Author: "Thomas, Geeraerts" / Topic: business.industry - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Thomas, Geeraerts"' showing total 139 results

Start Over Author "Thomas, Geeraerts" Topic business.industry

139 results on '"Thomas, Geeraerts"'

1. Mass Training In Situ During COVID-19 Pandemic

Author: Charles-Henri Houze-Cerfon, Stein Silva, Vincent Minville, Marilyne Fernandes, Rachel Rigal, Sébastien Couarraze, Thomas Geeraerts, Fanny Vardon-Bounes, Richard Pizzuto, Fouad Marhar, Jean Ruiz, Thierry Seguin, Bernard Georges, Muriel Legendre, Béatrice Riu, Louis Delamarre, Claire Larcher, Sandra Malavaud, Diane Osinski, Fabrice Ferré, Olivier Mathe, and Olivier Fourcade
Subjects: training, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, healthcare workers, Epidemiology, business.industry, Training (meteorology), COVID-19, sick leave, Medicine (miscellaneous), simulation, medicine.disease, Education, Personnel, Hospital, Contamination, Modeling and Simulation, Pandemic, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Humans, Medicine, Empirical Investigations, Medical emergency, business, Pandemics
Abstract: Supplemental digital content is available in the text., Introduction Avoiding coronavirus disease 2019 (COVID-19) work-related infection in frontline healthcare workers is a major challenge. A massive training program was launched in our university hospital for anesthesia/intensive care unit and operating room staff, aiming at upskilling 2249 healthcare workers for COVID-19 patients' management. We hypothesized that such a massive training was feasible in a 2-week time frame and efficient in avoiding sick leaves. Methods We performed a retrospective observational study. Training focused on personal protective equipment donning/doffing and airway management in a COVID-19 simulated patient. The educational models used were in situ procedural and immersive simulation, peer-teaching, and rapid cycle deliberate practice. Self-learning organization principles were used for trainers' management. Ordinary disease quantity in full-time equivalent in March and April 2020 were compared with the same period in 2017, 2018, and 2019. Results A total of 1668 healthcare workers were trained (74.2% of the target population) in 99 training sessions over 11 days. The median number of learners per session was 16 (interquartile range = 9–25). In the first 5 days, the median number of people trained per weekday was 311 (interquartile range = 124–385). Sick leaves did not increase in March to April 2020 compared with the same period in the 3 preceding years. Conclusions Massive training for COVID-19 patient management in frontline healthcare workers is feasible in a very short time and efficient in limiting the rate of sick leave. This experience could be used in the anticipation of new COVID-19 waves or for rapidly preparing hospital staff for an unexpected major health crisis.
Published: 2022
Full Text: View/download PDF

2. Guidelines: Anaesthesia in the context of COVID-19 pandemic

Author: Lionel Velly, Etienne Gayat, Hervé Quintard, Emmanuel Weiss, Audrey De Jong, Philippe Cuvillon, Gérard Audibert, Julien Amour, Marc Beaussier, Matthieu Biais, Sébastien Bloc, Marie Pierre Bonnet, Pierre Bouzat, Gilles Brezac, Claire Dahyot-Fizelier, Souhayl Dahmani, Mathilde de Queiroz, Sophie Di Maria, Claude Ecoffey, Emmanuel Futier, Thomas Geeraerts, Haithem Jaber, Laurent Heyer, Rim Hoteit, Olivier Joannes-Boyau, Delphine Kern, Olivier Langeron, Sigismond Lasocki, Yoan Launey, Frederic le Saché, Anne Claire Lukaszewicz, Axel Maurice-Szamburski, Nicolas Mayeur, Fabrice Michel, Vincent Minville, Sébastien Mirek, Philippe Montravers, Estelle Morau, Laurent Muller, Jane Muret, Karine Nouette-Gaulain, Jean Christophe Orban, Gilles Orliaguet, Pierre François Perrigault, Florence Plantet, Julien Pottecher, Christophe Quesnel, Vanessa Reubrecht, Bertrand Rozec, Benoit Tavernier, Benoit Veber, Francis Veyckmans, Hélène Charbonneau, Isabelle Constant, Denis Frasca, Marc-Olivier Fischer, Catherine Huraux, Alice Blet, Marc Garnier, Assistance Publique - Hôpitaux de Marseille (APHM), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, 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), Institut de pharmacologie moléculaire et cellulaire (IPMC), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'Anesthésie et Réanimation [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [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), Institut Mutualiste de Montsouris (IMM), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, CHU Toulouse [Toulouse], Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Physiopathologie et Pharmacologie Clinique de la Douleur, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), 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), Clinique Juge - Clinique du sport [Marseille], Pôle d'Anesthésie-Réanimation [CHU Rangueil], CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Hôpital de Rangueil, Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département d'Anesthésie Réanimation, 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), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Institut Curie [Paris], Réanimation Médico-Chirurgicale, Service d'Anesthésie Réanimation, CHU Necker - Enfants Malades [AP-HP], Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe d’Anesthésie-Réanimation Chirurgie cardio-thoracique et vasculaire [Toulouse], Clinique Pasteur [Toulouse], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Département d'anesthésiologie [CHU Caen], 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), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-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 Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Pôle Anesthésie Réanimation [CHU de Toulouse], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), Histoire et Cultures de l'Antiquité et du Moyen Âge (HISCANT-MA), Université de Lorraine (UL), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Emergency Department, Université Bordeaux Segalen - Bordeaux 2-Hôpital Pellegrin - Bordeaux, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Anaesthesiology, Robert Debré Hospital, Service d'anesthésie réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie mitochondriale, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherches sur les Herbivores - UMR 1213 (UMRH), Institut National de la Recherche Agronomique (INRA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Anesthésiologie, Université Pierre et Marie Curie - Paris 6 (UPMC), and Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France.
Subjects: Infection prevention and control, [SDV]Life Sciences [q-bio], Psychological intervention, Airway management, Context (language use), Critical Care and Intensive Care Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030202 anesthesiology, Informed consent, Personal protective equipment, Pandemic, Health care, Medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Modalities, SARS-CoV-2, business.industry, COVID-19, 030208 emergency & critical care medicine, General Medicine, Guideline, 3. Good health, Anesthesiology and Pain Medicine, Universal precautions, Anesthesia, Viruses, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: Objectives The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. Results The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. Conclusion We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
Published: 2020
Full Text: View/download PDF

3. Functional and Structural Integrity of Frontoparietal Connectivity in Traumatic and Anoxic Coma

Author: Vincent Minville, Béatrice Riu, Jean Albert Lotterie, Hélène Vinour, Benjamine Sarton, Jean François Albucher, Thierry Seguin, Segolène Mrozeck, Xavier Deboissezon, Briguitta Malagurski, Stein Silva, Olivier Fourcade, Federico Nemmi, Patrice Péran, Fanny Vardon Bounes, Thomas Geeraerts, David Rousset, Jean-Marc Olivot, Fabrice Ferré, and Lionel Naccache
Subjects: brain anoxia, Adult, Male, medicine.medical_specialty, Traumatic brain injury, coma, Neuroimaging, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Physical medicine and rehabilitation, Parietal Lobe, Medicine, Humans, Glasgow Coma Scale, Longitudinal Studies, Prospective Studies, Prospective cohort study, Prefrontal cortex, Aged, Univariate analysis, business.industry, Binary outcome, Online Clinical Investigations, Structural integrity, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, functional magnetic resonance imaging, Magnetic Resonance Imaging, Coma, Post-Head Injury, Frontal Lobe, Heart Arrest, 030228 respiratory system, Case-Control Studies, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, brain trauma, Female, Disconnection, prognosis, business
Abstract: Supplemental Digital Content is available in the text., Objectives: Recovery from coma might critically depend on the structural and functional integrity of frontoparietal networks. We aimed to measure this integrity in traumatic brain injury and anoxo-ischemic (cardiac arrest) coma patients by using an original multimodal MRI protocol. Design: Prospective cohort study. Setting: Three Intensive Critical Care Units affiliated to the University in Toulouse (France). Patients: We longitudinally recruited 43 coma patients (Glasgow Coma Scale at the admission < 8; 29 cardiac arrest and 14 traumatic brain injury) and 34 age-matched healthy volunteers. Exclusion criteria were disorders of consciousness lasting more than 30 days and focal brain damage within the explored brain regions. Patient assessments were conducted at least 2 days (5 ± 2 d) after complete withdrawal of sedation. All patients were followed up (Coma Recovery Scale-Revised) 3 months after acute brain injury. Interventions: None. Measurements and Main Results: Functional and structural MRI data were recorded, and the analysis was targeted on the posteromedial cortex, the medial prefrontal cortex, and the cingulum. Univariate analyses and machine learning techniques were used to assess diagnostic and predictive values. Coma patients displayed significantly lower medial prefrontal cortex–posteromedial cortex functional connectivity (area under the curve, 0.94; 95% CI, 0.93–0.95). Cardiac arrest patients showed specific structural disturbances within posteromedial cortex. Significant cingulum architectural disturbances were observed in traumatic brain injury patients. The machine learning medial prefrontal cortex–posteromedial cortex multimodal classifier had a significant predictive value (area under the curve, 0.96; 95% CI, 0.95–0.97), best combination of subregions that discriminates a binary outcome based on Coma Recovery Scale-Revised). Conclusions: This exploratory study suggests that frontoparietal functional disconnections are specifically observed in coma and their structural counterpart provides information about brain injury mechanisms. Multimodal MRI biomarkers of frontoparietal disconnection predict 3-month outcome in our sample. These findings suggest that fronto-parietal disconnection might be particularly relevant for coma outcome prediction and could inspire innovative precision medicine approaches.
Published: 2020

4. Simulation-based teaching in critical care, anaesthesia and emergency medicine

Author: Jean-Philippe Desclefs, Thomas Geeraerts, Erwan L'Her, Chirine Mossadegh, François Lecomte, Charles Cerf, Antonia Blanié, Marc Garnier, Véronique Delmas, Dan Benhamou, Mercedes Jourdain, and Islem Ouanes
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Emergency medicine, Medicine, General Medicine, Critical Care and Intensive Care Medicine, business, Simulation based
Published: 2020
Full Text: View/download PDF

5. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury

Author: E. Cesareo, C. Court, Jean-François Payen, Aurore Rodrigues, Patrick Tropiano, Karim Tazarourte, Antoine Roquilly, Hervé Quintard, B. Perrouin-Verbe, Mathieu Boutonnet, V. Vermeersch, T. Gauss, P. Denys, Kevin Buffenoir, Pierre Bouzat, A.C. de Crouy, Thomas Geeraerts, V. Martinez, Bertrand Prunet, Fabrice Cook, Stéphane Fuentes, B Vigué, Lionel Velly, Anthony Chauvin, Christian Laplace, and Jacques Duranteau
Subjects: Mechanical ventilation, medicine.medical_specialty, Resuscitation, business.industry, medicine.medical_treatment, 030208 emergency & critical care medicine, General Medicine, Evidence-based medicine, Critical Care and Intensive Care Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, medicine, Physical therapy, Sampling (medicine), Paraplegia, business, Grading (education), Tetraplegia, Spinal cord injury
Abstract: Objectives To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. Design A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Methods The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. Results The experts’ work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/−) and 12 have a low level of evidence (GRADE 2+/−). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. Conclusions There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
Published: 2020
Full Text: View/download PDF

6. Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

Author: Camilo N. Rodríguez and Thomas Geeraerts
Subjects: medicine.medical_specialty, business.industry, Hemodynamics, Blood flow, Intensive care unit, law.invention, Transcranial Doppler, Cerebral blood flow, law, Anesthesia, Parenchyma, medicine, Neurosurgery, business, Perfusion
Abstract: Neurosurgical patients frequently require admission to intensive care unit (ICU), either for postoperative management or for treating complications. Postoperative neurosurgical monitoring has two interrelated goals related to secondary brain injury: (1) early detection of neurologic deterioration (neuroworsening) facilitating timely intervention, and (2) maintenance or reestablishment of systemic and neurologic homeostasis. The multimodal monitoring (MMM) approach aims to optimize patient care, if necessary, to ensure optimal brain tissue perfusion, maintaining a sufficient blood flow to supply energy and oxygen to the brain parenchyma. Therefore, transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) (as a part of MMM) are noninvasive bedside monitoring techniques that can evaluate cerebral blood flow hemodynamics and brain parenchyma structures, allowing real-time assessment of cerebral blood flow velocity (CBFV) and bedside monitoring changes in the brain parenchyma during postoperative management.
Published: 2021
Full Text: View/download PDF

7. Clinical decision support for severe trauma patients: Machine learning based definition of a bundle of care for hemorrhagic shock and traumatic brain injury

Author: V Legros, Anatole Harrois, Romain Pirracchio, J L Hanouz, E Lang, Arthur Neuschwander, P Esnault, Gersende Favé, Thomas Geeraerts, Julien Pottecher, Sophie Hamada, Paer Selim Abback, N Mellati, Marc Leone, and E Kipnis
Subjects: Adult, Male, Emergency Medical Services, Multivariate analysis, Critical Care, Traumatic brain injury, MEDLINE, Shock, Hemorrhagic, Critical Care and Intensive Care Medicine, Machine learning, computer.software_genre, Machine Learning, Brain Injuries, Traumatic, medicine, Humans, Hospital Mortality, Registries, Univariate analysis, Trauma Severity Indices, business.industry, Mortality rate, Univariate, Evidence-based medicine, medicine.disease, Decision Support Systems, Clinical, Quality Improvement, Cohort, Practice Guidelines as Topic, Surgery, Female, Artificial intelligence, France, Guideline Adherence, business, computer, Patient Care Bundles
Abstract: Background Deviation from guidelines is frequent in emergency situations and this may lead to increased mortality. Probably because of time constraints, 55% is the greatest reported guidelines compliance rate in severe trauma patients. This study aimed to identify among all available recommendations a reasonable bundle of items that should be followed to optimize the outcome of hemorrhagic shocks (HS) and severe traumatic brain injuries (TBI). Methods We first estimated the compliance with French and European guidelines using the data from the French TraumaBase® registry. Then, we used a machine learning procedure to reduce the number of recommendations into a minimal set of items to be followed to minimize 7-day mortality. We evaluated the bundles using an external validation cohort. Results This study included 5,924 trauma patients (1,414 HS and 4,955 TBI) between 2011 and August 2019 and studied compliance to 36 recommendation items. Overall compliance rate to recommendation items was 71.6% and 66.9% for HS and TBI respectively. In HS, compliance was significantly associated with 7-day decreased mortality in univariate analysis but not in multivariate analysis (RR = 0.91, 95%CI = 0.90-1.17, p = 0.06). In TBI, compliance was significantly associated with decreased mortality in univariate and multivariate analysis (RR = 0.85, 95%CI = 0.75-0.92, p = 0.01). For HS, the bundle included 13 recommendation items. In the validation cohort, when this bundle was applied, patients were found to have a lower 7-day mortality rate (RR = 0.46, 95%CI = 0.27-0.63, p = 0.01). In TBI, the bundle included 7 items. In the validation cohort, when this bundle was applied, patients had a lower 7-day mortality rate (RR = 0.55, 95%CI = 0.34-0.71, p = 0.02). Discussion Using a machine-learning procedure, we were able to identify a subset of recommendations that minimizes 7-day mortality following traumatic HS and TBI. These two bundles remain to be evaluated in a prospective manner. Level of evidence II.
Published: 2021

8. La surveillance neurologique clinique infirmière du traumatisé crânien en réanimation

Author: Saloua Mrid, Dominique Capdordy, Thomas Geeraerts, Nadia Moussa, Ségolène Mrozek, and Gérald Dauban
Subjects: business.industry, Emergency Medicine, Medicine, Emergency Nursing, business
Published: 2021
Full Text: View/download PDF

9. COVID-19–associated acute necrotising encephalopathy successfully treated with steroids and polyvalent immunoglobulin with unusual IgG targeting the cerebral fibre network

Author: Jérôme Roustan, Fabrice Bonneville, Olivier Fourcade, Gaspard Grouteau, Etienne Aldigé, J. Pariente, David Rousset, Cédric Gollion, Louis Delamarre, Guillaume Jimena, Thomas Geeraerts, Françoise Fortenfant, Chloé Bost, François Gaussiat, Charlène Gaffard, Guillaume Martin-Blondel, Julien Duplantier, Pierre Delobel, and Charlotte Martin
Subjects: Encephalopathy, Clinical Neurology, Neurological examination, Sixth nerve palsy, neuropathology, virology, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Intensive care, medicine, intensive care, Autoimmune encephalitis, medicine.diagnostic_test, business.industry, Glasgow Coma Scale, PostScript, medicine.disease, Hyperintensity, autoimmune encephalitis, Psychiatry and Mental health, Anesthesia, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, steroids
Abstract: A recent case report described the radiological features of a suspected COVID-19 necrotising haemorrhagic encephalopathy.1 We present here a description of clinical, biological, radiological and immunological features of a COVID-19 patient case, evocative of virus-associated acute necrotising encephalopathy (ANE) possibly mediated by antibodies. Patient’s representative consent has been obtained in agreement with the journal’s policy. A 51-year-old man without personal or family history of neurological disease was hospitalised after 10 days of fever and cough. COVID-19 was diagnosed by reverse-transcriptase PCR on nasal swab and bilateral ground-glass opacities on thoracic CT scan. At day 12, he was admitted in intensive care unit (ICU) for non-invasive ventilation. The result of the neurological examination was normal. At day 21, while the patient had been weaned off oxygen, he became unresponsive and rapidly comatose (Glasgow Coma Scale 6: E1, V1, M4) with a disconjugated gaze. The patient was groaning and showing rhythmic movements of the right upper limb. An urgent brain MRI, including diffusion-weighted imaging (DWI) and MR angiogram, ruled out vertebrobasilar ischaemic stroke; gradient echo T2*-weighted images excluded haemorrhage and thrombus in the venous system. It revealed only subtle hyperintensities in bilateral thalami on FLAIR sequence (figure 1). Consciousness impairment required tracheal intubation. He was hyperthermic (39°C) without shock. Blood and cerebrospinal fluid (CSF) samples revealed thrombopenia and lymphopenia, mild inflammatory response (C reactive protein, ferritin and fibrinogen), CSF albumin-cytological dissociation with increased CSF IgG antibodies (91.9 mg/L, normal 10–30 mg/L) and altered blood–brain barrier integrity (CSF/serum albumin index=17.3, normal
Published: 2020

10. L’éducation interprofessionnelle des équipes de soins critiques par la simulation : concept, mise en œuvre et évaluation

Author: Charles-Henri Houze-Cerfon, Michèle Saint-Jean, Sylvain Boet, Thomas Geeraerts, Fouad Marhar, CHU Toulouse [Toulouse], Département des Sciences de l'éducation et de la formation, Université de Tours, Education, Formation, Travail, Savoirs (EFTS), and Université Toulouse - Jean Jaurès (UT2J)-École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA)
Subjects: Medical education, Teamwork, Hierarchy, 020205 medical informatics, business.industry, [SDV]Life Sciences [q-bio], 4. Education, Debriefing, media_common.quotation_subject, 02 engineering and technology, General Medicine, Interprofessional education, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Interprofessional teamwork, 030212 general & internal medicine, business, Curriculum, Simulation based, ComputingMilieux_MISCELLANEOUS, media_common
Abstract: Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.
Published: 2019
Full Text: View/download PDF

11. 'Real life' impact of anesthesia strategy for mechanical thrombectomy on the delay, recanalization and outcome in acute ischemic stroke patients

Author: Jean-Marc Olivot, Thomas Geeraerts, Caterina Michelozzi, Christophe Cognard, Jean Darcourt, Fabrice Bonneville, Philippe Tall, Ivan Vukasinovic, Ségolène Mrozek, Anne-Christine Januel, and Adrien Guenego
Subjects: Mechanical Thrombolysis, medicine.medical_treatment, Sedation, Conscious Sedation, Anesthesia, General, Revascularization, Brain Ischemia, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Text mining, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Stroke, Aged, Radiological and Ultrasound Technology, Groin, business.industry, Mortality rate, Middle Aged, medicine.disease, Mechanical thrombectomy, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Observational study, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Background and purpose Choice of anesthesia type on outcome for mechanical thrombectomy (MT) in acute ischemic stroke remains controversial. The goal of our research was to study the impact of anesthesia strategy on the delay, angiographic and neurological outcome of MT performed under general anesthesia (GA) vs. conscious sedation (CS). Methods This prospective, single-center observational study included patients with anterior circulation large vessel occlusion (ACLVO) strokes treated with MT within 6 hours of symptom onset. All time metrics were evaluated. Angiographic and clinical outcomes were assessed by recanalization rate (mTICI) and 3-month functional independence (mRs). Complications and mortality rate were recorded as safety outcomes. Results In total, 303 consecutive thrombectomies were performed, 86.8% under GA. NIHSS was higher in GA, with median of 19.0 for GA and 16.5 for CS (P = 0.049). Median time from arrival in hospital (door) to groin puncture was 83 min (IQR = 45.0–109.5) for GA compared to 72 min (IQR = 35.0–85.3) for CS, P = 0.170). Median time from arrival in the angiosuite to groin puncture was 20 min (IQR = 15.0–29.0) for GA compared to 15 min (IQR = 10.0–20.0) for CS, P = 0.017). There were no significant differences in recanalization time metrics, successful revascularization rate, functional independence and mortality rate at three months. Conclusions GA induced a 5 to 10 minutes delay for groin puncture, without impact on recanalization time metrics, or neurological outcome at 3 months. Our results demonstrate that a well-organized workflow is associated with reasonable delay in performing GA for MT, without effect on outcome compared to sedation.
Published: 2019
Full Text: View/download PDF

12. Effects of Resistance Exercise with or without Whey Protein Supplementation on Ocular Changes after a 21-Day Head-Down Bed Rest

Author: Laurence Mahieu, Jean-Claude Quintyn, Marc Kermorgant, Sirine Hammoud, Vincent Soler, Arnaud Beck, Marie-Pierre Bareille, Anne Pavy-Le Traon, and Thomas Geeraerts
Subjects: Applanation tonometry, medicine.medical_specialty, Intraocular pressure, Heel, Nutritional Supplementation, genetic structures, medicine.medical_treatment, Science, Bed rest, Article, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, optical coherence tomography, intraocular pressure, head-down bed rest, microgravity, Internal medicine, medicine, Ecology, Evolution, Behavior and Systematics, business.industry, Resistance training, Paleontology, eye diseases, Prolonged exposure, medicine.anatomical_structure, Space and Planetary Science, 030221 ophthalmology & optometry, Cardiology, sense organs, business, 030217 neurology & neurosurgery
Abstract: Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 21 days of head-down bed rest (HDBR) and (2) to determine the effects of resistance vibration exercise (RVE) alone or combined with nutritional supplementation (NeX). In this case, 12 healthy male subjects completed three interventions of a 21-day HDBR: a control condition without countermeasure (CON), a condition with resistance vibration exercise (RVE) comprising of squats, single leg heel and bilateral heel raises and a condition using also RVE associated with nutritional supplementation (NeX). Intraocular pressure (IOP) was assessed by applanation tonometry. Retinal nerve fiber layer thickness (RNFLT) was assessed with spectral-domain optical coherence tomography, before HDBR and between Day 2 and Day 4 after each session of HDBR. In CON condition, IOP was preserved; while in RVE and NeX conditions, IOP was increased. In CON condition, RNFLT was preserved after HDBR. RVE and NeX conditions did not have significant effects on RNFLT. This study showed that a 3-week HDBR did not induce significant ophthalmological changes. However, RVE induced an elevation in IOP after HDBR. Nutritional supplementation did not reduce or exacerbate the side effects of RVE.
Published: 2021

13. PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia

Author: Alexandra Fournel, Jérôme Rollin, Claire Pouplard, Thomas Geeraerts, Guillaume Mourey, Gilles Pernod, Sophie Susen, Hubert Galinat, Vincent Mémier, Yves Gruel, Caroline Vayne, Olivier Huet, Raphaël Marlu, and Charlotte Cordonnier
Subjects: Laboratory methods, 2019-20 coronavirus outbreak, medicine.diagnostic_test, Coronavirus disease 2019 (COVID-19), business.industry, General Medicine, Heparin, 030204 cardiovascular system & hematology, medicine.disease, Thrombosis, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Immune system, hemic and lymphatic diseases, Immunoassay, Immunology, Correspondence, medicine, 030212 general & internal medicine, business, medicine.drug
Abstract: Laboratory Method to Detect VITT The rare vaccine-induced immune thrombotic thrombocytopenia that may follow adenovirus-based Covid-19 vaccination resembles heparin-induced thrombocytopenia, but ra...
Published: 2021

14. Ventilator-associated pneumonia due to Staphylococcus aureus in brain-injured patients: Beyond risk factors

Author: Marc Leone, Ines Lakbar, Thomas Geeraerts, Alice Baldovini, Microbes évolution phylogénie et infections (MEPHI), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), and Université de Toulouse (UT)
Subjects: medicine.medical_specialty, Staphylococcus aureus, Critical Care and Intensive Care Medicine, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Medicine, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Ventilator-associated pneumonia, Brain, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, General Medicine, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 3. Good health, Anti-Bacterial Agents, Intensive Care Units, Anesthesiology and Pain Medicine, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, business
Abstract: International audience
Published: 2021
Full Text: View/download PDF

15. Moderate hypocapnia for intracranial pressure control after traumatic brain injury: a common practice requiring further investigations

Author: Thomas Geeraerts
Subjects: medicine.medical_specialty, Hypocapnia, business.industry, Traumatic brain injury, Anesthesiology, Pain medicine, Emergency medicine, Medicine, Critical Care and Intensive Care Medicine, business, medicine.disease, Intracranial pressure
Published: 2021
Full Text: View/download PDF

16. Systematic Screening for Deep Vein Thrombosis in Critically Ill Inpatients With COVID-19: Impact on the Incidence of Venous Thromboembolism

Author: Bertrand Combis, Stein Silva, Vincent Minville, Agnès Ribes, Fanny Vardon-Bounes, Arthur Thery, François-Xavier Lapébie, Alessandra Bura-Rivière, and Thomas Geeraerts
Subjects: medicine.medical_specialty, Deep vein, venous thromboembolism, intensive care unit, deep vein thrombosis, law.invention, law, Intensive care, Internal medicine, medicine, Cumulative incidence, cardiovascular diseases, lcsh:R5-920, business.industry, Incidence (epidemiology), Hazard ratio, COVID-19, General Medicine, ultrasonography, Brief Research Report, medicine.disease, Intensive care unit, Thrombosis, Pulmonary embolism, medicine.anatomical_structure, Medicine, business, lcsh:Medicine (General)
Abstract: Background: Several studies suggest an increased incidence of thrombosis in COVID-19 patients. However, evidence on how to prevent and even treat it is scarce. The aim of this study was to compare the cumulative incidence of venous thromboembolism (VTE) of two different methods for lower extremity deep vein thrombosis (LE-DVT) diagnosis: systematic vs. clinically guided complete compression venous ultrasonography (CCUS). We conducted a monocentric, prospective, open-label, non-randomized study. All consecutive patients admitted in three intensive care units (ICUs) of University Hospital of Toulouse for COVID-19 pneumonia were included: one performed systematic screening for LE-DVT, the others did not. The primary outcome was the 21-day cumulative incidence of VTE. The secondary end points were the 21-day cumulative incidences of major bleeding and death.Results: Among the 78 patients included, 27 (34.6%) underwent systematic screening for DVT 7 ± 2 days after ICU admission. Thirty-two patients (41.0%) were diagnosed with VTE, with a 21-day cumulative incidence of 42.3% (95% CI, 31.4–55.2), without difference between screened and non-screened patients (hazard ratio 1.45, 95% CI, 0.72–2.93). In the screened group, the frequency of isolated DVT was higher (25.9 vs. 5.9%, p-value = 0.027), but the frequency of pulmonary embolism was not reduced (25.9 vs. 29.4%, p-value = 0.745). The 21-day cumulative incidences of major bleeding and death were 9.6% (95% CI, 4.7–19.2) and 10.3% (95% CI, 5.0–20.8), respectively, without difference between the two groups.Conclusions: A systematic screening for DVT in patients hospitalized in ICU was not associated with a higher diagnosis of VTE or a reduced diagnosis of PE.
Published: 2021
Full Text: View/download PDF

17. Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia

Author: Gregory Polkinghorne, Jean-François Payen, Fabrice Vuillier, Katarina Jood, Simon Nagel, Suzanne Silvis, Hans D. Katzberg, Aarti Sharma, Anemon Puthuppallil Philip, Caroline Vayne, Pankaj Sharma, Marcel Levi, Sini Hiltunen, Mayte Sánchez van Kammen, Monica Bandettini di Poggio, Erik Lindgren, Moritz J Scholz, Roberto Acampora, Felix J. Bode, Shyam S Sharma, Jim Burrow, Miguel Miranda, Alfonso Ciccone, Guillaume Franchineau, Ana Paiva Nunes, Yildiz Arslan, Christian Pfrepper, Vanessa Dizonno, Frank Maier, Emmanuel De Maistre, Domenico S Zimatore, Ahmed Elkady, Giovanni Frisullo, Fabrizio Giammello, Laurent Puy, Albrecht Günther, Dominik Michalski, Clement Tracol, Marta Carvalho, Irem Baharoglu, Jukka Putaala, José M. Ferro, Olivier Huet, Matthias Wittstock, Florindo d'Onofrio, Sophie Susen, Ronen R. Leker, Brian Buck, Jaskiran Brar, Katia Garambois, Barbara Casolla, Lukas Kellermair, Robert Kahnis, Avinash Aujayeb, Lucia Lebrato Hernandez, Catherine Legault, Simerpreet Bal, Mar Morin Martin, David Bougon, Anita van de Munckhof, Ricardo Vieira, Julian Zimmerman, Turgut Tatlisumak, Audrey Tawa, Hakan Cangür, Cristina Soriano, Georgios Tsivgoulis, Alberto Negro, Annerose Mengel, Jonathan M. Coutinho, Saskia Middeldorp, Dylan Blacquiere, Emmanuel Carrera, Antonio Arauz, Sean Murphy, Elias Johansson, Silvia Schönenberger, Judith Schouten, Thomas Gattringer, Sven Poli, François Cotton, Miguel A Barboza, Thomas Geeraerts, Nicolas Raposo, Nyika D. Kruyt, Mirjam Rachel Heldner, Shelagh B. Coutts, Timothy Kleinig, Elisa Cuadrado-Godia, Katarzyna Krzywicka, Mona Skjelland, Daniel Guisado-Alonso, Charlotte Cordonnier, Andreas Tiede, Marie-Cécile Dubois, Maria Cotelli, Diana Aguiar de Sousa, Maryam Mansour, Katharina Althaus, Peggy Reiner, Carlos Garcia-Esperon, Marcel Arnold, Thomas Cox, Laurent Derex, Thalia S. Field, Thijs F. van Haaps, Carla Zanferrari, Paolo Candelaresi, François Caparros, Åslög Hellström Vogel, Lisa Humbertjean, Francesco Grillo, A. Medina, Giosue Gulli, Marco Petruzzellis, Rolf Kern, Igor Sibon, João Fernandes, Fabrice Bonneville, Johanna A. Kremer Hovinga, Alexander Gutschalk, Alina Buture, Thorsten Bartsch, Graduate School, Neurology, Amsterdam Neuroscience - Neurovascular Disorders, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, Amsterdam Reproduction & Development, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, and ARD - Amsterdam Reproduction and Development
Subjects: Male, Pediatrics, Outcome Assessment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], 030204 cardiovascular system & hematology, Sinus Thrombosis, Sinus Thrombosis, Intracranial/blood, Cohort Studies, Sinus Thrombosis, Intracranial, Venous Thromboembolism/blood, 0302 clinical medicine, Outcome Assessment, Health Care, Hospital Mortality, Registries, Original Investigation, Mortality rate, Syndrome, Venous Thromboembolism, Heparin, Middle Aged, Thrombosis, 3. Good health, Vaccination, Female, Thrombocytopenia/blood, Cohort study, medicine.drug, Adult, medicine.medical_specialty, COVID-19 Vaccines, Drug-Related Side Effects and Adverse Reactions, Young Adult, 03 medical and health sciences, Sex Factors, ChAdOx1 nCoV-19, medicine, Intracranial/blood, Humans, Thrombus, Cerebral venous sinus thrombosis, BNT162 Vaccine, Aged, Ad26COVS1, business.industry, medicine.disease, Intracranial, Thrombocytopenia, Health Care, Drug-Related Side Effects and Adverse Reactions/mortality, Concomitant, Neurology (clinical), business, 030217 neurology & neurosurgery, COVID-19 Vaccines/adverse effects
Abstract: Contains fulltext : 245661.pdf (Publisher’s version ) (Closed access) IMPORTANCE: Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). OBJECTIVE: To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. EXPOSURES: Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. MAIN OUTCOMES AND MEASURES: Clinical characteristics and mortality rate. RESULTS: Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. CONCLUSIONS AND RELEVANCE: In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
Published: 2021

18. Atypical thrombosis associated with VaxZevria (R) (AstraZeneca) vaccine: Data from the French Network of Regional Pharmacovigilance Centres

Author: Anthony Bron, Joëlle Micallef, Nathalie Massy, Thomas Geeraerts, Thierry Vial, Francesco Salvo, Hugo Laujin, Mariette Baud, Sophie Liabeuf, Marie Blanche Valnet-Rabier, Marie Girot, Céline Mounier, Antoine El Kaddissi, Antoine Pariente, Mehdi Benkebil, Justine Perez, Kamel Masmoudi, Jean François Albucher, Sophie Gautier, François Montastruc, Annie Pierre Jonville-Béra, Aurélie Grandvuillemin, Evelyne Massardier, Nicolas Raposo, Charlène Boulay, Valérie Gras-Champel, CHU Amiens-Picardie, Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Agence nationale de sécurité du médicament et des produits de santé [Saint-Denis] (ANSM), CHU Rouen, Normandie Université (NU), Hôpital JeanMinjoz, CHU Lille, Toulouse Neuro Imaging Center (ToNIC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Roger Salengro [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Aix Marseille Université (AMU), CHU Marseille, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Bordeaux [Bordeaux], Centre régional de pharmacovigilance de Grenoble [CHU Grenoble], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), French Network of Pharmacovigilance Centres, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Institut de Neurosciences des Systèmes (INS), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANR-21-CO17-0001,Vigi-Drugs COVID-19,Identification précoce du risque associé aux médicaments utilisés dans le cadre de COVID-19 : analyse des données mondiales de pharmacovigilance(2021), DESSAIVRE, Louise, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3)
Subjects: 2019-20 coronavirus outbreak, Time Factors, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), [SDV]Life Sciences [q-bio], Letter to Editor, Antiviral Agents, Pharmacovigilance, medicine, Adverse Drug Reaction Reporting Systems, Humans, Pharmacology (medical), Pandemics, ComputingMilieux_MISCELLANEOUS, Covid-19 vaccine, SARS-CoV-2, business.industry, COVID-19, VaxZevria®, medicine.disease, Atypical thrombosis, Thrombosis, Virology, [SDV] Life Sciences [q-bio], Anti-PF4 antibodies, France, business, Thrombopenia
Abstract: The current COVID-19 pandemic is an exceptional health situation including for drug use. As there was no known effective drug for COVID-19 at the beginning of the pandemic, different candidates were proposed. In this short article, we present the French public pharmacovigilance activities during this health crisis. Although COVID-19 is a confounding factor per se, owing to its potential for multi-organ damage including the heart and kidney, the quality of the transmitted data in adverse drug reaction reports, the timeliness of feedback from clinicians, and the real-time pharmacological and medical analysis by the French network of the regional pharmacovigilance centers made it possible to swiftly identify relevant safety signals. The French National Agency of Medicine was thus able to validate the data and convey their findings very early. This decentralized organization based on medical and pharmacological evaluation of case reports has proven to be efficient and responsive in this unique and challenging healthcare emergency.
Published: 2021
Full Text: View/download PDF

19. Major rise of a chronic lymphoid leukemia clone during the course of COVID‐19

Author: Frédérique Dubois-Galopin, Clément Gaudin, Laetitia Largeaud, David Rousset, Elise Noel-Savina, François Vergez, Thomas Geeraerts, Agnès Ribes, Jean Baptiste Rieu, Vincent Mémier, and Yves Rolland
Subjects: Biochemistry, medical, 2019-20 coronavirus outbreak, Lymphocytosis, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Biochemistry (medical), Disease progression, Clinical Biochemistry, Clone (cell biology), Chronic lymphoid leukemia, Spontaneous remission, Hematology, General Medicine, Immunology, medicine, medicine.symptom, business
Published: 2020
Full Text: View/download PDF

20. Towards a new pattern for epidemiology of traumatic brain injury

Author: Hervé Quintard, Pierre Bouzat, and Thomas Geeraerts
Subjects: medicine.medical_specialty, business.industry, Traumatic brain injury, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Anesthesiology and Pain Medicine, Text mining, Brain Injuries, Epidemiology, Brain Injuries, Traumatic, Medicine, Humans, business, Intensive care medicine
Published: 2020

21. Optic Nerve Sheath Diameter

Author: Charles-Henri Houze-Cerfon, Thomas Geeraerts, and Louis Delamarre
Subjects: medicine.medical_specialty, Optic nerve sheath, business.industry, Medicine, Neurointensive care, Radiology, business, Intracranial pressure
Abstract: Ocular sonography with optic nerve sheath diameter (ONSD) does not require specialized skills. This chapter describes the anatomical background supporting the use of ONSD as a surrogate marker of intracranial pressure (ICP). Normal views, technological issues, and methodological aspects are discussed, as well as possible pitfalls and safety concerns.
Published: 2020
Full Text: View/download PDF

22. Diagnostic accuracy of a revised computed tomography angiography score for brain death confirmation, combining supra-tentorial arteries and infra-tentorial veins

Author: Olivier Fourcade, Jean-Christophe Sol, François Gaussiat, Bernard Georges, Claire Larcher, Ségolène Mrozek, Vincent Minville, Fabrice Bonneville, Fouad Marhar, Vincent Atthar, Mohamed Srairi, Stein Silva, Matteo Paoletti, Béatrice Riu, Timothée Abaziou, Gilles Georget, Rémi Menut, Zuzana Meluchova, Thierry Seguin, Diane Osinski, Fanny Vardon Bounes, David Brauge, Thomas Geeraerts, Maria Ahmad, Toulouse Neuro Imaging Center (ToNIC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), and CCSD, Accord Elsevier
Subjects: Adult, Male, Brain Death, medicine.medical_specialty, Psychometrics, Computed Tomography Angiography, [SDV]Life Sciences [q-bio], Cerebral arteries, Physical examination, Diagnostic accuracy, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Basilar artery, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Aged, Retrospective Studies, Computed tomography angiography, medicine.diagnostic_test, business.industry, Reproducibility of Results, Data accuracy, Retrospective cohort study, General Medicine, Cerebral Arteries, Middle Aged, Internal Cerebral Vein, University hospital, Cerebral Veins, Cerebral Angiography, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, Female, France, Radiology, business
Abstract: International audience; Purpose: The 4-point score is the corner stone of brain death (BD) confirmation using computed tomography angiography (CTA). We hypothesized that considering the superior petrosal veins (SPVs) may improve CTA diagnosis performance in BD setting. We aimed at comparing the diagnosis performance of three revised CTA scores including SPVs and the 4-point score in the confirmation of BD.Methods: In this retrospective study, 69 consecutive adult-patients admitted in a French University Hospital meeting clinical brain death criteria and receiving at least one CTA were included. CTA images were reviewed by two blinded neuroradiologists. A first analysis compared the 4-point score, considered as the reference and three non-opacification scores: a "Toulouse score" including SPVs and middle cerebral arteries, a "venous score" including SPVs and internal cerebral veins and a "7-score" including all these vessels and the basilar artery. Psychometric tools, observer agreement and misclassification rates were assessed. A second analysis considered clinical examination as the reference.Results: Brain death was confirmed by the 4-score in 59 cases (89.4 %). When compared to the 4-score, the Toulouse score displayed a 100 % positive predictive value, a substantial observer agreement (0.77 [0.53; 1]) and the least misclassification rate (3.03 %). Results were similar in the craniectomy subgroup. The Toulouse score was the only revised test that combined a sensitivity close to that of the 4-score (86.4 % [75.7; 93.6] and 89.4 % [79.4; 95.6], p-value < 0.001, respectively) and a substantial observer agreement.Conclusions: A score including SPVs and middle cerebral arteries is a valid method for BD confirmation using CTA even in patients receiving craniectomy.
Published: 2020
Full Text: View/download PDF

23. Incidence and predicting factors of perioperative complications during monitored anesthesia care for awake craniotomy

Author: Timothée Abaziou, Fouad Marhar, Rémi Menut, Diane Osinski, Louis Delamarre, David Brauge, Raphaël Cinotti, Olivier Fourcade, Jean-Christophe Sol, Franck-Emmanuel Roux, Francis Tincres, Claire Larcher, Thomas Geeraerts, Ségolène Mrozek, CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre de recherche cerveau et cognition (CERCO), Institut des sciences du cerveau de Toulouse. (ISCT), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Bradycardia, business.industry, [SDV]Life Sciences [q-bio], Remifentanil, Retrospective cohort study, Odds ratio, Perioperative, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Respiratory failure, 030202 anesthesiology, Anesthesia, Post-anesthesia care unit, medicine, medicine.symptom, business, Complication, 030217 neurology & neurosurgery, medicine.drug
Abstract: Study objective To assess incidence and predicting factors of awake craniotomy complications. Design Retrospective cohort study. Setting Operating room and Post Anesthesia Care unit. Patients 162 patients who underwent 188 awake craniotomy procedures for brain tumor, ASA I to III, with monitored anesthesia care. Measurements We classified procedures in 3 groups: major event group, minor event group, and no event group. Major events were defined as respiratory failure requiring face mask or invasive ventilation; hemodynamic instability treated by vasoactive drugs, or bradycardia treated by atropine, bleeding >500 ml, transfusion, gaseous embolism, cardiac arrest; seizure, cerebral edema, or any events leading to stopping of the cerebral mapping. Minor event was defined as any complication not classified as major. Multivariate logistic regression was used to determine predicting factors of major complication, adjusted for age and ASA score. Main results 45 procedures (24%) were classified in major event group, 126 (67%) in minor event group, and 17 (9%) in no event group. Seizure was the main complication (n = 13). Asthma (odds ratio: 10.85 [1.34; 235.6]), Remifentanil infusion (odds ratio: 2.97 [1.08; 9.85]) and length of the operation after the brain mapping (odds ratio per supplementary minute: 1.01 [1.01; 1.03]) were associated with major events. Conclusions Previous medical history of asthma, remifentanil infusion and a long duration of neurosurgery after cortical mapping appear to be risk factors for major complications during AC.
Published: 2020
Full Text: View/download PDF

24. Clinical Course and Risk Factors for severe Disease and Death of Adult Critically Ill Inpatients with COVID-19 in Toulouse, France: A Retrospective Cohort Study

Author: Jean-Marie Conil, Fanny Vardon Bounes, Guillaume Ducos, Charline Zadro, Jacques Izopet, Damien Guinault, Stein Silva, Thomas Geeraerts, Jean Ruiz, Benjamine Sarton, David Rousset, Thierry Seguin, Samia Collot, Thomas Filleron, Stéphanie Ruiz, Olivier Fourcade, Marie Virtos, William Buffières, Vincent Minville, Béatrice Riu, Veronique Ramonda, Diane Osinski, Bernard Georges, and Benoit Bataille
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critically ill, business.industry, Emergency medicine, Clinical course, Severe disease, Medicine, Retrospective cohort study, business
Abstract: BackgroundTo explore risk factors for unfavorable outcome (death or requiring invasive mechanical ventilation at 28 days from ICU admission) of critically ill COVID-19 patients hospitalized in the Toulouse regionMethodsRetrospective cohort of critically ill COVID-19 patients sequentially admitted to 12 ICUs in Toulouse region (March 9, 2020, to April 8, 2020). All patients had laboratory confirmed SARS-CoV-2 infection and required invasive mechanical ventilation. Baseline characteristics, pathophysiological respiratory data, clinical outcomes, viral shredding, and chest CT scan were collected.ResultsA total of 150 patients were included (median age, 68 years (interquartile range, (IQR), 58-72; 81% male). The most common comorbidities were hypertension (77, 51%) and obesity (42, 28%). At ICU admission, the median PaO2/FiO2 ratio was 138 (IQR,112-178). During hospitalization, the rate of ventilator-acquired pneumonia (VAP) was 61% and 51 (34%) patients had acute kidney injury (AKI) with a Kidney Disease Improving Global Outcomes (KDIGO) score > 1. The 28-day mortality was 15.3%, and 50 (33%) patients had unfavorable outcome. We found that VAP (5.91; 2.10-10.03; p value = 0.002) and AKI with a KDIGO score > 1 (4.71; 1.69-14.41; p value = 0.004) were associated with increased odds of unfavorable outcome. Neither, chest CT scan data on admission, nor pathophysiological respiratory data during ICU stay were associated to patient’s outcome.ConclusionThe potential risk factors of AKI and VAP could help clinicians to identify patients with poor prognosis at an early stage. Targeted care of these factors might have a significant impact on COVID-19 patient’s outcome.
Published: 2020
Full Text: View/download PDF

25. Crosstalk between brain, lung and heart in critical care

Author: Jean-Michel Constantin, Julie Gobin, Ségolène Mrozek, Olivier Fourcade, Thomas Geeraerts, CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [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: medicine.medical_specialty, Heart Injury, ARDS, Critical Care, [SDV]Life Sciences [q-bio], Cardiomyopathy, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Epidemiology, medicine, Humans, 030212 general & internal medicine, Lung, Respiratory Distress Syndrome, business.industry, Cardiogenic shock, Brain, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Pathophysiology, respiratory tract diseases, 3. Good health, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Ventricle, Brain Injuries, Cardiology, business
Abstract: Extracerebral complications, especially pulmonary and cardiovascular, are frequent in brain-injured patients and are major outcome determinants. Two major pathways have been described: brain-lung and brain-heart interactions. Lung injuries after acute brain damages include ventilator-associated pneumonia (VAP), acute respiratory distress syndrome (ARDS) and neurogenic pulmonary œdema (NPE), whereas heart injuries can range from cardiac enzymes release, ECG abnormalities to left ventricle dysfunction or cardiogenic shock. The pathophysiologies of these brain-lung and brain-heart crosstalk are complex and sometimes interconnected. This review aims to describe the epidemiology and pathophysiology of lung and heart injuries in brain-injured patients with the different pathways implicated and the clinical implications for critical care physicians.
Published: 2020
Full Text: View/download PDF

26. Cerebral Venous Thrombosis and Subdural Collection in a Comatose Patient: Do Not Forget Intracranial Hypotension. A Case Report

Author: Stanislas Faguer, David Rousset, Diane Paris, Fabrice Bonneville, Nelly Fabre, Claire Larcher, Ségolène Mrozek, Charlotte Martin, Thomas Geeraerts, Diane Osinski, David Brauge, Françoise Huguet-Rigal, François Gaussiat, Olivier Fourcade, and Louis Delamarre
Subjects: Male, Intracranial Hypotension, 03 medical and health sciences, Orthostatic vital signs, 0302 clinical medicine, Neuroimaging, medicine, Humans, 030212 general & internal medicine, Coma, medicine.diagnostic_test, business.industry, Subdural hemorrhage, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Venous thrombosis, Hematoma, Subdural, Neurology, Anesthesia, Neurology (clinical), medicine.symptom, Headaches, Intracranial Thrombosis, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery
Abstract: Background The typical sign of intracranial hypotension (IH) is postural headache. However, IH can be associated with a large diversity of clinical or radiological signs leading to difficult diagnosis especially in case of coma. The association of cerebral venous thrombosis (CVT) and subdural hemorrhage is rare but should suggest the diagnosis of IH. Methods Case report. Case description We report here a case of comatose patient due to spontaneous IH complicated by CVT and subdural hemorrhage. The correct diagnosis was delayed due to many confounding factors. IH was suspected after subdural hemorrhage recurrence and confirmed by magnetic resonance imaging (MRI). After 2 epidural patches with colloid, favorable outcome was observed. Discussion The most common presentation of IH is postural orthostatic headaches. In the present case report, the major clinical signs were worsening of consciousness and coma, which are a rare presentation. Diagnosis of IH is based on the association of clinical history, evocative symptomatology, and cerebral imaging. CVT occurs in 1-2% of IH cases and the association between IH, CVT, and subdural hemorrhage is rare. MRI is probably the key imaging examination. In the present case, epidural patch was performed after confounding factors for coma had been treated. Benefit of anticoagulation had to be balanced in this case with potential hemorrhagic complications, especially within the brain. Conclusion Association of CVT and subdural hemorrhage should lead to suspect IH. Brain imaging can help and find specific signs of IH.
Published: 2020

27. A One-Day Prospective National Observational Study on Sedation-Analgesia of Patients with Brain Injury in French Intensive Care Units: The SEDA-BIP-ICU (Sedation-Analgesia in Brain Injury Patient in ICU) Study

Author: Emmanuel Vega, Simon Poignant, Romain Carillon, Thomas Geeraerts, B Vigué, Patrick Jeanjean, Sigismond Lasocki, Vincent Degos, Fabien Espitalier, Claire Dahyot-Fizelier, Vincent Cottenceau, Marc Laffon, Patricia Balram, Mathieu Biais, and Anarlf
Subjects: Sedation, Pain, Richmond Agitation-Sedation Scale, Critical Care and Intensive Care Medicine, law.invention, Sufentanil, law, Intensive care, Medicine, Humans, Hypnotics and Sedatives, Prospective Studies, business.industry, Pain scale, Intensive care unit, Respiration, Artificial, Intensive Care Units, Cross-Sectional Studies, Anesthesia, Brain Injuries, Midazolam, Neurology (clinical), medicine.symptom, Analgesia, business, Propofol, medicine.drug
Abstract: Sedation/analgesia is a daily challenge faced by intensivists managing patients with brain injury (BI) in intensive care units (ICUs). The optimization of sedation in patients with BI presents particular challenges. A choice must be made between the potential benefit of a rapid clinical evaluation and the potential exacerbation of intracranial hypertension in patients with impaired cerebral compliance. In the ICU, a pragmatic approach to the use of sedation/analgesia, including the optimal titration, management of multiple drugs, and use of any type of brain monitor, is needed. Our research question was as follows: the aim of the study is to identify what is the current daily practice regarding sedation/analgesia in the management of patients with BI in the ICU in France? This study was composed of two parts. The first part was a descriptive survey of sedation practices and characteristics in 30 French ICUs and 27 academic hospitals specializing in care for patients with BI. This first step validates ICU participation in data collection regarding sedation-analgesia practices. The second part was a 1-day prospective cross-sectional snapshot of all characteristics and prescriptions of patients with BI. On the study day, among the 246 patients with BI, 106 (43%) had a brain monitoring device and 74 patients (30%) were sedated. Thirty-nine of the sedated patients (53%) suffered from intracranial hypertension, 14 patients (19%) suffered from agitation and delirium, and 7 patients (9%) were sedated because of respiratory failure. Fourteen patients (19%) no longer had a formal indication for sedation. In 60% of the sedated patients, the sedatives were titrated by nurses based on sedation scales. The Richmond Agitation Sedation Scale was used in 80% of the patients, and the Behavioral Pain Scale was used in 92%. The common sedatives and opioids used were midazolam (58.1%), propofol (40.5%), and sufentanil (67.5%). The cerebral monitoring devices available in the participating ICUs were transcranial Doppler ultrasound (100%), intracranial and intraventricular pressure monitoring (93.3%), and brain tissue oxygenation (60%). Cerebral monitoring by one or more monitoring devices was performed in 62% of the sedated patients. This proportion increased to 74% in the subgroup of patients with intracranial hypertension, with multimodal cerebral monitoring in 43.6%. The doses of midazolam and sufentanil were lower in sedated patients managed based on a sedation/analgesia scale. Midazolam and sufentanil are frequently used, often in combination, in French ICUs instead of alternative drugs. In our study, cerebral monitoring was performed in more than 60% of the sedated patients, although that proportion is still insufficient. Future efforts should stress the use of multiple monitoring modes and adherence to the indications for sedation to improve care of patients with BI. Our study suggests that the use of sedation and analgesia scales by nurses involved in the management of patients with BI could decrease the dosages of midazolam and sufentanil administered. Updated guidelines are needed for the management of sedation/analgesia in patients with BI.
Published: 2020

28. Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy

Author: Yvonnick Blanloeil, Mohamed Srairi, Anaïs Guéguen, Catherine Paugam-Burtz, Fanny Feuillet, Vincent Atthar, Karim Asehnoune, Aurélie Le Thuaut, Nicolas Bruder, Julien Pottecher, Thomas Geeraerts, Doris Vigouroux, Thibault Triglia, Julien Josserand, Bertrand Rozec, Hélène Beloeil, Michel Galliez, Raphaël Cinotti, Karim Lakhal, and Simon Viquesnel
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Glasgow Coma Scale, MEDLINE, Intensive care unit, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, law, Predictive value of tests, Emergency medicine, Medicine, Observational study, business, Prospective cohort study, 030217 neurology & neurosurgery, Craniotomy, Cohort study
Abstract: Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting. Methods Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in–intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression. Results Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In–intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively. Conclusions The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score’s performance before routine use.
Published: 2018
Full Text: View/download PDF

29. Quality And Feasibility of Sonographic Measurement of the Optic Nerve Sheath Diameter to Estimate the Risk of Raised Intracranial Pressure After Traumatic Brain Injury in Prehospital Setting

Author: Johanna Guemon, Thibault Le Gourrierec, Vincent Bounes, Thomas Geeraerts, and Charles-Henri Houze-Cerfon
Subjects: Adult, Male, Emergency Medical Services, Optic nerve sheath, Traumatic brain injury, Early detection, 030204 cardiovascular system & hematology, Emergency Nursing, Raised intracranial pressure, 03 medical and health sciences, 0302 clinical medicine, Brain Injuries, Traumatic, Humans, Medicine, In patient, Prospective Studies, Elevated Intracranial Pressure, Aged, Ultrasonography, Aged, 80 and over, integumentary system, business.industry, Optic Nerve, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, nervous system diseases, Anesthesia, Emergency Medicine, Feasibility Studies, Female, Intracranial Hypertension, business
Abstract: Objective: In patients with traumatic brain injury (TBI), early detection and subsequent prompt treatment of elevated intracranial pressure (ICP) is a challenge in the prehospital setting, because physical examination is limited in comatose patients and invasive device placement is not possible. The aim of this study was to evaluate the quality and feasibility of optic nerve sheath diameter (ONSD) measurements obtained during the prehospital management of patients with TBI. Methods: This study was a prospective, observational study of 23 patients with moderate and severe TBI during prehospital medical care. The primary endpoint was the quality of ONSD measurements expressed as the percentage of ONSD validated by the experts. Secondary endpoints included the feasibility of ONSD measurements as the percentage of ONSD performed and assessment by operators of ease and duration to perform. Results: Ultrasound ONSD was performed in 19 (82%) patients and 80% of ONSD measurements were validated by the experts. The ONSD measurements were possible in 15 (79%) cases. The physicians have assessed the ease of use at 8 (interquartile range [IQR] = 2.5–8) on 10 for and the median time to obtain ONSD measurement was 4 min (IQR = 3–5). ONSD measurement was performed in 12 (63%) cases during the transport and in 7 (37%) cases on scene, with 58% (n = 7) and 71% (n = 5) validated ONSD, respectively. The success rate in the helicopter was 43% compared to 80% in the ambulance. Conclusion: This study shows that it is feasible to obtain high-quality ONSD measurements in the management of patients with TBI in a prehospital setting. A randomized study evaluating the usefulness of ONSD to guide management of TBI in the prehospital phase may be of great interest.
Published: 2018
Full Text: View/download PDF

30. Oxford-AstraZeneca COVID-19 vaccine-induced cerebral venous thrombosis and thrombocytopaenia: A missed opportunity for a rapid return of experience

Author: Thomas Geeraerts, François Montastruc, Fabrice Bonneville, Vincent Mémier, Nicolas Raposo, Jean Darcourt, Maxime Pommier, Fanny Vardon-Bounes, Muriel Alvarez, Jacques Izopet, Sophie Voisin, Pierre Sié, Franck Roux, Jean Marc Olivot, and Jean-François Albucher
Subjects: Venous Thrombosis, medicine.medical_specialty, 2019-20 coronavirus outbreak, COVID-19 Vaccines, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, COVID-19, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Thrombocytopenia, Venous thrombosis, Anesthesiology and Pain Medicine, medicine, Humans, Intensive care medicine, Missed opportunity, business, Letter to the Editor
Published: 2021
Full Text: View/download PDF

31. Principes de prise en charge de l’ischémie cérébrale : ce que l’anesthésiste-réanimateur doit savoir

Author: Thomas Geeraerts and Mohamed Srairi
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Anesthesiology and Pain Medicine, business.industry, Emergency Medicine, Medicine, 030212 general & internal medicine, Emergency Nursing, business, 030217 neurology & neurosurgery
Abstract: Resume L’implication des anesthesiste-reanimateurs dans la prise en charge des infarctus cerebraux a la phase aigue augmente en raison de la mise en œuvre de nouveaux moyens therapeutiques (thrombectomie, craniectomie decompressive) et des conditions d’admission en reanimation de plus en plus large. La repermeabilisation arterielle peut etre obtenue par fibrinolyse et/ou traitement endovasculaire. Le traitement endovasculaire pratique en radiologie interventionnelle chez des patients selectionnes, ameliore le pronostic fonctionnel sous couvert d’une prise en charge anesthesique specifique. En cas d’ischemie cerebrale sylvienne etendue, la craniectomie decompressive diminue la mortalite au prix du risque d’un handicap neurologique plus lourd chez les survivants. Un sejour en reanimation peut etre justifie du fait de defaillances d’organes, et/ou pour prevenir et controler les agressions cerebrales et les complications. En cas d’echec, la decision collegiale de limitation des soins doit prendre en compte les difficultes pour evaluer a la phase aigue, le pronostic et la qualite de vie ulterieure.
Published: 2017
Full Text: View/download PDF

32. Traumatisme crânien grave à la phase aiguë

Author: Mohamed Srairi, Ségolène Mrozek, and Thomas Geeraerts
Subjects: medicine.medical_specialty, Traumatic brain injury, business.industry, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, medicine.disease, Transcranial Doppler, 03 medical and health sciences, Anesthesiology and Pain Medicine, 0302 clinical medicine, Osmotherapy, Anesthesia, Emergency Medicine, medicine, Neurosurgery, business, 030217 neurology & neurosurgery
Abstract: Points essentiels La prevention et le controle des agressions cerebrales secondaires sont des elements essentiels dans la prise en charge du traumatise crânien grave des la phase pre-hospitaliere permettant par des moyens assez simples une amelioration du pronostic neurologique et de la mortalite. Des objectifs de pression arterielle systolique > 110 mmHg et de SpO 2 > 90 % doivent etre respectes des la phase pre-hospitaliere et durant le sejour en reanimation. Un monitorage de la capnographie est egalement essentiel des que possible (EtCO 2 :30–35 mmHg avec un objectif de normocapnie, PaCO 2 : 35–40 mmHg). En cas de tomodensitometrie strictement normale, en l’absence de signe de gravite clinique et au Doppler transcrânien, le reveil precoce est possible sans recours systematique a un monitorage invasif de la pression intracrânienne. Le Doppler transcrânien permet de detecter precocement (avant de disposer d’un monitorage invasif) les patients a haut risque d’ischemie cerebrale. Les objectifs de pression de perfusion doivent etre adaptes individuellement afin de correspondre a la meilleure autoregulation cerebrale, en s’aidant du monitorage multimodal. Une approche multimodale individualisee du patient TC grave pourrait permettre d’optimiser sa prise en charge, notamment par une evaluation de l’oxygenation cerebrale en complement des donnees de PIC et PPC afin de prevenir et/ou detecter les lesions cerebrales ischemiques secondaires. La mise en place d’une derivation ventriculaire externe doit etre envisagee lors d’une hypertension intracrânienne apres echec d’un traitement comportant optimisation des agressions secondaires et de la sedation. Une craniectomie decompressive large peut etre envisagee lors d’une hypertension intracrânienne refractaire dans le cadre d’une approche multidisciplinaire. Le coma barbiturique et l’hypothermie therapeutique moderee sont des alternatives possibles lors d’HTIC refractaire en connaissance de leurs effets indesirables et sous monitorage accru bien que leurs benefices sur le devenir neurologique et la mortalite ne soient pas demontres.
Published: 2017
Full Text: View/download PDF

33. Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus: A post hoc study of a randomized controlled trial

Author: Bruno Mégarbane, Christophe Guitton, Jonathan Chelly, Matthieu Resche-Rigon, Hervé Mentec, Cendrine Chaffaut, Candice Fontaine, Jean-Yves Lefrant, Aicha Hamdi, Ferhat Meziani, Virginie Lemiale, Stéphane Legriel, Maleka Schenck, Alain Cariou, Thomas Geeraerts, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hopital Saint-Louis [AP-HP] (AP-HP), Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer [Boulogne] (INCA)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Centre Hospitalier de Melun, Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre Hospitalier Le Mans (CH Le Mans), Hôpital de Hautepierre [Strasbourg], Hôpital Lariboisière-Fernand-Widal [APHP], Centre Hospitalier Victor Dupouy, AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC)
Subjects: Male, Fever, Population, Glasgow Outcome Scale, law.invention, Hypercapnia, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Status Epilepticus, Randomized controlled trial, law, Hypothermia, Induced, Intensive care, Clinical endpoint, Medicine, Humans, 030212 general & internal medicine, education, Hypoxia, Aged, Randomized Controlled Trials as Topic, education.field_of_study, business.industry, Brain, Odds ratio, Middle Aged, medicine.disease, Respiration, Artificial, 3. Good health, Blood pressure, Anesthesia, Female, Neurology (clinical), Hypotension, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: ObjectiveTo evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus.MethodsThis was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C–34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus.ResultsThe 172 men and 93 women had a median age of 57 years (45–68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35–120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20–3.85; p = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04–3.85; p = 0.04), primary brain insult (OR 2.00, 95% CI 1.02–4.00; p = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05–5.59; p = 0.04).ConclusionsIn our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus.ClinicalTrials.gov identifierNCT01359332.
Published: 2020
Full Text: View/download PDF

34. Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol

Author: Laurent Gergelé, Kristina Skaare, Marion Richard, Emmanuel Barbier, Bernard Vigué, Gilles Francony, Jean-François Payen, Pierre Bouzat, Nicolas Bruder, Claire Dahyot-Fizelier, Gérard Audibert, Jean Luc Bosson, Thomas Geeraerts, Louis Puybasset, [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Aix Marseille Université (AMU), Assistance Publique - Hôpitaux de Marseille (APHM), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, CHU Toulouse [Toulouse], Hôpital privé de la Loire, 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), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier Universitaire [Grenoble] (CHU), Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP ), Université Grenoble Alpes (UGA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP ), Université Grenoble Alpes (UGA), ANR-19-P3IA-0003,MIAI,MIAI @ Grenoble Alpes(2019), Université de Toulouse (UT), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: medicine.medical_specialty, Intracranial Pressure, Traumatic brain injury, Neurosurgery, Glasgow Outcome Scale, 03 medical and health sciences, 0302 clinical medicine, Superiority Trial, Brain Injuries, Traumatic, medicine, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, adult intensive & critical care, Monitoring, Physiologic, Randomized Controlled Trials as Topic, Intracranial pressure, business.industry, Mortality rate, Intensive Care, Brain, General Medicine, Institutional review board, medicine.disease, 3. Good health, Emergency medicine, trauma management, Medicine, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Intracranial Hypertension, business, Early phase, 030217 neurology & neurosurgery
Abstract: IntroductionIntracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI.Methods and analysisMulticentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2group is managed to maintain PbtO2≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze.Ethics and disseminationThis study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrialsNCT02754063on 28 April 2016 (pre-results).
Published: 2020
Full Text: View/download PDF

35. Outcomes in 886 Critically Ill Patients After Near-Hanging Injury

Author: Candice Belony, Guillaume Schnell, Caroline Durant, Gwenaëlle Jacq, Pascal Beuret, Emmanuelle Noel, Olivier Lesieur, Sébastien Perbet, Lucie Biard, Christophe Guitton, Nicolas Deye, Thomas Geeraerts, Pauline Moriss, Pierrick Cronier, Nicolas Girard, Charles Cerf, Cédric Daubin, Charlene Leparq, Guillaume Thiery, Elie Azoulay, Alexis Soummer, Pierre Kalfon, Jean Pierre Quenot, Michael Darmon, Quentin de Roux, Gwenhael Colin, Julien Mayaux, Adriaan Prisacariu, Cécile Carre, Abdelkader Ouchenir, Michael Piagnerelli, Laurent Argaud, François Vincent, Maleka Schenck, Vincent Das, Alain Cariou, Marc Danguy Des Déserts, Matthieu Resche-Rigon, Jonathan Chelly, Auguste Dargent, Sébastien Cavelot, Charlotte Martin, Stein Silva, Thibaut Baudic, Thomas Rossignol, Philippe Vignon, Marie Salvetti, Alexandre Demoule, Marc A. Simon, Bruno Mégarbane, Hamid Merdji, Bertrand Sauneuf, Frédéric Jacobs, Louise de Charentenay, Martin Cour, Delphine Bachelet, Bernard Cholley, Marine Paul, Ferhat Meziani, Nicolas Mongardon, Segolene Couraud, Stéphane Legriel, Nicolas Pichon, Jean-Baptiste Lascarrou, Centre Hospitalier de Versailles André Mignot (CHV), Groupe Hospitalier du Havre, Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, AfterROSC Network Group [Paris], Les Hôpitaux Universitaires de Strasbourg (HUS), Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Génétique, Reproduction et Développement (GReD), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Hôpital Hôtel-Dieu de Nantes - Centre Hospitalier Universitaire de Nantes (Hôpital Hôtel-Dieu de Nantes - CHU de Nantes), Centre Hospitalier Le Mans (CH Le Mans), Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CH La Rochelle, Hospices Civils de Lyon (HCL), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Nanomédecine Régénérative (NanoRegMed), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation, hôpital Purpan, CHU Toulouse [Toulouse], Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital d'Instruction des Armées Clermont Tonnerre, Service de Santé des Armées, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CHU bobigny, Centre Hospitalier Intercommunal André Grégoire [Montreuil] (CHI André Gregoire), Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Foch [Suresnes], Hôpital de la Pitié-Salpêtrière, Centre Hospitalier de Roanne, Hôpital Louis Pasteur [Chartres], Centre Hospitalier Public du Cotentin (CHPC), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Henri Mondor, Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], 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, 12/17, FUNDING/SUPPORT: This study was supported by the Délégation à la Recherche Clinique et à l’Innovation de Versailles, the non-profit publicly funded research agency for the Versailles Hospital, Versailles, France [Grant 12/17]., CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), 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), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CH Centre Hospitalier Public du Cotentin (CHPC), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), CCSD, Accord Elsevier, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), and CHU Henri Mondor [Créteil]
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Multivariate analysis, near-hanging, medicine.medical_treatment, Critical Illness, [SDV]Life Sciences [q-bio], Suicide, Attempted, coma, Critical Care and Intensive Care Medicine, cardiopulmonary resuscitation, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Belgium, Interquartile range, Medicine, Humans, Glasgow Coma Scale, 030212 general & internal medicine, Cardiopulmonary resuscitation, Hospital Mortality, Retrospective Studies, Coma, business.industry, Glasgow Outcome Scale, Retrospective cohort study, Prognosis, Survival Analysis, Patient Discharge, 3. Good health, Heart Arrest, [SDV] Life Sciences [q-bio], Functional Status, 030228 respiratory system, SAPS II, Emergency medicine, ICU, outcome, CPR, Female, France, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Background: Near-hanging experiences are life-threatening events about which few data are available. Research Question: What are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience? Study Design and Methods: Adult patients who were resuscitated successfully after suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively. Patients were identified by searching the hospital databases for International Statistical Classification of Diseases and Related Health Problems, 9th and 10th revisions, codes and hospital charts for hanging. Logistic multivariate regression was performed to identify factors associated vital and functional outcomes at hospital discharge as the primary end points. Secondary outcomes were evaluation of temporal trends and identification of predictors of hospital mortality. Results: Of the 886 patients (181 women and 705 men; median age, 43 years; interquartile range, 34-52 years), 266 (30.0%) had attempted suicide previously, 600 (67.7%) had a diagnosed mental illness, and 55 (6.2%) attempted hanging while hospitalized. Median time from hanging awareness to unhanging was 0 min (interquartile range [IQR], 0-0; range, 0-82 min). Median Glasgow Coma Scale score was 3 (IQR, 3-5) at ICU admission. Hanging induced cardiac arrest in 450 of 886 patients (50.8%). Overall, 497 of 886 patients (56.1%) were alive at hospital discharge, including 479 of 497 patients (96.4%) with a favorable neurocognitive outcome (defined as a Glasgow Outcome Scale score of 4 or 5). By multivariate analysis, factors associated with hospital mortality were hanging-induced cardiac arrest (OR, 19.50; 95% CI, 7.21-60.90; P < .00001) and findings at ICU admission of glycemia level > 1.4 g/L (OR, 4.34; 95% CI, 1.82-10.81; P = .0007) and of lactate level > 3.5 mmol/L (OR, 9.98; 95% CI, 4.17-25.36; P < .00001). Interpretation: The findings from this large multicenter retrospective cohort emphasize the very high mortality after hanging injury chiefly because of hanging-induced cardiac arrest. However, patients who survive near-hanging experiences achieve excellent neurocognitive recovery. Studies of early neuroprotective strategies for patients who have undergone near-hanging experiences are warranted. Trial Registry: ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov
Published: 2020
Full Text: View/download PDF

36. A study of patients' quality of life more than 5 years after trauma: a prospective follow-up

Author: Jean-Marie Conil, Laure Crognier, Romain Gracia, Thomas Geeraerts, Bernard Georges, François Labaste, Vincent Minville, Timothée Abaziou, Fanny Vardon-Bounes, and Thierry Seguin
Subjects: Moderate to severe, Adult, Male, Quality of life, medicine.medical_specialty, Adolescent, medicine.medical_treatment, NHP, 030204 cardiovascular system & hematology, lcsh:Computer applications to medicine. Medical informatics, Trauma, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Injury Severity Score, Physical functioning, medicine, Humans, Disabled Persons, 030212 general & internal medicine, Prospective Studies, Aged, Aged, 80 and over, MOS-SF36, Rehabilitation, Disability, business.industry, Major trauma, Research, Public Health, Environmental and Occupational Health, Retraining, General Medicine, Middle Aged, medicine.disease, Physical therapy, lcsh:R858-859.7, Wounds and Injuries, Female, France, business, Early rehabilitation, Follow-Up Studies
Abstract: Background The long-term fate of severely injured patients in terms of their quality of life is not well known. Our aim was to assess the quality of life of patients who have suffered moderate to severe trauma and to identify primary factors of long-term quality of life impairment. Methods A prospective monocentric study conducted on a number of patients who were victims of moderate to severe injuries during the year 2012. Patients were selected based on an Injury Severity Score (ISS) more than or equal to 9. Quality of life was assessed by the MOS SF-36 and NHP scores as a primary evaluation criterion. The secondary evaluation criteria were the determination of the socio-economic impact on quality of life and the identification of factors associated with disability. Results Two hundred and eight patients were contacted by e-mail or telephone. Fifty-five patients participated in this study (with a participation level of 26.4%), including 78.2% men, with a median age of 46. Significant alterations in quality of life were observed with the NHP and MOS SF-36 scale, including physical and psychological components. This resulted in a major socio-economic impact as 26% of the patients could not resume their professional activities (n = 10), 20% required retraining in other lines of work, and 36.4% had a disability status. The study showed that scores ≤ 85 on the physical functioning variable of the MOS SF 36 scale was associated with disability. Conclusion More than five years after a moderate to severe injury, patients’ quality of life was significantly impacted, resulting in significant socio-economic consequences. Disability secondary to major trauma seems to be associated with a score ≤ 85 on the physical functioning dimension of the MOS SF-36 scale. This study raises the question of whether or not early rehabilitation programs should be implemented in order to limit the long-term impact of major trauma.
Published: 2019

37. Consider brain perfusion imaging rather than just the delay from symptoms onset to indicate reperfusion strategies after stroke: Implications for perioperative care

Author: Thomas Geeraerts, Ségolène Mrozek, Jean-Marc Olivot, and Clément Monet
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Perfusion Imaging, Perfusion scanning, General Medicine, Thrombolysis, Critical Care and Intensive Care Medicine, medicine.disease, Perioperative Care, Time-to-Treatment, Stroke, Anesthesiology and Pain Medicine, Internal medicine, Perioperative care, Reperfusion, medicine, Cardiology, Humans, Symptom Assessment, business
Published: 2019

38. Pharmacotherapy of sodium disorders in neurocritical care

Author: David Rousset, Thomas Geeraerts, and Ségolène Mrozek
Subjects: medicine.medical_specialty, Hypernatremia, Critical Care, business.industry, Sodium, Water-Electrolyte Imbalance, Neurointensive care, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Increased risk, Pharmacotherapy, 030228 respiratory system, Hypotonic Solutions, medicine, Sodium Disorders, Humans, Nervous System Diseases, Intensive care medicine, business, Hyponatremia
Abstract: To describe the pathophysiology and pharmacotherapy of dysnatremia in neurocritical care patients.Sodium disorders may affect approximately half of the neurocritical care patients and are associated with worse neurological outcome and increased risk of death. Pharmacotherapy of sodium disorders in neurocritical care patients may be challenging and is guided by a careful investigation of water and sodium balance.In case of hyponatremia, because of excessive loss of sodium, fluid challenge with isotonic solution, associated with salt intake is the first-line therapy, completed with mineralocorticoids if needed. In case of hyponatremia because of SIADH, fluid restriction is the first-line therapy followed by urea if necessary. Hypernatremia should always be treated with hypotonic solutions according to the free water deficit, associated in case of DI with desmopressin. The correction speed should take into consideration the symptoms associated with dysnatremia and the rapidity of the onset.
Published: 2019

39. Reversible Cerebral Vasoconstriction Syndrome with Intracranial Hypertension: Should Decompressive Craniectomy Be Considered?

Author: Aude Jaffre, Olivier Fourcade, Jean-François Albucher, Thomas Geeraerts, Nicolas Raposo, Sergio Boetto, Ségolène Mrozek, Anne-Christine Januel, and Laurent Lonjaret
Subjects: Intracerebral hemorrhage, musculoskeletal diseases, business.industry, medicine.medical_treatment, Case Report, Decompressive craniectomy, medicine.disease, Reversible cerebral vasoconstriction syndrome, lcsh:RC346-429, Intracranial hypertension, 03 medical and health sciences, 0302 clinical medicine, Anesthesia, Medicine, 030212 general & internal medicine, Neurology (clinical), business, 030217 neurology & neurosurgery, lcsh:Neurology. Diseases of the nervous system
Abstract: Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension. Methods: Case report. Results: We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good. Conclusion: RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
Published: 2017

40. Accidental hypothermia in severe trauma

Author: Ségolène Mrozek, Thomas Geeraerts, Fanny Vardon, and Olivier Fourcade
Subjects: Accidental hypothermia, Hypothermia, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Coagulopathy, Humans, Medicine, Dosing, Acidosis, business.industry, 030208 emergency & critical care medicine, General Medicine, Blood Coagulation Disorders, Prognosis, medicine.disease, Polytrauma, Pneumonia, Anesthesiology and Pain Medicine, Severe trauma, Anesthesia, Wounds and Injuries, medicine.symptom, business
Abstract: Hypothermia, along with acidosis and coagulopathy, is part of the lethal triad that worsen the prognosis of severe trauma patients. While accidental hypothermia is easy to identify by a simple measurement, it is no less pernicious if it is not detected or treated in the initial phase of patient care. It is a multifactorial process and is a factor of mortality in severe trauma cases. The consequences of hypothermia are many: it modifies myocardial contractions and may induce arrhythmias; it contributes to trauma-induced coagulopathy; from an immunological point of view, it diminishes inflammatory response and increases the chance of pneumonia in the patient; it inhibits the elimination of anaesthetic drugs and can complicate the calculation of dosing requirements; and it leads to an over-estimation of coagulation factor activities. This review will detail the pathophysiological consequences of hypothermia, as well as the most recent principle recommendations in dealing with it.
Published: 2016
Full Text: View/download PDF

41. Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review

Author: Chiara Robba, Alberto Goffi, Giuseppe Citerio, Aarti Sarwal, Llewellyn Padayachy, Frank Rasulo, Thomas Geeraerts, Gabriele Via, Soojin Park, Danilo Cardim, Marek Czosnyka, Robba, C, Goffi, A, Geeraerts, T, Cardim, D, Via, G, Czosnyka, M, Park, S, Sarwal, A, Padayachy, L, Rasulo, F, Citerio, G, University of Zurich, and Robba, Chiara
Subjects: medicine.medical_specialty, Brain Death, Neurosonology, Critical Care, Intracranial Pressure, Ultrasonography, Doppler, Transcranial, Traumatic brain injury, Point-of-Care Systems, 610 Medicine & health, Brain ultrasonography, Optic nerve sheath diameter, Transcranial Doppler, Blood Flow Velocity, Brain, Brain Diseases, Cerebrovascular Circulation, Emergency Service, Hospital, Humans, Intensive Care Units, Ultrasonography, Transcranial, Critical Care and Intensive Care Medicine, 11171 Cardiocentro Ticino, law.invention, 03 medical and health sciences, Cerebral circulation, Hospital, 0302 clinical medicine, law, Anesthesiology, medicine, Intensive care medicine, Emergency Service, business.industry, Doppler, Neurointensive care, 030208 emergency & critical care medicine, Emergency department, medicine.disease, Intensive care unit, Hydrocephalus, 030228 respiratory system, 2706 Critical Care and Intensive Care Medicine, business
Abstract: Brain ultrasonography can be used to evaluate cerebral anatomy and pathology, as well as cerebral circulation through analysis of blood flow velocities. Transcranial colour-coded duplex sonography is a generally safe, repeatable, non-invasive, bedside technique that has a strong potential in neurocritical care patients in many clinical scenarios, including traumatic brain injury, aneurysmal subarachnoid haemorrhage, hydrocephalus, and the diagnosis of cerebral circulatory arrest. Furthermore, the clinical applications of this technique may extend to different settings, including the general intensive care unit and the emergency department. Its increasing use reflects a growing interest in non-invasive cerebral and systemic assessment. The aim of this manuscript is to provide an overview of the basic and advanced principles underlying brain ultrasonography, and to review the different techniques and different clinical applications of this approach in the monitoring and treatment of critically ill patients.
Published: 2019

42. Diagnostic performance of abdominal point of care ultrasound performed by an emergency physician in acute right iliac fossa pain

Author: Jean-Eudes Bourcier, Jean-Marie Bourgeois, Dominique Deshaie, Jean-Philippe Redonnet, Thomas Geeraerts, Emeric Gallard, Didier Garnier, and Magali Majourau
Subjects: lcsh:Medical physics. Medical radiology. Nuclear medicine, Abdominal pain, medicine.medical_specialty, lcsh:R895-920, Iliac fossa, Diagnostic methods, Surgical pathology, 03 medical and health sciences, 0302 clinical medicine, Bedside ultrasound, medicine, 030212 general & internal medicine, Medical diagnosis, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Ultrasound, 030208 emergency & critical care medicine, Interventional radiology, Emergency department, Appendicitis, medicine.disease, medicine.anatomical_structure, Original Article, Radiology, medicine.symptom, business
Abstract: Background Right iliac fossa abdominal pain is a common reason for emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by emergency physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an emergency physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. Methods This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) emergency physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two emergency physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. Results From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p
Published: 2018
Full Text: View/download PDF

43. Transient diabetes insipidus after severe subarachnoid hemorrhage: not always central

Author: Mohamed Srairi, Thomas Geeraerts, Timothée Abaziou, Rémi Menut, Ségolène Mrozek, Olivier Fourcade, Fouad Marhar, Jean Christophe Sol, Vincent Atthar, Claire Larcher, François Gaussiat, Diane Osinski, and David Brauge
Subjects: Subarachnoid hemorrhage, business.industry, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Parathyroid Hormone, Anesthesia, Diabetes insipidus, Hypercalcemia, medicine, Humans, Female, Surgery, Transient (computer programming), Neurology (clinical), Vitamin D, business, Diabetes Insipidus
Published: 2018
Full Text: View/download PDF

44. Strategic proposal for a national trauma system in France

Author: Delphine Garrigue, Guillaume de Saint Maurice, Jérôme Tonetti, Marc Leone, Benjamin Bijok, Jean François Payen, Groupe d’intérêt en traumatologie grave, Thomas Geeraerts, Romain Pirracchio, Isabelle Plenier, Sandrine Barbois, Julio Abba, Catherine Paugam-Burtz, Jonathan Charbit, Sébastien Perbet, Catherine Arvieux, Julien Picard, Abdel Nadji, Bruno Riou, Paul Balandraud, Sébastien Mirek, Sylvain Rigal, Pierre-Francois Wey, Frédéric Thony, Dominique Savary, Hicham Kobeiter, Thierry Secheresse, Jacques Duranteau, Xavier Bobbia, François-Xavier Ageron, Pierre Bouzat, Jean-Stéphane David, Karim Tazarourte, Pierre Albaladejo, Julien Ghelfi, Anatole Harrois, Albrice Levrat, Sophie Hamada, Julien Pottecher, Christophe Tresallet, Fabrice Cook, Julien Frandon, Tobias Gauss, Clinic of Abdominal, Thoracic and Vascular Surgery, Laveran Military Hospital, Marseille, France, parent, Biotop, Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), CHU Grenoble, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes (UGA), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Soins Intensifs [Mondor], Hôpital Henri Mondor, Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Microcirculation, bioénergétique, inflammation et insuffisance circulatoire aiguë (URCT), Université Paris-Sud - Paris 11 (UP11)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC), Fédération des Urgences - SAMU 59, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Unité Générale de Soins Intensifs, Hôpital d'Estaing, Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Laboratoire de Recherche sur les Apprentissages en Contexte (LaRAC), Centre d’enseignement par simulation (CEnSIM), Urgences Médicales, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Service de chirurgie générale d'endocrinologie [CHU Pitié–Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Institut franco-allemand de recherches de Saint-Louis (ISL), DGA-Matériaux et nanosciences d'Alsace, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpitaux Universitaires Paris Nord Val de Seine, Académie de Médecine Militaire Française [Ecole du Val-de-Grâce, Paris], Ecole du Val-de-Grâce [Paris, France], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire [Grenoble] (CHU), CHU Lille, Hôpital Lapeyronie [Montpellier] (CHU), Université de Montpellier (UM), CHU Henri Mondor, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Université Paris-Saclay, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpitaux Universitaires Paris Sud, Toulouse Neuro Imaging Center (ToNIC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Nord [CHU - APHM], Université Paris Diderot - Paris 7 (UPD7), CHU Clermont-Ferrand, 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 Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), CHU Strasbourg, Hôpital de Hautepierre [Strasbourg], Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU 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), 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)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Service de Chirurgie Générale, Viscérale et Endocrinienne [CHU Pitié-Sapêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire International de Neuroimagerie et Modélisation (Linem), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université de Montréal (UdeM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital d'Instruction des Armées Desgenettes, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], 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), 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-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Paris 13 (UP13)-Université Paris-Sud - Paris 11 (UP11)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), 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 Pierre et Marie Curie - Paris 6 (UPMC)-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], Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Université de Strasbourg (UNISTRA), and Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: National Health Programs, education, Strategy, Certification, Guidelines, Critical Care and Intensive Care Medicine, Trauma, [SHS]Humanities and Social Sciences, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, 030202 anesthesiology, Trauma Trauma system Guidelines Strategy Organisation, Medicine, Humans, Road map, Registries, Implementation, Data collection, Education, Medical, business.industry, Major trauma, Rehabilitation, 030208 emergency & critical care medicine, Trauma system, General Medicine, medicine.disease, Triage, Anesthesiology and Pain Medicine, Organisation, Scale (social sciences), Wounds and Injuries, Medical emergency, France, business, Trauma surgery, Delivery of Health Care
Abstract: International audience; In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years.
Published: 2018
Full Text: View/download PDF

45. Management of severe traumatic brain injury (first 24 hours)

Author: Jean-François Payen, Romain Carrillon, Gilles Orliaguet, Pierre-Etienne Leblanc, François Proust, Sébastien Mirek, Frédéric Dailler, Nicolas Bruder, Hervé Quintard, Gérard Audibert, Lamine Abdennour, Etienne Javouhey, François Cotton, L. Velly, Karim Tazarourte, Philippe Meyer, Vincent Cottenceau, Thomas Geeraerts, Bernard Vigué, Thomas Lieutaud, Nicolas Engrand, Catherine Ract, Gilles Francony, Claire Dahyot-Fizelier, Carole Ichai, Sonia Courtil-Teyssedre, Laurent Gergelé, Mohamed Srairi, Jean-Stéphane David, Dominique Fletcher, Pierre Bouzat, Karim Asehnoune, Toulouse Neuro Imaging Center (ToNIC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], 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 d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), 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), [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Service de Réanimation Médicale [CHU Bordeaux], CHU Bordeaux [Bordeaux]-Hôpital Pellegrin, RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), 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)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation pédiatrique, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'Anesthésie Réanimation Chirurgicale [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hôpital Raymond Poincaré [AP-HP], Pôle anesthésie-réanimation (Grenoble), CHU Grenoble-Hôpital Michallon, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Institut de pharmacologie moléculaire et cellulaire (IPMC), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Service d'Anesthésie et de Soins Intensifs [Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Translational and Integrative Group in Epilepsy Research (TIGER), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Service de Génétique, Hospices Civils de Lyon (HCL)-Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Groupe Hospitalier Est-Hospices Civils de Lyon (HCL)-Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Groupe Hospitalier Est, Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR T9405), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Service d'Anesthésie Réanimation [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation thérapeutique et pharmacologie périnatale et pédiatrique (EA_7323), Université Paris Descartes - Paris 5 (UPD5), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital de Hautepierre [Strasbourg], Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Velly, Lionel, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), TIGER, Centre de recherche en neurosciences de Lyon (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Necker - Enfants Malades [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Adult, Emergency Medical Services, medicine.medical_specialty, Critical Care, Traumatic brain injury, Sedation, Psychological intervention, MEDLINE, Guidelines as Topic, Critical Care and Intensive Care Medicine, Neurosurgical Procedures, 03 medical and health sciences, 0302 clinical medicine, Brain Injuries, Traumatic, medicine, Emergency medical services, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Cerebral perfusion pressure, Child, Modalities, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, 030208 emergency & critical care medicine, General Medicine, Guideline, medicine.disease, 3. Good health, Anesthesiology and Pain Medicine, Emergency medicine, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], France, medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; The latest French Guidelines for the management in the first 24 hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société francaise d’anesthésie et de réanimation [SFAR]) in partnership with the Association de neuro-anesthésie-réanimation de langue française (ANARLF), The French Society of Emergency Medicine (Société française de médecine d'urgence (SFMU), the Société française de neurochirurgie (SFN), the Groupe francophone de réanimation et d’urgences pédiatriques (GFRUP) and the Association des anesthésistes-réanimateurs pédiatriques d’expression française (ADARPEF). The method used to elaborate these guidelines was the Grade® method. After two Delphi rounds, 32 recommendations were formally developed by the experts focusing on the evaluation the initial severity of traumatic brain injury, the modalities of prehospital management, imaging strategies, indications for neurosurgical interventions, sedation and analgesia, indications and modalities of cerebral monitoring, medical management of raised intracranial pressure, management of multiple trauma with severe traumatic brain injury, detection and prevention of post-traumatic epilepsia, biological homeostasis (osmolarity, glycaemia, adrenal axis) and paediatric specificities.
Published: 2018
Full Text: View/download PDF

46. Management of critical events in the operating room: Usefulness of implementing a cognitive aid on the knowledge and satisfaction in French health-care providers

Author: Thomas Geeraerts, Caroline Halimi, Fabrice Ferré, Matt M. Kurrek, and Vincent Minville
Subjects: Health Knowledge, Attitudes, Practice, Operating Rooms, business.industry, Cognition, Personnel, Hospital, Anesthesiology and Pain Medicine, Nursing, Anesthesia, Health care, Humans, Medicine, France, Prospective Studies, business
Published: 2019
Full Text: View/download PDF

47. Epidemiology of trauma: From medico-administrative database to large prospective registry

Author: Pierre Bouzat, Thomas Geeraerts, and Tobias Gauss
Subjects: medicine.medical_specialty, Databases, Factual, business.industry, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Anesthesiology and Pain Medicine, Severe trauma, Risk Factors, Administrative database, Epidemiology, Medicine, France, Registries, Medical emergency, business
Published: 2019
Full Text: View/download PDF

48. Severe pelvic trauma: A complex and challenging situation

Author: Véronique Ramonda, Fanny Vardon Bounes, and Thomas Geeraerts
Subjects: Pelvic trauma, medicine.medical_specialty, Anesthesiology and Pain Medicine, Severe trauma, medicine.diagnostic_test, business.industry, Angiography, medicine, General Medicine, Critical Care and Intensive Care Medicine, business, Surgery, Haemorrhagic shock
Published: 2019
Full Text: View/download PDF

49. Hypothermie accidentelle chez le traumatisé grave

Author: Fanny Vardon, Ségolène Mrozek, Thomas Geeraerts, and Olivier Fourcade
Subjects: Gynecology, medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, medicine, business
Abstract: Resume L’hypothermie fait partie, avec l’acidose et la coagulopathie, de la triade letale aggravant le pronostic des traumatises graves. Si l’hypothermie accidentelle est facile a reconnaitre par une simple mesure, elle n’en reste pas moins deletere si elle n’est pas prevenue ou traitee des la phase initiale de la prise en charge du patient. Elle est multifactorielle et est un facteur de risque de mortalite chez le traumatise grave. Les consequences de l’hypothermie sont multiples : elle modifie la contractilite myocardique et favorise les arythmies. Elle participe a la coagulopathie traumatique. Du point de vue immunologique, elle diminue la reponse inflammatoire et augmente le taux de pneumopathies chez le traumatise. Elle diminue l’elimination des medicaments utilises pour l’anesthesie et la sedation et perturbe l’interpretation des dosages biologiques en particulier, elle entraine une surestimation de l’activite des facteurs de la coagulation. Cette mise au point se propose de detailler les consequences physiopathologiques de l’hypothermie, ainsi que les principales recommandations recemment formulees sur ce theme.
Published: 2015
Full Text: View/download PDF

50. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea

Author: Nicolas Largeteau, Jean-Marie Bourgeois, Didier Garnier, Jeanne-Marie Amalric, Dominique Deshaies, Thomas Geeraerts, Emeric Gallard, Fouad Chedaddi, Jean-Eudes Bourcier, and Jean-Philippe Redonnet
Subjects: Male, medicine.medical_specialty, Pleural effusion, Physical examination, Sensitivity and Specificity, Cohort Studies, Pulmonary Disease, Chronic Obstructive, Natriuretic Peptide, Brain, medicine, Humans, Medical history, Prospective Studies, Intensive care medicine, Prospective cohort study, Lung, Physical Examination, Aged, Asthma, Aged, 80 and over, Heart Failure, medicine.diagnostic_test, business.industry, Pneumonia, General Medicine, Emergency department, medicine.disease, Peptide Fragments, Pleural Effusion, Dyspnea, Echocardiography, Anesthesia, Heart failure, Disease Progression, Emergency Medicine, Female, Radiography, Thoracic, Emergency Service, Hospital, business
Abstract: Objective The etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED. Methods Patients admitted to the ED for acute dyspnea underwent upon arrival a cardiopulmonary ultrasound performed by an emergency physician, in addition to standard care. The performances of the clinical examination, chest x-ray, N-terminal brain natriuretic peptide (NT-proBNP), and cardiopulmonary ultrasound were compared with the final diagnosis made by 2 independent physicians. Results One hundred thirty patients were analyzed. For the diagnosis of acute left-sided heart failure, cardiopulmonary ultrasound had an accuracy of 90% (95% confidence interval [CI], 84-95) vs 67% (95% CI, 57-75), P = .0001 for clinical examination, and 81% (95% CI, 72-88), P = .04 for the combination "clinical examination–NT-proBNP–x-ray". Cardiopulmonary ultrasound led to the diagnosis of pneumonia or pleural effusion with an accuracy of 86% (95% CI, 80-92) and decompensated chronic obstructive pulmonary disease or asthma with an accuracy of 95% (95% CI, 92-99). Cardiopulmonary ultrasound lasted an average of 12 ± 3 minutes. Conclusions Cardiopulmonary ultrasounds performed in the ED setting allow one to rapidly establish the etiology of acute dyspnea with an accuracy of 90%.
Published: 2015
Full Text: View/download PDF

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Journal

Database

Publisher

139 results on '"Thomas, Geeraerts"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources