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19 results on '"Maxens Decavèle"'

1. Prediction models of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia relapse in trauma and brain injury patients: A retrospective analysis

Author

Maël Gennequin, Nathalie Gault, Pierre-Antoine Allain, Jean Denis Moyer, Arnaud Foucrier, Maxens Decavèle, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique (CIC 1425), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-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), and Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158)

Subjects
Staphylococcus aureus, medicine.medical_specialty, Multivariate analysis, Ventilator associated pneumonia, 030309 nutrition & dietetics, Critical Care and Intensive Care Medicine, medicine.disease_cause, Trauma, Brain injury patient, Cohort Studies, Ventilator associated pneumonia relapse, Methicillin, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, 030225 pediatrics, Internal medicine, polycyclic compounds, medicine, Humans, Retrospective Studies, First episode, 0303 health sciences, business.industry, Incidence (epidemiology), Glasgow Coma Scale, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, Odds ratio, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, medicine.disease, respiratory tract diseases, 3. Good health, Methicillin Sensitive Staphylococcus aureus (MSSA), Brain Injuries, bacteria, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study
Abstract

Purpose To describe the incidence and risk factors of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia (MSSA-VAP) relapse in trauma and non-traumatic brain injury patients. Materials and methods Retrospective observational monocentric cohort study of consecutive ICU patients who developed a first episode of MSSA-VAP after trauma and non-traumatic brain injury. MSSA-VAP relapse encompass MSSA-VAP treatment failure (persistence or recurrence of MSSA) or other pathogen - VAP. Results A total of 165 patients (71% of trauma and 29% of non-traumatic brain injury) with MSSA-VAP were included. MSSA-VAP relapse occurred in 54 (33%) patients, including 28 (17%) MSSA-VAP treatment failure and 46 (28%) other pathogen-VAP. Empirical first-line antibiotic therapy was appropriate in 96% of cases. In multivariate analysis, the presence of Streptococcus species (Odds ratio [OR] 7.37) and oropharyngeal flora (OR 3.64) as initial MSSA co-pathogen, suggested aspiration at the time of admission and independently predicted MSSA-VAP treatment failure. Initial Glasgow coma scale (OR 0.89), need for emergent surgery (OR 5.71) and the presence of an acute respiratory distress syndrome at the time of the first MSSA-VAP (3.99), independently predicted the onset of other pathogen – VAP. Conclusion Early and simple factors may help to identify patients with high-risk of MSSA-VAP relapse.

Published
2021
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2. Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial

Author

Arnaud W. Thille, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Maxens Decavèle, Romain Sonneville, François Beloncle, Christophe Girault, Laurence Dangers, Alexandre Lautrette, Quentin Levrat, Anahita Rouzé, Emmanuel Vivier, Jean-Baptiste Lascarrou, Jean-Damien Ricard, Keyvan Razazi, Guillaume Barberet, Christine Lebert, Stephan Ehrmann, Alexandre Massri, Jeremy Bourenne, Gael Pradel, Pierre Bailly, Nicolas Terzi, Jean Dellamonica, Guillaume Lacave, René Robert, Stéphanie Ragot, Jean-Pierre Frat, for the HIGH-WEAN Study Group, for the REVA Research Network, Service de Médecine Intensive Réanimation [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, Airway Extubation, Weaning, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Anesthesiology, Post-hoc analysis, medicine, Respiratory system, COPD, business.industry, Research, Airway extubation, Chronic obstructive pulmonary disease, Respiratory disease, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, High-flow nasal oxygen, 3. Good health, 030228 respiratory system, Anesthesia, Breathing, Non-invasive ventilation, business
Abstract

Background Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD). We hypothesized that prophylactic NIV after extubation may decrease the risk of reintubation in COPD patients as compared with high-flow nasal oxygen. We performed a post hoc subgroup analysis of COPD patients included in a multicenter, randomized, controlled trial comparing prophylactic use of NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone immediately after extubation. Results Among the 651 patients included in the original study, 150 (23%) had underlying COPD including 86 patients treated with NIV alternating with high-flow nasal oxygen and 64 patients treated with high-flow nasal oxygen alone. The reintubation rate was 13% (11 out of 86 patients) with NIV and 27% (17 out of 64 patients) with high-flow nasal oxygen alone [difference, − 14% (95% CI − 27% to − 1%); p = 0.03]. Whereas reintubation rates were significantly lower with NIV than with high-flow nasal oxygen alone at 72 h and until ICU discharge, mortality in ICU did not differ between groups: 6% (5/86) with NIV vs. 9% (6/64) with high-flow nasal oxygen alone [difference − 4% (95% CI − 14% to 5%); p = 0.40]. Conclusions In COPD patients, prophylactic NIV alternating with high-flow nasal oxygen significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial registration The study was registered at http://www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017)

Published
2021
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3. Proportional assist ventilation relieves clinically significant dyspnea in critically ill ventilated patients

Author

Côme Bureau, Maxens Decavèle, Sébastien Campion, Marie-Cécile Nierat, Julien Mayaux, Elise Morawiec, Mathieu Raux, Thomas Similowski, Alexandre Demoule, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], Gestionnaire, Hal Sorbonne Université, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158)

Subjects
[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, genetic structures, RC86-88.9, Physiology, Research, Medical emergencies. Critical care. Intensive care. First aid, Critical Care and Intensive Care Medicine, Clinical study, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Dyspnea, 030228 respiratory system, 030225 pediatrics, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, circulatory and respiratory physiology
Abstract

Introduction Dyspnea is common and often severe symptom in mechanically ventilated patients. Proportional assist ventilation (PAV) is an assist ventilatory mode that adjusts the level of assistance to the activity of respiratory muscles. We hypothesized that PAV reduce dyspnea compared to pressure support ventilation (PSV). Patients and methods Mechanically ventilated patients with clinically significant dyspnea were included. Dyspnea intensity was assessed by the Dyspnea—Visual Analog Scale (D-VAS) and the Intensive Care-Respiratory Distress Observation Scale (IC-RDOS) at inclusion (PSV-Baseline), after personalization of ventilator settings in order to minimize dyspnea (PSV-Personalization), and after switch to PAV. Respiratory drive was assessed by record of electromyographic activity of inspiratory muscles, the proportion of asynchrony was analyzed. Results Thirty-four patients were included (73% males, median age of 66 [57–77] years). The D-VAS score was lower with PSV-Personalization (37 mm [20‒55]) and PAV (31 mm [14‒45]) than with PSV-Baseline (62 mm [28‒76]) (p p p Conclusion In mechanically ventilated patients exhibiting clinically significant dyspnea with PSV, personalization of PSV settings and PAV results in not different decreased dyspnea and activity of muscles to a similar degree, even though PAV was able to reduce asynchrony more effectively.

Published
2021
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4. Beneficial Effects of Non-Invasive Ventilation After Extubation in Obese or Overweight Patients : A Post-Hoc Analysis of a Randomized Clinical Trial

Author

Arnaud W. Thille, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Maxens Decavèle, Romain Sonneville, François Beloncle, Christophe Girault, Laurence Dangers, Alexandre Lautrette, Quentin Levrat, Anahita Rouzé, Emmanuel Vivier, Jean-Baptiste Lascarrou, Jean-Damien Ricard, Armand Mekontso-Dessap, Guillaume Barberet, Christine Lebert, Stephan Ehrmann, Alexandre Massri, Jeremy Bourenne, Gael Pradel, Pierre Bailly, Nicolas Terzi, Jean Dellamonica, Guillaume Lacave, René Robert, Jean-Pierre Frat, Stéphanie Ragot, Florence Boissier, Delphine Chatellier, Céline Deletage, Carole Guignon, Florent Joly, Morgane Olivry, Anne Veinstein, Dalila Benzekri-Lefevre, Thierry Boulain, Grégoire Muller, Yves Le Tulzo, Jean-Marc Tadié, Adel Maamar, Suela Demiri, Julien Mayaux, Alexandre Demoule, Lila Bouadma, Claire Dupuis, Pierre Asfar, Marc Pierrot, Gaëtan Béduneau, Déborah Boyer, Benjamin Delmas, Bérénice Puech, Konstantinos Bachoumas, Edouard Soum, Séverin Cabasson, Marie-Anne Hoppe, Saad Nseir, Olivier Pouly, Gaël Bourdin, Sylvène Rosselli, Anthony Le Meur, Charlotte Garret, Maelle Martin, Guillaume Berquier, Abirami Thiagarajah, Guillaume Carteaux, Keyvan Razazi, Antoine Poidevin, Anne-Florence Dureau, Marie-Ange Azais, Gwenhaël Colin, Emmanuelle Mercier, Marlène Morisseau, Caroline Sabatier, Walter Picard, Marc Gainnier, Thi-My-Hue Nguyen, Gwenaël Prat, Carole Schwebel, Matthieu Buscot, Service de Médecine Intensive Réanimation [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Pulmonary and Respiratory Medicine, business.industry, Airway Extubation, Overweight, Critical Care and Intensive Care Medicine, Intensive care unit, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Randomized controlled trial, law, Intensive care, Anesthesia, Post-hoc analysis, Breathing, medicine, 030212 general & internal medicine, medicine.symptom, Underweight, business, ComputingMilieux_MISCELLANEOUS
Abstract

RATIONALE Whereas non-invasive ventilation (NIV) may prevent reintubation in patients at high-risk of extubation failure in intensive care units (ICUs), this oxygenation strategy has not been specifically assessed in obese patients. OBJECTIVES We hypothesized that NIV may decrease the risk of reintubation in obese patients compared with high-flow nasal oxygen (HFNO). METHODS Post-hoc analysis of a multicenter, randomized, controlled trial (not pre-specified) comparing NIV alternating with HFNO versus HFNO alone after extubation, with the aim of assessing NIV effects according to patient body-mass index (BMI). MEASUREMENTS AND MAIN RESULTS Among 623 patients at high-risk of extubation failure, 206 (33%) were obese (BMI≥30 kg/m2), 204 (33%) were overweight (25≤BMI

Published
2021
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5. Clinical features and outcome of patients with primary central nervous system lymphoma admitted to the intensive care unit: a French national expert center experience

Author

Caroline Houillier, Isabelle Rivals, Nicolas Gatulle, Charles-Edouard Luyt, Maxens Decavèle, Nicolas Weiss, Thomas Similowski, Aliénor Dreyfus, Julie Delemazure, Khê Hoang-Xuan, Elise Morawiec, Julien Mayaux, Sophie Demeret, Alexandre Demoule, Sylvain Choquet, Martin Dres, Gestionnaire, HAL Sorbonne Université 5, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Institut de neurosciences translationnelles de Paris (NeurATRIS - IHU-A-ICM), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Centre d'investigation clinique Neurosciences [CHU Pitié Salpêtrière] (CIC Neurosciences), Centre d'investigation clinique pluridisciplinaire [CHU Pitié Salpêtrière] (CIC-P 1421), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL), Service d'Hématologie clinique [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Central Nervous System, medicine.medical_specialty, Neurology, Lymphoma, medicine.medical_treatment, Aspiration pneumonia, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Neuro-oncology, medicine, Humans, Intensive care medicine, Hospital Mortality, 030212 general & internal medicine, Primary central nervous system lymphoma, Retrospective Studies, Mechanical ventilation, Coma, Original Communication, business.industry, Prognosis, medicine.disease, Triage, Intensive care unit, 3. Good health, Hospitalization, Intensive Care Units, Critical care, Emergency medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, Cohort study
Abstract

Introduction To describe the reasons for intensive care unit (ICU) admission and to evaluate the outcomes and prognostic factors of patients with primary central nervous system lymphoma (PCNSL) admitted to the ICU. Patients and methods Retrospective observational cohort study of 101 PCNSL patients admitted to 3 ICUs over a two-decade period. Results Acute respiratory failure, mainly secondary to aspiration pneumonia and Pneumocystis jirovecii pneumonia, was the leading reason for ICU admission (33%). Aspiration pneumonia was more common in patients with brainstem tumor (67% vs. 0%, p

Published
2021
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6. Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure

Author

Alexandre Massri, Christine Lebert, Claire Dupuis, Carole Guignon, Konstantinos Bachoumas, Saad Nseir, Morgane Olivry, Maelle Martin, Keyvan Razazi, Alexandre Lautrette, Jean-Marc Tadié, Laurence Dangers, G. Barberet, Carole Schwebel, Pierre Bailly, Jean-Damien Ricard, Jeremy Bourenne, Maxens Decavèle, Guillaume Lacave, Thierry Boulain, Caroline Sabatier, Séverin Cabasson, Nicolas Terzi, Olivier Pouly, Thi-My-Hue Nguyen, Gael Bourdin, Matthieu Buscot, Florence Boissier, Suela Demiri, Arnaud Gacouin, Quentin Levrat, Charlotte Garret, Antoine Poidevin, Jean Dellamonica, René Robert, Gael Pradel, Anne-Florence Dureau, Dalila Benzekri-Lefevre, Rémi Coudroy, Benjamin Delmas, Abirami Thiagarajah, Romain Sonneville, Anahita Rouzé, Emmanuelle Mercier, Déborah Boyer, Christophe Girault, Lila Bouadma, Grégoire Muller, Marie-Ange Azais, Walter Picard, Emmanuel Vivier, Sylvène Rosselli, Mai-Anh Nay, Céline Deletage, Julien Mayaux, Adel Maamar, Anthony Le Meur, Pierre Asfar, Marie-Anne Hoppe, François Beloncle, Anne Veinstein, Guillaume Berquier, Alexandre Demoule, Marlène Morisseau, Marc Pierrot, Stéphanie Ragot, Edouard Soum, Gwenhael Colin, Gwenaël Prat, Bérénice Puech, Stephan Ehrmann, Florent Joly, Arnaud W. Thille, Delphine Chatellier, Jean-Pierre Frat, Jean-Baptiste Lascarrou, Marc Gainnier, Gaetan Beduneau, Armand Mekontso-Dessap, Guillaume Carteaux, Yves Le Tulzo, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Régional d'Orléans (CHRO), CHU Pontchaillou [Rennes], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Rouen, Normandie Université (NU), Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Unité de Glycobiologie Structurale et Fonctionnelle UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Louis Mourier - AP-HP [Colombes], CHU Henri Mondor [Créteil], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier de Pau, Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Henri Mondor d'Aurillac, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Grenoble, CHU Nice [Cimiez], Hôpital Cimiez [Nice] (CHU), Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Recherche Agronomique (INRA)-Université de Lille-Centre National de la Recherche Scientifique (CNRS), CHU Henri Mondor, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, 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), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Pulmonary and Respiratory Medicine, airway extubation, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pressure support ventilation, Airway Extubation, mechanical ventilation, Critical Care and Intensive Care Medicine, law.invention, Spontaneous breathing trial, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Interquartile range, law, Multicenter trial, Post-hoc analysis, medicine, 030212 general & internal medicine, Mechanical ventilation, business.industry, 3. Good health, 030228 respiratory system, Anesthesia, ICU, ventilator weaning, Cardiology and Cardiovascular Medicine, business
Abstract

Background Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs. Research Question We aimed at determining whether initial SBT using pressure-support ventilation (PSV) could increase successful extubation rates among patients at high risk of extubation failure. Study Design and Methods Post hoc analysis of a multicenter trial focusing on reintubation in patients at high-risk of extubation failure. The initial SBT was performed using PSV or T-piece according to the physician/center decision. The primary outcome was the proportion of patients successfully extubated 72 hours after initial SBT, that is, extubated after initial SBT and not reintubated within the following 72 hours. Results Among the 641 patients included in the original study, initial SBT was performed using PSV (7.0 cm H2O in median without positive end-expiratory pressure) in 243 patients (38%) and using a T-piece in 398 patients (62%). The proportion of patients successfully extubated 72 hours after initial SBT was 67% (162/243) using PSV and 56% (223/398) using T-piece (absolute difference 10.6%; 95% CI, 2.8 to 28.1; P = .0076). The proportion of patients extubated after initial SBT was 77% (186/283) using PSV and 63% (249/398) using T-piece (P = .0002), whereas reintubation rates within the following 72 hours did not significantly differ (13% vs 10%, respectively; P = .4259). Performing an initial SBT using PSV was independently associated with successful extubation (adjusted OR, 1.60; 95% CI, 1.30 to 2.18; P = .0061). Interpretation In patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation.

Published
2020
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7. One-year survival of patients with high-grade glioma discharged alive from the intensive care unit

Author

Isabelle Rivals, Khê Hoang-Xuan, Martin Dres, Sophie Demeret, Nicolas Weiss, Ahmed Idbaih, Elise Morawiec, Julien Mayaux, Nicolas Gatulle, Maxens Decavèle, Alexandre Demoule, and Thomas Similowski

Subjects
medicine.medical_specialty, Critical Care, One-year survival, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Glioma, Internal medicine, medicine, Humans, Intensive care unit, 030212 general & internal medicine, Hospital Mortality, Retrospective Studies, Original Communication, Performance status, business.industry, Mortality rate, Anticancer therapy, Cancer, Odds ratio, medicine.disease, Malignant brain tumors, Patient Discharge, Intensive Care Units, Neurology, Neurology (clinical), business, 030217 neurology & neurosurgery, Cohort study
Abstract

Introduction Only limited data are available regarding the long-term prognosis of patients with high-grade glioma discharged alive from the intensive care unit. We sought to quantify 1-year mortality and evaluate the association between mortality and (1) functional status, and (2) management of anticancer therapy in patients with high-grade glioma discharged alive from the intensive care unit. Patients and methods Retrospective observational cohort study of patients with high-grade glioma admitted to two intensive care units between January 2009 and June 2018. Functional status was assessed by the Karnofsky Performance Status. Anticancer therapy after discharge was classified as (1) continued (unchanged), (2) modified (changed or stopped), or (3) initiated (for newly diagnosed disease). Results Ninety-one high-grade glioma patients (73% of whom had glioblastoma) were included and 78 (86%) of these patients were discharged alive from the intensive care unit. Anticancer therapy was continued, modified, and initiated in 41%, 42%, and 17% of patients, respectively. Corticosteroid therapy at the time of ICU admission [odds ratio (OR) 0.07] and cancer progression (OR 0.09) was independently associated with continuation of anticancer therapy. The mortality rate 1 year after ICU admission was 73%. On multivariate analysis, continuation of anticancer therapy (OR 0.18) and Karnofsky performance status on admission (OR 0.90) were independently associated with lower 1-year mortality. Conclusion The presence of high-grade glioma is not sufficient to justify refusal of intensive care unit admission. Performance status and continuation of anticancer therapy are associated with higher survival after intensive care unit discharge. Previous presentation Preliminary results were presented at the most recent congress of the French Intensive Care Society, Paris, 2019. Electronic supplementary material The online version of this article (10.1007/s00415-020-10191-0) contains supplementary material, which is available to authorized users.

Published
2020

8. High-Flow Nasal Oxygen Therapy in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure

Author

Alexandre Demoule, Maxens Decavèle, Clémence Marois, Morgane Faure, Elie Azoulay, Virginie Lemiale, Djamel Mokart, and François Pousset

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Acute hypoxemic respiratory failure, business.industry, medicine.medical_treatment, chemistry.chemical_element, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Oxygen, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, chemistry, Internal medicine, Oxygen therapy, medicine, Cardiology, Acute respiratory failure, Inspired gas, High flow, business
Abstract

Acute respiratory failure (ARF) is common in immunocompromised patients. Low/intermediate-flow oxygen devices have several drawbacks, such as insufficient humidification and warming of the inspired gas or limited FiO2, which imply suboptimal therapeutic management. Compared with unselected patients

Published
2018
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9. Adjusting ventilator settings to relieve dyspnoea modifies brain activity in critically ill patients: an electroencephalogram pilot study

Author

Nicolas Wattiez, Marine Le Corre, Mario Chavez, Alexandre Demoule, Thomas Similowski, Xavier Navarro-Sune, Suela Demiri, Mathieu Raux, Maxens Decavèle, Felix Kindler, Sorbonne Université (SU), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, Visual analogue scale, Brain activity and meditation, medicine.medical_treatment, Critical Illness, [SDV]Life Sciences [q-bio], Population, lcsh:Medicine, Action Potentials, Pilot Projects, Electroencephalography, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Article, 03 medical and health sciences, 0302 clinical medicine, Medical research, Interquartile range, Diagnosis, medicine, Pressure, Humans, lcsh:Science, education, Aged, Mechanical ventilation, Aged, 80 and over, education.field_of_study, Multidisciplinary, Ventilators, Mechanical, medicine.diagnostic_test, business.industry, lcsh:R, Area under the curve, Brain, Middle Aged, 3. Good health, Dyspnea, 030228 respiratory system, Anesthesia, Area Under Curve, lcsh:Q, Observational study, Female, business, 030217 neurology & neurosurgery
Abstract

Dyspnoea is frequent and distressing in patients receiving mechanical ventilation, but it is often not properly evaluated by caregivers. Electroencephalographic signatures of dyspnoea have been identified experimentally in healthy subjects. We hypothesized that adjusting ventilator settings to relieve dyspnoea in MV patients would induce EEG changes. This was a first-of-its-kind observational study in a convenience population of 12 dyspnoeic, mechanically ventilated patients for whom a decision to adjust the ventilator settings was taken by the physician in charge (adjustments of pressure support, slope, or trigger). Pre- and post-ventilator adjustment electroencephalogram recordings were processed using covariance matrix statistical classifiers and pre-inspiratory potentials. The pre-ventilator adjustment median dyspnoea visual analogue scale was 3.0 (interquartile range: 2.5–4.0; minimum-maximum: 1–5) and decreased by (median) 3.0 post-ventilator adjustment. Statistical classifiers adequately detected electroencephalographic changes in 8 cases (area under the curve ≥0.7). Previously present pre-inspiratory potentials disappeared in 7 cases post-ventilator adjustment. Dyspnoea improvement was consistent with electroencephalographic changes in 9 cases. Adjusting ventilator settings to relieve dyspnoea produced detectable changes in brain activity. This paves the way for studies aimed at determining whether monitoring respiratory-related electroencephalographic activity can improve outcomes in critically ill patients under mechanical ventilation.

Published
2019
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10. High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol

Author

Damien Contou, Gwenhael Colin, Dalila Benzekri, Gwenaël Prat, Sebastien Jochmans, Rémi Coudroy, Arnaud W. Thille, Nicolas Terzi, Alexandre Herbland, Guylaine Labro, Achille Kouatchet, Stéphanie Ragot, Jean Dellamonica, Giacomo Grasselli, Claude Guérin, Mona Assefi, David Bougon, Jean-Pierre Quenot, Frédéric Pène, T Lherm, Didier Thevenin, Jeremy Bourenne, Emmanuel Vivier, Jean-Pierre Frat, Saad Nseir, Jérôme Devaquet, Maxens Decavèle, Arnaud Gacouin, Charlotte Garret, Christophe Girault, Stephan Ehrmann, Dominique Malacrino, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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 de la Timone [CHU - APHM] (TIMONE), CHU Pontchaillou [Rennes], Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Centre Hospitalier Universitaire de Nice (CHU Nice), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Centre hospitalier Saint Joseph - Saint Luc [Lyon], Urgence respiratoire et réanimation médicale, Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Réanimation, Centre Hospitalier René Dubos [Pontoise], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), 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), Bourse de recherche, AADAIRC, Programme Hospitalier de Recherche Clinique Inter-, French Ministry of Health, Le Nouveau Souffle, SOS Oxygène, 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), 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), Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Ehrmann, Stephan, and Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Randomized controlled trial, law, Informed consent, Oxygen therapy, Intubation, Intratracheal, Protocol, Medicine, Intubation, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, high-flow nasal cannula oxygen therapy, Randomized Controlled Trials as Topic, Noninvasive Ventilation, acute respiratory failure, immunosuppression, business.industry, Mortality rate, non-invasive ventilation, Oxygen Inhalation Therapy, Intensive Care, clinical trial, General Medicine, Intensive care unit, mortality, 3. Good health, Clinical trial, Intensive Care Units, 030228 respiratory system, Respiratory failure, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Respiratory Insufficiency, Ventilator Weaning
Abstract

IntroductionNon-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180.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 numberNCT02978300

Published
2019
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11. Detection and management of dyspnea In mechanically ventilated patients

Author

Alexandre Demoule, Thomas Similowski, Maxens Decavèle, Sorbonne Université (SU), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [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), Gestionnaire, Hal Sorbonne Université, Neurophysiologie Respiratoire Expérimentale et Clinique, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
medicine.medical_specialty, Visual analogue scale, medicine.medical_treatment, Critical Illness, Airway Extubation, Critical Care and Intensive Care Medicine, intensive care unit, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, heteroevaluation scale, medicine, Ventilator settings, Intubation, Humans, Intensive care medicine, evaluation, Critically ill, business.industry, 030208 emergency & critical care medicine, Intensive care unit, Respiration, Artificial, 3. Good health, respiratory tract diseases, Intensive Care Units, Increased risk, Dyspnea, 030228 respiratory system, non-communicative patient, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Observational study, business
Abstract

International audience; PURPOSE OF REVIEW: In ICU patients, dyspnea is one of the most prominent and distressing symptom. We sought to summarize current data on the prevalence and prognostic influence of dyspnea in the ICU setting and to provide concise and useful information for dyspnea detection and management.RECENT FINDINGS: As opposed to pain, dyspnea has been a neglected symptom with regard to detection and management. Many factors contribute to the pathogenesis of dyspnea. Among them, ventilator settings seem to play a major role. Dyspnea affects half of mechanically ventilated patient and causes immediate intense suffering [median dyspnea visual analog scale of 5 (4-7)]. In addition, it is associated with delayed extubation and with an increased risk of intubation and mortality in those receiving noninvasive ventilation. However, one-third of critically ill patients are noncommunicative, and therefore, at high risk of misdiagnosis. Heteroevaluation scales based on physical and behavioral signs of respiratory discomfort are reliable and promising alternatives to self-report.SUMMARY: Dyspnea is frequent and severe in critically ill patients. Implementation of observational scale will help physicians to access to noncommunicative patient's respiratory suffering and tailor its treatment. Further studies on the prognostic impact and management strategies are needed.

Published
2019
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12. Dyspnoea and respiratory muscle ultrasound to predict extubation failure

Author

Domenico Luca Grieco, L. Felipe Damiani, Thomas Similowski, Michael C. Sklar, Irene Telias, Luana T. Melo, Ewan C. Goligher, Liliya Sergenyuk, Tài Pham, Maxens Decavèle, Alexandre Demoule, Lauriane Degravi, Cesar Santis, Laurent Brochard, Martin Dres, Wissale Ouechani, Detajin Junhasavasdikul, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [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), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], University of Toronto, University Health Network, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Fondazione 'Policlinico Universitario A. Gemelli' [Rome], Università cattolica del Sacro Cuore [Piacenza e Cremona] (Unicatt), Mahidol University [Bangkok], Pontificia Universidad Católica de Chile (UC), Universidad de Chile, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gestionnaire, Hal Sorbonne Université, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universidad de Chile = University of Chile [Santiago] (UCHILE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), St. Michael's Hospital, Hôpital Bicêtre, Fondazione Policlinico Universitario A. Gemelli [Rome] (FPUAG), Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt), and dres, martin

Subjects
Pulmonary and Respiratory Medicine, [SDV]Life Sciences [q-bio], Diaphragm, Spontaneous breathing trial, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Respiratory system, Respiratory distress, business.industry, Ultrasound, Respiration, Artificial, Diaphragm (structural system), [SDV] Life Sciences [q-bio], Dyspnea, medicine.anatomical_structure, 030228 respiratory system, Parasternal line, Anesthesia, Airway Extubation, business, Ventilator Weaning, Intercostal muscle
Abstract

BackgroundThis study investigated dyspnoea intensity and respiratory muscle ultrasound early after extubation to predict extubation failure.MethodsThe study was conducted prospectively in two intensive care units in France and Canada. Patients intubated for at least 48 h were studied within 2 h after an extubation following a successful spontaneous breathing trial. Dyspnoea was evaluated by a dyspnoea visual analogue scale (Dyspnoea-VAS) ranging from 0 to 10 and the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). The ultrasound thickening fraction of the parasternal intercostal and the diaphragm was measured; limb muscle strength was evaluated using the Medical Research Council (MRC) score (range 0–60).ResultsExtubation failure occurred in 21 out of 122 enrolled patients (17%). The median (interquartile range (IQR)) Dyspnoea-VAS and IC-RDOS were higher in patients with extubation failure versus success: 7 (4–9) versus 3 (1–5) (pversus 1.7 (1.5–2.1) (pversus 0.3 (0.2–0.5) (pversus 52 (44–60) (p=0.012), respectively. The thickening fraction of the parasternal intercostal and its ratio to diaphragm thickening showed the highest area under the receiver operating characteristic curve (AUC) for an early prediction of extubation failure (0.81). AUCs of Dyspnoea-VAS and IC-RDOS reached 0.78 and 0.74, respectively.ConclusionsRespiratory muscle ultrasound and dyspnoea measured within 2 h after extubation predict subsequent extubation failure.

Published
2021
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13. Endobronchial ultrasound-guided transbronchial needle aspiration is feasible, safe, and reaches a 90 % diagnostic yield in patients with hypoxemic acute respiratory failure

Author

Jean-Marc Naccache, Michel Febvre, Antoine Parrot, Jocelyne Fleury Feith, Maxens Decavèle, Valérie Gounant, Muriel Fartoukh, Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Diderot - Paris 7 (UPD7), Service d’oncologie thoracique et essais précoces [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], Service d’Anatomie et cytologie pathologiques [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, business.industry, Pain medicine, Yield (finance), Biopsy, Fine-Needle, Bronchi, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Anesthesia, Anesthesiology, Bronchoscopy, Humans, Medicine, Acute respiratory failure, In patient, Endobronchial ultrasound, Hypoxia, Respiratory Insufficiency, business, Ultrasonography
Abstract

International audience; Adverse events are common during conventional invasive lung sampling procedures [1] and may be particularly detrimental in critically ill patients [2]. We sought to describe the feasibility, safety, and diagnostic accuracy of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in the intensive care unit (ICU).Between May 2011 and May 2015, nine consecutive patients with acute respiratory failure (ARF) and mediastinal or hilar involvement were selected from a prospective cohort [3] that comprehensively describes all EBUS-TBNA procedures in Tenon hospital, a tertiary university teaching hospital in Paris, France. EBUS-TBNA was performed using a 6.7-mm-outer-diameter, real-time, bronchoscope with a 7.5-MHz linear ultrasound transducer.

Published
2016
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14. Observation scales to suspect dyspnea in non-communicative intensive care unit patients

Author

Alexandre Demoule, Romain Persichini, Maxens Decavèle, Capucine Morelot-Panzini, Frédérick Gay, Thomas Similowski, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de parasitologie - mycologie [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Parasitologie - Mycologie [CHU Pitié-Salpétrière], and HAL-UPMC, Gestionnaire

Subjects
medicine.medical_specialty, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Critical Care, business.industry, Pain medicine, MEDLINE, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, medicine.disease, Intensive care unit, 3. Good health, law.invention, Intensive Care Units, 03 medical and health sciences, Dyspnea, 0302 clinical medicine, 030228 respiratory system, law, Anesthesiology, Humans, Medicine, Medical emergency, Suspect, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Dyspnea, like pain, is a major cause of physical suffering and emotional distress. In the intensive care unit, mechanically ventilated patients are at high risk of dyspnea [1], and increasing attention is being given to this symptom [1, 2]. Because its evaluation relies on self-report and self-assessment [3], dyspnea carries the risk of being underestimated or even unrecognized and therefore unattended in many intensive care unit patients. This is particularly so in patients unable to communicate with their caregivers (sedation, delirium, etc.). We have recently developed and validated a specific intensive care unit version of the respiratory distress observation scale (IC-RDOS, http://www.ic-rdos.com) [4]. IC-RDOS, based on respiratory and behavioral signs, correlates strongly with ratings of dyspnea on a visual analogic scale in “communicative” patients, but this is by definition not the most pertinent target population. The present secondary analysis describes IC-RDOS in “non-communicative” intensive care unit patients, as the first step of its clinical and prognostic evaluation in this setting.

Published
2017
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15. Etiology and prognosis of acute respiratory failure in patients with primary malignant brain tumors admitted to the intensive care unit

Author

Léa Lemasle, Thomas Similowski, Isabelle Rivals, Marie Cantier, Alexandre Demoule, Ahmed Idbaih, Clémence Marois, Khê Hoang-Xuan, Maxens Decavèle, Hélène Prodanovic, and Nicolas Weiss

Subjects
Male, Cancer Research, medicine.medical_specialty, Acute infectious pneumonia, Aspiration pneumonia, Pneumocystis pneumonia, Pneumonia, Aspiration, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, medicine, Humans, Aged, Retrospective Studies, business.industry, Brain Neoplasms, Pneumonia, Pneumocystis, Cancer, Middle Aged, medicine.disease, Prognosis, Intensive care unit, Pulmonary embolism, Survival Rate, Intensive Care Units, Neurology, Oncology, Respiratory failure, 030220 oncology & carcinogenesis, Case-Control Studies, Etiology, Female, Neurology (clinical), business, Respiratory Insufficiency, 030217 neurology & neurosurgery
Abstract

Acute respiratory failure (ARF) is common and potentially fatal in patients with primary malignant brain tumors (PMBT). However, few data are available regarding its precipitating factors and prognosis. We sought to: (1) compare the causes of ARF and the outcome between patients with PMBT and patients with other peripheral solid tumors (PST), (2) identify the factors influencing ICU survival in PMBT patients. Two-center retrospective case-control study from March 1996 to May 2014. Primary central nervous system lymphomas were also included. Eighty-four patients with PMBT and 133 patients with PST were included. Acute infectious pneumonia was more frequent in PMBT than PST patients (77 vs. 36%, p

Published
2018

16. Plastic bronchitis: An unusual complication of acute chest syndrome in adult

Author

Muriel Fartoukh, Tài Pham, Maxens Decavèle, Sarah Feray, El Mahdi Hafiani, Pierre Mora, 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), Université Pierre et Marie Curie - Paris 6 (UPMC), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Pulmonary and Respiratory Medicine, lcsh:RC705-779, medicine.medical_specialty, business.industry, Plastic bronchitis, Case Report, Disease, lcsh:Diseases of the respiratory system, 030204 cardiovascular system & hematology, medicine.disease, Cystic fibrosis, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Acute chest syndrome, 3. Good health, Surgery, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Medicine, Sputum, Stage (cooking), medicine.symptom, business, Complication, Asthma
Abstract

International audience; Plastic bronchitis is used to designate endobronchial plugs of rubber-like consistency that form into bronchial trees. It has been described in several diseases like asthma, cystic fibrosis, pulmonary infection, cyanotic congenital heart disease and in few young children with homozygous sickle cell disease. We report the first sickle cell adult case of plastic bronchitis during acute chest syndrome. He developed severe acute respiratory distress syndrome. This unusual presentation related to obstruction by voluminous casts may alert physicians to focus more on the bronchi in sickle cell patients. Realization of fiberoptic bronchoscopy to diagnose endobronchial injury and preventive measures such as fluidification of sputum at the early stage of thoracic vaso-occlusive crisis are essential.

Published
2017
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17. Management of Dyspnea in the Noncommunicative Patients

Author

Thomas Similowski, Maxens Decavèle, Margaret L. Campbell, Alexandre Demoule, Martin Dres, Romain Persichini, and Capucine Morélot-Panzini

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, MEDLINE, Terminally ill, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Severity of illness, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2018
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18. Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure

Author

Pierre Bailly, Jean-Pierre Frat, Gael Pradel, Nicolas Terzi, Nicolas Deye, Arnaud W. Thille, Hodanou Nanadoumgar, Alexandre Lautrette, Mai-Anh Nay, Rémi Coudroy, Stéphanie Ragot, Aude Gibelin, Maxens Decavèle, Christine Lebert, Anahita Rouzé, François Beloncle, Grégoire Muller, Emmanuel Vivier, Guillaume Lacave, Adel Maamar, Laurence Dangers, Jean-Damien Ricard, Jeremy Bourenne, Anthony Le Meur, Alexandre Demoule, Romain Sonneville, Arnaud Gacouin, Séverin Cabasson, Jean Dellamonica, Caroline Sabatier, Guillaume Barberet, Keyvan Razazi, Stephan Ehrmann, Lassane Zanre, Christophe Girault, René Robert, and Pierre-Eric Danin

Subjects
Mechanical ventilation, business.industry, medicine.medical_treatment, 010102 general mathematics, General Medicine, Airway Extubation, 01 natural sciences, Intensive care unit, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Randomized controlled trial, Respiratory failure, law, Anesthesia, medicine, Breathing, Intubation, 030212 general & internal medicine, 0101 mathematics, business, Nose
Abstract

Importance High-flow nasal oxygen may prevent postextubation respiratory failure in the intensive care unit (ICU). The combination of high-flow nasal oxygen with noninvasive ventilation (NIV) may be an optimal strategy of ventilation to avoid reintubation. Objective To determine whether high-flow nasal oxygen with prophylactic NIV applied immediately after extubation could reduce the rate of reintubation, compared with high-flow nasal oxygen alone, in patients at high risk of extubation failure in the ICU. Design, Setting, and Participants Multicenter randomized clinical trial conducted from April 2017 to January 2018 among 641 patients at high risk of extubation failure (ie, older than 65 years or with an underlying cardiac or respiratory disease) at 30 ICUs in France; follow-up was until April 2018. Interventions Patients were randomly assigned to high-flow nasal oxygen alone (n = 306) or high-flow nasal oxygen with NIV (n = 342) immediately after extubation. Main Outcomes and Measures The primary outcome was the proportion of patients reintubated at day 7; secondary outcomes included postextubation respiratory failure at day 7, reintubation rates up until ICU discharge, and ICU mortality. Results Among 648 patients who were randomized (mean [SD] age, 70 [10] years; 219 women [34%]), 641 patients completed the trial. The reintubation rate at day 7 was 11.8% (95% CI, 8.4%-15.2%) (40/339) with high-flow nasal oxygen and NIV and 18.2% (95% CI, 13.9%-22.6%) (55/302) with high-flow nasal oxygen alone (difference, −6.4% [95% CI, −12.0% to −0.9%];P = .02). Among the 11 prespecified secondary outcomes, 6 showed no significant difference. The proportion of patients with postextubation respiratory failure at day 7 (21% vs 29%; difference, −8.7% [95% CI, −15.2% to −1.8%];P = .01) and reintubation rates up until ICU discharge (12% vs 20%, difference −7.4% [95% CI, −13.2% to −1.8%];P = .009) were significantly lower with high-flow nasal oxygen and NIV than with high-flow nasal oxygen alone. ICU mortality rates were not significantly different: 6% with high-flow nasal oxygen and NIV and 9% with high-flow nasal oxygen alone (difference, −2.4% [95% CI, −6.7% to 1.7%];P = .25). Conclusions and Relevance In mechanically ventilated patients at high risk of extubation failure, the use of high-flow nasal oxygen with NIV immediately after extubation significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial Registration ClinicalTrials.gov Identifier:NCT03121482

Published
2019
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19. Faisabilité et validation d’un score comportemental de dyspnée chez les patients non communicants en réanimation

Author

Alexandre Demoule, Thomas Similowski, S. Campion, Marie-Cécile Niérat, Côme Bureau, Mathieu Raux, R. Ainsouya, and Maxens Decavèle

Subjects
Pulmonary and Respiratory Medicine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, 030217 neurology & neurosurgery
Abstract

Introduction La dyspnee est frequente chez les patients sous ventilation mecanique (VM) et impacte severement leur pronostic. Sa mesure implique une auto-evaluation par le patient et requiert un certain niveau de communication. Par consequent, une large proportion de patients ventiles, non communicants (NC), echappe a son evaluation et aux potentiels benefices therapeutiques associes a son controle. L’activite electrique de surface des muscles extradiaphragmatiques inspiratoires a ete validee comme un biomarqueur fiable de dyspnee. Son utilisation complexe en routine a pousse notre equipe a developper un score comportemental denomme IC-RDOS [1] . Valide chez les patients vigiles essentiellement non ventiles, notre objectif etait de le valider chez les patients ventiles NC en le comparant a l’activite EMG. Methodes Des patients sous VM invasive presentant des signes d’inconfort respiratoire ont ete inclus. L’IC-RDOS et l’activite EMG des parasternaux et des Alae Nasi etaient mesures avant (etat basal, EB) et apres une intervention therapeutique visant a soulager la dyspnee. Ces interventions consistaient en une optimisation des reglages du ventilateur (Opt) pour tous les patients et une injection de morphine lorsque juge necessaire par le clinicien en charge du patient. Resultats Au total 35 patients (âge 67 [56–76], IGS II 51 [35–61]); med [IQR]) ont ete inclus dont 17 NC. Parmi les patients NC, le IC-RDOS a diminue de 6,18 [4,34–6,62] en EB a 4,35 [2,68–6,29] (p = 0,046) et 4,31 [2,94–4,75] (p = 0,011) apres Opt et injection de morphine respectivement. En parallele, comparativement a l’EB, on observait une diminution significative de l’EMG area under curve (EMG AUC) des parasternaux (−65% [p = 0,039]) apres injection de morphine ainsi qu’une diminution de l’EMG AUC des Alae Nasi (−38% [p = 0,003] et −64% [p = 0,008] apres Opt et injection de morphine respectivement). Le IC-RDOS etait significativement correle a l’EMG AUC des parasternaux (r = 0,668, p = 0,008). Apres recueil des EVA-dyspnee parmi les 18 patients communicants, on observait une correlation significative entre l’EVA-dyspnee et le IC-RDOS (r = 0,545, p = 0,038). Conclusion Ces resultats suggerent que le IC-RDOS est un score de mesure de dyspnee fiable chez les patients de reanimation sous VM invasive NC.

Published
2017
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