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51. Mécanismes immunologiques post-traumatiques : de l’attrition tissulaire à la défaillance d’organes

Author: Pierre-Olivier Ludes, Eric Noll, and Julien Pottecher
Subjects: 0301 basic medicine, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030208 emergency & critical care medicine
Abstract: Resume Le traumatisme severe reste greve d’une mortalite et d’une morbidite particulierement elevees, au point de constituer la premiere cause d’annees de vie perdues ponderees par la qualite (QALYs). Si le choc hemorragique et les lesions severes du systeme nerveux central restent les deux premieres causes de mortalite precoce apres un traumatisme grave, 25 a 30 % des deces post-traumatiques surviennent plus tard en reanimation des suites de defaillances d’organes (secondary organ failures ou SOF). Ces SOF font intervenir principalement deux mecanismes physiopathologiques : 1) une reaction exacerbee de l’immunite innee, dont l’intensite est proportionnelle a l’etendue des lesions traumatiques et aux concentrations d’alarmines circulantes (aussi nommees Damage-Associated Molecular Patterns ou DAMPs). Ces alarmines de natures diverses (complement, polynucleaires neutrophiles et leur arsenal proteolytique) vont directement leser les cellules endotheliales et epitheliales des organes vitaux (poumon, foie, rein) aboutissant a des syndromes qui menacent le pronostic vital (ALI, ARDS, AKI, vasoplegie et coagulopathie post-traumatiques…) A cote des lesions tissulaires traumatiques directement liees au stress mecanique et a la destruction des barrieres macro- et microscopiques, le choc hemorragique constitue un facteur aggravant et decuple la liberation de DAMPs par un mecanisme d’hypoperfusion tissulaire et cellulaire. Il en va de meme pour les interventions chirurgicales extensives lorsqu’elles sont realisees en phase inflammatoire a un moment ou elles amplifient la reponse immunitaire innee ; 2) une immunosuppression post-traumatique, qui s’initie dans les suites immediates du traumatisme mais dont les consequences (anergie immunitaire, desactivation monocytaire, reponse de type Th2, reactivations virales, susceptibilite accrue aux infections bacteriennes et fongiques) n’apparaissent qu’apres quelques jours et confinent le patient dans un etat persistant d’inflammation, d’immunosuppression et de catabolisme (PICS syndrome). En plus de conforter le bien-fonde de doctrines deja adoptees (parfois de facon empirique) sur des bases cliniques (damage-control surgery, reanimation hemostatique, administration precoce d’acide tranexamique), ces decouvertes recentes laissent entrevoir des voies therapeutiques nouvelles, ciblant les DAMPs eux-memes (dornase alfa), leurs recepteurs (cyclosporine H) et l’arsenal des polynucleaires ou modulant l’activite de l’immunite innee (glucocorticoides, IFNγ, GM-CSF).
Published: 2020
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52. Anesthésie pour fracture de l’extrémité supérieure du fémur

Author: Eric Noll, Julien Pottecher, and Pierre Diemunsch
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030212 general & internal medicine
Abstract: Resume Les fractures de l’extremite superieure du femur touchent un nombre important de patients, frequemment âges et sont responsables d’une morbi-mortalite tres importante. Pour ameliorer le devenir de ces patients, une chirurgie d’osteosynthese doit etre proposee rapidement apres l’admission : un delai de 48 heures entre l’admission et l’intervention ne doit pas etre depasse. L’organisation d’un parcours de soins multidisciplinaire ortho-geriatrique associant notamment urgentistes, chirurgiens traumatologues, anesthesistes-reanimateurs, geriatres et pharmaciens est un facteur d’efficience de la medecine perioperatoire proposee a ces patients âges. La prise en charge anesthesique intraoperatoire repose sur le choix de molecules a demi-vie courte, et leur administration titree, guidee par des objectifs individualises. Les strategies d’optimisation de la recuperation postoperatoire ont pour but la reprise d’une deambulation correspondant a l’etat basal du patient, avant sa chute.
Published: 2020
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53. Le point de vue du patient concernant son état de santé en médecine périopératoire : outils et applications

Author: Eric Noll, Pierre Olivier Ludes, Julien Pottecher, and Pierre Diemunsch
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030212 general & internal medicine
Abstract: Resume La prise en compte du point de vue du patient pour evaluer son etat de sante est un developpement important pour la medecine perioperatoire. En complement des monitorages cliniques et paracliniques habituels des patients operes, elle permet de completer la semeiologie et ainsi la finesse analytique de l’etat de sante des patients recemment operes. De nombreux outils ont ete developpes pour recueillir directement le point de vue du patient de maniere standardisee et etudies du point de vue psychometrique. Ces outils permettant l’autoevaluation directe par le patient de son etat de sante sont parfois decrits par le terme anglais « Patient-Reported Outcomes Mesures » (PROMs). Ils sont de constructions et caracteristiques tres variees. Leurs utilisations principales en medecine perioperatoire peuvent se regrouper sous deux axes : 1) en pratique courante pour l’evaluation in situ de la performance des protocoles de soins standardises, du parcours patient et la personnalisation de la prise en charge ; 2) en recherche clinique en tant que critere de jugement de la qualite des soins. Dans l’ensemble de ces domaines, bien que prometteurs, les PROMs doivent encore faire l’objet d’etudes visant notamment a caracteriser leurs limites methodologiques et analytiques.
Published: 2020
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54. Intrahospital Trauma Flowcharts - cognitive aids for intrahospital trauma management from the French Society of Anaesthesia and Intensive Care Medicine and the French Society of Emergency Medicine

Author: Tobias Gauss, Hervé Quintard, Benjamin Bijok, Guillaume Bouhours, Thomas Clavier, Fabrice Cook, Hugues de Courson, Jean-Stéphane David, Caroline Duracher-Gout, Delphine Garrigue, Thomas Geeraerts, Sophie Hamada, Olivier Joannes-Boyau, Romain Jouffroy, Antoine Lamblin, Olivier Langeron, Pierre Lanot, Sigismond Lasocki, Marc Leone, Sébastien Mirek, Laurent Muller, Pierre Pasquier, Bertrand Prunet, Sébastien Perbet, Mathieu Raux, Justin Richards, Claire Roger, Antoine Roquilly, Emmanuel Weiss, Pierre Bouzat, Julien Pottecher, Bordeaux population health (BPH), and 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)
Subjects: Anesthesiology and Pain Medicine, Traumatic Brain Injury, Resuscitation, Cognitive aid, Shock, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Guideline, Damage Control, Critical Care and Intensive Care Medicine, Trauma
Published: 2022
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55. Withholding and withdrawal of life-sustaining therapy in 8569 trauma patients: A multicentre, analytical registry study

Author: Malik Haddam, Laura Kubacsi, Sophie Hamada, Anatole Harrois, Arthur James, Olivier Langeron, Mathieu Boutonnet, Mathilde Holleville, Delphine Garrigue, Marion Leclercq, Jean-Luc Hanouz, Julien Pottecher, Gérard Audibert, Mickael Cardinale, Hélène Vinour, Laurent Zieleskiewicz, Noemie Resseguier, and Marc Leone
Subjects: Male, Intensive Care Units, Anesthesiology and Pain Medicine, Withholding Treatment, Humans, Registries, Middle Aged, Aged, Retrospective Studies
Abstract: This study aimed to determine the prevalence of withholding or withdrawal of life-sustaining therapy (WLST) decisions in trauma ICU patients, using a large registry. We hypothesised that this prevalence is similar to that of the general population admitted to an ICU. As secondary aims, it sought to describe the trauma patients for whom the decision was made for WLST and the factors associated with this decision.This observational study assessed data from 14 French centres listed in the TraumaBaseTM registry. All trauma patients hospitalised for more than 48 h were pro-spectively included.Data from 8569 trauma patients, obtained from January 2016 to December 2018, were included in this study. A WLST decision was made in 6% of all cases. In the WLST group, 67% of the patients were older men (age: 62 versus 36, P 0.001); more often they had a prior medical history and higher median severity scores than the patients in the no WLST decision group; SAPS II 58 (46 to 69) versus 21 (13 to 35) and ISS 26 (22 to 24) versus 12 (5 to 22), P 0.001. Neurological status was strongly associated with WLST decisions. The geographic area of the ICUs affected the rate of the WLST decisions. The ICU mortality was 11% (n = 907) of which 47% (n = 422) were preceded by WLST decisions. Fourteen percent of WLST orders were not associated to the death.Among 8569 patients, medical history, trauma severity criteria, notably neurological status and geographical areas were associated with WLST. These regional differences deserve to be investigated in future studies.
Published: 2022

56. Association of Organizational Pathways With the Delay of Emergency Surgery

Author: Delphine Lepercq, Tobias Gauss, Anne Godier, Julie Bellet, Guillaume Bouhours, Pierre Bouzat, Emeline Cailliau, Fabrice Cook, Jean-Stéphane David, Fatou Drame, Marvin Gauthier, Antoine Lamblin, Julien Pottecher, Benoit Tavernier, and Delphine Garrigue-Huet
Subjects: General Medicine
Abstract: ImportanceDelayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date.ObjectiveTo examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France.Design, Setting, and ParticipantsThis prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded.ExposuresEmergency surgery.Main Outcomes and MeasuresThe main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1.ResultsA total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P Conclusions and RelevanceIn this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.
Published: 2023
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57. Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

Author: Hervé Quintard, Vincent Degos, Mikael Mazighi, Jérôme Berge, Pierre Boussemart, Russel Chabanne, Samy Figueiredo, Thomas Geeraerts, Yoann Launey, Ludovic Meuret, Jean-Marc Olivot, Julien Pottecher, Francesca Rapido, Sébastien Richard, Suzana Saleme, Virginie Siguret-Depasse, Olivier Naggara, Hugues De Courson, and Marc Garnier
Subjects: Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Published: 2023
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58. Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France

Author: Hélène Coignard, Jean-Marc Philippe, Olivier Grimaud, Marc-Antoine Sanchez, Stéphane Sanchez, Julien Pottecher, Agnès Ricard Hibon, Mathieu Boutonnet, Albert Vuagnat, François-Xavier Lescure, Emmanuelle Leray, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département Méthodes quantitatives en santé publique (METIS), Collectif de recherche handicap, autonomie et société inclusive (CoRHASI), and Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)
Subjects: medicine.medical_specialty, Inter-hospital transfers, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Pandemic, Health care, Clinical endpoint, Medicine, 030212 general & internal medicine, business.industry, RC86-88.9, Mortality rate, Research, 030208 emergency & critical care medicine, Medical emergencies. Critical care. Intensive care. First aid, Odds ratio, Intensive care unit, 3. Good health, Emergency medicine, Observational study, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Covid-19
Abstract: Background The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to. Method A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality. Results In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6–0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2–0.4, p 200 km). Mortality decreased overall over the 3-month study period. Conclusions Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients.
Published: 2021
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59. Factors associated with coinfections in invasive aspergillosis: a retrospective cohort study

Author: François Danion, Céline Duval, François Séverac, Philippe Bachellier, Ermanno Candolfi, Vincent Castelain, Raphaël Clere-Jehl, Julie Denis, Laurence Dillenseger, Eric Epailly, Justine Gantzer, Blandine Guffroy, Yves Hansmann, Jean-Etienne Herbrecht, Valérie Letscher-Bru, Pierre Leyendecker, Pauline Le Van Quyen, Pierre-Olivier Ludes, Guillaume Morel, Bruno Moulin, Catherine Paillard, Benjamin Renaud-Picard, Anne-Claude Roche, Marcela Sabou, Francis Schneider, Morgane Solis, Emilie Talagrand-Reboul, Francis Veillon, Marie-Pierre Ledoux, Célestine Simand, Raoul Herbrecht, Pietro Francesco Addeo, Dominique Astruc, Mathieu Baldacini, Karin Bilger, Marie-Pierrette Chenard, Olivier Collange, Tristan Degot, Nadia Dhif, Elise Dicop, Samira Fafi-Kremer, Luc-Matthieu Fornecker, Charline Fuseau, Max Guillot, Mary-Line Harlay, Ralf Janssen-Langenstein, Benoît Jaulhac, Charlotte Kaeuffer, Romain Kessler, Christine Kummerlen, Annegret Laplace, Anne Launoy, Bruno Lioure, Hamid Merdji, Paul-Michel Mertes, Shanti Natarajan-Ame, Gabriel Nisand, Michele Porzio, Julien Pottecher, Maleka Schenck-Dhif, Cécile Sonntag, Elise Toussaint, Anne Zilliox, Les Hôpitaux Universitaires de Strasbourg (HUS), Institut de Cancérologie de Strasbourg Europe (ICANS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Dynamique des interactions Hôte pathogène, Université de Strasbourg (UNISTRA), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Nanomédecine Régénérative (NanoRegMed), Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-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), Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë, Interface de Recherche Fondamentale et Appliquée en Cancérologie (IRFAC - Inserm U1113), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Paul Strauss : Centre Régional de Lutte contre le Cancer (CRLCC)-Fédération de Médecine Translationelle de Strasbourg (FMTS), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), 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)-Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), 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)-Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), and univOAK, Archive ouverte
Subjects: 0301 basic medicine, Microbiology (medical), Adult, medicine.medical_specialty, Adolescent, 030106 microbiology, Coinfections, Computed tomography, Aspergillosis, Gastroenterology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Invasive fungal infections, Internal medicine, medicine, Humans, Leukaemia, 030212 general & internal medicine, Mortality, Child, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Aged, Retrospective Studies, Aspergillus species, Aged, 80 and over, medicine.diagnostic_test, business.industry, Coinfection, Hematopoietic Stem Cell Transplantation, Infant, Newborn, Infant, Retrospective cohort study, General Medicine, Middle Aged, Sciences du Vivant [q-bio]/Microbiologie et Parasitologie, medicine.disease, 3. Good health, Transplantation, Infectious Diseases, Fungal, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Risk factors, Child, Preschool, Hematologic Neoplasms, business
Abstract: Objectives To describe the coinfections in invasive aspergillosis (IA), to identify factors associated with coinfections, and to evaluate the impact of coinfection on mortality. Patients and methods We conducted a monocentric retrospective study of consecutive putative, probable, or proven IA that occurred between 1997 and 2017. All coinfections, with an onset within 7 days before or after the first sign of aspergillosis, were identified. Factors associated with coinfections and mortality were analysed by multivariable analysis. Results Among the 690 patients with IA included in the study, the median age was 57 years (range 7 days to 90 years). A coinfection was diagnosed in 272/690 patients (39.4%, 95%CI 35.8–43.2). The location of this coinfection was pulmonary only in 131/272 patients (48%), bloodstream only in 66/272 patients (24%) and other/multiple sites in 75/272 patients (28%). Coinfections were bacterial (110/272 patients, 40%), viral (58/272, 21%), fungal (57/272, 21%), parasitic (5/272, 2%) or due to multiple types of pathogens (42/272, 15%). Factors associated with a coinfection in adjusted analysis were: allogeneic haematopoietic stem-cell transplantation (OR 2.3 (1.2–4.4)), other haematological malignancies (OR 2.1 (1.2–3.8)), other underlying diseases (OR 4.3 (1.4–13.6)), lymphopenia (OR 1.7 (1.1-2.5)), C-reactive protein >180 mg/L (OR 1.9 (1.2–3.0)), fever (OR 2.4 (1.5–4.1)), tracheal intubation (OR 2.6 (1.5–4.7)), isolation of two or more different Aspergillus species (OR 2.7 (1.1–6.3)), and the presence of non-nodular lesions on chest computed tomography (OR 2.2 (1.3–3.7) and OR 2.2 (1.2–4.0)). Coinfections were independently associated with a higher mortality at week 12 (adjusted HR 1.5 (1.1–1.9), p Conclusions Coinfections are frequent in IA patients and are associated with higher mortality.
Published: 2021
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60. Identification of driver genes for critical forms of COVID-19 in a deeply phenotyped young patient cohort

Author: Qian Zhang, Paul Bastard, Haiguo Wu, Adrian Gervais, Seiamak Bahram, Sylvain Mayeur, Sharvari Gujja, Anne Thomas, Alexandre Lederle, Julie Helms, Christiane Moog, Xavier Mariette, Alain Viari, Tristan Stemmelen, Christine Carapito, Olivier Hermine, Richard Li, Daniel A. Lidar, Cécile Macquin, Jean Sibilia, Géraldine Laumond, Shweta Kailasan, Leslie Muller, Sabrina Bibi-Triki, Sylvie Schmidt, Aurélie Hirschler, Raony Guimaraes, Michael Simons, Anne Molitor, Francis Schneider, Damien Sanlaville, Thiên-Nga Chamaraux-Tran, Samira Fafi-Kremer, Pierre-Louis Tharaux, Thomas Chittenden, Angélique Pichot, A. Hanauer, Raphael Carapito, Mirjana Radosavljevic, Véronique Rolli, Bernard Goichot, Yvon Ruch, Olivier Collange, Ouria Tahar, Julien Pottecher, Khaldoun Kuteifan, Razieh Mohseninia, Perrine Spinnhirny, Alice Bernard, Bernard Drenou, Jean-Laurent Casanova, Elisa Pin, Jeffrey R. Gulcher, Paul-Michel Mertes, M. Javad Aman, Peter Nilsson, Jose Malagon-Lopez, François Danion, Yves Hansmann, Ferhat Meziani, Maleka Schenck, Nicodème Paul, Annabel Larnicol, Julia Frappier, Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), GENOMAX [plateforme], Fédération Hospitalo-Universitaire OMICARE, Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Genuity Science [Boston], Département Sciences Analytiques et Interactions Ioniques et Biomoléculaires (DSA-IPHC), Institut Pluridisciplinaire Hubert Curien (IPHC), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-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 Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), University of Southern California (USC), Rockefeller University [New York], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital de Hautepierre [Strasbourg], Yale School of Medicine [New Haven, Connecticut] (YSM), Hôpital Bicêtre, Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Groupe hospitalier de la région de Mulhouse et Sud-Alsace, Integrated biotherapeutics [Rockville], Royal Institute of Technology [Stockholm] (KTH ), Auragen [Lyon], Equipe de recherche européenne en algorithmique et biologie formelle et expérimentale (ERABLE), Inria Grenoble - Rhône-Alpes, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Synergie Lyon Cancer-Platform of Bioinformatics-Gilles Thomas, Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), 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 Paris Cité (UPCité), Harvard Medical School [Boston] (HMS), ANR-10-IDEX-0002,UNISTRA,Par-delà les frontières, l'Université de Strasbourg(2010), ANR-20-SFRI-0012,STRAT'US,Façonner les talents en formation et en recherche à l'Université de Strasbourg(2020), ANR-10-INBS-0008,ProFI,Infrastructure Française de Protéomique(2010), CARAPITO, Christine, Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), LabEx Transplantex [Strasbourg], Fédération Hospitalo-Universitaire (OMICARE), Centre de Recherche d’Immunologie et d’Hématologie [Strasbourg], Laboratoire de Spectrométrie de Masse BioOrganique [Strasbourg] (LSMBO), Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS)-Institut Pluridisciplinaire Hubert Curien (IPHC), Université de Strasbourg (UNISTRA)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Département Ecologie, Physiologie et Ethologie (DEPE-IPHC), Génétique Humaine des Maladies Infectieuses (Inserm U980), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Yale University School of Medicine, Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), 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), 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), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut Pluridisciplinaire Hubert Curien (IPHC), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), and Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Aucun, MEDLINE, Bioinformatics, 03 medical and health sciences, 0302 clinical medicine, Artificial Intelligence, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Medicine, Humans, Gene, ComputingMilieux_MISCELLANEOUS, 030304 developmental biology, 0303 health sciences, business.industry, SARS-CoV-2, Confounding, COVID-19, Membrane Proteins, General Medicine, Respiration, Artificial, 3. Good health, ADAM Proteins, Intensive Care Units, 030220 oncology & carcinogenesis, Cohort, [SDV.BBM.GTP] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Identification (biology), business
Abstract: International audience; The etiopathogenesis of critical COVID-19 remains unknown. Indeed given major confounding factors (age and comorbidities), true drivers of this condition have remained elusive. Here, we employ an unprecedented multi-omics analysis, combined with artificial intelligence, in a young patient cohort where major comorbidities have been excluded at the onset. Here, we established a three-tier cohort of individuals younger than 50 years without major comorbidities. These included 47 “critical” (in the ICU under mechanical ventilation) and 25 “non-critical” (in a non-critical care ward) COVID-19 patients as well as 22 healthy individuals. The analyses included whole-genome sequencing, whole-blood RNA sequencing, plasma and blood mononuclear cells proteomics, cytokine profiling and high-throughput immunophenotyping. An ensemble of machine learning, deep learning, quantum annealing and structural causal modeling led to key findings. Critical patients were characterized by exacerbated inflammation, perturbed lymphoid/myeloid compartments, coagulation and viral cell biology. Within a unique gene signature that differentiated critical from non-critical patients, several driver genes promoted critical COVID-19 among which the upregulated metalloprotease ADAM9 was key. This gene signature was supported in a second independent cohort of 81 critical and 73 recovered COVID-19 patients, as were ADAM9 transcripts, soluble form and proteolytic activity. Ex vivo ADAM9 inhibition affected SARS-CoV-2 uptake and replication in human lung epithelial cells. In conclusion, within a young, otherwise healthy, COVID-19 cohort, we provide the landscape of biological perturbations in vivo where a unique gene signature differentiated critical from non-critical patients. The key driver, ADAM9, interfered with SARS-CoV-2 biology. A repositioning strategy for anti-ADAM9 therapeutic is feasible.
Published: 2021
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61. Author response for 'Influenza vaccination and prognosis of COVID ‐19 in hospitalized patients with diabetes: Results from the CORONADO study'

Author: null A Diallo, null M Pichelin, null M Wargny, null P Gourdy, null JB Bonnet, null S Hadjadj, null B Cariou, null A Sultan, null F Galtier, null Matthieu Wargny, null Pascale Mahot, null Bertrand Cariou, null Samy Hadjadj, null Matthieu Pichelin, null Anne‐Laure Fournier‐Guilloux, null Nicolas Mauduit, null Edith Bigot‐Corbel, null Anne‐Sophie Boureau, null Laure Dekcer, null Audrey Ernould, null Claire Primot, null Anne Seguin, null Marielle Joliveau, null Sonia Pouvreau, null Chloé FOURNIER, null Jeremy Thureau, null Edith Fonteneau, null Pamela Hublain, null Chu Nantes, null Carole Agasse, null Mathilde DE Kergaradec, null Vincent Minville, null Fanny Vardon‐Bounes, null Guillaume Martin‐Blondel, null Pierre Gourdy, null Blandine Tramunt, null Marie‐Christine Turnin, null Hélène Hanaire, null Jean‐Michel Mansuy, null Didier Fabre, null Marie‐Blanche Arhainx, null Laurent Cazals, null Laure Combes, null Emmanuelle Lami, null Mallory Cianferani, null Bruno Megarbane, null Pierre Leroy, null Jean‐François Gautier, null Tiphaine Vidal‐Trecan, null Jean‐Pierre Riveline, null Jean‐Louis Laplanche, null Stéphane Mouly, null Louis Potier, null Ronan Roussel, null Malak Taher, null Yawa Abouleka, null Fetta Yaker, null Aurelie Carlier, null Anne Boutten, null Marilyne Hallot‐Feron, null Fadila Mourah, null Charles Thivolet, null Emilie Blond, null Muriel Rolland, null Josep Verdecho Mendez, null Marine Alexandre, null Julien Pottecher, null Emilie Richer, null Laurent Meyer, null Florina Luca, null Jean‐Marc Lessinger, null Thibault Bahougne, null Bruno Guerci, null Lisa Ludwig, null Siham Benzirar, null Catherine Malaplate, null Thierry Matton, null Julien Poissy, null Karine Faure, null Pierre Fontaine, null Florence Baudoux, null Anne Vambergue, null Jean David Pekar, null Marc Lambert, null Cécile Yelnik, null Amélie Bruandet, null Laurent Petit, null Didier Neau, null Vincent Rigalleau, null Annie Berard, null Amandine Galioot, null Remy Coudroy, null Arnaud Thille, null René Robert, null France Roblot‐Cazenave, null Blandine Rammaert, null Pierre Jean Saulnier, null Xavier Piguel, null Nesrine Benhenda, null Camille Husson, null Celine Olivier, null Florence Torremocha, null Mathilde Fraty, null Marie Flamen d'assigny, null Aurelie Miot, null Valentin Bossard, null Kada Klouche, null Alain Makinson, null Ariane Sultan, null Jean‐Baptiste Bonnet, null Vincent Foulongne, null Florence Galtier, null Cécile Aubron, null Séverine Ansart, null Véronique Kerlan, null Pascale Quiniou, null Jean‐Luc Carre, null Stéphane Quesnot, null Bruno Laviolle, null Carole Schwebel, null Olivier Epaulard, null Pierre‐Yves Benhamou, null Cécile Betry, null Anne‐Laure Borel, null Sandrine Lablanche, null Dorra Guergour, null Catherine Duclos, null Emmanuel Cosson, null Erwan Guyot, null Aurore Deniau, null Phucthutrang Nguyen, null Yves Reznik, null Michael Joubert, null Stéphane Allouche, null Lydia Guittet, null Steven Grange, null Manuel Etienne, null Gaëtan Prévost, null Valéry Brunel, null Jean‐Christophe Lagier, null Didier Raoult, null Anne Dutour, null Bénédicte Gaborit, null Sandrine Boulllu, null Patrice Darmon, null Adèle Lasbleiz, null Mathieu Cerino, null Fanny Romain, null Marie Houssays, null Jean Pierre Quenot, null Lionel Piroth, null Bruno Vergès, null Laurence Duvillard, null Bernard Bonnotte, null Alain Mercat, null Vincent Dubee, null Ingrid Allix, null Patrice Rodien, null Robin Dhersin, null Maylis Lebeault, null Wojciech Trzepizur, null Jocelyne Loison, null Antoine Brangier, null Pierre Asfar, null Pascal Reynier, null Françoise Larcher, null Françoise Joubaud, null Marie‐Rita Andreu, null Geoffrey Urbanski, null Laurent Hubert, null Cedric Annweiler, null Jean Dellamonica, null Johan Courjon, null Nicolas Chevalier, null Giulia Chinetti, null Magda Chafai, null Bruno Mourvillier, null Firouze Bani‐Sadr, null Sarra Barraud, null Brigitte Delemer, null Philippe Gillery, null Pascale Labedade, null Amélie Chabrol, null Alfred Penfornis, null Catherine Petit, null Coralie Amadou, null Maxime Adler, null Clément Dubost, null Pierre‐Louis Conan, null Lyse Bordier, null Franck Ceppa, null Cyril Garcia, null Mathilde Sollier, null Olivier Dupuy, null Sophie Laplance, null Olivier Billuart, null Marie Joseph Aroulanda, null Frédérique Olivier, null Florence Ayon, null Nathalie Wilhelm, null Loic Epelboin, null Nadia Sabbah, null Aurelie Charpin, null Pierre Squara, null Olivier Belliard, null Claude Dubois, null Michel Marre, null Johann Auchabie, null Roxane Courtois, null Thierry Duriez, null Tiphaine Mergey, null Laura Vallee, null Laetitia Seguin, null Abdallah Al‐Salameh, null Jean‐Philippe Lanoix, null Sandrine Soriot‐Thomas, null Anne‐Marie Bourgeois‐Descouls, null Rachel Desailloud, null Natacha Germain, null Bogdan Galusca, null Gwenaelle Belleton, null Nesrine Marouani, null Delia Palaghiu, null Amira Hammour, null Fernando Berdaguer, null Thimothée Klopfenstein, null Hajer Zayet, null Patrice Winiszewski, null Marie Zanusso, null Pauline Garnier, null Ingrid Julier, null Karim Hamzaoui, null Sophie Marty‐Gres, null Tarik Sadki, null Lucile Cadot, null Jean‐Louis Dubost, null Céline Gonfroy, null Catherine Campinos, null Pascale Martres, null Marie Pierre Coulhon, null Nicolas Allou, null Marwa Bachir, null Stella Hoang, null Candice Kembellec, null Olivia Suply, null Fatima Kharcha, null Anne‐Claire Devouge, null Anna Flaus‐Furmanuk, null Isabelle Madeline, null Vincent Ehinger, null Sophie Bastard, null Loic Raffray, null Frederic Renou, null Aude Bojarski, null Caroline Paul, null Karine Borsu, null Angelique Gorlin, null Servane Bernardo, null Carole Truong Ut, null Stephane Renaud, null Antoine Vignoles, null Emilie Foch, null Laurie Masse, null Hubert Grand, null Helene Ferrand, null Christelle Raffaitin‐Cardin, null Hadjer Zellagui, null Celine Castang‐Brachet, null Frederique Boury, null Ana Alvarez Tena, null Isabelle Moura, null Pierre Kalfon, null Juliana Darasteanu, null Arnaud Monier, null Pascal Foucault, null Alexandra Depuille, null Stéphanie Laugier‐Robiolle, null Patrick Caneiro, null Maud Basso, null Etienne Larger, null Samir Bouam, null Wahiba Benzenati, null Leila Ait Bachir, null Camille Cussac Pillegand, null Marc Vasse, null Christophe Michard, null Nathanaëlle Montanier, null Luc Millot, null Françoise Crepet, null Danielle Ratsimba, null Kevin Bouiller, null Sophie Borot, null Isabelle Bruckert, null Annie Clergeot, null Franck Schillo, null Dorothée Vignes, null Muriel Bourgeon‐Ghittori, null Hamoud Lachgar, null Claire Lambert DE Cursay, null Stéphane Levante, null Jean Charles Auregan, null Antoine Merlet, null Cécile Zaragoza, null Gwénaëlle Arnault, null Anne‐Gaëlle Loupp, null Olivier Lesieur, null Mariam Roncato‐Saberan, null Didier Gouet, null Romain Lemarie, null Hong_an Allano, null Emmanuel Vivier, null Caroline Pariset, null Cédric Luyton, null Lucien Marchand, null Fanny Doroszewski, null Matthieu Pecquet, null Laurent Perard, null Sylvie Vuillermoz‐Blas, null Nicolas Kacki, null Patricia Charrier, null Amélie Ducet‐Boiffard, null Françoise Desroys Roure, null Olivier Bourron, null Dominique Bonnefont‐Rousselot, null Suzanne Laroche, null Franck Phan, null Agnès Hartemann, null Cyrielle Caussy, null Emmanuel Disse, null Claude Guerin, null Thomas Perpoint, null Philippe Moulin, null Régine Cartier, null Geoffroy Hariri, null Dorothée Chopin, null Camille Vatier, null Nathalie Bourcigaux, null Emmanuelle Chaigneau, null Sophie Christin‐Maitre, null Bruno Donadille, null Bruno Feve, null Sophie Lamothe, null Julie Sarfati, null Pascal Pernet, null Anne Chambon, null Delphine Demarsy, null Hugo Campagne, null Françoise Latil‐Plat, null Monica Berne, null Marilyne Grinand, null Marion Touzet, null Aydrey Zabulon, null Jocelyne Craspag, null Catherine Ledoux, null Cedric Contaret, null Blandine Janand‐Delenne, null Anaïs Giraud, null Marie Lou Lacrimini, null Joëlle Arrivie, null Deborah Ancelle, null Carine Guillois, null Bénédicte Fremy, null Amina Chaalal, null Gaëlle Barrande, null Anne Dorange, null Eglantine Rouanet, null Dominique Seret‐Begue, null Audrey Saoud, null Anne‐Marie Guedj, null Nathalie Bedos, null Fritz‐Line Velayoudom, null Marie Dumas, null Benoite Gonda, null Christine Coffin, null Stéphanie Gibiat, null Myriam Lungo, null Chantal Bully, null Pierre Serusclat, null Stella Bully, null Patricia Carre, null Jean‐Philippe Leberre, null Carlos Elkhoury, null Marine Thieux, null Laetitia Paradisi‐Prieur, and null CORONADO investigators
Subjects: Vaccination, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Hospitalized patients, Diabetes mellitus, Medicine, business, medicine.disease
Published: 2021
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62. 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

63. Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results

Author: Marie Couture, Stephanos Finitsis, Gaultier Marnat, Sébastien Richard, Romain Bourcier, Pacôme Constant-dits-Beaufils, Cyril Dargazanli, Caroline Arquizan, Mikaël Mazighi, Raphaël Blanc, François Eugène, Stéphane Vannier, Laurent Spelle, Christian Denier, Emmanuel Touzé, Charlotte Barbier, Suzana Saleme, Francisco Macian, Charlotte Rosso, Frédéric Clarençon, Olivier Naggara, Guillaume Turc, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Alain Viguier, Christophe Cognard, Anthony Lebras, Sarah Evain, Valérie Wolff, Raoul Pop, Serge Timsit, Jean-Christophe Gentric, Frédéric Bourdain, Louis Veunac, Bertrand Lapergue, Arturo Consoli, Benjamin Gory, Igor Sibon, Michel Piotin, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Hebert Solène, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David WeisenburgerLile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, Romain Tonnelet, François Liao, Emmanuelle Zhu, Sophie Schmitt, Sébastien Planel, Lisa Richard, Gioia Humbertjean, Jean-Christophe Mione, Nolwenn Lacour, Gérard Riou-Comte, Marcela Audibert, Lionel Voicu, Marie Alb, Madalina Reitter, Agnès Brezeanu, Adriana Masson, Iona Tabarna, Sarah Podar, Fatiha Guy, Fatiha Bechiri, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Laura Venditti, Mariana Sarov, Nicolas Legris, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun, Anne Christine Januel, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti, Julien Ognard, Francois Mathias Merrien., Ozlem Ozku Wermester, Evelyne Massardier, Aude Triquenot, Margeaux Lefebvre, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, David Higue, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran, Anthony Le Bras, Arnaud Le Guen, Norbert Nighoghossian, Roberto Riva, Omer Eker, Francis turjman, Laurent Derex, Tae-Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc-Lasserre, and Anne-Evelyne Vallet
Subjects: Adult, Male, medicine.medical_specialty, Endovascular therapy, Brain ischemia, Internal medicine, medicine, Humans, Registries, Endovascular treatment, Prospective cohort study, Acute ischemic stroke, Acute stroke, Aged, Ischemic Stroke, Advanced and Specialized Nursing, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Embolic stroke, Treatment Outcome, Ischemic stroke, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Abstract: Background and Purpose: The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset. Methods: We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT−) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences. Results: A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT− group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88–1.34]; P =0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7–1.2]; P =0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63–1.37]; P =0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0–2; aOR, 0.98 [95% CI, 0.77–1.25]; P =0.89), and mortality (aOR, 0.95 [95% CI, 0.72–1.26]; P =0.76) at 90 days did not differ between the groups. Conclusions: Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.
Published: 2021

64. Four-factor prothrombin complex concentrate to reduce allogenic blood product transfusion in patients with major trauma, the PROCOAG trial: study protocol for a randomized multicenter double-blind superiority study

Author: Jean-François Payen, Jacques Duranteau, Paër-Sélim Abback, Jean-Stéphane David, Pierre Bouzat, Jonathan Charbit, Delphine Garrigue, Bruno Riou, Albrice Levrat, Karim Asehnoune, Jean-Luc Bosson, Guillaume Marcotte, Julien Pottecher, and Marc Leone
Subjects: Medicine (General), Resuscitation, Medicine (miscellaneous), Context (language use), Factor IX, Study Protocol, R5-920, Blood product, Intensive care, Medicine, Severe trauma, Humans, Multicenter Studies as Topic, Pharmacology (medical), Blood Transfusion, Prospective Studies, Randomized Controlled Trials as Topic, business.industry, Prothrombin complex concentrate, Glasgow Outcome Scale, Major trauma, Trauma center, Massive transfusion, medicine.disease, Blood Coagulation Factors, Acute traumatic coagulopathy, Anesthesia, business, medicine.drug
Abstract: BackgroundOptimal management of severe trauma patients with active hemorrhage relies on adequate initial resuscitation. Early administration of coagulation factors improves post-traumatic coagulation disorders, and four-factor prothrombin complex concentrate (PCC) might be useful in this context. Our main hypothesis is that four-factor PCC in addition to a massive transfusion protocol decreases blood product consumption at day 1 in severe trauma patients with major bleeding.MethodsThis is a prospective, randomized, multicenter, double-blind, parallel, controlled superiority trial. Eligible patients are trauma patients with major bleeding admitted to a French level-I trauma center. Patients randomized in the treatment arm receive 1 mL/kg (25 IU/ml of Factor IX/Kg) four-factor PCC within 1-h post-admission while patients randomized in the controlled group receive 1 mL/kg of saline solution 0.9% as a placebo. Treatments are given as soon as possible using syringe pumps (120 mL/h). The primary endpoint is the amount of blood products transfused in the first 24 h post-admission (including red blood cells, frozen fresh plasma, and platelets). The secondary endpoints are the amount of each blood product transfused in the first 24 h, time to achieve prothrombin time ratio < 1.5, time to hemostasis, number of thrombo-embolic events at 28 days, mortality at 24 h and 28 days, number of intensive care unit-free days, number of ventilator-free days, number of hospital-free days within the first 28 days, hospitalization status at day 28, Glasgow outcome scale extended for patients with brain lesions on initial cerebral imaging, and cost of each strategy at days 8 and 28. Inclusions have started in December 2017 and are expected to be complete by June 2021.DiscussionIf PCC reduces total blood consumption at day 1 after severe trauma, this therapy, in adjunction to a classic massive transfusion protocol, may be used empirically on admission in patients at risk of massive transfusion to enhance coagulation. Moreover, this treatment may decrease blood product-related complications and may improve clinical outcomes after post-traumatic hemorrhage.Trial registrationClinicalTrials.govNCT03218722. Registered on July 14, 2017
Published: 2021

65. Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated

Author: Olivier Mimoz, Benoit Veber, Matthieu Boisson, Dominique Falcon, Carole Ichai, Claire-Marie Drevet, Lilit Kelesyan, Thiên-Nga Chamaraux-Tran, Laurent Muler, Julien Pottecher, Marc Leone, Abdelouaid Nadji, Hervé Quintard, Claire Dahyot-Fizelier, Belaid Bouhemad, Nicolas Marjanovic, Sigismond Lasocki, Claire Roger, Thomas Kerforne, Jean-Yves Lefrant, Catherine Paugam-Burtz, Marc Ginet, Antoine Roquilly, Elodie Caumon, Emmanuelle Hammad, Florian Grimaldi, Pierre-Olivier Ludes, Jérémy Guenezan, Arnaud Foucrier, Sébastien Leduc, Guillaume Besch, Sabrina Seguin, Russell Chabanne, Karim Asehnoune, Philippe Gouin, Pierre-Gildas Guitard, Denis Frasca, Maxime Léger, Sebastien Pili-Floury, Raphaël Cinotti, Marie-Héléne Po, Joe de Keizer, Soizic Gergaud, Thomas Gaillard, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Département d'Anesthésie et Réanimation [Hôpital Beaujon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'Anesthésie-Réanimation [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Universitaire de Nice (CHU Nice), 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], Hôpital de Hautepierre [Strasbourg], Université de Strasbourg - Faculté de Médecine [Strabourg] (FMTS), Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts (IMAGINE), Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire [Grenoble] (CHU), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Clermont-Ferrand, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), AGATE Study Group: Guillaume Besch, Bélaid Bouhemad, Elodie Caumon, Thien-Nga Chamaraux-Tran, Raphael Cinotti, Thomas Gaillard, Soizic Gergaud, Marc Ginet, Philippe Gouin, Florian Grimaldi, Pierre-Gildas Guitard, Emmanuelle Hammad, Lilit Kelesyan, Sébastien Leduc, Maxime Leger, Pierre-Olivier Ludes, Laurent Muler, Abdelouaid Nadji, Catherine Paugam-Burtz, Marie-Héléne Po, Hervé Quintard, Claire Roger, Antoine Roquilly, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Chauzy, Alexia, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Critical Care and Intensive Care Medicine, Tracheal tube, 03 medical and health sciences, 0302 clinical medicine, Intensive care, ventilator-associated, medicine, pneumonia, 030212 general & internal medicine, education, intensive care, Mechanical ventilation, education.field_of_study, business.industry, Tracheal intubation, Ventilator-associated pneumonia, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, infection, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, 030228 respiratory system, Anesthesia, Cuff, tracheal cuff pressure, Injury Severity Score, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Background: Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination.Research question: Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma?Study design and methods: In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age ≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for ≥ 48 h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants.Results: A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71). No serious adverse events related to the use of the pneumatic device were noted.Interpretation: Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma.Clinical trial registration: ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.
Published: 2021
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66. Opération Code Bleu : mettons en place un numéro d’appel unique (2222) pour les urgences vitales intra-hospitalières !

Author: Pierre Carli, David K. Whitaker, Frédéric Adnet, Alain Mercat, Pierre Pasquier, Julien Pottecher, and Alain Cariou
Subjects: Emergency Medicine, Emergency Nursing
Abstract: La survenue d’un arrêt cardiaque intra-hospitalier, quiconstitue la forme la plus extrême de l’urgence vitaleintra-hospitalière (UVIH), constitue un évènementindésirable majeur qui concerne environ 1 à 5 patientspour 1000 admissions. Le pronostic de ces victimesest étroitement dépendant de la mise en œuvre d’unechaîne de survie intra-hospitalière efficace, dont l’élémentle plus important est le déclenchement immédiat dessecours. Chaque minute compte : tout retard engendrénotamment par une incertitude ou une hésitation surle système d’alerte diminue les chances de survie etaugmente les risques de séquelles.
Published: 2020
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67. Vascular endothelial growth factor D is a biomarker of fluid overload in haemodialysis patients

Author: Kerem Gerritsen, Andrew Davenport, Malha Sadoune, Pietro E. Cippà, Mattia Arrigo, Julien Pottecher, Seraina von Moos, Frank Ruschitzka, Stephan Segerer, Alexandre Mebazaa, and University of Zurich
Subjects: 0301 basic medicine, medicine.medical_specialty, medicine.drug_class, Vascular Endothelial Growth Factor D, Water-Electrolyte Imbalance, 610 Medicine & health, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Natriuretic peptide, Humans, Epidermal growth factor receptor, Transplantation, biology, business.industry, Leptin, Prognosis, Brain natriuretic peptide, Survival Rate, 030104 developmental biology, Endocrinology, Vascular endothelial growth factor C, Cardiovascular Diseases, Nephrology, 10209 Clinic for Cardiology, biology.protein, Kidney Failure, Chronic, Biomarker (medicine), GDF15, business, Biomarkers
Abstract: Background Improved understanding and assessment of the complex physiology of volume regulation in haemodialysis (HD) patients are required to improve patient care and reduce mortality associated with fluid overload (FO). Methods We searched for FO-related biomarkers among 184 peptides associated with cardiovascular disease in a cohort of 30 HD patients. First, we assessed the direct impact of HD on the peptides of interest by comparing plasma concentrations before and after treatment. Then, we compared cardiovascular peptide profiles between patients with and without FO as defined by bioimpedance analysis (BIA). The plasma concentration of selected candidate biomarkers for FO was determined by enzyme-linked immunosorbent assay (ELISA) and correlated with previously described FO-related clinical and laboratory parameters. For validation, results were confirmed in an independent cohort of 144 HD patients. Results We found seven peptides positively [NT-proBNP, B-type natriuretic peptide (BNP), vascular endothelial growth factor D (VEGFD), tumour necrosis factor-related apoptosis-inducing ligand receptor 2, growth differentiation factor 15, tumour necrosis factor ligand superfamily member 13B, chitinase-3-like protein 1] and five negatively (leptin, renin, epidermal growth factor receptor, interleukin-1 receptor antagonist, myeloblastin) correlated to FO. In addition to natriuretic peptides, VEGFD emerged as third peptide highly correlated with BIA (ρ = 0.619, P Conclusion VEGFD is a novel FO-related biomarker with unique diagnostic and prognostic properties.
Published: 2020
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68. Urgence vitale intra-hospitalière : état des lieux en 2018

Author: Pierre Bouzat, Laurent Ducros, Guillaume Bouhours, Delphine Garigue, Julien Pottecher, Bertrand Prunet, Sébastien Perbet, Fabrice Cook, Claire Roger, Tobias Gauss, Antoine Lamblin, Pierre Michelet, Xavier Bobbia, and Romain Jouffroy
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology
Abstract: Resume Objectif En France, la prise en charge des urgences vitales intra-hospitalieres (UVIH) est peu connue malgre des recommandations d’experts de 2004. Cette etude visait a decrire l’organisation de leur prise en charge dans les hopitaux universitaires (HU). Methodes En 2017, une enquete descriptive, multicentrique, basee sur un questionnaire comportant 27 questions envoye par voie electronique au chef de service d’anesthesie reanimation a ete conduite. Resultats Trente-huit (sur 52) reponses (73 %) ont ete recueillies et analysees. La plupart des HU ont declare disposer d’une procedure UVIH : applicable a toutes les UVIH pour 29 (76 %) et uniquement dediee a l’arret cardiaque pour 8 HU (21 %). Un numero de telephone dedie existe dans 35 HU (92 %). L’interlocuteur est principalement le SAMU pour 11 (29 %), les urgences pour 6 (16 %) et la reanimation pour 5 HU (13 %). L’interlocuteur differe selon l’heure et/ou le service demandeur pour 22 HU (58 %). L’intervention de l’equipe de reponse aux urgences vitales intra-hospitalieres (ERUVIH) est realisee exclusivement par l’equipe des urgences dans 6 (16 %), de reanimation dans 5 (13 %) et variable dans 26 HU (74 %). L’ERUVIH est composee d’un medecin senior dans 36 (95 %), d’un interne dans 30 (79 %), d’un infirmier dans 32 (84 %) et d’un aide-soignant dans 16 HU (42 %). Conclusion Une procedure UVIH et un numero de telephone dedie existent dans la majorite des HU francais. Alors qu’un medecin senior est implique dans la plupart des ERUVIH, de grandes disparites subsistent dans la constitution de cette derniere entre les urgences, l’anesthesie reanimation et la reanimation.
Published: 2019
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69. Critical airway management in the intensive care unit: homogeneity in practice?

Author: Gordon Lyons, Andy Higgs, Hervé Quintard, and Julien Pottecher
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, law, business.industry, Homogeneity (statistics), medicine.medical_treatment, medicine, Airway management, Intensive care medicine, business, Intensive care unit, law.invention
Published: 2019
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70. A multifaceted approach to intensive care unit capacity

Author: Aamer Ahmed, Gilles Orliaguet, Franck Verdonk, Kai Zacharowski, Julien Pottecher, Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Goethe-Universität Frankfurt am Main, University Hospitals Leicester, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Hôpital de Hautepierre [Strasbourg]
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), [SDV]Life Sciences [q-bio], Public Health, Environmental and Occupational Health, Articles, Length of Stay, 030204 cardiovascular system & hematology, medicine.disease, Intensive care unit, law.invention, Intensive Care Units, 03 medical and health sciences, 0302 clinical medicine, Geography, law, Correspondence, medicine, Humans, 030212 general & internal medicine, Medical emergency, ComputingMilieux_MISCELLANEOUS
Abstract: Background The objective of this study was to better understand the factors associated with the heterogeneity of in-hospital COVID-19 morbidity and mortality across France, one of the countries most affected by COVID-19 in the early months of the pandemic. Methods This geo-epidemiological analysis was based on data publicly available on government and administration websites for the 96 administrative departments of metropolitan France between March 19 and May 11, 2020, including Public Health France, the Regional Health Agencies, the French national statistics institute, and the Ministry of Health. Using hierarchical ascendant classification on principal component analysis of multidimensional variables, and multivariate analyses with generalised additive models, we assessed the associations between several factors (spatiotemporal spread of the epidemic between Feb 7 and March 17, 2020, the national lockdown, demographic population structure, baseline intensive care capacities, baseline population health and health-care services, new chloroquine and hydroxychloroquine dispensations, economic indicators, degree of urbanisation, and climate profile) and in-hospital COVID-19 incidence, mortality, and case fatality rates. Incidence rate was defined as the cumulative number of in-hospital COVID-19 cases per 100 000 inhabitants, mortality rate as the cumulative number of in-hospital COVID-19 deaths per 100 000, and case fatality rate as the cumulative number of in-hospital COVID-19 deaths per cumulative number of in-hospital COVID-19 cases. Findings From March 19 to May 11, 2020, hospitals in metropolitan France notified a total of 100 988 COVID-19 cases, including 16 597 people who were admitted to intensive care and 17 062 deaths. There was an overall cumulative in-hospital incidence rate of 155·6 cases per 100 000 inhabitants (range 19·4–489·5), in-hospital mortality rate of 26·3 deaths per 100 000 (1·1–119·2), and in-hospital case fatality rate of 16·9% (4·8–26·2). We found clear spatial heterogeneity of in-hospital COVID-19 incidence and mortality rates, following the spread of the epidemic. After multivariate adjustment, the delay between the first COVID-19-associated death and the onset of the national lockdown was positively associated with in-hospital incidence (adjusted standardised incidence ratio 1·02, 95% CI 1·01–1·04), mortality (adjusted standardised mortality ratio 1·04, 1·02–1·06), and case fatality rates (adjusted standardised fatality ratio 1·01, 1·01–1·02). Mortality and case fatality rates were higher in departments with older populations (adjusted standardised ratio for populations with a high proportion older than aged >85 years 2·17 [95% CI 1·20–3·90] for mortality and 1·43 [1·08–1·88] for case fatality rate). Mortality rate was also associated with incidence rate (1·0004, 1·0002–1·001), but mortality and case fatality rates did not appear to be associated with baseline intensive care capacities. We found no association between climate and in-hospital COVID-19 incidence, or between economic indicators and in-hospital COVID-19 incidence or mortality rates. Interpretation This ecological study highlights the impact of the epidemic spread, national lockdown, and reactive adaptation of intensive care capacities on the spatial distribution of COVID-19 morbidity and mortality. It provides information for future geo-epidemiological analyses and has implications for preparedness and response policies to current and future epidemic waves in France and elsewhere. Funding None.
Published: 2021
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71. Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients

Author: Samir, Jaber, Amélie, Rollé, Thomas, Godet, Nicolas, Terzi, Béatrice, Riu, Pierre, Asfar, Jeremy, Bourenne, Séverin, Ramin, Virginie, Lemiale, Jean-Pierre, Quenot, Christophe, Guitton, Eloi, Prudhomme, Cyril, Quemeneur, Raiko, Blondonnet, Mathieu, Biais, Laurent, Muller, Alexandre, Ouattara, Martine, Ferrandiere, Piehr, Saint-Léger, Thomas, Rimmelé, Julien, Pottecher, Gerald, Chanques, Fouad, Belafia, Claire, Chauveton, Helena, Huguet, Karim, Asehnoune, Emmanuel, Futier, Elie, Azoulay, Nicolas, Molinari, Audrey, De Jong, and Jean, Dellamonica
Subjects: Adult, Intensive Care Units, Critical Illness, Intubation, Intratracheal, Humans
Abstract: The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.A total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, - 1.5; 95%CI - 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83-1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, - 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59-2.06. P = 0.76).Among critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.
Published: 2021

72. Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

Author: Mathieu Vautier, Florence Tubach, Marion Licois, Estelle Henry, Marie-Alexandra Alyanakian, Julien Poissy, Solaya Chalal, Anne Gysembergh-Houal, Stéphanie Alary, Sophie Diemunsch, Jonathan London, Camille Petit-Hoang, Ruben Benainous, Catherine Metzger, Olivier Benveniste, Hala Semri, Charléne Jouve, Robin Dhote, johann Cailhol, Elise Morawiec, Kristina Beziriganyan, Mathieu Oberlin, Paul Legendre, Hélène François, Claire Davoine, F Louni, Myriam Virlouvet, Stéphane Renaud, Christiane Verny, Bertrand Guidet, Bob Heger, Lara Zafrani, Pierre-Louis Tharaux, Mandy Nizard, Adrien Contejean, Segolene Toquet, Ulrich Clarac, Sylviane Ravato, Gaëtan Deslée, Frédéric De Blay, Christian Richard, Raphaël Porcher, Malikhone Chansombat, Marie Lachatre, Ines Ben-Mabrouk, Matthieu Uzzan, Lauren Demerville, Amélie Servettaz, Annabelle Pourbaix, Philippe Manivet, Fanny Charbonnier, Pierre-Grégoire Guinot, Alexandre Demoule, Nicolas Champtiaux, Nicolas Belaube, Jean-Pierre Riveline, Kamil Chitour, Joseph Emmerich, Arthur Neuschwander, Mickael Henriques, Anne Hutt, Arthur Pavot, Anne Rachline, Elena Fois, Audrey Phibel, Xavier Monnet, Jean-Charles Duclos-Vallée, Félix Ackermann, Maria Pereira, Anne Sophie Korganow, Elodie Drouet, Tabassome Simon, Morgane Faure, Anne Pattyn, Aida Zahrate-Ghoul, Karine Martin, Jean-Jacques Tudesq, Gladys Aratus, Kévin Cardet, Julien Pottecher, Eric Demonsant, Arsène Mekinian, Rémy Gauzit, Julie Smati, Robin Deleris, Jean-Simon Rech, Boris Bienvenu, Nicolas Lefebvre, Elodie Baudry, Nicolas Bonnet, Alexis Régent, François Weill, Lalia Djaghout, Anne Tréhan, Isabelle Lehir, Elena Kiouris, Sophie Renet, Yasmina Mekid, Vanessa Rathouin, David Montani, Annick Tibi, Anne Blanchard, Fanette Denies, Nathalie Menage, Guillaume Becker, Valérie Camara-Clayette, Loic Kassegne, Nathalie Chavarot, Aurélie Clan Hew Wai, Jeremy Arzoine, Louise Bondeelle, Mohamad Zaidan, S Lariven, Laurent Cylly, Edouard Flamarion, Chaouki Bouras, Florence Bellenfant, Melissa Clément, Lola-Jade Palmieri, Marie hélène Pari, Lionel Galicier, Valérie Dejean, Delphine Feyeux, Naima Sguiouar, Anne Bergeron, Laurence Annonay, Anouk Walter-Petrich, Camille Knosp, Laurence Drouard, Thiziri Sadaoui, Julie Delemazure, Antoine Parrot, Carole Burger, Laurence Berard, Nicolas Gambier, Eric Marquis, Isabelle Madeleine, Gwenaël Lorillon, Matthieu Resche-Rigon, Yves Hansmann, Claire Rouzaud, Hélène Gros, Sophie Caillat-Zucman, Bernard Cholley, Celine Wilpotte, Chistophe Willekens, Lydia Suarez, Syllia Belazouz, Valérie Pourchet-Martinez, Dhiaa Meriem Hai, Olivier Collange, Paul Jaubert, Marie-Thérèse Tremorin, Nathalie Marin, Diane Le Pluart, Madona Sakkal, Juliette Djadi-Prat, Alexandre Morel, Agathe Bounhiol, Xavier Jaïs, Nicolas Meyer, Vixra Keo, Michaël Darmont, Benedicte Giroux-Leprieur, Anatole Harrois, Anne Adda, Yaël Amara, Fanny Pommeret, Antony Canellas, Matheus Vieira, Clotilde Le Tiec Le Tiec, Corinne Pernot, Bernard Goichot, Céline Louapre, Roza Rahli, Anne Jacolot, Anne Daguenel-Nguyen, Marie Dubert, Anaïs Razurel, Aurelie Sautereau, Mitja Jevnikar, Pierre Faye, Jeanne CHAUFFiER, Mathieu Jozwiak, Laurent Savale, Florence Patin, Kahina Cheref, Mélanie Dehais, Paul Michel Mertes, Caroline Morbieu, Valérie Paquet, Dominique Roulot, Giovanna Melica, Pauline Jouany, Frédéric Schlemmer, Blandine Lehmann, Pascal Martel, Tomas Urbina, Yazdan Yazdanpanah, Veronique Joly, Damien Bergerot, Claire Courtin, Benjamin Fournier, Guillaume Grailles, Asmaa Mamoune, Caroline Gaudefroy, Charlotte Kaeuffer, Bruno Crestani, Thinhinane Bariz, C Rioux, Karine Celli Lebras, Sophie Granville, Marion Bouhris, Hugues Cordel, Jean-Marie Michot, Mohamed Belloul, Nadège Lemarié, Philippe Dieudé, Sylvie Le Gac, Matthieu Mahévas, Pascal Richette, Anaïs Codorniu, Camille Rolland-Debord, Edouard Lefèvre, Sophie-Rym Hamada, Tristan Martin, Vincent Castelain, Aude Rigolet, Valentin Greigert, Gaelle Leroux, Simon Valayer, Eliane Bertrand, Eric Vicaut, Stéphane Brin, Jacques-Eric Gottenberg, Olivier Clovet, Marc Bardou, Muriel Fartoukh, Valentina Isernia, Ada Clarke, Bao Phung, Grégoire Martin de Frémont, Jeanne Meunier, Gonçalo Boleto, David Lebeaux, Hassan Tarhini, Asmaa Mabrouki, Pascaline Choinier, Etienne Canouï, Eric D'Ortenzio, Constance Guillaud, Corine Nyanou, Alexandre Moores, Linda Gimeno, Victoire De Lastours, F-Xavier Lescure, Claire Montlahuc, Sophie Georgin-Lavialle, A Soria, Xavier Mariette, Sophie Ismael, Prissile Bakouboula, Olivier Lambotte, Jérémie Zerbit, Aude Jacob, Z Julia, Nathalie Dournon, Marthe Rigal, Mireille Adda, Nathan Ebstein, Frédéric Duée, Helene Chambrin-Lauvray, Ramdane Meftali, Hélène Lafoeste, Coralie Bloch Queyrat, Sabrina Brahmi, Catherine Le Bourlout, Nicolas Noel, Emmanuelle Guillot, Hakim Tayebi, Sandrine Briois, Anne-Lise Pouliquen, Lakhdar Mameri, Sophie-Caroline Sacleux, Nathalie Rozensztajn, Lelia Escaut, Clément Jourdaine, Cédric Pierron, Marc Garnier, Yves Cohen, Abdellatif Tazi, Maxence Decavele, Paul Henri Grisot, Patrice Cacoub, Laure Allanic, Amira Benattia, Martin Siguier, Luca Semerano, Jean-Sébastien Hulot, Jean-Jacques Mourad, Sara Sambin, Miguel Alejandro Vasquez-Ibarra, Nabil Raked, Christine Lemagner, Martin Dres, Clara Campos-Vega, Tali-Anne Szwebel, Benjamin Chaigne, Emmanuel Andrès, Gabriel Steg, Frédéric Blanc, Isabelle Peigney, Catherine Fauvaux, Côme Bureau, Samira Saleh-Mghir, Julie Jambon, Pierre Dupland, Anne Lise Jegu, Mamadou Salif Cisse, Damien Roux, Moez Jallouli, Philippe Blanche, Sébastien Cavelot, Sophie Ohlmann-Caillard, Louise-Laure Mariani, Adrien Michon, Alain Wynckel, Saskia Flamand, Safaa Nemlaghi, Benjamin G. Chousterman, Geoffroy Volle, Cécile Kedzia, Fanny Domont, Lee S. Nguyen, Férial Berbour, Pierre Diemunsch, Celine Dupré, Etienne Lengliné, Claire Tantet, Gaël Leprun, Sara Virolle, Perrine Guillaume-Jugnot, Soumeya Hammal, B. Duchemann, Mathilde Le Marchand, Vincent Poindron, Victor Lancon, Ruxandra Burlacu, Guillaume Lefèvre, Kamyl Baghli, Emilia Stan, Yann Nguyen, Olivier Sanchez, Olivier Sitbon, Loren Soyez-Herkert, Fanny Defrancq, Véronique Vigna, Aurélien Guffroy, Martine Meunier, Pierre Mora, Léa Resmini, Liem Binh Luong Nguyen, Jean-Luc Diehl, Johanna Oziel, Emmanuelle Bugnet, Lamiae Grimaldi, Olivia Daconceicao, Marie Matignon, Mourad Djadel, Yasmine Messaoudi, Hassan Joumaa, Isabelle Dusanter, Sarah Benghanem, Julien Mayaux, Marc Michel, Claire Pernin, Antoine Gros, Nassim Mahtal, Philippe Benoit, Cloé Comarmond, Laurence Lecomte, Patricia Senet, Sebastien Abad, Jérôme Pacanowski, Céline Leplay, Claire Aguilar, Cédric Sublon, Jesuthasan Denis, Régis Peffault de Latour, Gabrielle Archer, Alain Fourreau, Emmanuelle Blin, Lise Bernard, Alexandra Beurton, Alexandre Buffet, Pierre Le Guen, Clairelyne Dupin, Olivier Fain, A Gervais, Marc Humbert, Yves Allenbach, Alexandre Bourgoin, Agnes Maurer, Eric Noll, Virginie Elisee, Adrien Mirouse, Cecile Larcheveque, Carine Karachi, Samy Figueiredo, Hakim Meddah, Greggory Ducrocq, Jeanne Goupil de Bouille, Awa Ndiaye, Jessica Krause le Garrec, Maxime Dougados, Yasmina Ferfar, Damien Vimpere, Olivier Olivier, Annabelle Stoclin, Jean-Louis Teboul, Ridha Belilita, Serge Bureau, Naura Gamany, Emeline Colomba, Baptiste Duceau, Philippe Ravaud, Corinne Guerin, Florence Morin, Pélagie Thibaut, Younes Keroumi, Julie Chas, Elisabeth Coupez, Laetitia Languille, Mathias Cornic, Jean-Michel Molina, Caroline Pradon, Alison Klasen, Zakaria Ait Hamou, Armand Mekontso-Dessaps, Yurdagul Uzunhan, Samir Hamiria, Anne Godier, Elsa Feredj, Nessima Yelles, Jean-Benoit Arlet, Christine Broissand, Belkacem Asselate, Jaouad Benhida, Julien Le Marec, Nawal Derridj, Laurène Deconinck, A. Dossier, Eric Oksenhendler, Eva Chatron, Lucie Aunay, Candice Estellat, Julie Fillon, Marie Antignac, Jade Ghosn, Ilias Koumis, David Schmitz, Domitille Molinari, Soraya Fellahi, Bruno Mégarbane, Aline Frazier, Ramon Junquera, Vincent Provitolo, Marie Lecronier, Dimitri Fremont, Pierrick Le Borgne, Emmanuel Weiss, Faouzi Saliba, Stéphan Pavy, Geoffrey Rossi, Chloe McAvoy, Eric Mariotte, Dorothee Vallois, Sabrine Ouamri, Pierre Tissieres, Luc Mouthon, Blandine Denis, Celine Comparon, Emmanuelle Sacco, Frédéric Pène, Marjolaine Morgand, Vasco Honsel, Laure Choupeaux, Bruno Mourvillier, Ewa Kozaliewicz, Marie-Hélène Legros, Isabelle Debrix, Gabriel Nisand, Julien Chabert, Juliette Camuset, Stéphane Jauréguiberry, Lynda Chalal, Marine Livrozet, Lucie Biard, Elodie Perrodeau, Brigitte Sabatier, Raphael Borie, Rosa Da Silva, Nathalie Costedoat-Chalumeau, Emmanuel Chatelus, Jean-Christophe Corvol, Nathalie De Castro, David Boutboul, Benjamin Planquette, Anne Claire Desbois, François Danion, Brigitte Ranque, Amélie Cransac, Marine Nadal, Coralie Gernez, Yacine Boudali, Claire Madelaine, Georgina Maalouf, Jonathan Marey, Sophie Bayer, Antoine Fayol, Souad Benarab, Luc Haudebourg, Sophie Bulifon, Claire Pacheco, Philippe Durand, Olivier Hermine, Fanny Alby-Laurent, Geoffroy Liégeon, Axelle Fuentes, Jean-Daniel Lelievre, Gilles Garcia, Céline Verstuyft Verstuyft, Marie-Aude Penet, Constance Delaugerre, Nicolas Carlier, Aurélie Durel Maurisse, Gilles Pialoux, Zeina Louis, Marion Parisey, Pascal Lim, Gaelle Clavere, Martin De Sarcus, Marie Vayssettes, Thomas Papo, Adrien Joseph, Hilario Nunes, Hanane Fodil, Solen Kernéis, Antoine Bachelard, Jacques Duranteau, Karine Lacombe, Olivia Lenoir, Mathilde Vallet, Isabelle Brindele, Robin Charreteur, Elie Azoulay, Dorothée Chopin, Aïcha Bah, Moustafa Benafla, Marie Gilbert, Matthieu Lemoine, Abolfazl Mohebbi, Mathilde Noaillon, Amina Kebir, Virginie Zarrouk, Cécile Yelnik, Benjamin Terrier, Solène Fabre, Paul Crespin, Sarah Dalibey, Thierno Dieye, Renaud Felten, Oriane Puéchal, Pernelle Vauboin, Caroline Hauw-Berlemont, Gabriel Baron, Paul Vermes, Yvon Ruch, Dominique Dautel, Tassadit Hadjam, Anne-Marie Roques, Jean-Philippe Bastard, Younes El Amine, Damien Sène, Alaki Thiemele, Catherine Boussard, Vincent Fallet, Timothee Bironne, Damien Vanhoye, Guillaume Geri, Amine Ghembaza, Bertrand Dunogue, Nadia Anguel, Laure Berton, Caroline Semaille, Thomas Volpe, Jacques Cadranel, Thomas Gorget, Julien Saussereau, Elodie Issorat, Sami Kolta, Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Cité (UPCité), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Centre de recherche en Myologie – U974 SU-INSERM, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and Porcher, Raphaël
Subjects: Male, medicine.medical_treatment, [SDV]Life Sciences [q-bio], [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 0302 clinical medicine, Randomized controlled trial, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, law, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, education.field_of_study, Hazard ratio, Articles, Middle Aged, Intensive care unit, Hospitals, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Hospitalization, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Treatment Outcome, [SDV.TOX]Life Sciences [q-bio]/Toxicology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, France, medicine.drug, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, Population, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, education, Critical Care Outcomes, Aged, Mechanical ventilation, Anakinra, SARS-CoV-2, business.industry, Comment, COVID-19, Bayes Theorem, Pneumonia, medicine.disease, Respiration, Artificial, COVID-19 Drug Treatment, Clinical trial, Interleukin 1 Receptor Antagonist Protein, 030228 respiratory system, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, business, Interleukin-1
Abstract: International audience; Background: Patients with COVID-19 pneumonia have an excess of inflammation and increased concentrations of cytokines including interleukin-1 (IL-1). We aimed to determine whether anakinra, a recombinant human IL-1 receptor antagonist, could improve outcomes in patients in hospital with mild-to-moderate COVID-19 pneumonia.Methods: In this multicentre, open-label, Bayesian randomised clinical trial (CORIMUNO-ANA-1), nested within the CORIMUNO-19 cohort, we recruited patients from 16 University hospitals in France with mild-to-moderate COVID-19 pneumonia, severe acute respiratory syndrome coronavirus 2 infection confirmed by real-time RT-PCR, requiring at least 3 L/min of oxygen by mask or nasal cannula but without ventilation assistance, a score of 5 on the WHO Clinical Progression Scale (WHO-CPS), and a C-reactive protein serum concentration of more than 25 mg/L not requiring admission to the intensive care unit at admission to hospital. Eligible patients were randomly assigned (1:1) using a web-based secure centralised system, stratified by centre and blocked with varying block sizes (randomly of size two or four), to either usual care plus anakinra (200 mg twice a day on days 1-3, 100 mg twice on day 4, 100 mg once on day 5) or usual care alone. Usual care was provided at the discretion of the site clinicians. The two coprimary outcomes were the proportion of patients who had died or needed non-invasive or mechanical ventilation by day 4 (ie, a score of >5 on the WHO-CPS) and survival without need for mechanical or non-invasive ventilation (including high-flow oxygen) at day 14. All analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT04341584, and is now closed to accrual.Findings: Between April 8 and April 26, 2020, we screened 153 patients. The study was stopped early following the recommendation of the data and safety monitoring board, after the recruitment of 116 patients: 59 were assigned to the anakinra group, and 57 were assigned to the usual care group. Two patients in the usual care group withdrew consent and were not analysed. In the analysable population, the median age was 66 years (IQR 59 to 76) and 80 (70%) participants were men. In the anakinra group, 21 (36%) of 59 patients had a WHO-CPS score of more than 5 at day 4 versus 21 (38%) of 55 in the usual care group (median posterior absolute risk difference [ARD] -2·5%, 90% credible interval [CrI] -17·1 to 12·0), with a posterior probability of ARD of less than 0 (ie, anakinra better than usual care) of 61·2%. At day 14, 28 (47%; 95% CI 33 to 59) patients in the anakinra group and 28 (51%; 95% CI 36 to 62) in the usual care group needed ventilation or died, with a posterior probability of any efficacy of anakinra (hazard ratio [HR] being less than 1) of 54·5% (median posterior HR 0·97; 90% CrI 0·62 to 1·52). At day 90, 16 (27%) patients in the anakinra group and 15 (27%) in the usual care group had died. Serious adverse events occurred in 27 (46%) patients in the anakinra group and 21 (38%) in the usual care group (p=0·45).Interpretation: Anakinra did not improve outcomes in patients with mild-to-moderate COVID-19 pneumonia. Further studies are needed to assess the efficacy of anakinra in other selected groups of patients with more severe COVID-19.Funding: The Ministry of Health, Programme Hospitalier de Recherche Clinique, Foundation for Medical Research, and AP-HP Foundation.
Published: 2021
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73. Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis

Author: Benjamin Gory, Alain Meyer, Romain Tonnelet, Ioan Martin, Sébastien Richard, Rémy Beaujeux, Dan Mihoc, Julien Pottecher, Mihaela Simu, Liang Liao, Anne-Laure Derelle, Emmanuel Happi Ngankou, François Severac, Valérie Wolff, François Zhu, Monica Manisor, Gérard Audibert, Serge Bracard, Roxana Gheoca, Salvatore Chibbaro, Raoul Pop, Oana Harsan, René Anxionnat, L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Victor Babeş University of Medicine and Pharmacy (UMFT), Service de Neurologie [Strasbourg], CHU Strasbourg-Hopital Civil, CHU Strasbourg, Faculté de Médecine [Nancy], Université de Lorraine (UL), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de neurologie [CHRU Nancy], Service de radiologie [Strasbourg], and CHU Strasbourg-Hôpital de Hautepierre [Strasbourg]
Subjects: Male, medicine.medical_treatment, Ischemia, Conscious Sedation, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Anesthesia, General, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Local anesthesia, Prospective Studies, Propensity Score, Stroke, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Endovascular Procedures, General Medicine, Thrombolysis, Middle Aged, medicine.disease, 3. Good health, Treatment Outcome, Anesthesia, Propensity score matching, Anesthetic, Surgery, Female, Neurology (clinical), business, Complication, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug, Anesthesia, Local
Abstract: BackgroundTo date, the choice of optimal anesthetic management during endovascular therapy (EVT) of acute ischemic stroke patients remains subject to debate. We aimed to compare functional outcomes and complication rates of EVT according to the first-line anesthetic management in two comprehensive stroke centers: local anesthesia (LA) versus general anesthesia (GA).MethodsRetrospective analysis of prospectively collected databases, identifying all consecutive EVT for strokes in the anterior circulation performed between January 1, 2018 and December 31, 2018 in two EVT-capable stroke centers. One center performed EVT under LA in the first intention, while the other center systematically used GA. Using propensity score analysis, the two groups underwent 1:1 matching, then procedural metrics, complications, and clinical outcomes were compared. Good outcome was defined as 90 days modified Rankin Scale (mRS) ≤2, and successful recanalization as modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3.ResultsDuring the study period, 219 patients were treated in the LA center and 142 in the GA center. Using the propensity score, 97 patients from each center were matched 1:1 according to the baseline characteristics. Local anesthesia was associated with a significantly lower proportion of good outcome (36.1% vs 52.0%, OR 0.53, 95% CI 0.33 to 0.87; p=0.039), lower rate of successful recanalization (70.1% vs 95.8%, OR 0.13, 95% CI 0.04 to 0.39; pConclusionsIn this study, systematic use of GA for stroke EVT was associated with better clinical outcomes, higher recanalization rates, and fewer procedural complications compared with patients treated under LA as the primary anesthetic approach.
Published: 2021
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74. A novel, automated, quantification of abnormal lung parenchyma in patients with COVID-19 infection: Initial description of feasibility and association with clinical outcome

Author: Luc Soler, Julien Pottecher, Nicolas Meyer, Francis Veillon, Francis Schneider, Bernard Goichot, Elliott Bennett-Guerrero, Eric Noll, Pierre Diemunsch, Mickaël Ohana, Pierre-Olivier Ludes, Hôpital de Hautepierre [Strasbourg], CHU Strasbourg, Nouvel Hôpital Civil de Strasbourg, Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-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)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), Laboratoire de pharmacologie et de toxicologie neurocardiovasculaire (LPTNC), Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et nanosciences d'Alsace (FMNGE), and Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-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)
Subjects: Male, ARDS, Time Factors, Supine position, Intraclass correlation, Critical Care and Intensive Care Medicine, computer.software_genre, Severity of Illness Index, Severity assessment, Automation, 0302 clinical medicine, Voxel, Supine Position, Medicine, Lung volumes, 030212 general & internal medicine, Lung, Infectious disease, General Medicine, Middle Aged, 3. Good health, Treatment Outcome, medicine.anatomical_structure, Original Article, Female, Lung Volume Measurements, Algorithms, 03 medical and health sciences, Severity of illness, Humans, Retrospective Studies, business.industry, Reproducibility of Results, COVID-19, 030208 emergency & critical care medicine, Retrospective cohort study, CT-scan, Triage, medicine.disease, Anesthesiology and Pain Medicine, Feasibility Studies, Tomography, X-Ray Computed, business, Nuclear medicine, computer, Software, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Objective: Ground-glass opacities are the most frequent radiologic features of COVID-19 patients. We aimed to determine the feasibility of automated lung volume measurements, including ground-glass volumes, on the CT of suspected COVID-19 patients. Our goal was to create an automated and quantitative measure of ground-glass opacities from lung CT images that could be used clinically for diagnosis, triage and research. Design: Single centre, retrospective, observational study. Measurements: Demographic data, respiratory support treatment (synthetised in the maximal respiratory severity score) and CT-images were collected. Volume of abnormal lung parenchyma was measured with conventional semi-automatic software and with a novel automated algorithm based on voxels X-Ray attenuation. We looked for the relationship between the automated and semi-automated evaluations. The association between the ground-glass opacities volume and the maximal respiratory severity score was assessed. Main results: Thirty-seven patients were included in the main outcome analysis. The mean duration of automated and semi-automated volume measurement process were 15 (2) and 93 (41) min, respectively (p=8.05*10-8). The intraclass correlation coefficient between the semi-automated and automated measurement of ground-glass opacities and restricted normally aerated lung were both superior to 0.99. The association between the automated measured lung volume and the maximal clinical severity score was statistically significant for the restricted normally aerated (p=0.0097, effect-size: -385mL) volumes and for the ratio of ground-glass opacities/restricted normally aerated volumes (p=0.027, effect-size: 3.3). Conclusion: The feasibility and preliminary validity of automated impaired lung volume measurements in a high-density COVID-19 cluster was confirmed by our results. Keywords: ARDS; COVID-19; CT-scan; Infectious disease; Severity assessment; Triage.
Published: 2021
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75. Cognitive flowcharts to support the multidisciplinary prehospital and intrahospital care of severe pelvic trauma patients: Strengthening the chain of survival and closing the ring

Author: Julien, Pottecher and Jean-Stéphane, David
Subjects: Emergency Medical Services, Fractures, Bone, Cognition, Anesthesiology and Pain Medicine, Software Design, Humans, General Medicine, Critical Care and Intensive Care Medicine
Published: 2022
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76. Impact of the SARS-COV-2 Outbreak on Epidemiology and Management of Major Trauma in France: Registry-Based Study. The COVITRAUMA Study

Author: Jean-Denis Moyer, Arthur James, Clément Gakuba, Mathieu Boutonnet, Emeline Angles, Emmanuel Rozenberg, Jean Bardon, Thomas Clavier, Vincent Legros, Marie Werner, Quentin Mathais, Veronique Ramonda, Yann Berthelot, Clelia Colas, Pierre Le Minh, Julien Pottecher, and Tobias Gauss
Abstract: BackgroundEvidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. MethodsThis retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers participating to the TraumaBase® registry in France during the first wave of the SARS-CoV-2 pandemic in France. ResultsOver a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Patient demographics changed substantially during the pandemic and more specifically during the lockdown period specially with a reduction in both absolute numbers admitted and the proportion of road traffic accidents (348 annually 2017-2019 [55.4 % of trauma admissions] vs 143 [36.8 %] in 2020 p
Published: 2021
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77. Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients

Author: Jean-Pierre Quenot, Amélie Rollé, Béatrice Riu, Alexandre Ouattara, Emmanuel Futier, Karim Asehnoune, Gerald Chanques, Piehr Saint-Léger, Claire Chauveton, Samir Jaber, Julien Pottecher, Nicolas Terzi, Laurent Muller, Raiko Blondonnet, Severin Ramin, Nicolas Molinari, Audrey De Jong, Christophe Guitton, Martine Ferrandière, Thomas Godet, Fouad Belafia, Mathieu Biais, Elie Azoulay, Helena Huguet, Jeremy Bourenne, Virginie Lemiale, Pierre Asfar, Cyril Quemeneur, Eloi Prud'Homme, Thomas Rimmelé, 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), Centre Hospitalier de Basse-Terre [Guadeloupe], Pôle de Médecine Périopératoire [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU d'Angers [Département Urgences], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Réanimation médico-chirurgicale [CH Le Mans], Centre Hospitalier Le Mans (CH Le Mans), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire (GRC 29 - ARPE), Sorbonne Université (SU), CHU Clermont-Ferrand, Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Université de Bordeaux Ségalen [Bordeaux 2], Unité de réanimation médicale [CHU de Carémeau, Nîmes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Magellan Medico-Surgical Center [Bordeaux], Adaptation cardiovasculaire à l'ischémie, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier [Valenciennes, Nord], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression (PI3), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), Université de Montpellier (UM), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôtel-Dieu de Nantes, and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Complications, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Tracheal tube, Acute respiratory failure, MESH: Intubation, Intratracheal / adverse effects, law.invention, MESH: Critical illness, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Medicine, Intubation, Stylet, Intensive care unit, ComputingMilieux_MISCELLANEOUS, MESH: Humans, business.industry, Tracheal intubation, 030208 emergency & critical care medicine, MESH: Adult, respiratory system, 3. Good health, Airway, Critical care, 030228 respiratory system, Anesthesia, Relative risk, business
Abstract: International audience; Purpose: The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.Methods: In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.Results: A total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, - 1.5; 95%CI - 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83-1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, - 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59-2.06. P = 0.76).Conclusions: Among critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.
Published: 2021
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78. Investigating the real impact of COVID-19 pandemic on the daily neurosurgical practice?

Author: J. Todeschi, François Proust, Charles-Henry Mallereau, Helene Cebula, Mario Ganau, Guillaume Dannhoff, Irène Ollivier, Julien Pottecher, and Salvatore Chibbaro
Subjects: Patient Transfer, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critical Care, Clinical Neurology, Neurosurgery, Neurosurgical Procedures, Surgical practice, 03 medical and health sciences, 0302 clinical medicine, Pandemic, medicine, Humans, Registries, Patient transfer, Pandemics, Retrospective Studies, business.industry, SARS-CoV-2, Gold standard, COVID-19, Retrospective cohort study, Coronavirus, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Emergency medicine, Cohort, Emergency, Surgery, Original Article, Neurology (clinical), Elective Surgical Procedure, business, 030217 neurology & neurosurgery
Abstract: Objective The objective of this study was to relate the neurosurgical activity during a time of sanitary crisis such as experienced during the SARS-CoV-2 pandemic. Methods A monocentric retrospective analysis was made based on a prospectively gathered cohort of all patients requiring neurosurgical care between March 15th and May 12th, 2020. Local impact of SARS-CoV-2 was analysed regarding number of patients admitted in ICU. Results One hundred and sixty patients could benefit from neurosurgical care with a wide-ranging profile of clinical and surgical activities performed during the study that seemed similar to last year profile activity. Surgical indications were restricted to non-deferrable surgeries, leading to a drop in operative volume of 50%. Only 1.3% of patients required transfer to other units due to the impossibility of providing gold standard neurosurgical care in our centre. Conclusion Despite the challenges represented by the SARS-CoV-2 pandemic, it was proven possible to ensure the routine neurosurgical continuity and provide high standards of neurosurgical care without compromising patients’ access to the required treatments.
Published: 2021

79. Theory and practical use of Bayesian methods in interpreting clinical trial data: a narrative review

Author: Pierre Diemunsch, Nicolas Meyer, David Ferreira, Klaus D. Torp, Julien Pottecher, Mael Barthoulot, Service d'anesthésie et soins intensifs [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), 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)-Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, CHU Strasbourg, Mayo Clinic [Jacksonville], CCSD, Accord Elsevier, Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), and Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Consensus, Bayesian methods, Comparative method, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Bayesian probability, clinician, computer.software_genre, 03 medical and health sciences, 0302 clinical medicine, statistical analysis, 030202 anesthesiology, Frequentist inference, Reading (process), frequentist, Medicine, theory, media_common, business.industry, Contrast (statistics), Bayes Theorem, Checklist, 3. Good health, [SDV] Life Sciences [q-bio], Clinical trial, Comprehension, Anesthesiology and Pain Medicine, Critical reading, Artificial intelligence, business, computer, randomised controlled trial, Natural language processing
Abstract: International audience; The critical reading of scientific articles is necessary for the daily practice of evidence-based medicine. Rigorous comprehension of statistical methods is essential, as reflected by the extensive use of statistics in the biomedical literature. In contrast to the customary frequentist approach, which never uses or gives the probability of a hypothesis, Bayesian theory uses probabilities for both hypotheses and data. This statistical approach is increasingly used for analyses of clinical trial data and for applied machine learning. The aim of this review is to compare general Bayesian concepts with frequentist methods to facilitate a better understanding of Bayesian theory for readers who are not familiar with this approach. The review is intended to be used in combination with a checklist we have devised for reading reports analysed by Bayesian methods. We compare and contrast the different approaches of Bayesian vs frequentist statistical methods by considering data from a clinical trial that lends itself to this comparative approach.
Published: 2020
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80. A consensus checklist to help clinicians interpret clinical trial results analysed by Bayesian methods

Author: Pierre Diemunsch, Nicolas Meyer, Mael Barthoulot, Klaus D. Torp, David Ferreira, Julien Pottecher, Service d'anesthésie et soins intensifs [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), 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)-Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), and Institut de Chimie du CNRS (INC)-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)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: medicine.medical_specialty, Consensus, [SDV]Life Sciences [q-bio], Bayesian probability, Context (language use), law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Credible interval, Medicine, Humans, Medical physics, Point estimation, Clinical Trials as Topic, business.industry, Reproducibility of Results, Bayes Theorem, Checklist, 3. Good health, Clinical trial, Anesthesiology and Pain Medicine, Biostatistics, business
Abstract: Introduction In the context of an increasing number of publications of trial data analysed by Bayesian methods, clinicians need support to better understand Bayesian statistical methods. The existing checklists are intended for people who already know these methods. We aimed to establish and validate a checklist that contains a group of items considered crucial in interpreting the results of a phase III RCT analysed with Bayesian methods. Methods A team of biostatisticians created a checklist of previously reported items and additional items identified from a literature review. Using three different articles in three rounds, the items were then validated by residents in anaesthesiology with no skills in statistics. Results Based on an initial item list, three rounds led to a consensus checklist. Eleven items were considered important information to be specified for understanding the validity of the results. Of these, three were considered essential: specification of the prior, source of the prior (when prior is informative), and the effect size point estimate with its credible interval. Conclusion The checklist can help clinicians interpret the results of a phase III randomised clinical trial analysed by Bayesian methods, even clinicians with no particular knowledge of statistics, to ensure that the major elements of the statistical section are present and valid. Care should be taken in interpreting the results of a trial analysed by Bayesian methods that are not reported with these three essential items because the validity of the results cannot be established.
Published: 2020
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81. Organisation d’un détachement pour renfort médical en situation de crise sanitaire lors de la pandémie COVID-19 : retour sur une collaboration entre les CHU de Lille et de Strasbourg

Author: Armelle Drexler, Julien Pottecher, Loïs Henry, Benjamin Bijok, Mitochondrie, stress oxydant et protection musculaire (MSP), and Université de Strasbourg (UNISTRA)
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Détachement médical, 030202 anesthesiology, Medical detachment, Organisation des soins, [SDV]Life Sciences [q-bio], COVID-19, 030208 emergency & critical care medicine, Healthcare organisation, Article, 3. Good health
Abstract: Resume La pandemie de COVID-19 a mis sous tension extreme un systeme de sante fonde essentiellement sur une organisation locale et regionale. Au plus fort de la crise, la necessite exceptionnelle de faire appel a un renfort de medecins specialistes en anesthesie-reanimation disponibles sur le territoire francais a permis d’optimiser la prise en charge des patients, les plus gravement atteints par le SARS-CoV-2, hospitalises au CHU de Strasbourg. Cette formidable chaine de solidarite a fonctionne grâce a une co-organisation administrative et medicale. Une gestion rigoureuse des moyens necessaires doit permettre l’anticipation des besoins en renfort, la preparation de leurs arrivees et leurs affections dans un service adapte a leurs competences. Afin d’optimiser l’efficience d’un tel processus, le maximum doit etre fait pour faciliter l’exercice du praticien en renfort. Le facteur humain, souvent neglige dans nos exercices medicaux, se revele etre une fois de plus une composante essentielle dans la gestion de crise.
Published: 2020
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82. Preliminary pragmatic lessons from the SARS-CoV-2 pandemic in France

Author: Olivier Langeron, T. Gauss, Jean-Michel Constantin, Olivier Joannes-Boyau, Pierre Pasquier, Pierre Bouzat, Julien Pottecher, Université Paris Cité (UPCité), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Hôpital d'Instruction des Armées du Val de Grâce, Magellan Medico-Surgical Center [Bordeaux], CHU Bordeaux [Bordeaux], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Henri Mondor, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Grenoble, Université Grenoble Alpes (UGA), Les Hôpitaux Universitaires de Strasbourg (HUS), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Université de Paris (UP), IMRB - PROTECT/'Pharmacologie et Technologies pour les Maladies Cardiovasculaires' [Créteil] (U955 Inserm - UPEC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Anesthésie-Réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP)
Subjects: surge capacity, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Health Services Accessibility, Professional Staff Committees, 0302 clinical medicine, Professional-Family Relations, Pandemic, Medicine, Bed Conversion, 030212 general & internal medicine, Surge Capacity, General Medicine, Continuity of Patient Care, Checklist, 3. Good health, Practice Guidelines as Topic, Workforce, France, Patient Safety, Coronavirus Infections, Next of kin, Health Personnel, Pneumonia, Viral, Disaster Planning, World Health Organization, Article, 03 medical and health sciences, Patient safety, Betacoronavirus, Nursing, Intensive care, Humans, Human resources, Pandemics, Health Services Needs and Demand, business.industry, SARS-CoV-2, pandemic, COVID-19, Social Support, 030208 emergency & critical care medicine, Triage, critical care, Anesthesiology and Pain Medicine, recommendations, Interdisciplinary Communication, business
Abstract: International audience; The first wave of the SARS-CoV-2 pandemic required an unprecedented and historic increase in critical care capacity on a global scale in France. Authors and members from the ACUTE and REANIMATION committees of the French Society of Anaesthesia and Intensive Care (SFAR) wished to share experience and insights gained during the first weeks of this pandemic. These were summarised following the World Health Organization Response Checklist and detailed according to the subsequent subheadings: 1. Command and Control, 2. Communication, 3. Safety and Security, 4. Triage, 5. Surge Capacity, 6. Continuity of essential services, 7. Human resources, 8. Logistics and supply management, 9. Training/Preparation, 10. Psychological comfort for patients and next of kin, 11. Learning and 12. Post disaster recovery. These experience-based recommendations, consensual across all members from both committees of our national society, establish a practical framework for medical teams, either spared by the first wave of severe COVID patients or preparing for the second one.
Published: 2020
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83. Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome

Author: Julio Badie, Belaid Bouhemad, Florent Montini, Guillaume Louis, Julien Pottecher, Frédéric Mauny, Jean-Michel Constantin, Hadrien Winiszewski, Loco Investigators, Jean-Pierre Quenot, Sebastien Pili-Floury, Bertrand Souweine, Lucie Vettoretti, Loïc Barrot, Olivier Collange, Bruno Levy, Pierre Asfar, Gilles Capellier, Marc Puyraveau, Institut National de la Santé et de la Recherche Médicale (INSERM), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Clermont-Ferrand, CHU Strasbourg, and Centre Hospitalier Universitaire de Nancy (CHU Nancy)
Subjects: medicine.medical_specialty, ARDS, Lung, business.industry, medicine.medical_treatment, [SDV]Life Sciences [q-bio], General Medicine, Respiratory physiology, Acute respiratory distress, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, law.invention, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Randomized controlled trial, law, Oxygen therapy, medicine, 030212 general & internal medicine, Intensive care medicine, business, Survival analysis
Abstract: International audience; Background: In patients with acute respiratory distress syndrome (ARDS), the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network recommends a target partial pressure of arterial oxygen (Pao2) between 55 and 80 mm Hg. Prospective validation of this range in patients with ARDS is lacking. We hypothesized that targeting the lower limit of this range would improve outcomes in patients with ARDS.Methods: In this multicenter, randomized trial, we assigned patients with ARDS to receive either conservative oxygen therapy (target Pao2, 55 to 70 mm Hg; oxygen saturation as measured by pulse oximetry [Spo2], 88 to 92%) or liberal oxygen therapy (target Pao2, 90 to 105 mm Hg; Spo2, ≥96%) for 7 days. The same mechanical-ventilation strategies were used in both groups. The primary outcome was death from any cause at 28 days.Results: After the enrollment of 205 patients, the trial was prematurely stopped by the data and safety monitoring board because of safety concerns and a low likelihood of a significant difference between the two groups in the primary outcome. Four patients who did not meet the eligibility criteria were excluded. At day 28, a total of 34 of 99 patients (34.3%) in the conservative-oxygen group and 27 of 102 patients (26.5%) in the liberal-oxygen group had died (difference, 7.8 percentage points; 95% confidence interval [CI], -4.8 to 20.6). At day 90, 44.4% of the patients in the conservative-oxygen group and 30.4% of the patients in the liberal-oxygen group had died (difference, 14.0 percentage points; 95% CI, 0.7 to 27.2). Five mesenteric ischemic events occurred in the conservative-oxygen group.Conclusions: Among patients with ARDS, early exposure to a conservative-oxygenation strategy with a Pao2 between 55 and 70 mm Hg did not increase survival at 28 days. (Funded by the French Ministry of Health; LOCO2 ClinicalTrials.gov number, NCT02713451.).
Published: 2020
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84. Protocol for TRAUMADORNASE: a prospective, randomized, multicentre, double-blinded, placebo-controlled clinical trial of aerosolized dornase alfa to reduce the incidence of moderate-to-severe hypoxaemia in ventilated trauma patients

Author: Christian Meyer, Walter Land, Vincent Legros, Gérard Audibert, Raphael Carapito, Béatrice Uring-Lambert, Alain Meyer, Erik Sauleau, Bernard Geny, Seiamak Bahram, Marie Borel, Pierre Diemunsch, Julien Pottecher, Eric Noll, Sébastien Gette, Elisabeth Gaertner, Gestionnaire, Hal Sorbonne Université, Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital de Hautepierre [Strasbourg], Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Sorbonne Université (SU), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service 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), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Centre Hospitalier Universitaire de Reims (CHU Reims), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Neurophysiologie Respiratoire Expérimentale et Clinique, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_treatment, Medicine (miscellaneous), [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Neutrophil extracellular traps, Extracellular Traps, law.invention, Study Protocol, 0302 clinical medicine, Injury Severity Score, Randomized controlled trial, law, Multicenter Studies as Topic, Pharmacology (medical), Prospective Studies, Hypoxia, Randomized Controlled Trials as Topic, 0303 health sciences, lcsh:R5-920, Respiratory Distress Syndrome, Rehabilitation, Acute respiratory distress syndrome, Incidence, Dornase alfa, Institutional review board, Recombinant Proteins, 3. Good health, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, lcsh:Medicine (General), medicine.drug, Adult, medicine.medical_specialty, Randomization, Lung injury, Placebo, 03 medical and health sciences, Double-Blind Method, medicine, Deoxyribonuclease I, Humans, 030304 developmental biology, Aerosols, business.industry, 030208 emergency & critical care medicine, Multiple trauma, Bayes Theorem, Respiration, Artificial, Clinical trial, Clinical Trials, Phase III as Topic, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Wounds and Injuries, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Hypoxaemia
Abstract: Background Acute respiratory distress syndrome continues to drive significant morbidity and mortality after severe trauma. The incidence of trauma-induced, moderate-to-severe hypoxaemia, according to the Berlin definition, could be as high as 45%. Its pathophysiology includes the release of damage-associated molecular patterns (DAMPs), which propagate tissue injuries by triggering neutrophil extracellular traps (NETs). NETs include a DNA backbone coated with cytoplasmic proteins, which drive pulmonary cytotoxic effects. The structure of NETs and many DAMPs includes double-stranded DNA, which prevents their neutralization by plasma. Dornase alfa is a US Food and Drug Administration-approved recombinant DNase, which cleaves extracellular DNA and may therefore break up the backbone of NETs and DAMPs. Aerosolized dornase alfa was shown to reduce trauma-induced lung injury in experimental models and to improve arterial oxygenation in ventilated patients. Methods TRAUMADORNASE will be an institution-led, multicentre, double-blinded, placebo-controlled randomized trial in ventilated trauma patients. The primary trial objective is to demonstrate a reduction in the incidence of moderate-to-severe hypoxaemia in severe trauma patients during the first 7 days from 45% to 30% by providing aerosolized dornase alfa as compared to placebo. The secondary objectives are to demonstrate an improvement in lung function and a reduction in morbidity and mortality. Randomization of 250 patients per treatment arm will be carried out through a secure, web-based system. Statistical analyses will include a descriptive step and an inferential step using fully Bayesian techniques. The study was approved by both the Agence Nationale de la Sécurité du Médicament et des Produits de Santé (ANSM, on 5 October 2018) and a National Institutional Review Board (CPP, on 6 November 2018). Participant recruitment began in March 2019. Results will be published in international peer-reviewed medical journals. Discussion If early administration of inhaled dornase alfa actually reduces the incidence of moderate-to-severe hypoxaemia in patients with severe trauma, this new therapeutic strategy may be easily implemented in many clinical trauma care settings. This treatment may facilitate ventilator weaning, reduce the burden of trauma-induced lung inflammation and facilitate recovery and rehabilitation in severe trauma patients. Trial registration ClinicalTrials.gov, NCT03368092. Registered on 11 December 2017.
Published: 2020
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85. 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
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86. Intubation et extubation du patient de réanimation

Author: Hervé Quintard, Erwan l’Her, Julien Pottecher, Frédéric Adnet, Jean-Michel Constantin, Audrey Dejong, Pierre Diemunsch, Rose Fesseau, Anne Freynet, Christophe Girault, Christophe Guitton, Yan Hamonic, Eric Maury, Armand Mekontso-Dessap, Fabrice Michel, Paul Nolent, Sébastien Perbet, Gwenaël Prat, Antoine Roquilly, Karim Tazarourte, Nicolas Terzi, Arnaud W. Thille, Mikael Alves, Etienne Gayat, and Laurence Donetti
Subjects: Anesthesiology and Pain Medicine
Published: 2018
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87. Manuel d’hémodynamique appliquée en anesthésie réanimation et médecine périopératoire

Author: Marc-Olivier Fischer and Julien Pottecher
Subjects: Anesthesiology and Pain Medicine
Published: 2021
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88. Guidelines for the acute care of severe limb trauma patients

Author: Cédric Gil-Jardiné, Jonathan Charbit, Olivier Barbier, Hugues Lefort, Stéphane Travers, Bertrand Prunet, Julien Pottecher, Sophie Rym Hamada, Hervé Quintard, Pierre Pasquier, Philippe Adam, T. Gauss, Delphine Garrigue, Pierre Bouzat, Karim Tazarourte, Anatole Harrois, Lionel Velly, M. Galinski, Yannick Georg, Claire Roger, Romain Kedzierewicz, 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), Société Française d’Anesthésie et de Réanimation, and Société Française de Médecine d'Urgence
Subjects: Damage control, medicine.medical_specialty, Referral, Physical examination, Guidelines, Critical Care and Intensive Care Medicine, Rhabdomyolysis, 03 medical and health sciences, 0302 clinical medicine, Acute care, Fracture fixation, medicine, Medical history, 030212 general & internal medicine, Grading (education), Intensive care medicine, Modalities, medicine.diagnostic_test, business.industry, Fat embolism syndrome, 030208 emergency & critical care medicine, General Medicine, Evidence-based medicine, Severe limb trauma patient, Tourniquet, 3. Good health, Anesthesiology and Pain Medicine, Compartment syndrome, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: Goal To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. Design A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset 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 the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. Methods The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient's prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient 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' synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/−) and 12 had a low level of evidence (GRADE 2+/−). For 3 recommendations, the GRADE method could not be applied, resulting in an 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 severe limb trauma patients.
Published: 2021
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89. Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome After Pneumonectomy

Author: Stéphane Renaud, Xavier Delabranche, Julien Pottecher, Pierre-Emmanuel Falcoz, Nicola Santelmo, Mickaël Schaeffer, Jérémie Reeb, Romain Kessler, Gilbert Massard, and Anne Olland
Subjects: Male, Pulmonary and Respiratory Medicine, ARDS, medicine.medical_treatment, 030204 cardiovascular system & hematology, Hypoxemia, 03 medical and health sciences, Plateau pressure, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Fraction of inspired oxygen, Extracorporeal membrane oxygenation, Humans, Medicine, Pneumonectomy, Positive end-expiratory pressure, Tidal volume, Aged, Retrospective Studies, Aged, 80 and over, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Middle Aged, medicine.disease, Respiration, Artificial, Oxygen, surgical procedures, operative, 030228 respiratory system, Anesthesia, Female, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Background Postpneumonectomy acute respiratory distress syndrome (ppARDS) is a life-threatening condition with a disastrous prognosis. This study assessed the efficacy of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with unresponsive severe ppARDS. Methods We retrospectively reviewed data of all patients treated with VV-ECMO for ppARDS from January 2009 to December 2015. We calculated the Sequential Organ Failure Assessment score before ECMO insertion and monitored the subsequent mechanical ventilation settings. The primary end point was hospital survival. The secondary end point was the ability to achieve a protective ventilatory strategy allowing lung recovery on ECMO. Results VV-ECMO was indicated in 8 ppARDS patients for refractory hypoxemia (median partial pressure of arterial oxygen/fraction of inspired oxygen: 68 [range, 60 to 75] mm Hg). Median Sequential Organ Failure Assessment before ECMO was 15 (range, 12 to 17), predicting a mortality rate greater than 80%. Median duration of ECMO was 9.5 (range, 5 to 16) days. Tidal volumes and plateau pressures both decreased on ECMO (pre-ECMO tidal volume: 412 [range, 250 to 450 mL] vs ECMO tidal volume: 277 [range, 105 to 367 mL], p = 0.0156; pre-ECMO plateau pressure: 34 [range, 32 to 40] cm H 2 O vs ECMO plateau pressure: 24.5 [range, 23.3 to 27.3] cm H 2 O, p = 0.0195). ECMO could be weaned in 7 patients (87.5%). Hospital survival was 50%. Conclusions Hospital survival was better than predicted before ECMO insertion. In severe and refractory ppARDS, VV-ECMO allows lung recovery and therefore increased survival.
Published: 2017
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90. La réanimation éphémère en situation sanitaire exceptionnelle

Author: Julien Pottecher and Marc-Olivier Fischer
Subjects: Anesthesiology and Pain Medicine, Political science, Library science, Article
Published: 2020
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91. Early management of severe abdominal trauma

Author: Catherine Arvieux, Julien Pottecher, Bertrand Prunet, Guillaume Valdenaire, Tobias Gauss, Christophe Tresallet, Pierre Bouzat, Bruno Simonnet, Xavier Bobbia, Barbara Villoing, Paul Balandraud, Jean-Stéphane David, Jean-Alexandre Long, Jonhatan Charbit, Emmanuel Weiss, Delphine Garrigue, Julien Vaux, Laurent Zieleskiewicz, Damien Viglino, Karim Tazarourte, Cédric Gil-Jardiné, Julien Frandon, Bordeaux population health (BPH), and 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)
Subjects: medicine.medical_specialty, medicine.medical_treatment, Population, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, IETO, Laparotomy, medicine, Focused assessment with sonography for trauma, 030212 general & internal medicine, education, education.field_of_study, medicine.diagnostic_test, business.industry, General surgery, 030208 emergency & critical care medicine, Interventional radiology, General Medicine, Guideline, Evidence-based medicine, medicine.disease, 3. Good health, Anesthesiology and Pain Medicine, Abdominal trauma, Damage control surgery, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: Objective To develop French guidelines on the management of patients with severe abdominal trauma. Design A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Societe francaise d’anesthesie et de reanimation, SFAR), the French Society of Emergency Medicine (Societe francaise de medecine d’urgence, SFMU), the French Society of Urology (Societe francaise d’urologie, SFU) and from the French Association of Surgery (Association francaise de chirurgie, AFC), the Val-de-Grâce School (Ecole du Val-De-Grâce, EVG) and the Federation for Interventional Radiology (Federation de radiologie interventionnelle, FRI-SFR) was convened. Declaration of all conflicts of interest (COI) policy by all participants was mandatory throughout the development of the guidelines. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for assessment of the available level of evidence with particular emphasis to avoid formulating strong recommendations in the absence of high level. Some recommendations were left ungraded. Methods The guidelines are divided in diagnostic and, therapeutic strategy and early surveillance. All questions were formulated according to Population, Intervention, Comparison, and Outcomes (PICO) format. The panel focused on three questions for diagnostic strategy: (1) What is the diagnostic performance of clinical signs to suggest abdominal injury in trauma patients? (2) Suspecting abdominal trauma, what is the diagnostic performance of prehospital FAST (Focused Abdominal Sonography for Trauma) to rule in abdominal injury and guide the prehospital triage of the patient? and (3) When suspecting abdominal trauma, does carrying out a contrast enhanced thoraco-abdominal CT scan allow identification of abdominal injuries and reduction of mortality? Four questions dealt with therapeutic strategy: (1) After severe abdominal trauma, does immediate laparotomy reduce morbidity and mortality? (2) Does a “damage control surgery” strategy decrease morbidity and mortality in patients with a severe abdominal trauma? (3) Does a laparoscopic approach in patients with abdominal trauma decrease mortality or morbidity? and (4) Does non-operative management of patients with abdominal trauma without bleeding reduce mortality and morbidity? Finally, one question was formulated regarding the early monitoring of these patients: In case of severe abdominal trauma, which kind of initial monitoring does allow to reduce the morbi-mortality? The analysis of the literature and the recommendations were conducted following the GRADE® methodology. Results The SFAR/SFMU Guideline panel provided 15 statements on early management of severe abdominal trauma. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), six have a low level of evidence (Grade 2±) and four are expert judgments. Finally, no recommendation was provided for one question. Conclusions Substantial agreement exists among experts regarding many strong recommendations for the best early management of severe abdominal trauma.
Published: 2020
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92. Trauma-Induced, DAMP-Mediated Remote Organ Injury, and Immunosuppression in the Acutely Ill Patient

Author: Julien Pottecher, Alain Meyer, Camilla Ferreira Wenceslau, Kim Timmermans, Carl Jeffrey Hauser, and Walter Gottlieb Land
Subjects: lcsh:Immunologic diseases. Allergy, Damp, medicine.medical_specialty, damage-associated molecular pattern (DAMP), business.industry, medicine.medical_treatment, Immunology, Remote organ, Immunosuppression, organ injury, Systemic Inflammatory Response Syndrome, critical care, Editorial, trauma, medicine, Immune Tolerance, Immunology and Allergy, Alarmins, Humans, Wounds and Injuries, lcsh:RC581-607, Intensive care medicine, business
Published: 2019

93. Routine use of viscoelastic tests for severe trauma management: The bright side

Author: Delphine Garrigue, Bertrand Prunet, and Julien Pottecher
Subjects: business.industry, Fibrinolysis, General Medicine, Blood Coagulation Disorders, Critical Care and Intensive Care Medicine, Blood Viscosity, Elasticity, Thrombelastography, Anesthesiology and Pain Medicine, Severe trauma, Anesthesia, Medicine, Humans, Wounds and Injuries, Blood Coagulation Tests, business, Blood Coagulation, Trauma induced coagulopathy, Randomized Controlled Trials as Topic
Published: 2019

94. French multicentre observational study on SARS-CoV-2 infections intensive care initial management: the FRENCH CORONA study

Author: Mouhamed Djahoum Moussa, Bernard Allaouchiche, Marine Bouex, Pierre-Grégoire Guinot, Nicolas Mayeur, Etienne Hautin, Guillaume Besch, Olivier Collange, Julien Pottecher, Pierre-Yves Cordier, Emmanuel Novy, Olivier Joannes-Boyau, Julien Cady, Thomas Clavier, Myriam Mezzarobba, Laurent Favier, Younes Ait Tamlihat, Clément Hoffmann, Alexandre Ouattara, Thibault Mura, Marc-Olivier Fischer, Philippe Aussant, Jean-Michel Julia, Osama Abou-Arab, Lauranne Teule, Paul Abraham, Marc Danguy des Déserts, Laurent Muller, Michel Fiani, Jeremy Bourenne, Jean-Yves Lefrant, Marc Leone, Claire Roger, Marc Garnier, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts (IMAGINE), Université de Montpellier (UM), Nouvel Hôpital Civil de Strasbourg, Les Hôpitaux Universitaires de Strasbourg (HUS), CHU Amiens-Picardie, Centre Hospitalier Saint Jean de Perpignan, Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire (GRC 29 - ARPE), Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Rouen, Normandie Université (NU), Hôpital de la Timone [CHU - APHM] (TIMONE), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CH Béziers, CHU Bordeaux [Bordeaux], Hôpital Haut-Lévêque - CHU de Bordeaux (Centre médico chirurgical Magellan), Service d'Anesthésie - Réanimation Chirurgicale [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), Hôpital Nord [CHU - APHM], Aix Marseille Université (AMU), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Hôpital d'Instruction des Armées Laveran, Centre hospitalier Robert Brisson [Lisieux], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Ramsay Santé, Clinique de la Sauvegarde [Lyon], Centre Hospitalier Alès-Cévennes (CHAC), CRP Clinique du Parc, Castelnau-Le-Lez, Institut Arnault Tzanck, Hôpital d'Instruction des Armées Clermont Tonnerre, Clinique Pasteur [Toulouse], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), and AZUREA group
Subjects: medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease_cause, Cohort Studies, Interquartile range, Oxygen therapy, MESH: COVID-19, Prospective Studies, MESH: Respiration, Artificial, MESH: Cohort Studies, SOFA, Sequential Organ Failure Assessment, Outcome, MESH: Aged, MESH: Middle Aged, General Medicine, Middle Aged, ICU, intensive care unit, Management, Intensive Care Units, SAPS II, Original Article, Nasal cannula, SAPS II, Simplified Acute Physiology Score, Cohort study, LOS, length of stay, medicine.medical_specialty, Critical Care, Viral pneumonia, MESH: Critical Care, Intensive care, medicine, Humans, MESH: SARS-CoV-2, ARDS, acute respiratory distress syndrome, RRT, renal replacement therapy, Aged, Mechanical ventilation, MESH: Humans, business.industry, SARS-CoV-2, ECMO, extra corporeal membrane oxygenation, NIV, non-invasive ventilation, COVID-19, Respiration, Artificial, MESH: Prospective Studies, Anesthesiology and Pain Medicine, IMV, invasive mechanical ventilation, Respiratory failure, Emergency medicine, HFNC, high-flow nasal cannula, MESH: Intensive Care Units, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Aim: Describing acute respiratory distress syndrome patterns, therapeutics management, and outcomes of ICU COVID-19 patients and indentifying risk factors of 28-day mortality.Methods: Prospective multicentre, cohort study conducted in 29 French ICUs. Baseline characteristics, comorbidities, adjunctive therapies, ventilatory support at ICU admission and survival data were collected.Results: From March to July 2020, 966 patients were enrolled with a median age of 66 (interquartile range 58-73) years and a median SAPS II of 37 (29-48). During the first 24 h of ICU admission, COVID-19 patients received one of the following respiratory supports: mechanical ventilation for 559 (58%), standard oxygen therapy for 228 (24%) and high-flow nasal cannula (HFNC) for 179 (19%) patients. Overall, 721 (75%) patients were mechanically ventilated during their ICU stay. Prone positioning and neuromuscular blocking agents were used in 494 (51%) and 460 (48%) patients, respectively. Bacterial co-infections and ventilator-associated pneumonia were diagnosed in 79 (3%) and 411 (43%) patients, respectively. The overall 28-day mortality was 18%. Age, pre-existing comorbidities, severity of respiratory failure and the absence of antiviral therapy on admission were identified as independent predictors of 28-day outcome.Conclusion: Severity of hypoxaemia on admission, older age (> 70 years), cardiovascular and renal comorbidities were associated with worse outcome in COVID-19 patients. Antiviral treatment on admission was identified as a protective factor for 28-day mortality. Ascertaining the outcomes of critically ill COVID-19 patients is crucial to optimise hospital and ICU resources and provide the appropriate intensity level of care.
Published: 2021
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95. ICU bed capacity during COVID-19 pandemic in France: From ephemeral beds to continuous and permanent adaptation

Author: Jean-Yves Lefrant, Dan Benhamou, Hervé Bouaziz, Romain Pirracchio, Julien Pottecher, Olivier Joannes-Boyau, Emmanuel Samain, and Bertrand Dureuil
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Ecology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Ephemeral key, COVID-19, General Medicine, Critical Care and Intensive Care Medicine, Bed capacity, Intensive Care Units, Pediatric, Intensive Care Units, Anesthesiology and Pain Medicine, Editorial, Hospital Bed Capacity, Pandemic, ICU, Bed availability, Medicine, Humans, France, Adaptation, business, Hospital Units, Pandemics
Published: 2021

96. Increased Extravascular Lung Water and Plasma Biomarkers of Acute Lung Injury Precede Oxygenation Impairment in Primary Graft Dysfunction After Lung Transplantation

Author: Béatrice Uring-Lambert, Philippe Lassalle, Annick Steib, Pierre Diemunsch, Jean-Paul Schmitt, Bernard Geny, Olivier Helms, Nicolas Meyer, François Levy, Pierre-Emmanuel Falcoz, Anne-Claude Roche, Julien Pottecher, Tristan Dégot, J. G. Hentz, Romain Kessler, Gilbert Massard, Nicola Santelmo, Siamak Bahram, Mickaël Schaeffer, and Olivier Collange
Subjects: Heart transplantation, Transplantation, medicine.medical_specialty, Lung, business.industry, medicine.medical_treatment, Primary Graft Dysfunction, respiratory system, 030204 cardiovascular system & hematology, Lung injury, Pulmonary edema, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Internal medicine, Predictive value of tests, medicine.artery, Pulmonary artery, medicine, Cardiology, Lung transplantation, business
Abstract: Background After lung transplantation (LT), early prediction of grade 3 pulmonary graft dysfunction (PGD) remains a research gap for clinicians. We hypothesized that it could be improved using extravascular lung water (EVLWi) and plasma biomarkers of acute lung injury. Methods After institutional review board approval and informed consent, consecutive LT recipients were included. Transpulmonary thermodilution-based EVLWi, plasma concentrations of epithelial (soluble receptor for advanced glycation endproducts [sRAGE]) and endothelial biomarkers (soluble intercellular adhesion molecule-1 and endocan [full-length and cleaved p14 fragment]) were obtained before and after LT (0 [H0], 6, 12, 24, 48 and 72 hours after pulmonary artery unclamping). Grade 3 PGD was defined according to the International Society for Lung and Heart Transplantation definition, combining arterial oxygen partial pressure (PaO2)/inspired fraction of oxygen (FiO2) ratio and chest X-rays. Association of clinical risk factors, EVLWi and biomarkers with grade 3 PGD was analyzed under the Bayesian paradigm, using logistic model and areas under the receiver operating characteristic curves (AUCs). Results In 47 LT recipients, 10 developed grade 3 PGD, which was obvious at H6 in 8 cases. Clinical risk factors, soluble intercellular adhesion molecule-1 and endocan (both forms) were not associated with grade 3 PGD. Significant predictors of grade 3 PGD included (1) EVLWi (optimal cutoff, 13.7 mL/kg; AUC, 0.74; 95% confidence interval [CI], 0.48-0.99), (2) PaO2/FiO2 ratio (optimal cutoff, 236; AUC, 0.68; 95% CI, 0.52-0.84), and (3) sRAGE (optimal cutoff, 11 760 pg/mL; AUC, 0.66; 95% CI, 0.41-0.91) measured at H0. Conclusions Immediate postreperfusion increases in EVLWi and sRAGE along with impaired PaO2/FiO2 ratios were early predictors of grade 3 PGD at or beyond 6 hours and may trigger early therapeutic interventions.
Published: 2017
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97. Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma

Author: Laurent Chapiteau, Eric Noll, Denis Chemla, Jean François Payen, François-Xavier Ageron, Jacques Duranteau, Julien Pottecher, Pierre Bouzat, and Clémence Fauché
Subjects: Adult, Male, Emergency Medical Services, medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Hemodynamics, Blood Pressure, Shock, Hemorrhagic, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Heart Rate, Predictive Value of Tests, Internal medicine, Heart rate, medicine, Humans, Blood Transfusion, Registries, Retrospective Studies, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Surgery, Pulse pressure, Blood pressure, Shock (circulatory), Cardiology, Female, medicine.symptom, business
Abstract: Early and accurate detection of severe hemorrhage is critical for a timely trigger of massive transfusion (MT). Hemodynamic indices combining heart rate (HR) and either systolic (shock index [SI]) or pulse pressure (PP) (PP/HR ratio) have been shown to track blood loss during hemorrhage. The present study assessed the accuracy of prehospital SI and PP/HR ratio to predict subsequent MT, using the gray-zone approach.This was a retrospective analysis (January 1, 2009, to December 31, 2011) of a prospectively developed trauma registry (TRENAU), in which the triage scheme combines patient severity and hospital facilities. Thresholds for MT were defined as either classic (≥10 red blood cell units within the first 24 hours [MT1]) or critical (≥3 red blood cells within the first hour [MT2]). The receiver operating characteristic curves and gray zones were defined for SI and PP/HR ratio to predict MT1 and MT2 and faced with initial triage scheme.The TRENAU registry included 3,689 trauma patients, of which 2,557 had complete chart recovery and 176 (6.9%) required MT. In the whole population, PP/HR ratio and SI moderately and similarly predicted MT1 (area under the receiver operating characteristic curve, 0.77 [95% confidence interval {CI}, 0.70-0.84] and 0.80 [95% CI, 0.74-0.87], respectively, p = 0.064) and MT2 (0.71 [95% CI, 0.67-0.76] and 0.72 [95% CI, 0.68-0.77], respectively, p = 0.48). The proportions of patients in the gray zone for PP/HR ratio and SI were 61% versus 40%, respectively, to predict MT1 (p0.001) and 62% versus 71%, respectively, to predict MT2 (p0.001). In the least severe patient, both indices had fair accuracy to predict MT1 (0.91 [95% CI, 0.82-1.00] vs. 0.87 [95% CI, 0.79-1.00]; p = 0.638), and PP/HR ratio outperformed SI to predict MT2 (0.72 [95% CI, 0.59-0.84] vs. 0.54 [95% CI, 0.33-0.74]; p0.015).In an unselected trauma population, prehospital SI and PP/HR ratio were moderately accurate in predicting MT. In the seemingly least severe patients, an improvement of prehospital undertriage for MT may be gained by using the PP/HR ratio.Epidemiolgic study, level III.
Published: 2016
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98. Impact of nitrous oxide on the haemodynamic consequences of venous carbon dioxide embolism

Author: Julien Pottecher, Pierre Diemunsch, Girish P. Joshi, Michele Diana, Bernard Geny, and Eric Noll
Subjects: Time Factors, Sus scrofa, Nitrous Oxide, Hemodynamics, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Pneumoperitoneum, 030202 anesthesiology, medicine.artery, Administration, Inhalation, Animals, Embolism, Air, Medicine, General anaesthesia, Pulmonary wedge pressure, business.industry, Central venous pressure, Carbon Dioxide, equipment and supplies, medicine.disease, Disease Models, Animal, Anesthesiology and Pain Medicine, Blood pressure, Embolism, Anesthesia, Anesthetics, Inhalation, Pulmonary artery, Pulmonary Ventilation, business, Pneumoperitoneum, Artificial, 030217 neurology & neurosurgery
Abstract: Background Nitrous oxide (N2O) is still considered an important component of general anaesthesia. However, should gas embolisation occur as result of carbon dioxide (CO2) pneumoperitoneum, N2O may compromise safety, as the consequences of a gas embolus consisting of a combination of CO2 and N2O may be more severe than CO2 alone. Objective This experimental study was designed to compare the cardiopulmonary consequences of gas embolisation with a N2O/CO2 mixture, or CO2 alone. Design Experimental study. Setting Research Institute Against Digestive Cancer laboratory, Strasbourg, France. Animals Seven Large-White pigs receiving standardised inhalation anaesthesia. Interventions Each animal, acting as its own control, was studied in two successive experimental conditions - intravenous gas injections of 2 ml kg of 100% CO2 and 2 ml kg of a gas mixture consisting of 10% N2O and 90% CO2. Main outcomes measures Haemodynamic and ventilatory consequences of embolisation with the gases. Results We found that the haemodynamic (heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary artery occlusion pressure and transoesophageal echocardiography parameters) and ventilatory (arterial oxygen saturation, end-tidal CO2 concentration and mixed venous oxygen saturation) consequences of embolisation with either 100% CO2 or 10% N2O with 90% CO2 were similar. Conclusion The findings of this study may alleviate concerns that the use of N2O, as a part of a balanced general anaesthesia technique, may have greater adverse consequences should embolisation of pneumoperitoneal gas containing N2O occur.
Published: 2016
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99. Diffusion tensor imaging reveals diffuse white matter injuries in locked-in syndrome patients

Author: Félix Renard, Daniel Roquet, Marc Braun, Nicolas Meyer, Pierre Froehlig, Julien Pottecher, Mylene Leonard, Laura Harsan, Stéphane Kremer, Francis Schneider, Frédéric Blanc, and Sophie Achard
Subjects: Adult, Central Nervous System, Male, Auditory Pathways, Science, Normal Distribution, Pyramidal Tracts, 050105 experimental psychology, White matter, Lesion, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 0501 psychology and cognitive sciences, Aged, Multidisciplinary, medicine.diagnostic_test, business.industry, 05 social sciences, Medial lemniscus, Magnetic resonance imaging, Anatomy, Middle Aged, White Matter, Pons, medicine.anatomical_structure, Diffusion Tensor Imaging, Brain Injuries, Corticospinal tract, Medicine, Female, Locked-In Syndrome, Brainstem, medicine.symptom, business, Cognition Disorders, 030217 neurology & neurosurgery, Diffusion MRI, Brain Stem
Abstract: Locked-in syndrome (LIS) is a state of quadriplegia and anarthria with preserved consciousness, which is generally triggered by a disruption of specific white matter fiber tracts, following a lesion in the ventral part of the pons. However, the impact of focal lesions on the whole brain white matter microstructure and structural connectivity pathways remains unknown. We used diffusion tensor magnetic resonance imaging (DT-MRI) and tract-based statistics to characterise the whole white matter tracts in seven consecutive LIS patients, with ventral pontine injuries but no significant supratentorial lesions detected with morphological MRI. The imaging was performed in the acute phase of the disease (26 ± 13 days after the accident). DT-MRI-derived metrics were used to quantitatively assess global white matter alterations. All diffusion coefficient Z-scores were decreased for almost all fiber tracts in all LIS patients, with diffuse white matter alterations in both infratentorial and supratentorial areas. A mixture model of two multidimensional Gaussian distributions was fitted to cluster the white matter fiber tracts studied in two groups: the least (group 1) and most injured white matter fiber tracts (group 2). The greatest injuries were revealed along pathways crossing the lesion responsible for the LIS: left and right medial lemniscus (98.4% and 97.9% probability of belonging to group 2, respectively), left and right superior cerebellar peduncles (69.3% and 45.7% probability) and left and right corticospinal tract (20.6% and 46.5% probability). This approach demonstrated globally compromised white matter tracts in the acute phase of LIS, potentially underlying cognitive deficits.
Published: 2019

100. Anesthésie locale versus anesthésie générale pour la thrombectomie cérébrale

Author: Liang Liao, Rémy Beaujeux, Romain Tonnelet, Dan Mihoc, Monica Manisor, Ioan Martin, Valérie Wolff, Anne-Laure Derelle, Benjamin Gory, Julien Pottecher, Serge Bracard, Sébastien Richard, Gérard Audibert, Oana Harsan, François Zhu, Raoul Pop, René Anxionnat, and François Severac
Subjects: Radiological and Ultrasound Technology, Radiology, Nuclear Medicine and imaging, Neurology (clinical)
Abstract: Introduction L’efficacite et la securite des thrombectomies mecaniques (TM) cerebrales realisees sous anesthesie locale sont peu etudiees. Nous avons compare les resultats des TM en utilisant deux strategies d’anesthesie en premiere intention : anesthesie locale (AL) dans un centre et anesthesie generale (AG) dans un deuxieme centre. Materiel et methodes Etude retrospective des TM de la circulation anterieure realises entre 01/01/2018 et 31/12/2018 dans deux centres francais de la meme region. Pendant cette periode, les TM dans le centre A ont ete effectues sous AL en premiere intention, et dans le centre B, toutes les TM ont ete effectues sous AG. Les deux populations de patients ont ete appariees 1 :1 en utilisant un score de propension calcule en fonction des caracteristiques cliniques et d’imagerie a l’admission. Les resultats angiographiques et cliniques apres TM ont ete compares entre les deux groupes apparies. Resultats Pendant la periode etudiee, 219 patients ont ete traites dans le centre A et 142 dans le centre B. Apres application du score de propension, 97 patients de chaque groupe ont ete apparies 1 :1 en obtenant deux groupes avec des caracteristiques initiales similaires. L’utilisation systematique de l’AG etait associee avec une proportion plus importante de patients independants a 3 mois (modified Rankin Score ≤ 2) (52,0 % vs 36,1 %, p = 0,039, OR : 0,53 IC95 % : 0,33–0,87), un taux plus eleve de recanalisation mTICI 2b-3 (95,8 % vs 70,1 %, p Conclusion Dans cette etude, l’utilisation systematique de l’anesthesie generale pour les TM a ete associee avec une meilleure reperfusion, moins de complications procedurales et une meilleure evolution clinique a 3 mois.
Published: 2020
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