Clinique et Toxicologie [CHRU Besancon], Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Service de parasitologie et mycologie [CHRU de Besançon]

Subjects
Letter, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Aspergillosis, 03 medical and health sciences, 0302 clinical medicine, MESH: Extracorporeal Membrane Oxygenation, Pharmacokinetics, Extracorporeal membrane oxygenation, Medicine, MESH: Aspergillosis, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, MESH: Bronchopulmonary Sequestration, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, MESH: Humans, MESH: Middle Aged, business.industry, MESH: Influenza, Human, MESH: Pyridines, lcsh:Medical emergencies. Critical care. Intensive care. First aid, MESH: Voriconazole, lcsh:RC86-88.9, MESH: Antifungal Agents, medicine.disease, MESH: Nitriles, MESH: Male, 3. Good health, MESH: Triazoles, 030228 respiratory system, Anesthesia, MESH: Aspergillus fumigatus, business, MESH: Invasive Fungal Infections
Abstract

International audience

Published
2018
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25. Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis

Author

Remi Trusson, Djillali Annane, Christine Lebert, Jean-Paul Mira, Rémi Bruyère, Saber Barbar, Claire Roger, Philippe Guiot, Samir Jaber, Mai-Anh Nay, Julio Badie, Raphaël Clere-Jehl, Jean-Michel Constantin, Gaël Piton, Jean-Pierre Quenot, Bruno Levy, Lila Bouadma, Romain Hernu, Emmanuelle Mercier, Shidasp Siami, Julien Bohé, Auguste Dargent, Loïc Chimot, Julie Helms, Benjamin Louart, Guillaume Louis, Florent Montini, Ferhat Meziani, Carole Schwebel, Jean-Philippe Rigaud, Christine Binquet, Jean-Pierre Eraldi, Thierry Van Der Linden, Abderrahmane Bourredjem, Damien du Cheyron, Gilles Blasco, Kada Klouche, 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), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Equipe LIPNESS (LNC - U1231) (LIPNESS), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), 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 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), 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)-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), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), 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-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, 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), 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), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Septic shock, business.industry, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Acute kidney injury, Renal function, 030208 emergency & critical care medicine, General Medicine, Acute Kidney Injury, medicine.disease, Interim analysis, 3. Good health, Time-to-Treatment, Sepsis, Renal Replacement Therapy, 03 medical and health sciences, 0302 clinical medicine, Anesthesia, medicine, Anuria, 030212 general & internal medicine, Renal replacement therapy, medicine.symptom, business, Kidney disease
Abstract

IF 79.258 (2017); International audience; BackgroundAcute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial.MethodsIn a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification system but without life-threatening complications related to acute kidney injury to receive renal-replacement therapy either within 12 hours after documentation of failure-stage acute kidney injury (early strategy) or after a delay of 48 hours if renal recovery had not occurred (delayed strategy). The failure stage of the RIFLE classification system is characterized by a serum creatinine level 3 times the baseline level (or ≥4 mg per deciliter with a rapid increase of ≥0.5 mg per deciliter), urine output less than 0.3 ml per kilogram of body weight per hour for 24 hours or longer, or anuria for at least 12 hours. The primary outcome was death at 90 days.ResultsThe trial was stopped early for futility after the second planned interim analysis. A total of 488 patients underwent randomization; there were no significant between-group differences in the characteristics at baseline. Among the 477 patients for whom follow-up data at 90 days were available, 58% of the patients in the early-strategy group (138 of 239 patients) and 54% in the delayed-strategy group (128 of 238 patients) had died (P=0.38). In the delayed-strategy group, 38% (93 patients) did not receive renal-replacement therapy. Criteria for emergency renal-replacement therapy were met in 17% of the patients in the delayed-strategy group (41 patients).ConclusionsAmong patients with septic shock who had severe acute kidney injury, there was no significant difference in overall mortality at 90 days between patients who were assigned to an early strategy for the initiation of renal-replacement therapy and those who were assigned to a delayed strategy. (Funded by the French Ministry of Health; IDEAL-ICU ClinicalTrials.gov number, NCT01682590.)

Published
2018
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26. Multicentric Standardized Flow Cytometry Routine Assessment of Patients With Sepsis to Predict Clinical Worsening

Author

Thomas Daix, Estelle Guerin, Elsa Tavernier, Emmanuelle Mercier, Valérie Gissot, Olivier Hérault, Jean-Paul Mira, Florence Dumas, Nicolas Chapuis, Christophe Guitton, Marie C. Béné, Jean-Pierre Quenot, Cindy Tissier, Julien Guy, Gaël Piton, Anne Roggy, Grégoire Muller, Éric Legac, Nicolas de Prost, Mehdi Khellaf, Orianne Wagner-Ballon, Rémi Coudroy, Elodie Dindinaud, Fabrice Uhel, Mikaël Roussel, Thomas Lafon, Robin Jeannet, Frédéric Vargas, Catherine Fleureau, Mickaël Roux, Kaoutar Allou, Philippe Vignon, Jean Feuillard, Bruno François, Adollës Di Vittorio, Sébastien Lachot, Marie-Thérèse Georget, Joelle Hanna, Cédric Bretonnière, Olivier Zambon, Laurent Nicolet, Noëlle Brule, Camille Debord, Yannick Le Bris, Nelly Robillard, Auguste Dargent, Anne Bretagnol, Armelle Mathonnet, Thierry Boulain, François Barbier, Dalila Benzekri, Isabelle Runge, Toufik Kamel, Jérôme Cecchini, Sabrina Bouyer, René Robert, Alexandre Ouattara, Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Limoges, Contrôle de la Réponse Immune B et des Lymphoproliférations (CRIBL), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), CIC Tours, Hôpital Bretonneau-Université de Tours-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), CIC - Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre hospitalier universitaire de Nantes (CHU Nantes), Equipe LIPNESS (LNC - U1231) (LIPNESS), 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-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, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), 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), 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, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (HOTE GREFFON), Université de Franche-Comté (UFC)-Etablissement français du sang [Bourgogne-France-Comté] (EFS [Bourgogne-France-Comté])-Institut National de la Santé et de la Recherche Médicale (INSERM), 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)-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), Réanimation Médicale [CHR d'Orléans], Centre Hospitalier Régional d'Orléans (CHR), Hématologie Biologique [CHR d'Orléans], Réanimation Médicale [CHU Henri Mondor - APHP] (DHU A-TVB), Université Paris-Est Créteil, Faculté de Médecine [Créteil] (UPEC-Médecine), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], CHU Bordeaux [Bordeaux], Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Septiflux Trial Group : Di Vittorio A, Lachot S, Georget MT, Hanna J, Bretonnière C, Zambon O, Nicolet L, Brule N, Debord C, Le Bris Y, Robillard N, Dargent A, Bretagnol A, Mathonnet A, Boulain T, Barbier F, Benzekri D, Runge I, Kamel T, Cecchini J, Bouyer S, Robert R, Ouattara A., 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), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), 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), Centre Hospitalier Régional d'Orléans (CHRO), CHU Henri Mondor-Université Paris-Est Créteil, Faculté de Médecine [Créteil] (UPEC-Médecine), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), 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 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 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), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), 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), Université Paris-Est Créteil, Faculté de Médecine [Créteil] (UPEC-Médecine)-CHU Henri Mondor, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Degauque, Nicolas, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges, Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), 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 CHU Henri Mondor [Créteil]-Université Paris-Est Créteil, Faculté de Médecine [Créteil] (UPEC-Médecine)

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, [SDV.IMM] Life Sciences [q-bio]/Immunology, Organ Dysfunction Scores, medicine.medical_treatment, Inflammation, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Sepsis, sepsis, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Humans, Prospective Studies, Simplified Acute Physiology Score, Aged, immunosuppression, Clinical Deterioration, Immature Granulocyte, business.industry, Septic shock, flow cytometry, Area under the curve, 030208 emergency & critical care medicine, Immunosuppression, medicine.disease, Survival Analysis, 3. Good health, Systemic inflammatory response syndrome, inflammation, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, prognosis, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; Background In this study, we primarily sought to assess the ability of flow cytometry to predict early clinical deterioration and overall survival in patients with sepsis admitted in the ED and ICU. Methods Patients admitted for community-acquired acute sepsis from 11 hospital centers were eligible. Early (day 7) and late (day 28) deaths were notified. Levels of CD64pos granulocytes, CD16pos monocytes, CD16dim immature granulocytes (IGs), and T and B lymphocytes were assessed by flow cytometry using an identical, cross-validated, robust, and simple consensus standardized protocol in each center. Results Among 1,062 patients screened, 781 patients with confirmed sepsis were studied (age, 67 ± 48 years; Simplified Acute Physiology Score II, 36 ± 17; Sequential Organ Failure Assessment, 5 ± 4). Patients were divided into three groups (sepsis, severe sepsis, and septic shock) on day 0 and on day 2. On day 0, patients with sepsis exhibited increased levels of CD64pos granulocytes, CD16pos monocytes, and IGs with T-cell lymphopenia. Clinical severity was associated with higher percentages of IGs and deeper T-cell lymphopenia. IG percentages tended to be higher in patients whose clinical status worsened on day 2 (35.1 ± 35.6 vs 43.5 ± 35.2, P =.07). Increased IG percentages were also related to occurrence of new organ failures on day 2. Increased IG percentages, especially when associated with T-cell lymphopenia, were independently associated with early (P andlt;.01) and late (P andlt;.01) death. Conclusions Increased circulating IGs at the acute phase of sepsis are linked to clinical worsening, especially when associated with T-cell lymphopenia. Early flow cytometry could help clinicians to target patients at high risk of clinical deterioration. Trial Registry ClinicalTrials.gov; No. NCT01995448; URL www.clinicaltrials.gov © 2018 American College of Chest Physicians

Published
2018
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27. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients: diagnostic value of computed tomography

Author

Eric Delabrousse, Guillaume Besch, Gaël Piton, Sébastien Bouveresse, Sebastien Pili-Floury, and Nicolas Badet

Subjects
Male, medicine.medical_specialty, Abdominal compartment syndrome, Critical Illness, Abdominal ct, Computed tomography, Compartment Syndromes, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, 0302 clinical medicine, Intravesical pressure, law, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Aged, medicine.diagnostic_test, business.industry, Critically ill, General Medicine, Middle Aged, medicine.disease, Intensive care unit, Intensive Care Units, 030220 oncology & carcinogenesis, Shock (circulatory), Area Under Curve, Female, Radiology, medicine.symptom, Intra-Abdominal Hypertension, business, Tomography, X-Ray Computed
Abstract

The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS.Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP 12 mmHg).Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40-0.49] in patients with IVP 12 mmHg and PAR = 0.52 [0.48-0.53] in patients with IVP ≥ 12 mmHg; p 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis.The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH.• CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome. • Raising the possibility of an IAH on a CT examination is relevant information for the clinician. • The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when 0.8).

Published
2018

28. Echography of the Portal Vein in a Patient With Shock

Author

Eric Delabrousse, Gilles Capellier, and Gaël Piton

Subjects
Male, medicine.medical_specialty, Portal vein, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Fatal Outcome, Postoperative Complications, 0302 clinical medicine, Acute mesenteric ischemia, medicine, Humans, In patient, Cardiac Surgical Procedures, Aged, Ultrasonography, medicine.diagnostic_test, Portal Vein, business.industry, Shock, medicine.disease, Tomography x ray computed, Mesenteric ischemia, Mesenteric Ischemia, Shock (circulatory), Abdominal ultrasonography, Radiology, medicine.symptom, Tomography, X-Ray Computed, business
Abstract

To report the utility of abdominal ultrasonography to identify portal venous gas in patients with shock, as an indicator of acute mesenteric ischemia, and to illustrate the aspect of portal venous gas on ultrasonography.Clinical observation of a patient, images of abdominal ultrasonography and abdominal computed tomography, and video of portal venous gas.Not applicable.Relevant information contained in the medical observation of the patient and selection of image and video of ultrasonography performed in the patient.We report a case of nonocclusive mesenteric ischemia in a 76-year-old patient following cardiac surgery. The diagnosis of acute mesenteric ischemia was proposed based on evidence of portal venous gas on abdominal ultrasonography and then confirmed by abdominal computed tomography showing transverse colonic ischemia, the presence of gas in the mesenteric veins but not in the portal vein. Urgent laparotomy confirmed extensive nonocclusive mesenteric ischemia, and the patient rapidly died of multiple organ failure.Intensive care physicians should be aware of the ultrasound characteristics of portal venous gas. In patients with shock, in addition to cardiac and thoracic echography, investigation of portal venous gas using bedside ultrasonography may help the clinician to identify patients in whom acute mesenteric ischemia develops.

Published
2016
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29. Outcomes after extracorporeal membrane oxygenation for the treatment of high-risk pulmonary embolism: a multicentre series of 52 cases

Author

Nadia Aissaoui, Fiona Ecarnot, Francois Schiele, Guy Meyer, Nicolas Meneveau, Lucie Gaide-Chevronnay, Alexis Ferré, Raphaël Favory, Antoine Kimmoun, Gaël Piton, Philippe Girard, Arthur Neuschwander, Gilles Capellier, Olivier Sanchez, Hervé Dupont, Mircea Cristinar, Elie Zogheib, Nicolas de Prost, B. Guillon, Benjamin Planquette, Nicolas Deye, Sebastien Pili-Floury, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier de Versailles André Mignot (CHV), Réanimation Médicale CHRU Besançon, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), 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), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Réanimation Médicale [CHU Henri Mondor - APHP] (DHU A-TVB), CHU Henri Mondor-Université Paris-Est Créteil, Faculté de Médecine [Créteil] (UPEC-Médecine), Service de soins intensifs, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire de l'intégration, du matériau au système (IMS), Université Sciences et Technologies - Bordeaux 1 (UB)-Institut Polytechnique de Bordeaux-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5), CIC - HEGP (CIC 1418), 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)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pneumologie, soins intensifs (Pneumo - HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), DESSAIVRE, Louise, and Université Sciences et Technologies - Bordeaux 1-Institut Polytechnique de Bordeaux-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Embolectomy, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Extracorporeal Membrane Oxygenation, Fibrinolysis, medicine, Extracorporeal membrane oxygenation, Humans, 030212 general & internal medicine, Retrospective Studies, business.industry, Retrospective cohort study, Thrombolysis, Middle Aged, medicine.disease, Prognosis, Pulmonary embolism, Surgery, Survival Rate, [SDV] Life Sciences [q-bio], surgical procedures, operative, Echocardiography, Adjunctive treatment, Female, France, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Follow-Up Studies
Abstract

International audience; Aims The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy). Primary outcome was all-cause 30-day mortality. Secondary outcome was 90-day major bleeding. One hundred and twenty-eight patients were treated without ECMO; 52 (mean age 47.6 years) underwent ECMO. Overall 30-day mortality was 48.3% [95% confidence interval (CI) 41-56] (87/180); 43% (95% CI 34-52) (55/128) in those treated without ECMO vs. 61.5% (95% CI 52-78) (32/52) in those with ECMO (P = 0.008). In patients undergoing ECMO, 30-day mortality was 76.5% (95% CI 57-97) (13/17) for ECMO+fibrinolysis, 29.4% (95% CI 51-89) (5/17) for ECMO+surgical embolectomy, and 77.7% (95% CI 59-97) (14/18) for ECMO alone (P = 0.004). Among patients with ECMO, 20 (38.5%, 95% CI 25-52) had a major bleeding event in-hospital; without significant difference across groups. Conclusion In patients with high-risk PE, those with ECMO have a more severe presentation and worse prognosis. Extracorporeal membrane oxygenation in patients with failed fibrinolysis and in those with no reperfusion seems to be associated with particularly unfavourable prognosis compared with ECMO performed in addition to surgical embolectomy. Our findings suggest that ECMO does not appear justified as a stand-alone treatment strategy in PE patients, but shows promise as a complement to surgical embolectomy.

Published
2018
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30. Hyperoxemia and Veno-Arterial Extracorporeal Membrane Oxygenation: Do Not Forget the Gut

Author

Gaël Piton, Hadrien Winiszewski, Gilles Capellier, and Andrea Perrotti

Subjects
Adult, medicine.medical_specialty, business.industry, medicine.medical_treatment, Hyperoxemia, Arteries, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Oxygen, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Internal medicine, Extracorporeal membrane oxygenation, medicine, Cardiology, Humans, 030212 general & internal medicine, business, Respiratory Insufficiency
Published
2017

31. Ethical challenges involved in obtaining consent for research from patients hospitalized in the intensive care unit

Author

Jean-Pierre Quenot, Guillaume Besch, Fiona Ecarnot, Gaël Piton, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Service de cardiologie [CHRU de Besançon], Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Equipe LIPNESS (LNC - U1231) ( LIPNESS ), Lipides - Nutrition - Cancer [Dijon - U1231] ( LNC ), 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 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 ), 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 d'anesthésie et réanimation chirurgicale [CHRU de Besançon], Réanimation Médicale CHRU Besançon, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Equipe LIPNESS (LNC - U1231) (LIPNESS), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), 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 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), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), and 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)

Subjects
Surrogate decision-maker, Legislation, Review Article, law.invention, Consent, 03 medical and health sciences, 0302 clinical medicine, law, Informed consent, Intensive care, medicine, Generalizability theory, 030212 general & internal medicine, intensive care, research, business.industry, 030208 emergency & critical care medicine, Workload, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, medicine.disease, Intensive care unit, ethics, 3. Good health, Clinical trial, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Medical emergency, business
Abstract

International audience; Clinical research remains a vital contributor to medical knowledge, and is an established and integral part of the practice of medicine worldwide. Respect for patient autonomy and ethical principles dictate that informed consent must be obtained from subjects before they can be enrolled into clinical research, yet these conditions may be difficult to apply in real practice in the intensive care unit (ICU). A number of factors serve to complexify the consent process in critically ill patients, notably decisional incapacity of the patient due to illness or sedation. Obtaining consent for research from a designated proxy or family member, commonly termed a "surrogate decision maker" (SDM) may be difficult, since SDMs dealing with the emotional, psychological and logistic impact of a sudden hospitalisation of their loved-one are not always receptive to the idea of research or emotionally equipped to reflect rationally on the opportunities being proposed to them. In addition, time constraints and workload pressures on the attending physician may render consent opportunities unfeasible, and the resulting loss of eligible patients could represent a bias in clinical trials, or limit the generalizability of their results. Alternative procedures such as deferred or waived consent have been used in the past and may be suitable alternatives in certain conditions, provided appropriate approval from institutional review boards (IRBs) can be obtained, in accordance with existing legislation. Some of the main questions inherent to the conduct of clinical research in critically ill patients are discussed in this review.

Published
2017
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32. Septic shock with round necrotic skin lesions

Author

Gaël Piton, Jean-Christophe Navellou, Guylaine Labro, and Hadrien Winiszewski

Subjects
medicine.medical_specialty, Necrosis, Septic shock, business.industry, Pain medicine, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, medicine.disease, Shock, Septic, Skin Diseases, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Shock (circulatory), Anesthesiology, Anesthesia, medicine, Humans, medicine.symptom, Skin lesion, business
Published
2017

33. Ultrasound-guided vessel puncture: calling for Pythagoras’ help

Author

Gilles Capellier, Gaël Piton, and Hadrien Winiszewski

Subjects
Vessel puncture, medicine.medical_specialty, business.industry, MEDLINE, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Ultrasonography, Doppler, 030208 emergency & critical care medicine, Punctures, lcsh:RC86-88.9, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Ultrasound guided, 03 medical and health sciences, Editorial, 0302 clinical medicine, Central venous catheter placement, medicine, Technique, Radiology, Ultrasonography, business
Published
2018
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34. Transient portal venous gas associated with reversible non-occlusive mesenteric ischemia: A case report

Author

Brice Paquette, Gilles Capellier, Gaël Piton, and Eric Delabrousse

Subjects
medicine.medical_specialty, medicine.medical_treatment, Ischemia, Case Report, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Acute mesenteric ischemia, 03 medical and health sciences, 0302 clinical medicine, Portal venous gas, Intensive care, Laparotomy, ICU, Intensive Care Unit, medicine, Computed tomography, Ultrasonography, medicine.diagnostic_test, business.industry, US, ultrasonography, Pulmonary edema, medicine.disease, Cardiac surgery, CT, computed tomography, Mesenteric ischemia, Abdominal ultrasonography, AMI, acute mesenteric ischemia, PVG, portal venous gas, Surgery, Radiology, business
Abstract

Highlights • Ultrasonography is a useful tool for portal venous gas identification in critically ill patients. • Portal venous gas can be observed at the early phase of acute mesenteric ischemia. • Transient portal venous gas with rapid disappearance is indicative of the resolution of the ischemia., Objectives To report the utility of abdominal ultrasonography (US) to identify the presence of portal venous gas (PVG) during non-occlusive mesenteric ischemia (NOMI), and to follow the disappearance of portal venous gas after resolution of the NOMI. Data sources This was a clinical observation of a patient, with images of abdominal computed tomography (CT), and a video of portal venous gas identified by ultrasonography. Data synthesis We describe the case of an adult patient admitted to our ICU for NOMI developing 48 h after cardiac surgery. Medical intensive care associated with jejunal resection and vacuum-assisted closure led to rapid recovery. Three weeks later, the patient presented acute pulmonary edema, and developed a new episode of NOMI that was suspected by identification of PVG on US, and then confirmed on abdominal CT. The patient rapidly improved after orotracheal intubation and treatment of pulmonary edema. A second US performed 9 h later showed disappearance of PVG. The laparotomy performed 10 h after the first US did not find evidence of small bowel or colon ischemia. The postoperative period was uneventful. Conclusions US is a useful tool for the detection of PVG in critically ill patients, prompting suspicion of AMI. PVG can be observed at the early phase of AMI, even before irreversible transmural gut ischemia; transient PVG that disappears rapidly (within several hours) may suggest resolution of the NOMI.

Published
2017

35. Estimation of critically ill patients' complaints by the nurse, the physician and the patient's family: A prospective comparative study

Author

Gaël Piton, Gilles Capellier, Marc Puyraveau, Sylvain Langlume, and Guylaine Labro

Subjects
Male, Critical Care, Patient interview, Nurses, Critical Care Nursing, law.invention, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, Nursing, law, Critical care nursing, Intensive care, Physicians, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Aged, Estimation, 030504 nursing, Critically ill, business.industry, Outcome measures, Professional-Patient Relations, Middle Aged, University hospital, Intensive care unit, Intensive Care Units, Patient Satisfaction, Workforce, Female, Family Relations, 0305 other medical science, business
Abstract

Objectives To evaluate the ability of the families of critically ill patients and of the intensive care team caring for the patient to communicate and accurately identify patients’ complaints. Design The complaints of critically ill patients were evaluated by a psychologist using a list of 12 items. The same day as the patient interview, the psychologist collected an estimation of the patient’s complaints from the family, the nurse and the physician. Setting 20-bed Intensive Care Unit in a large University Hospital. Main Outcome Measures Patients’ complaints. Results 51 patients were included. The most frequently reported complaints were insomnia, the inability to talk and presence of a tracheal tube. Patients reported a significantly higher prevalence of “misunderstanding” than that estimated by the nurses (55% vs 33%, p = 0.045). The reported prevalence of “inability to talk” as the main complaint was significantly higher among patients than estimated by nurses and physicians (16% vs 2%, p = 0.03 and 16% vs 2%, p = 0.03 respectively). For the analysis of the individual complaints, there was a poor agreement between the patients and the other respondents. Conclusion This study found that the estimation of critically ill patients’ complaints by their families, nurses and physicians was largely suboptimal.

Published
2017

36. Echography for nasogastric tube placement verification

Author

R. Parel, Gaël Piton, Eric Delabrousse, and Gilles Capellier

Subjects
0301 basic medicine, endocrine system, medicine.medical_specialty, endocrine system diseases, medicine.medical_treatment, Medicine (miscellaneous), 03 medical and health sciences, 0302 clinical medicine, Medicine, Intubation, Humans, Intubation, Gastrointestinal, Ultrasonography, 030109 nutrition & dietetics, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Critically ill, Stomach, digestive, oral, and skin physiology, Nasogastric tube placement, nutritional and metabolic diseases, 030208 emergency & critical care medicine, Middle Aged, Respiration, Artificial, Intensive Care Units, medicine.anatomical_structure, Abdominal ultrasonography, Acute Disease, Radiology, business, Respiratory Insufficiency, hormones, hormone substitutes, and hormone antagonists
Abstract

To report the interest of abdominal ultrasonography for confirming the appropriate location of nasogastric tube (NGT) in the stomach using a new dynamic test, and to illustrate the aspect of this test at ultrasonography. Clinical observation of a patient, images of abdominal ultrasonography and video of the stomach visualized by ultrasonography. We describe the video of a critically ill patient in whom, immediately after NGT insertion, aspiration of gastric liquid and instillation within the NGT was associated with ultrasonographic evidence of turbulences in the stomach. In addition to the direct visualization of the NGT in the stomach, ultrasonographic visualization of turbulences after aspiration and instillation of gastric liquid may allow to assess the appropriate positioning of the NGT.

Published
2016

37. Refractory Cardiogenic Shock During Tramadol Poisoning: A Case Report

Author

Anne Laure Clairet, Gaël Piton, Nicolas Belin, Gilles Capellier, and Sidney Chocron

Subjects
Extracorporeal Circulation, Shock, Cardiogenic, Context (language use), Suicide, Attempted, Toxicology, Drug overdose, 03 medical and health sciences, 0302 clinical medicine, Refractory, medicine, Mydriasis, Humans, 030216 legal & forensic medicine, Molecular Biology, Tramadol, business.industry, Cardiogenic shock, Extracorporeal circulation, Hemodynamics, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Clonus, Analgesics, Opioid, Treatment Outcome, Anesthesia, Female, medicine.symptom, Drug Overdose, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe pain. Tramadol intoxication can be lethal, and this drug is frequently involved in voluntary overdose. Classically, tramadol intoxication is associated with neurological and respiratory side effects. In contrast, cardiac effects are poorly documented in the literature. We report a case of severe tramadol intoxication, with plasma concentration 20 times the toxic threshold, complicated by refractory cardiogenic shock, successfully treated by extra corporeal life support (ECLS) with a favorable cardiac outcome and ECLS weaning at day 10. Seizure, clonus, and nonreactive mydriasis were present during 4 days, and complete awakening was delayed to day 15. Poisoning caused by high doses of tramadol can lead to refractory cardiogenic shock, and ECLS can be considered as effective rescue therapy in this context.

Published
2016

38. Prognosis of cirrhotic patients admitted to the general ICU

Author

Gilles Capellier, Vincent Di Martino, Fabienne Tamion, Gaël Piton, Claire Chaignat, Mikhael Giabicani, Jean Paul Cervoni, Catherine Paugam-Burtz, and Emmanuel Weiss

Subjects
medicine.medical_specialty, health care facilities, manpower, and services, medicine.medical_treatment, Population, MEDLINE, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Intensive care, medicine, Renal replacement therapy, Intensive care medicine, education, education.field_of_study, business.industry, Research, 030208 emergency & critical care medicine, Cirrhotic patient, Intensive care unit, 3. Good health, Emergency medicine, 030211 gastroenterology & hepatology, business
Abstract

Background The prognosis of cirrhotic patients admitted to the ICU is considered to be poor but has been mainly reported in liver ICU. We aimed to describe the prognosis of cirrhotic patients admitted to a general ICU, to assess the predictors of mortality in this population, and, finally, to identify a subgroup of patients in whom intensive care escalation might be discussed. Results We performed a retrospective monocentric study of all cirrhotic patients consecutively admitted between 2002 and 2014 in a general ICU in a regional university hospital. Two hundred and eighteen cirrhotic patients were admitted to the ICU. The 28-day and 6-month mortality rates were 53 and 74 %, respectively. Among the 115 patients who were discharged from ICU, only eight patients underwent liver transplantation, whereas 48 had no clear contraindication. Multivariable analyses on 28-day mortality identified three independent variables, incorporated into a new three-variable prognostic model as follows: SOFA ≥ 12 (OR 4.2 [2.2–8.0]; 2 points), INR ≥ 2.6 (OR 2.5 [1.3–4.8]; 1 point), and renal replacement therapy (OR 2.3 [1.1–5.1]; 1 point). For a value of the score at 4 (16 % of patients), 28-day and 3-month mortality rates were 91 and 100 %, respectively. An external validation of the score among 149 critically ill cirrhotic patients showed a good accuracy for predicting in-ICU mortality. Conclusions Mortality of cirrhotic patients admitted to a general ICU was comparable to that of other studies. A pragmatic score integrating the SOFA score, INR, and the need for extrarenal epuration was strongly associated with mortality. Among the 16 % of patients presenting with score 4 at ICU admission, 100 % died in the 3-month follow-up period. The prognostic evaluation on day 3 remains essential for the majority of patients. However, this score calculable at ICU admission might identify patients in whom the benefit of intensive care escalation should be discussed, in particular when liver transplantation is contraindicated. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0194-9) contains supplementary material, which is available to authorized users.

Published
2016

39. Infliximab treatment for steroid-refractory acute graft-versus-host disease after orthotopic liver transplantation: A case report

Author

Anne Minello, Georges Mantion, Fabrice Larosa, Gaël Piton, Patrick Hillon, Becker Mc, Vincent Di Martino, Eric Deconinck, and François Aubin

Subjects
Transplantation, Hepatology, business.industry, medicine.medical_treatment, chemical and pharmacologic phenomena, Disease, Hematopoietic stem cell transplantation, 030230 surgery, Liver transplantation, Pathophysiology, Infliximab, 3. Good health, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Cytokine, Refractory, immune system diseases, Immunology, medicine, 030211 gastroenterology & hepatology, Surgery, Tumor necrosis factor alpha, business, medicine.drug
Abstract

Acute graft-versus-host disease (GVHD) following orthotopic liver transplantation is a rare but severe disease with a 75% death rate in adults. Various therapeutic strategies have been proposed for steroid-refractory GVHD, but there is still no consensus. Tumor necrosis factor-alpha is a key inflammatory cytokine involved in acute GVHD physiopathology, and infliximab has shown encouraging results for the treatment of acute GVHD following hematopoietic stem cell transplantation. We report the first case of acute GVHD following liver transplantation that was refractory to steroids and anti-lymphocyte globulin but was successfully treated with infliximab.

Published
2009
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40. Risk Factors Associated With Small Bowel Adenocarcinoma in Crohn's Disease: A CaseControl Study

Author

Elie Khouri, Philippe Marteau, Gaël Piton, Jacques Cosnes, Guillaume Savoye, Laurent Beaugerie, Elisabeth Monnet, Marc Lémann, Bruno Bonaz, Guillaume Cadiot, Jean-Frederic Colombel, Philippe Capelle, Bernard Flourié, Franck Carbonnel, Philippe Seksik, Service de gastro-entérologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Gastroentérologie et nutrition [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Département de santé publique, Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université de Reims Champagne-Ardenne (URCA), Hospices Civils de Lyon (HCL), Institut Mutualiste de Montsouris (IMM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'hépato-gastro-entérologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service d'Hépato-gastroentérologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier de Chaumont, ANTE-INSERM U836, équipe 8, Stress et interactions neurodigestives, Département d'hépato-gastroentérologie, CHU Grenoble-Université Grenoble Alpes (UGA)-CHU Grenoble-Université Grenoble Alpes (UGA), CHU de Grenoble, Sinniger, Valérie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Male, MESH: Intestine, Small, Small bowel adenocarcinoma, MESH: Logistic Models, Disease, Gastroenterology, 0302 clinical medicine, Crohn Disease, Risk Factors, MESH: Risk Factors, MESH: Child, Intestine, Small, Child, MESH: Aged, Crohn's disease, MESH: Middle Aged, Anti-Inflammatory Agents, Non-Steroidal, digestive, oral, and skin physiology, MESH: Salicylates, Middle Aged, MESH: Anti-Inflammatory Agents, Non-Steroidal, MESH: Case-Control Studies, Salicylates, 3. Good health, 030220 oncology & carcinogenesis, Adenocarcinoma, Female, 030211 gastroenterology & hepatology, Adult, medicine.medical_specialty, Adolescent, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Intestinal Neoplasms, medicine, Humans, Risk factor, MESH: Intestinal Neoplasms, Aged, MESH: Adolescent, MESH: Humans, MESH: Crohn Disease, Hepatology, business.industry, Crohn disease, MESH: Adenocarcinoma, Case-control study, Cancer, MESH: Adult, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, MESH: Male, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, digestive system diseases, Logistic Models, Case-Control Studies, business, MESH: Female
Abstract

International audience; BACKGROUND AND AIMS: It is well established that Crohn's disease (CD) is associated with an increased risk of small bowel adenocarcinoma (SBA). The data concerning SBA risk factors in CD are scanty. The aim of this study was to identify them. METHODS: In 11 French centers affiliated with the GETAID (Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif), we identified 29 patients with CD and SBA. Eighty-seven CD controls without SBA recruited in a single center were matched to the cases for sex, age, duration, and CD site. A conditional logistic regression, taking into account the matching between cases and controls, was performed. RESULTS: In univariate analysis, the cases had had significantly less small bowel resection and received prolonged treatment with salicylates (more than 2 yr), less often than the controls (odds ratio, OR [95% confidence interval, CI] 0.07 [0.01-0.32] and 0.29 [0.10-0.82], respectively). In multivariate analysis, both associations remained significant (OR 0.04 [0.01-0.28], P= 0.001; OR 0.16 [0.03-0.79], P= 0.02, respectively). CONCLUSION: This study suggests that small bowel resection and prolonged salicylates use may protect against SBA in CD patients.

Published
2008
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41. Biomarkers of gut barrier failure in the ICU

Author

Gilles Capellier and Gaël Piton

Subjects
Pathology, medicine.medical_specialty, Malabsorption, Critical Care, Enterocyte, Critical Illness, Multiple Organ Failure, Inflammation, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Systemic inflammation, Fatty Acid-Binding Proteins, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Enteral Nutrition, medicine, Humans, business.industry, 030208 emergency & critical care medicine, medicine.disease, Prognosis, Systemic inflammatory response syndrome, Intensive Care Units, Intestinal Diseases, medicine.anatomical_structure, Enterocytes, Immunology, Biomarker (medicine), medicine.symptom, Multiple organ dysfunction syndrome, business, Biomarkers
Abstract

Purpose of review Gut barrier failure is associated with bacterial translocation, systemic inflammation, and is presumed to be associated with the development of multiple organ dysfunction syndrome. As the gut barrier function is carried out by a monolayer of enterocytes, a minimum requirement is the integrity of the enterocytes, and controlled paracellular permeability between adjacent enterocytes. Many factors can cause critically ill patients to lose gut barrier function by a mechanism of enterocyte damage; for example, small bowel ischemia or hypoxia, sepsis, systemic inflammatory response syndrome, or absence of enteral feeding. Recent findings Two enterocyte biomarkers may help the intensivist to identify enterocyte damage and dysfunction, namely plasma citrulline, a biomarker of functional enterocyte mass, and plasma or urinary intestinal fatty acid-binding protein, a marker of enterocyte damage. This review focuses on results obtained with these biomarkers in the context of critical care, in particular: prevalence of enterocyte biomarker abnormalities; mechanisms associated with enterocyte damage and dysfunction; link with systemic inflammation, bacterial translocation, and clinical intestinal dysfunction; prognostic value of enterocyte biomarkers. Lastly, we also review the limits of these biomarkers. Summary Enterocyte biomarkers may help the intensivist to identify patients presenting with intestinal damage, and who are at risk of bacterial translocation and systemic inflammatory response syndrome, as well as those with decreased enterocyte function, at risk of malabsorption. Enterocyte biomarkers should be interpreted with caution in the critically ill and should be interpreted within the overall clinical context of the patient.

Published
2016

42. The Quick SOFA, a simple bedside score, identifies hospitalized cirrhotic patients with poor outcomes

Author

Frédéric Oberti, C. Bureau, J.-P. Cervoni, Claire Vanlemmens, Thong Dao, Violaine Ozenne, Marika Rudler, C. Richou, N. Talbodec, Philippe Saas, Vincent Di Martino, Aurélie Plessier, Gaël Piton, Delphine Weil, Isabelle Rosa, Thierry Thevenot, Emilie Muel, Rodolphe Anty, Alexandre Louvet, and Alexandra Heurgué-Berlot

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Hepatology, business.industry, Medicine, 030208 emergency & critical care medicine, 030212 general & internal medicine, business, Intensive care medicine, Simple (philosophy)
Published
2017
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43. The round belly sign

Author

Eric Delabrousse, Sébastien Bouveresse, and Gaël Piton

Subjects
medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, Urology, General surgery, Gastroenterology, Contrast Media, 030208 emergency & critical care medicine, Hepatology, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Intra-Abdominal Hypertension, Tomography, X-Ray Computed, business, Sign (mathematics)
Published
2016
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44. Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia

Author

Gilles Capellier, Sebastien Pili-Floury, Guillaume Besch, Hadrien Winiszewski, and Gaël Piton

Subjects
Chest Pain, medicine.medical_specialty, 030204 cardiovascular system & hematology, Left sided, Preeclampsia, Young Adult, 03 medical and health sciences, Text mining, 0302 clinical medicine, Pre-Eclampsia, 030202 anesthesiology, Pregnancy, medicine, Humans, Ultrasonography, Aortic Aneurysm, Thoracic, business.industry, Type B aortic dissection, General Medicine, medicine.disease, Abdominal Pain, Surgery, Aortic Dissection, Treatment Outcome, Anesthesiology and Pain Medicine, 030228 respiratory system, Female, Radiology, business, 030217 neurology & neurosurgery
Published
2017
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45. Small Bowel Adenocarcinomas Complicating Crohn's Disease Are Associated With Dysplasia: A Pathological and Molecular Study

Author

Pascale Cervera, Jean-François Rahier, Severine Vermeire, Gottfried Novacek, Dominique Cazals-Hatem, Sandro Ardizzone, Monique Delos, Guillaume Cadiot, Laurent Beaugerie, Paolo Fociani, Olivier Lascols, Nizar El-Murr, Sylvie Dumont, Jean-François Fléjou, Magali Svrcek, Fritz Wrba, Yoram Bouhnik, Florence Le Pessot, Marie-Danièle Diebold, Franck Carbonnel, Aurelie Scriva, Gaël Piton, Karel Geboes, Antoinette Lemoine, Emmanuelle Leteurtre, Jacques Cosnes, Guillaume Savoye, Jean-Frederic Colombel, Service de gastro-entérologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Microenvironnement et Physiopathologie de la Differenciation, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-Gastroentérologie [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service d'Hépato-gastroentérologie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Pole des maladies de l'appareil digestif, gastroentérologie et assistance nutritive, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Anatomo-Pathologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Reims Champagne-Ardenne (URCA), Laboratoire d'Anatomopathologie, Centre hospitalier Universitaire, UCL Mont Godinne, Hépatogastroentérologie, CHU de Bicêtre, Service de Gastroentérologie et nutrition [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service d'anatomie et cytologie pathologiques [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Hepato Gastroenterology, Hospital and University of Rouen, Service d'Hépato-Gastroentérologie [Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Hôpital Charles Nicolle [Rouen]-CHU Rouen, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc - U837 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université Lille 2 - Faculté de Médecine, AP-HP Hôpital Beaujon, and Hôpital Beaujon-Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Colorectal cancer, Fibromuscular dysplasia, Adenocarcinoma, Gastroenterology, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Risk Factors, Internal medicine, Intestine, Small, medicine, Fibromuscular Dysplasia, Humans, Immunology and Allergy, Survival rate, neoplasms, Inflammation, Crohn's disease, business.industry, [CHIM.ORGA]Chemical Sciences/Organic chemistry, Cancer, Middle Aged, Prognosis, medicine.disease, Ulcerative colitis, digestive system diseases, 3. Good health, Survival Rate, Dysplasia, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Colorectal Neoplasms, business, Follow-Up Studies
Abstract

International audience; BACKGROUND:: Crohn's disease (CD) is associated with an increased risk of small bowel adenocarcinoma (SBA). However, there are no guidelines for the screening and early diagnosis of SBA. Colorectal cancer associated with chronic colitis arises from dysplasia. High-risk patients benefit from surveillance colonoscopies aimed to detect dysplasia. The dysplasia-carcinoma sequence remains poorly documented in CD-associated SBA. Moreover, molecular data about SBA complicating CD and associated dysplasia are very limited. We therefore assessed dysplasia and several key molecular markers of carcinogenesis in SBA and dysplasia developed in patients with CD. METHODS:: Forty-five SBA complicating CD and 4 specimens with dysplasia without SBA were screened. In SBA, we looked for dysplasia and determined their pathological characteristics (type, grade, distribution). We also stained for mismatch repair proteins (MLH1, MSH2, MSH6, PMS2), p53, β-catenin, and p16 and looked for KRAS, BRAF and PIK3CA mutations. RESULTS:: All neoplastic lesions, except 1 lesion, were found in inflamed mucosal areas. Dysplasia was found in 20 of 41 patients with SBA (49%). Dysplasia was flat or raised, low grade or high grade, and adjacent or distant to concomitant SBA. Molecular markers of SBA carcinogenesis complicating CD were similar to those observed in chronic colitis-related colorectal cancer (KRAS, BRAF, p53, MSI), although differences were observed for β-catenin and p16. No PIK3CA mutations were observed. CONCLUSIONS:: These results suggest that there is an inflammation-dysplasia-adenocarcinoma sequence in at least half of CD-related SBA, similar to what is observed in chronic colitis-related colorectal cancer and may have implications for the prevention and treatment of this cancer.

Published
2014
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46. Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2)

Author

Didier Thevenin, Hoang-Nam Bui, Jérôme Devaquet, Virginie Maxime, Ahmed El Kalioubie, Erika Parmentier, Frédéric Martino, Véronique Leray, Jean-Paul Mira, Jean Etienne Herbrecht, Emmanuelle Mercier, Mercé Jourdain, Carole Schwebel, L. Brisard, Olivier Gontier, Nathalie Rolin, Daniel da Silva, Anne Bretagnol, Vlad Botoc, Vincent Das, Emilie Greau, Jean-Philippe Rigaud, Bertrand Guidet, Michael Darmon, Frédéric Bellec, Jean Reignier, Karim Asehnoune, Christophe Guitton, Saad Nseir, Nadia Anguel, Amélie Le Gouge, Hervé Dupont, Michel Sirodot, Bruno Giraudeau, Frédérique Ganster, Gaël Piton, Ferhat Meziani, René Robert, Jack Richecoeur, Jean-Baptiste Lascarrou, Emmanuel Canet, Michel Djibré, Ali Ait Hssain, Benoit Misset, Stéphanie Martin, Jean-Pierre Quenot, Stéphane Gaudry, Philippe Letocart, Pierre Asfar, Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Centre hospitalier universitaire de Nantes (CHU Nantes), 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), 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), Centre Hospitalier Départemental Les Oudairies, CHU La Roche sur Yon, CHU Amiens-Picardie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier de la Région d'Annecy (Pringy), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Bordeaux [Bordeaux], Hôpitaux de Chartres [Chartres], CHU Clermont-Ferrand, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Hôpital de Dieppe, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer (U866) (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-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Hôpital Raymond Poincaré [AP-HP], Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Lille, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Hospitalier de Melun, Hopital Montauban, Centre Hospitalier Intercommunal André Grégoire [Montreuil] (CHI André Gregoire), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Hôtel-Dieu de Nantes, Centre Hospitalier Régional d'Orléans (CHRO), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Cochin [AP-HP], Hopital Saint-Louis [AP-HP] (AP-HP), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier Saint-Joseph [Paris], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier Rodez, Hôpital de Saint-Denis, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CH de Saint-Malo [Broussais], CHU Strasbourg, Hôpital Foch [Suresnes], Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CH Beauvais, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Université Francois Rabelais [Tours], PRES Centre-Val de Loire Université, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), and Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée)

Subjects
Research design, Parenteral Nutrition, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Medicine (miscellaneous), Enteral administration, law.invention, Study Protocol, Mechanical ventilation, Nosocomial infection, Catecholamines, 0302 clinical medicine, Clinical Protocols, Randomized controlled trial, Risk Factors, law, Vasoconstrictor Agents, Pharmacology (medical), Hospital Mortality, 030212 general & internal medicine, Shock, 3. Good health, Intensive Care Units, Treatment Outcome, Research Design, Shock (circulatory), France, medicine.symptom, medicine.medical_specialty, Critical Care, Critical Illness, Shock, Cardiogenic, Nutritional Status, 03 medical and health sciences, Enteral Nutrition, Intensive care, medicine, Humans, In patient, Mortality, Intensive care medicine, Vasoactive drugs, business.industry, 030208 emergency & critical care medicine, Respiration, Artificial, Parenteral nutrition, Energy Intake, business, Biomarkers
Abstract

International audience; BACKGROUND: Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation (IMV) and the most commonly prescribed treatment in intensive care units (ICUs). International guidelines consistently indicate that enteral nutrition (EN) should be preferred over parenteral nutrition (PN) whenever possible and started as early as possible. However, no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality. The primary goal of this trial is to assess the hypothesis that early first-line EN, as compared to early first-line PN, decreases day 28 all-cause mortality in patients receiving IMV and vasoactive drugs for shock. METHODS/DESIGN: The NUTRIREA-2 study is a multicenter, open-label, parallel-group, randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least 48 hours, combined with vasoactive drugs, for shock. Patients will be allocated at random to first-line PN for at least 72 hours or to first-line EN. In both groups, nutritional support will be started within 24 hours after IMV initiation. Calorie targets will be 20 to 25 kcal/kg/day during the first week, then 25 to 30 kcal/kg/day thereafter. Patients receiving PN may be switched to EN after at least 72 hours in the event of shock resolution (no vasoactive drugs for 24 consecutive hours and arterial lactic acid level below 2 mmol/L). On day 7, all patients receiving PN and having no contraindications to EN will be switched to EN. In both groups, supplemental PN may be added to EN after day 7 in patients with persistent intolerance to EN and inadequate calorie intake. We plan to recruit 2,854 patients at 44 participating ICUs. DISCUSSION: The NUTRIREA-2 study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients. Enrollment started on 22 March 2013 and is expected to end in November 2015. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01802099 (registered 27 February 2013).

Published
2014
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47. Pre-travel consultation: evaluation of primary care physician practice in the Franche-Comté region

Author

Emeline Piotte, Anne-Pauline Bellanger, Laurence Millon, Gaël Piton, Philippe Marguet, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de gastro-entérologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), service accueil des urgences, hopital de Pontarlier, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz

Subjects
Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Multivariate analysis, 030231 tropical medicine, education, Physicians, Primary Care, Article, 03 medical and health sciences, 0302 clinical medicine, Nursing, Medical advice, Surveys and Questionnaires, Health care, Humans, Medicine, Travel medicine, 030212 general & internal medicine, Referral and Consultation, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, Response rate (survey), Travel, business.industry, Primary care physician, General Medicine, Patient Acceptance of Health Care, 3. Good health, Family medicine, Health education, Observational study, France, business, Travel Medicine
Abstract

Background Primary care physicians (PCP) are first in line to provide adequate pre-travel medical advice. Little data are available on the content of pre-travel PCP consultations in France. We undertook an observational survey to assess the level of specific knowledge among PCPs on health advice, vaccinations, and malaria prophylaxis. Methods Standardized questionnaires were sent to a random sample of 400 PCPs practicing in the Franche-Comte regions (eastern France) who were asked to complete and return it on a voluntary and anonymous basis. The questionnaire requested sociodemographic details, practice-related characteristics, and proposed three clinical situations with multiple choice questions (MCQ). To identify factors associated with a higher level of specific knowledge in travel medicine, results were studied by uni- and multivariate analyses. An overall score was calculated based on the MCQ answers and a motivation score was calculated based on parameters such as frequency and developments in pre-travel consulting at the practice, PCPs' personal experience as travelers, and the formal agreement of PCPs to administer yellow fever vaccination. Results The response rate was 37.5%, with 150 questionnaires returned completed and suitable for analysis. After multivariate logistic regression, the three variables associated with a higher score were: proximity of a vaccination center (p = 0.001), motivation score (p = 0.004), and absence of request for expert advice on malaria prophylaxis (p = 0.007). Conclusions PCPs play an important role in travel medicine. This study showed that their high level of knowledge in travel medicine was mostly linked to their motivation to practice in this specialized discipline.

Published
2013
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48. Plasma citrulline kinetics and prognostic value in critically ill patients

Author

Franck Carbonnel, Jean-Christophe Navellou, Benoit Cypriani, Olivier Barbot, Gilles Capellier, Elisabeth Monnet, C. Manzon, Gaël Piton, Service de gastro-entérologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Département de santé publique, Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
medicine.medical_specialty, Resuscitation, Critical Illness, Multiple Organ Failure, Ischemia, Critical Care and Intensive Care Medicine, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Intensive care, Intestine, Small, medicine, Citrulline, Humans, Hospital Mortality, Prospective Studies, Intensive care medicine, Prospective cohort study, Cause of death, Chi-Square Distribution, business.industry, 030208 emergency & critical care medicine, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Middle Aged, Prognosis, medicine.disease, 3. Good health, Enterocytes, Logistic Models, chemistry, Predictive value of tests, Biomarker (medicine), 030211 gastroenterology & hepatology, business, Biomarkers
Abstract

International audience; PURPOSE: Multiple organ failure is a leading cause of death in critically ill patients and could be secondary to early gut ischemia. Plasma citrulline is a biomarker of enterocyte mass, and critically ill patients may have enterocyte mass reduction. The objectives of this study were to assess plasma citrulline kinetics and its prognostic value in critically ill patients. METHODS: This prospective observational study included adults without small bowel disease and without chronic renal failure consecutively admitted to a single intensive care unit. Prognostic variables as well as plasma citrulline concentrations were studied at admission, 12, 24, 48 h, and the 7th day after admission. Univariate and multivariate analyses including plasma citrulline (0-10, 11-20, and >20 micromol l(-1)) and other variables were performed. RESULTS: Sixty-seven patients were included, and the 28-day mortality was 34%. During the 1st day mean plasma citrulline decreased from 18.8 to 13.5 micromol l(-1). Low plasma citrulline at 24 h was associated with low plasma glutamine and arginine (p = 0.01 and 0.04), and high plasma CRP concentration, nosocomial infection rate, and 28-day mortality (p = 0.008, 0.03, and 0.02, respectively). In multivariate analysis plasma citrulline < or = 10 micromol l(-1) at 24 h and SOFA score > or =8 at 24 h were associated with 28-day mortality(odds ratios 8.70 and 15.08). CONCLUSIONS: In critically ill patients, low plasma citrulline at 24 h is an independent factor of mortality and could be a marker of acute intestinal failure.

Published
2010
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49. Thrombotic thrombocytopenic purpura associated with severe acute pancreatitis in a context of decreased ADAMTS13 activity: a case report

Author

Cyrille Patry, Franck Carbonnel, Gaël Piton, Jean Christophe Navellou, Gilles Capellier, Pierre Morati, Service de gastro-entérologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Hemolytic anemia, MESH: ADAM Proteins, Adult, Abdominal pain, medicine.medical_specialty, Thrombotic microangiopathy, MESH: Purpura, Thrombotic Thrombocytopenic, Adolescent, Thrombotic thrombocytopenic purpura, ADAMTS13 Protein, Gastroenterology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Internal medicine, hemic and lymphatic diseases, Coagulopathy, Medicine, Humans, 030212 general & internal medicine, MESH: Adolescent, MESH: Humans, MESH: Middle Aged, Hepatology, Purpura, Thrombotic Thrombocytopenic, business.industry, MESH: Adult, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Middle Aged, medicine.disease, ADAMTS13, 3. Good health, MESH: Pancreatitis, ADAM Proteins, Pancreatitis, MESH: Young Adult, Immunology, Acute Disease, Acute pancreatitis, MESH: Acute Disease, 030211 gastroenterology & hepatology, Female, medicine.symptom, business, MESH: Female
Abstract

International audience; Thrombotic thrombocytopenic purpura (TTP) is a severe multisystemic microvascular disease defined by the association of hemolytic anemia, thrombocytopenia, acute renal failure, fever, and neurological disorders. The pathophysiology has recently been elucidated by the discovery of a von Willebrand factor-cleaving protease (ADAMTS13) deficiency involved in platelet aggregation and ischemia. The association between TTP and acute pancreatitis (AP) has rarely been reported, described either as a cause or a consequence. The role of ADAMTS13 during AP is still unknown. We describe the case of a 41-year-old woman who developed a TTP, with decreased ADAMTS13 activity, associated with severe AP. Published cases of thrombotic microangiopathy associated with AP are reviewed. The pathophysiology, management, prognostic factors, and rationale for treatment are discussed. AP should be sought in patients with TTP presenting with abdominal pain. On the other hand, TTP should be considered in patients with AP and thrombocytopenia.

Published
2008
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50. Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis

Author

Delphine, Weil, Eric, Levesque, Marc, McPhail, Rodrigo, Cavallazzi, Eleni, Theocharidou, Evangelos, Cholongitas, Arnaud, Galbois, Heng Chih, Pan, Constantine J, Karvellas, Bertrand, Sauneuf, René, Robert, Jérome, Fichet, Gaël, Piton, Thierry, Thevenot, Gilles, Capellier, Vincent, Di Martino, Ming-Hung, Tsai, Service d'hépatologie, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre hépato-biliaire - CHB [Paul Brousse, Paris], Hôpital Paul Brousse-Université Paris-Sud - Paris 11 (UP11), King‘s College London, University of Louisville, Royal Free Hospital, London, Aristotle University of Thessaloniki, Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Chang Gung Memorial Hospital [Taipei] (CGMH), University of Alberta, Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz-Université de Franche-Comté ( UFC ), Université Paris-Sud - Paris 11 ( UP11 ) -AP-HP Hôpital Paul Brousse, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Université Pierre et Marie Curie - Paris 6 ( UPMC ), Chang Gung Memorial Hospital, University of Alberta [Edmonton], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), CHRU Tours, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse, Royal Free Hospital [London, UK], CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Context (language use), Liver transplantation, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Hepatorenal syndrome, law, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Internal medicine, Intensive care, Anesthesiology, Medicine, Mortality, Prognostic scores, business.industry, CLIF-SOFA, Research, 030208 emergency & critical care medicine, medicine.disease, Intensive care unit, 3. Good health, MELD, Meta-analysis, Organ replacement therapy, Emergency medicine, Extrahepatic organ failure, 030211 gastroenterology & hepatology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background The best predictors of short- and medium-term mortality of cirrhotic patients receiving intensive care support are unknown. Methods We conducted meta-analyses from 13 studies (2523 cirrhotics) after selection of original articles and response to a standardized questionnaire by the corresponding authors. End-points were in-ICU, in-hospital, and 6-month mortality in ICU survivors. A total of 301 pooled analyses, including 95 analyses restricted to 6-month mortality among ICU survivors, were conducted considering 249 variables (including reason for admission, organ replacement therapy, and composite prognostic scores). Results In-ICU, in-hospital, and 6-month mortality was 42.7, 54.1, and 75.1%, respectively. Forty-eight patients (3.8%) underwent liver transplantation during follow-up. In-ICU mortality was lower in patients admitted for variceal bleeding (OR 0.46; 95% CI 0.36–0.59; p 19 at baseline (OR 8.54; 95% CI 2.09–34.91; p 26 (OR 3.97; 95% CI 1.92–8.22; p

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