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1. Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study

Author: Jean Baptiste Lascarrou, Wulfran Bougouin, Jonathan Chelly, Jeremy Bourenne, Cedric Daubin, Olivier Lesieur, Pierre Asfar, Gwenhael Colin, Marine Paul, Nicolas Chudeau, Gregoire Muller, Guillaume Geri, Sophier Jacquier, Nicolas Pichon, Thomas Klein, Bertrand Sauneuf, Kada Klouche, Martin Cour, Caroline Sejourne, Filippo Annoni, Jean-Herle Raphalen, Arnaud Galbois, Cedric Bruel, Nicolas Mongardon, Nadia Aissaoui, Nicolas Deye, Julien Maizel, Florence Dumas, Stephane Legriel, Alain Cariou, and the AfterROSC Network
Subjects: Cardiac arrest, Outcome prediction, Neurological prognosis, Functional outcome, Score, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis is useful to adapt therapeutic strategy, tailor intensity of care, and inform relatives. We aimed primarily to undertake a prospective multicentric study to evaluate predictive performance of the Cardiac Arrest Prognosis (CAHP) Score as compare to historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was to evaluate other dedicated scores for predicting outcome after OHCA and to compare them to Utstein style criteria. Methods We prospectively collected data from 24 French and Belgium Intensive Care Units (ICUs) between August 2020 and June 2022. All cases of non-traumatic OHCA (cardiac and non-cardiac causes) patients with stable return of spontaneous circulation (ROSC) and comatose at ICU admission (defined by Glasgow coma score ≤ 8) on ICU admission were included. The primary outcome was the modified Rankin scale (mRS) at day 90 after cardiac arrest, assessed by phone interviews. A wide range of developed scores (CAHP, OHCA, CREST, C-Graph, TTM, CAST, NULL-PLEASE, and MIRACLE2) were included, and their accuracies in predicting poor outcome at 90 days after OHCA (defined as mRS ≥ 4) were determined using the area under the receiving operating characteristic curve (AUROC) and the calibration belt. Results During the study period, 907 patients were screened, and 658 were included in the study. Patients were predominantly male (72%), with a mean age of 61 ± 15, most having collapsed from a supposed cardiac cause (64%). The mortality rate at day 90 was 63% and unfavorable neurological outcomes were observed in 66%. The performance (AUROC) of Utstein criteria for poor outcome prediction was moderate at 0.79 [0.76–0.83], whereas AUROCs from other scores varied from 0.79 [0.75–0.83] to 0.88 [0.86–0.91]. For each score, the proportion of patients for whom individual values could not be calculated varied from 1.4% to 17.4%. Conclusions In patients admitted to ICUs after a successfully resuscitated OHCA, most of the scores available for the evaluation of the subsequent prognosis are more efficient than the usual Utstein criteria but calibration is unacceptable for some of them. Our results show that some scores (CAHP, sCAHP, mCAHP, OHCA, rCAST) have superior performance, and that their ease and speed of determination should encourage their use. Trial registration https://clinicaltrials.gov/ct2/show/NCT04167891
Published: 2023
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2. Comparison of prognostic factors between bacteraemic and non-bacteraemic critically ill immunocompetent patients in community-acquired severe pneumococcal pneumonia: a STREPTOGENE sub-study

Author: Hugo Bellut, Raphael Porcher, Emmanuelle Varon, Pierre Asfar, Yves Le Tulzo, Bruno Megarbane, Armelle Mathonnet, Anthony Dugard, Anne Veinstein, Kader Ouchenir, Shidasp Siami, Jean Reignier, Arnaud Galbois, Joël Cousson, Sébastien Preau, Olivier Baldesi, Jean‑Philippe Rigaud, Bertrand Souweine, Benoit Misset, Frederic Jacobs, Florent Dewavrin, Jean‑Paul Mira, and Jean‑Pierre Bedos
Subjects: Pneumococcal pneumonia, Pneumococcal bacteraemia, Severe community-acquired pneumonia, Macrolides, Fluoroquinolones, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background The presence of bacteraemia in pneumococcal pneumonia in critically ill patients does not appear to be a strong independent prognostic factor in the existing literature. However, there may be a specific pattern of factors associated with mortality for ICU patients with bacteraemic pneumococcal community-acquired pneumonia (CAP). We aimed to compare the factors associated with mortality, according to the presence of bacteraemia or not on admission, for patients hospitalised in intensive care for severe pneumococcal CAP. Methods This was a post hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France between 2008 and 2012 for pneumococcal CAP. Patients were divided into two groups based on initial blood culture (positive vs. negative) for Streptococcus pneumoniae. The primary outcome was hospital mortality, which was compared between the two groups using odds ratios according to predefined variables to search for a prognostic interaction present in bacterial patients but not non-bacteraemic patients. Potential differences in the distribution of serotypes between the two groups were assessed. The prognostic consequences of the presence or not of initial bi-antibiotic therapy were assessed, specifically in bacteraemic patients. Results Among 614 included patients, 274 had a blood culture positive for S. pneumoniae at admission and 340 did not. The baseline difference between the groups was more frequent leukopaenia (26% vs. 14%, p = 0.0002) and less frequent pre-hospital antibiotic therapy (10% vs. 16.3%, p = 0.024) for the bacteraemic patients. Hospital mortality was not significantly different between the two groups (p = 0.11). We did not observe any prognostic factors specific to the bacteraemic patient population, as the statistical comparison of the odds ratios, as an indication of the association between the predefined prognostic parameters and mortality, showed them to be similar for the two groups. Bacteraemic patients more often had invasive serotypes but less often serotypes associated with high case fatality rates (p = 0.003). The antibiotic regimens were similar for the two groups. There was no difference in mortality for patients in either group given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. Conclusion Bacteraemia had no influence on the mortality of immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, regardless of the profile of the associated prognostic factors.
Published: 2021
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3. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

Author: Carole Ruault, Nathalie Zappella, Julien Labreuche, Pierrick Cronier, Baptiste Claude, Marc Garnier, Antoine Vieillard-Baron, Sofia Ortuno, Maxime Mallet, Olga Cosic, Laura Crosby, Olivier Lesieur, Nicolas Pichon, Arnaud Galbois, Cedric Bruel, Kenneth Ekpe, Bertrand Sauneuf, Damien Roux, and Stephane Legriel
Subjects: Medicine, Science
Abstract: Abstract Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38–9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
Published: 2021
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4. Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

Author: Jean-Rémi Lavillegrand, Emmanuelle Mercier-Des-Rochettes, Elodie Baron, Frédéric Pène, Damien Contou, Raphael Favory, Sébastien Préau, Arnaud Galbois, Chloé Molliere, Arnaud-Félix Miailhe, Jean Reignier, Mehran Monchi, Claire Pichereau, Sara Thietart, Thibault Vieille, Gael Piton, Gabriel Preda, Idriss Abdallah, Marine Camus, Eric Maury, Bertrand Guidet, Guillaume Dumas, and Hafid Ait-Oufella
Subjects: Cholangitis, Outcome, Prognosis, Microbiology, Intensive care unit, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis. Results Overall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02). Conclusions In this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.
Published: 2021
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5. Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study

Author: Christophe Camus, Clara Locher, Faouzi Saliba, Bernard Goubaux, Agnès Bonadona, Laurence Lavayssiere, Catherine Paugam, Alice Quinart, Olivier Barbot, Sébastien Dharancy, Bertrand Delafosse, Nicolas Pichon, Hélène Barraud, Arnaud Galbois, Benoit Veber, Sophie Cayot, and Bruno Souche
Subjects: liver transplantation, MARS albumin dialysis, outcome, retrospective study, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Abstract Background and Aim The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real‐life use are lacking. Methods This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injury–hepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44–54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1‐year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P
Published: 2020
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6. Multicentre observational status-epilepticus registry: protocol for ICTAL

Author: Cédric Bruel, Nicolas Mongardon, Jean-Pierre Quenot, Didier Ledoux, Pierre Bailly, Jean-Baptiste Lascarrou, Gaetan Plantefeve, Jean Philippe Rigaud, Arnaud Galbois, David Schnell, Annabelle Stoclin, Gwenaelle Jacq, Jonathan Chelly, Pauline Soulier, Olivier Lesieur, Pascal Beuret, Mathilde Holleville, Bertrand Sauneuf, Caroline Sejourne, Marine Arrayago, Candice Fontaine, François Perier, Wulfran Bougouin, Nicolas Pichon, and Stephane Legriel
Subjects: Medicine
Published: 2022
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7. Comparison of a preventive or curative strategy of fluid removal on the weaning of mechanical ventilation: a study protocol for a multicentre randomised open-label parallel-group trial

Author: Vincent Labbe, Gwenaël Prat, Guylaine Labro, Jean-Pierre Quenot, Jean-Paul Mira, Martin Dres, Armand Mekontso Dessap, François Beloncle, Laurent Guérin, Candice Estellat, Arnaud Galbois, Jean-Luc Baudel, Julien Cousty, and Jordane Lebut
Subjects: Medicine
Abstract: Introduction Fluid overload is associated with a poor prognosis in the critically ill patients, especially at the time of weaning from mechanical ventilation as it may promote weaning failure from cardiac origin. Some data suggest that early administration of diuretics would shorten the duration of mechanical ventilation. However, this strategy may expose patients to a higher risk of haemodynamic and metabolic complications. Currently, there is no recommendation for the use of diuretics during weaning and there is an equipoise on the timing of their initiation in this context.Methods and analysis This study is a multicentre randomised controlled trial comparing two strategies of fluid removal during weaning in 13 French intensive care units (ICU). The preventive strategy is initiated systematically when the fluid balance or weight change is positive and the patients have criteria for clinical stability; the curative strategy is initiated only in case of weaning failure documented as of cardiac origin. Four hundred and ten patients will be randomised with a 1:1 ratio. The primary outcome is the duration of weaning from mechanical ventilation, defined as the number of days between randomisation and successful extubation (alive without reintubation nor tracheostomy within the 7 days after extubation) at day 28. Secondary outcomes include daily and cumulated fluid balance, metabolic and haemodynamic complications, ventilator-associated pneumonia, weaning complications, number of ventilator-free days, total duration of mechanical ventilation, the length of stay in ICU and mortality in ICU, in hospital and, at day 28. A subgroup analysis for the primary outcome is planned in patients with kidney injury (Kidney Disease: Improving Global Outcomes class 2 or more) at the time of randomisation.Ethics and dissemination The study has been approved by the ethics committee (Comité de Protection des Personnes Paris 1) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration number NCT04050007.Protocol version V.1; 12 March 2019.
Published: 2021
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8. Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

Author: Antonio Artigas, Nuno Catorze, Bernhard Wernly, Wojciech Szczeklik, Raimund Helbok, Pål Klepstad, Emmanuel Guerot, Tim Rahmel, Kelly Tiercelet, Louise Bell, Clare Bolger, Helder Filipe, Michael Reay, Jean-Pierre Quenot, Saad Nseir, Didier Thévenin, Maurizio Cecconi, Susan Dowling, Jason Cupitt, Willem Dieperink, Henning Ebelt, Philipp Eller, Patrick Meybohm, Rene Schmutz, Michael Joannidis, Sally Humphreys, Filippo Boroli, Gerardo Aguilar, Jørund Langørgen, Malte Kelm, Marcus Franz, Hans Flaatten, Christian Jung, Michael Beil, Susannah Leaver, Bertrand Guidet, Tom Dormans, Jonathan Ball, Patrick Morgan, Nick Spittle, Tom Lawton, Diederik Gommers, Antoine Romen, Camilla Brorsson, Ana Rita Santos, JANE EVANS, Ala Khaled, Hazem Ahmed, Madhu Balasubramaniam, Simon Dubler, Jean-Philippe Rigaud, Michael Schuster, Julien Maizel, Christophe Vinsonneau, Carole Boulanger, Jeremy Henning, Catia Cillóniz, Michael Spivey, Kiran Salaunkey, Raphael Romano Bruno, Stephan Binnebössel, Sviri Sigal, Peter Vernon van Heerden, Ariane Boumendil, Brian Marsh, Rui Moreno, Sandra Oeyen, Bernardo Bollen Pinto, Sten Mikael Walther, Joerg C Schefold, Jesper Fjølner, Tilemachos Zafeiridis, Dylan de Lange, Joke Nollet, Nikolaas de Neve, Pieter De Buysscher, Walter Swinnen, Marijana Mikačić, Anders Bastiansen, Andreas Husted, Bård E S Dahle, Christine Cramer, Christoffer Sølling, Dorthe Ørsnes, Jakob Edelberg Thomsen, Jonas Juul Pedersen, Mathilde Hummelmose Enevoldsen, Thomas Elkmann, Agnieszka Kubisz-Pudelko, Alan Pope, Amy Collins, Ashok S Raj, Christian Frey, Ciaran Hart, Dominic Spray, Georgina Randell, Ingeborg D Welters, Irina Grecu, Jenny Lord, Joanne Jones, Julie North, Laura Ortiz-Ruiz De Gordoa, Marcela Vizcaychipi, Maria Faulkner, McDonald Mupudzi, Megan Lea-Hagerty, Nicholas Love, Nigel White, Patricia Williams, Phillipa Wakefield, Rachel Savine, Reni Jacob, Richard Innes, Ritoo Kapoor, Steve Rose, Tarkeshwari Mane, Vongayi Ogbeide, Waqas Khaliq, Yolanda Baird, Arnaud Galbois, Cyril Charron, Guillaume Besch, Guillaume Savary, Hervé Mentec, Jean-Luc Chagnon, Jeremy Castaneray, Jérémy Rosman, Lucie Vettoretti, Maud Mousset Hovaere, Messika Messika, Michel Djibré, Nathalie Rolin, Philippe Burtin, Pierre Garcon, Xavier Valette, Christian Rabe, Eberhard Barth, Kristina Fuest, Michael Horacek, Sebastian Allgäuer, Stefan J Schaller, Stefan Schering, Stephan Steiner, Thorben Dieck, Tobias Graf, Anastasia Koutsikou, Aristeidis Vakalos, Bogdan Raitsiou, Elli Niki Flioni, Evangelia Neou, Fotios Tsimpoukas, Georgios Papathanakos, Giorgos Marinakis, Ioannis Koutsodimitropoulos, Kounougeri Aikaterini, Nikoletta Rovina, Stylliani Kourelea, Tasioudis Polychronis, Vasiiios Zidianakis, Vryza Konstantinia, Zoi Aidoni, Catherine Motherway, Chris Read, Ignacio Martin-Loeches, Andrea Neville Cracchiolo, Aristide Morigi, Italo Calamai, Stefania Brusa, Ahmed Elhadi, Ahmed Tarek, Wesal Ali Belkhair, Alexander D Cornet, Evavan Boven, Jasper Haringman, Lenneke Haas, Lettie van den Berg, Oscar Hoiting, Peter de Jager, Rik T Gerritsen, Alena Breidablik, Anita Slapgard, Anne-Karin Rime, Bente Jannestad, Britt Sjøbøe, Eva Rice, Finn H Andersen, Hans Frank Strietzel, Jan Peter Jensen, Kirsti Tøien, Kristian Strand, Michael Hahn, Aleksandra Biernacka, Anna Kluzik, Bartosz Kudlinski, Dariusz Maciejewski, Dorota Studzińska, Hubert Hymczak, Jan Stefaniak, Joanna Solek-Pastuszka, Joanna Zorska, Katarzyna Cwyl, Lukasz J Krzych, Maciej Zukowski, Małgorzata Lipińska-Gediga, Marek Pietruszko, Mariusz Piechota, Marta Serwa, Miroslaw Czuczwar, Mirosław Ziętkiewicz, Natalia Kozera, Paweł Nasiłowski, Paweł Sendur, Paweł Zatorski, Piotr Galkin, Ryszard Gawda, Urszula Kościuczuk, Waldemar Cyrankiewicz, Wojciech Gola, Alexandre Fernandes Pinto, Ana Margarida Fernandes, Cristina Sousa, Inês Barros, Isabel Amorim Ferreira, Jacobo Bacariza Blanco, João Teles Carvalho, Jose Maia, Nuno Candeias, Vladislav Belskiy, Africa Lores, Angela Prado Mira, David Perez-Torres, Emilio Maseda, Enver Rodriguez, Estefania Prol-Silva, Gaspar Eixarch, Gemma Gomà, Gonzalo Navarro Velasco, MariánIrazábal Jaimes, Mercedes Ibarz Villamayor, Noemí Llamas Fernández, Patricia Jimeno Cubero, Sonia López-Cuenca, Teresa Tomasa, Anders Sjöqvist, Fredrik Schiöler, Henrik Westberg, Jessica Nauska, Joakim Sivik, Johan Berkius, Karin Kleiven Thiringer, Lina DeGeer, Sten Walther, Leila Hergafi, Philippe Eckert, Ismail Yıldız, Ihor Yovenko, Yuriy Nalapko, and Richard Pugh
Subjects: Medicine
Abstract: Objectives In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.Setting ICUs in 16 European countries.Participants In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.Primary and secondary outcomes measures We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.Results In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p
Published: 2021
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9. Correction: Determinants of Recovery from Severe Posterior Reversible Encephalopathy Syndrome.

Author: Stephane Legriel, Olivier Schraub, Elie Azoulay, Philippe Hantson, Eric Magalhaes, Isaline Coquet, Cedric Bretonniere, Olivier Gilhodes, Nadia Anguel, Bruno Megarbane, Laurent Benayoun, David Schnell, Gaetan Plantefeve, Julien Charpentier, Laurent Argaud, Bruno Mourvillier, Arnaud Galbois, Ludivine Chalumeau-Lemoine, Michel Rivoal, François Durand, Arnaud Geffroy, Marc Simon, Annabelle Stoclin, Jean-Louis Pallot, Charlotte Arbelot, Martine Nyunga, Olivier Lesieur, Gilles Troché, Fabrice Bruneel, Yves-Sébastien Cordoliani, Jean-Pierre Bedos, and Fernando Pico
Subjects: Medicine, Science
Published: 2013
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10. Determinants of recovery from severe posterior reversible encephalopathy syndrome.

Author: Stephane Legriel, Olivier Schraub, Elie Azoulay, Philippe Hantson, Eric Magalhaes, Isaline Coquet, Cedric Bretonniere, Olivier Gilhodes, Nadia Anguel, Bruno Megarbane, Laurent Benayoun, David Schnell, Gaetan Plantefeve, Julien Charpentier, Laurent Argaud, Bruno Mourvillier, Arnaud Galbois, Ludivine Chalumeau-Lemoine, Michel Rivoal, François Durand, Arnaud Geffroy, Marc Simon, Annabelle Stoclin, Jean-Louis Pallot, Charlotte Arbelot, Martine Nyunga, Olivier Lesieur, Gilles Troché, Fabrice Bruneel, Yves-Sébastien Cordoliani, Jean-Pierre Bedos, Fernando Pico, and Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS)
Subjects: Medicine, Science
Abstract: ObjectiveFew outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.Design70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.Main resultsConsciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOSConclusionsBy day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement.
Published: 2012
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11. Electrocardiographic Changes at the Early Stage of Status Epilepticus: First Insights From the ICTAL Registry

Author: Paul Chinardet, Floriane Gilles, Helene Cochet, Jonathan Chelly, Jean-Pierre Quenot, Gwenaelle Jacq, Pauline Soulier, Olivier Lesieur, Pascal Beuret, Mathilde Holleville, Cedric Bruel, Pierre Bailly, Bertrand Sauneuf, Caroline Sejourne, Arnaud Galbois, Candice Fontaine, François Perier, Nicolas Pichon, Marine Arrayago, Nicolas Mongardon, David Schnell, Jean-Baptiste Lascarrou, Raphaële Convers, and Stephane Legriel
Subjects: Critical Care and Intensive Care Medicine
Abstract: To describe early electrocardiogram (ECG) abnormalities after status epilepticus (SE) and evaluate their association with 90-day neurological outcomes.Retrospective analysis of a multicenter, national prospective registry between February 2018 and June 2020.Sixteen ICUs in France, IctalGroup Research Network.Adults with available ECG performed less than or equal to 24 hours after the onset of SE and less than or equal to 12 hours after its resolution.Double-blinded review of all ECGs was performed by two independent cardiologists. ECGs were categorized as normal/abnormal and then with minor/major early ECG abnormalities according to the Novacode ECG Classification system.Among 155 critically ill patients with SE, early ECG abnormalities were encountered in 145 (93.5%), categorized as major in 91 of 145 (62.8%). In addition to sinus tachycardia, the main abnormalities were in the ST segment (elevation [16.6%] or depression [17.9%]) or negative T waves (42.1%). Major early ECG abnormalities were significantly associated with respiratory distress and sinus tachycardia at the scene and hyperlactatemia at ICU admission. By multivariable analysis, three variables were significantly associated with 90-day poor outcome: age, preexisting ultimately fatal comorbidity, and cerebral insult as the cause of SE. Early major ECG abnormalities were not independently associated with 90-day functional outcome.In our study, early ECG abnormalities in the acute phase of SE were frequent, often unrecognized and were associated with clinical and biological stigma of hypoxemia. Although they were not independently associated with 90-day functional outcome, ECG changes at the early stage of SE should be systematically evaluated.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03457831.
Published: 2022

12. Characteristics, management, and outcomes of patients with infectious encephalitis requiring intensive care: A prospective multicentre observational study

Author: Pierre Fillatre, Alexandra Mailles, Jean Paul Stahl, Pierre Tattevin, Sophie Abgrall, Laurent Argaud, Xavier Argemi, Guillaume Baille, Aurélie Baldolli, Sarah Benghanem, Kevin Bertrand, Julien Biberon, Charlotte Biron, Geneviève Blanchet Fourcade, Mathieu Blot, Elisabeth Bothelo-Nevers, Frédéric Bourdain, David Boutoille, Hélène Brasme, Cédric Bruel, Fabrice Bruneel, Rodolphe Buzele, Emmanuel Canet, Etienne Canoui, Philippe Casenave, Bernard Castan, Charles Cazanave, Céline Cazorla, Pascal Chavanet, Catherine Chirouze, Tomasz Chroboczek, Johan Courjon, Daniel Da Silva, Thomas De Broucker, Arnaud De La Blanchardiere, Etienne De Montmollin, Eric Denes, Colin Deschanvres, Aurélien Dinh, Olivier Epaulard, Emmanuel Forestier, Thibaut Fraisse, Benjamin Gaborit, Amandine Gagneux-Brunon, Nicolas Gaillard, Arnaud Galbois, Mathieu Godement, François Goehringer, Pascale Goubin, Simon Gravier, Valentin Greigert, Isabelle Gueit, Thomas Guimard, Carole Henry, Maxime Hentzien, Pierre Jaquet, Fanny Jomier, Snejana Jurici, Solen Kerneis, Morgane Le Bras, Marion Le Marechal, Gwenael Le Moal, Paul Le Turnier, Anne-Sophie Lecompte, Raphael Lecomte, Stéphanie Lejeune, François-Xavier Lescure, Olivier Lesieur, Philippe Lesprit, Guillaume Louis, Rafael Mahieu, Alain Makinson, Guillaume Marc, Alexandre Maria, Nathalie Marin, Guillaume Martin-Blondel, Martin Martinot, Alexandre Mas, Philippe Mateu, Morgan Matt, Laurence Maulin, Frédéric Mechai, Eugénie Mutez, Jérémie Orain, Anne Pachart, Nathalie Pansu, Solene Patrat-Delon, Patricia Pavese, Hélène Pelerin, Véronique Pelonde-Erimée, Isabelle Pierre, Emilie Piet, Diane Ponscarme, Dimitri Psimaras, Mathilde Puges, Jean Reignier, Mathilde Reveillon Istin, Sylvain Rheims, Aurélie Richard-Mornas, Vincent Roubeau, Yvon Ruch, Isabelle Runge, Hélène Savini, Romain Sonneville, Jean-Marie Turmel, Louise Tyvaert, Marc-Olivier Vareil, Magali Vidal-Roux, Virginie Vitrat, Adrien Wang, Heidi Wille, Mathieu Zuber, Laurent Almoyna-Martinez, Jean-Louis Herrmann, Jérome Honnorat, Patrice Morand, France Roblot, Jean-Paul Stahl, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Santé publique France - French National Public Health Agency [Saint-Maurice, France], Centre Hospitalier Universitaire [Grenoble] (CHU), ARN régulateurs bactériens et médecine (BRM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and This work was supported by the French Infectious Diseases Society (Société de pathologie infectieuse de langue française, SPILF).
Subjects: Frailty, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV]Life Sciences [q-bio], Encephalitis, Intensive care unit, Functional outcome, Herpes simplex virus, Critical Care and Intensive Care Medicine
Abstract: International audience; PURPOSE: Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. MATERIALS AND METHODS: Ancillary study focusing on patients with ICU admission within the ENCEIF cohort, a French prospective observational multicentre study. The primary criteria for outcome was the functional status at hospital discharge, categorized using the Glasgow outcome scale (GOS). Logistic regression model was used to identify risk factors for poor outcome, defined as a GOS ≤ 3. RESULTS: We enrolled 198 ICU patients with IE. HSV was the primary cause (n = 72, 36% of all IE, 53% of IE with microbiological documentation). Fifty-two patients (26%) had poor outcome at hospital discharge, including 22 deaths (11%). Immunodeficiency, supratentorial focal signs on admission, lower cerebrospinal fluid (CSF) white cells count (2 days were independent predictors of poor outcome. CONCLUSION: HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.
Published: 2023
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13. Clinical phenotype and outcomes of pneumococcal versus meningococcal purpura fulminans: a multicenter retrospective cohort study

Author: Fabrice Daviaud, Xavier Valette, Martin Cour, Matthieu Schmidt, Frédéric Pène, Bertrand Sauneuf, Damien Contou, Jean Dellamonica, Bruno Mégarbane, Alexandre Lautrette, Cédric Bruel, Jean-Marc Tadié, Gaëtan Plantefève, Antoine Marchalot, Gaetan Beduneau, Martial Tchir, Christian Brun-Buisson, Julien Grouille, Nicolas Terzi, Delphine Colling, Jérémie Lemarié, Samir Jaber, Jean-Pierre Quenot, Elodie Gelisse, Nicolas de Prost, Gabriel Preda, Nicolas Lerolle, Pascal Beuret, Claire Pichereau, Guillaume Schnell, Mathieu Jozwiak, François Barbier, Armand Mekontso Dessap, Sylvie Ricome, Yacine Tandjaoui, Nadège Demars, Sebastien Preau, Damien Roux, Frédéric Bellec, Amélie Bazire, Arnaud Galbois, Laurent Argaud, Emmanuel Guerot, Stephan Ehrmann, Romain Sonneville, Rémi Coudroy, Olivier Leroy, Pierre Kalfon, Sebastien Jochmans, Lara Zafrani, Vincent Das, Benjamin Zuber, Laurent Guérin, Etienne de Montmollin, Christophe Lenclud, Antoine Kimmoun, Alexandre Conia, Caroline Jannière, Pascal Blanc, Gwenhael Colin, Charlène Le Moal, Centre Hospitalier Victor Dupouy, Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Henri Mondor, HOPEFUL Study group: Laurent Argaud, François Barbier, Amélie Bazire, Gaëtan Béduneau, Frédéric Bellec, Pascal Beuret, Pascal Blanc, Cédric Bruel, Christian Brun-Buisson, Gwenhaël Colin, Delphine Colling, Alexandre Conia, Rémi Coudroy, Martin Cour, Damien Contou, Fabrice Daviaud, Vincent Das, Jean Dellamonica, Nadège Demars, Stephan Ehrmann, Arnaud Galbois, Elodie Gelisse, Julien Grouille, Laurent Guérin, Emmanuel Guérot, Samir Jaber, Caroline Jannière, Sébastien Jochmans, Mathieu Jozwiak, Pierre Kalfon, Antoine Kimmoun, Alexandre Lautrette, Jérémie Lemarié, Charlène Le Moal, Christophe Lenclud, Nicolas Lerolle, Olivier Leroy, Antoine Marchalot, Bruno Mégarbane, Armand Mekontso Dessap, Etienne de Montmollin, Frédéric Pène, Claire Pichereau, Gaëtan Plantefève, Sébastien Préau, Gabriel Preda, Nicolas de Prost, Jean-Pierre Quenot, Sylvie Ricome, Damien Roux, Bertrand Sauneuf, Matthieu Schmidt, Guillaume Schnell, Romain Sonneville, Jean-Marc Tadié, Yacine Tandjaoui, Martial Tchir, Nicolas Terzi, Xavier Valette, Lara Zafrani, Benjamin Zuber, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Duchange, Nathalie
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], Neisseria meningitidis, Critical Care and Intensive Care Medicine, medicine.disease_cause, Pneumococcal Infections, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Septic shock, Streptococcus pneumoniae, Research Letter, Medicine, Humans, Meningitis, Clinical phenotype, ComputingMilieux_MISCELLANEOUS, 030304 developmental biology, Retrospective Studies, 0303 health sciences, Purpura fulminans, business.industry, RC86-88.9, 030208 emergency & critical care medicine, Retrospective cohort study, Medical emergencies. Critical care. Intensive care. First aid, medicine.disease, 3. Good health, Meningococcal Infections, [SDV] Life Sciences [q-bio], Phenotype, Treatment Outcome, business
Abstract: Auteurs : The HOPEFUL Study group; International audience; No abstract available
Published: 2021
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14. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis

Author: David Hajage, Alain Combes, Christophe Guervilly, Guillaume Lebreton, Alain Mercat, Arthur Pavot, Saad Nseir, Armand Mekontso-Dessap, Nicolas Mongardon, Jean Paul Mira, Jean-Damien Ricard, Alexandra Beurton, Guillaume Tachon, Loay Kontar, Christophe Le Terrier, Jean Christophe Richard, Bruno Mégarbane, Ruth H. Keogh, Aurélien Belot, Camille Maringe, Clémence Leyrat, Matthieu Schmidt, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dres, Julien Mayaux, Cédric Daubin, Richard Descamps, Aurélie Joret, Damien Du Cheyron, Frédéric Pene, Jean-Daniel Chiche, Mathieu Jozwiak, Paul Jaubert, Guillaume Voiriot, Muriel Fartoukh, Marion Teulier, Clarisse Blayau, Erwen L'Her, Cécile Aubron, Laetitia Bodenes, Nicolas Ferriere, Johann Auchabie, Anthony Le Meur, Sylvain Pignal, Thierry Mazzoni, Jean-Pierre Quenot, Pascal Andreu, Jean-Baptiste Roudau, Marie Labruyère, Sébastien Preau, Julien Poissy, Daniel Mathieu, Sarah Benhamida, Rémi Paulet, Nicolas Roucaud, Martial Thyrault, Florence Daviet, Sami Hraiech, Gabriel Parzy, Aude Sylvestre, Sébastien Jochmans, Anne-Laure Bouilland, Mehran Monchi, Marc Danguy des Déserts, Quentin Mathais, Gwendoline Rager, Pierre Pasquier, Jean Reignier, Amélie Seguin, Charlotte Garret, Emmanuel Canet, Jean Dellamonica, Clément Saccheri, Romain Lombardi, Yanis Kouchit, Sophie Jacquier, Armelle Mathonnet, Mai-Ahn Nay, Isabelle Runge, Frédéric Martino, Laure Flurin, Amélie Rolle, Michel Carles, Rémi Coudroy, Arnaud W. Thille, Jean-Pierre Frat, Maeva Rodriguez, Pascal Beuret, Audrey Tientcheu, Arthur Vincent, Florian Michelin, Fabienne Tamion, Dorothée Carpentier, Déborah Boyer, Gaetan Beduneau, Valérie Gissot, Stéphan Ehrmann, Charlotte Salmon Gandonniere, Djlali Elaroussi, Agathe Delbove, Yannick Fedun, Julien Huntzinger, Eddy Lebas, Grâce Kisoka, Céline Grégoire, Stella Marchetta, Bernard Lambermont, Laurent Argaud, Thomas Baudry, Pierre-Jean Bertrand, Auguste Dargent, Christophe Guitton, Nicolas Chudeau, Mickaël Landais, Cédric Darreau, Alexis Ferre, Antoine Gros, Guillaume Lacave, Fabrice Bruneel, Mathilde Neuville, Jérôme Devaquet, Richard Gallot, Riad Chelha, Arnaud Galbois, Anne Jallot, Ludivine Chalumeau Lemoine, Khaldoun Kuteifan, Valentin Pointurier, Louise-Marie Jandeaux, Joy Mootien, Charles Damoisel, Benjamin Sztrymf, Juliette Chommeloux, Charles Edouard Luyt, Frédérique Schortgen, Leon Rusel, Camille Jung, Florent Gobert, Damien Vimpere, Lionel Lamhaut, Bertrand Sauneuf, Liliane Charrrier, Julien Calus, Isabelle Desmeules, Benoît Painvin, Jean-Marc Tadie, Vincent Castelain, Baptiste Michard, Jean-Etienne Herbrecht, Mathieu Baldacini, Nicolas Weiss, Sophie Demeret, Clémence Marois, Benjamin Rohaut, Pierre-Henri Moury, Anne-Charlotte Savida, Emmanuel Couadau, Mathieu Série, Nica Alexandru, Cédric Bruel, Candice Fontaine, Sonia Garrigou, Juliette Courtiade Mahler, Maxime Leclerc, Michel Ramakers, Pierre Garçon, Nicole Massou, Ly Van Vong, Juliane Sen, Nolwenn Lucas, Franck Chemouni, Annabelle Stoclin, Alexandre Avenel, Henri Faure, Angélie Gentilhomme, Sylvie Ricome, Paul Abraham, Céline Monard, Julien Textoris, Thomas Rimmele, Florent Montini, Gabriel Lejour, Thierry Lazard, Isabelle Etienney, Younes Kerroumi, Claire Dupuis, Marine Bereiziat, Elisabeth Coupez, François Thouy, Clément Hoffmann, Nicolas Donat, Anne Chrisment, Rose-Marie Blot, Antoine Kimmoun, Audrey Jacquot, Matthieu Mattei, Bruno Levy, Ramin Ravan, Loïc Dopeux, Jean-Mathias Liteaudon, Delphine Roux, Brice Rey, Radu Anghel, Deborah Schenesse, Vincent Gevrey, Jermy Castanera, Philippe Petua, Benjamin Madeux, Otto Hartman, Michael Piagnerelli, Anne Joosten, Cinderella Noel, Patrick Biston, Thibaut Noel, Gurvan LE Bouar, Messabi Boukhanza, Elsa Demarest, Marie-France Bajolet, Nathanaël Charrier, Audrey Quenet, Cécile Zylberfajn, Nicolas Dufour, Buno Mégarbane, Sébastian Voicu, Nicolas Deye, Isabelle Malissin, François Legay, Matthieu Debarre, Nicolas Barbarot, Pierre Fillatre, Bertrand Delord, Thomas Laterrade, Tahar Saghi, Wilfried Pujol, Pierre Julien Cungi, Pierre Esnault, Mickael Cardinale, Vivien Hong Tuan Ha, Grégory Fleury, Marie-Ange Brou, Daniel Zafimahazo, David Tran-Van, Patrick Avargues, Lisa Carenco, Nicolas Robin, Alexandre Ouali, Lucie Houdou, Noémie Suh, Steve Primmaz, Jérome Pugin, Emmanuel Weiss, Tobias Gauss, Jean-Denis Moyer, Catherine Paugam Burtz, Béatrice La Combe, Rolland Smonig, Jade Violleau, Pauline Cailliez, Jonathan Chelly, Antoine Marchalot, Cécile Saladin, Christelle Bigot, Pierre-Marie Fayolle, Jules Fatséas, Amr Ibrahim, Dabor Resiere, Rabih Hage, Clémentine Cholet, Marie Cantier, Pierre Trouiler, Philippe Montravers, Brice Lortat-Jacob, Sebastien Tanaka, Alexy Tran Dinh, Jacques Duranteau, Anatole Harrois, Guillaume Dubreuil, Marie Werner, Anne Godier, Sophie Hamada, Diane Zlotnik, Hélène Nougue, Guillaume Carteaux, Keyvan Razazi, Nicolas De Prost, Meriam Lamraoui, Claire Alessandri, Quentin de Roux, Charles de Roquetaillade, Benjamin G. Chousterman, Alexandre Mebazaa, Etienne Gayat, Marc Garnier, Emmanuel Pardo, Lea Satre-Buisson, Christophe Gutton, Elise Yvin, Clémence Marcault, Elie Azoulay, Michael Darmon, Hafid Ait Oufella, Geoffroy Hariri, Tomas Urbina, Sandie Mazerand, Nicholas Heming, Francesca Santi, Pierre Moine, Djillali Annane, Adrien Bouglé, Edris Omar, Aymeric Lancelot, Emmanuelle Begot, Gaétan Plantefeve, Damien Contou, Hervé Mentec, Olivier Pajot, Stanislas Faguer, Olivier Cointault, Laurence Lavayssiere, Marie-Béatrice Nogier, Matthieu Jamme, Claire Pichereau, Jan Hayon, Hervé Outin, François Dépret, Maxime Coutrot, Maité Chaussard, Lucie Guillemet, Pierre Goffin, Romain Thouny, Julien Guntz, Laurent Jadot, Romain Persichini, Vanessa Jean-Michel, Hugues Georges, Thomas Caulier, Gaël Pradel, Marie-Hélène Hausermann, Thi My Hue Nguyen-Valat, Michel Boudinaud, Emmanuel Vivier, Sylvène Rosseli, Gaël Bourdin, Christian Pommier, Marc Vinclair, Simon Poignant, Sandrine Mons, Wulfran Bougouin, Franklin Bruna, Quentin Maestraggi, Christian Roth, Laurent Bitker, François Dhelft, Justine Bonnet-Chateau, Mathilde Filippelli, Tristan Morichau-Beauchant, Stéphane Thierry, Charlotte Le Roy, Mélanie Saint Jouan, Bruno Goncalves, Aurélien Mazeraud, Matthieu Daniel, Tarek Sharshar, Cyril Cadoz, Rostane Gaci, Sébastien Gette, Guillaune Louis, Sophe-Caroline Sacleux, Marie-Amélie Ordan, Aurélie Cravoisy, Marie Conrad, Guilhem Courte, Sébastien Gibot, Younès Benzidi, Claudia Casella, Laurent Serpin, Jean-Lou Setti, Marie-Catherine Besse, Anna Bourreau, Jérôme Pillot, Caroline Rivera, Camille Vinclair, Marie-Aline Robaux, Chloé Achino, Marie-Charlotte Delignette, Tessa Mazard, Frédéric Aubrun, Bruno Bouchet, Aurélien Frérou, Laura Muller, Charlotte Quentin, Samuel Degoul, Xavier Stihle, Claude Sumian, Nicoletta Bergero, Bernard Lanaspre, Hervé Quintard, Eve Marie Maiziere, Pierre-Yves Egreteau, Guillaume Leloup, Florin Berteau, Marjolaine Cottrel, Marie Bouteloup, Matthieu Jeannot, Quentin Blanc, Julien Saison, Isabelle Geneau, Romaric Grenot, Abdel Ouchike, Pascal Hazera, Anne-Lyse Masse, Suela Demiri, Corinne Vezinet, Elodie Baron, Deborah Benchetrit, Antoine Monsel, Grégoire Trebbia, Emmanuelle Schaack, Raphaël Lepecq, Mathieu Bobet, Christophe Vinsonneau, Thibault Dekeyser, Quentin Delforge, Imen Rahmani, Bérengère Vivet, Jonathan Paillot, Lucie Hierle, Claire Chaignat, Sarah Valette, Benoït Her, Jennifier Brunet, Mathieu Page, Fabienne Boiste, Anthony Collin, Florent Bavozet, Aude Garin, Mohamed Dlala, Kais Mhamdi, Bassem Beilouny, Alexandra Lavalard, Severine Perez, Benoit Veber, Pierre-Gildas Guitard, Philippe Gouin, Anna Lamacz, Fabienne Plouvier, Bertrand P Delaborde, Aïssa Kherchache, Amina Chaalal, Marc Amouretti, Santiago Freita-Ramos, Damien Roux, Jean-Michel Constantin, Mona Assefi, Marine Lecore, Agathe Selves, Florian Prevost, Christian Lamer, Ruiying Shi, Lyes Knani, Sébastien Pili Floury, Lucie Vettoretti, Michael Levy, Lucile Marsac, Stéphane Dauger, Sophie Guilmin-Crépon, Hadrien Winiszewski, Gael Piton, Thibaud Soumagne, Gilles Capellier, Jean-Baptiste Putegnat, Frédérique Bayle, Maya Perrou, Ghyslaine Thao, Guillaume Géri, Cyril Charron, Xavier Repessé, Antoine Vieillard-Baron, Mathieu Guilbart, Pierre-Alexandre Roger, Sébastien Hinard, Pierre-Yves Macq, Kevin Chaulier, Sylvie Goutte, Patrick Chillet, Anaïs Pitta, Barbara Darjent, Amandine Bruneau, Sigismond Lasocki, Maxime Leger, Soizic Gergaud, Pierre Lemarie, Nicolas Terzi, Carole Schwebel, Anaïs Dartevel, Louis-Marie Galerneau, Jean-Luc Diehl, Caroline Hauw-Berlemont, Nicolas Péron, Emmanuel Guérot, Abolfazl Mohebbi Amoli, Michel Benhamou, Jean-Pierre Deyme, Olivier Andremont, Diane Lena, Julien Cady, Arnaud Causeret, Arnaud De La Chapelle, Christophe Cracco, Stéphane Rouleau, David Schnell, Camille Foucault, Cécile Lory, Thibault Chapelle, Vincent Bruckert, Julie Garcia, Abdlazize Sahraoui, Nathalie Abbosh, Caroline Bornstain, Pierre Pernet, Florent Poirson, Ahmed Pasem, Philippe Karoubi, Virginie Poupinel, Caroline Gauthier, François Bouniol, Philippe Feuchere, Anne Heron, Serge Carreira, Malo Emery, Anne Sophie Le Floch, Luana Giovannangeli, Nicolas Herzog, Christophe Giacardi, Thibaut Baudic, Chloé Thill, Said Lebbah, Jessica Palmyre, Florence Tubach, Nicolas Bonnet, Nathan Ebstein, Stéphane Gaudry, Yves Cohen, Julie Noublanche, Olivier Lesieur, Arnaud Sément, Isabel Roca-Cerezo, Michel Pascal, Nesrine Sma, Gwenhaël Colin, Jean-Claude Lacherade, Gauthier Bionz, Natacha Maquigneau, Pierre Bouzat, Michel Durand, Marie-Christine Hérault, Jean-Francois Payen, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Université Paris-Saclay, CHU Lille, Hôpital Henri Mondor, Groupe de recherche clinique CARMAS [Créteil] (UPEC/Faculté de Médecine de Créteil), 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), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Hôpital Louis Mourier - AP-HP [Colombes], Hôpital Foch [Suresnes], CHU Amiens-Picardie, Geneva University Hospital (HUG), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Lariboisière-Fernand-Widal [APHP], London School of Hygiene and Tropical Medicine (LSHTM), RICHARD, Jean-Christophe, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Pulmonary and Respiratory Medicine, Adult, Respiratory Distress Syndrome, SARS-CoV-2, [SDV]Life Sciences [q-bio], acute respiratory distress syndrome (ARDS), COVID-19, extracorporeal membrane oxygenation, Critical Care and Intensive Care Medicine, Cohort Studies, [SDV] Life Sciences [q-bio], emulated target trial, acute respiratory distress syndrome, Treatment Outcome, surgical procedures, operative, Humans, Retrospective Studies
Abstract: International audience; Rationale: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown.Objectives: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2
Published: 2022
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15. Multicentre observational status-epilepticus registry: Protocol for ICTAL

Author: Gwenaelle Jacq, Jonathan Chelly, Jean-Pierre Quenot, Pauline Soulier, Olivier Lesieur, Pascal Beuret, Mathilde Holleville, Cedric Bruel, Pierre Bailly, Bertrand Sauneuf, Caroline Sejourne, Jean Philippe Rigaud, Arnaud Galbois, Marine Arrayago, Gaetan Plantefeve, Annabelle Stoclin, David Schnell, Candice Fontaine, François Perier, Wulfran Bougouin, Nicolas Pichon, Nicolas Mongardon, Didier Ledoux, Jean-Baptiste Lascarrou, Stephane Legriel, Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupe Hospitalier Sud, Groupe hospitalier de La Rochelle, Centre Hospitalier de Roanne, Hôpitaux Universitaires Paris Nord Val de Seine (HUPNVS), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier Saint-Joseph [Paris], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Réanimation Polyvalente [CHPC - Site Louis Pasteur], Site Louis Pasteur [CHPC], CH Centre Hospitalier Public du Cotentin (CHPC)-CH Centre Hospitalier Public du Cotentin (CHPC), Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Centre hospitalier de Dieppe, Centre Hospitalier Privé Claude Galien - Ramsay Santé, Centre Hospitalier de Cannes, Centre hospitalier Argenteuil (CH Argenteuil), Institut Gustave Roussy (IGR), Département de soins aigus [Gustave Roussy] (DSA), Centre Hospitalier d'Angoulême (CH Angoulême), Hôpital Privé Jacques Cartier [Massy], Hôpital de Brive, Hôpital Henri Mondor, Centre Hospitalier Universitaire de Liège (CHU-Liège), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Acknowledgements We thank A Wolfe MD (Chaumont, France) for helping to prepare the manuscript. The study was supported by the French public funding agency Délégation à la Recherche Clinique et à l’Innovation (DRCI), Versailles, France., and HAL UVSQ, Équipe
Subjects: Critical Care, adult neurology, General Medicine, Cross-Sectional Studies, Status Epilepticus, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Humans, Multicenter Studies as Topic, Medicine, epidemiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Registries, adult intensive & critical care, Retrospective Studies
Abstract: IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can cause long-term impairments. Overall outcomes remain poor. Major efforts are required to clarify the epidemiology of SE and the determinants of outcomes, thereby identifying targets for improved management.Methods and analysisICTAL Registry is a multicentre open cohort of critically ill patients with convulsive, non-convulsive or psychogenic non-epileptic SE. Observational methods are applied to collect uniform data. The goal of the ICTAL Registry is to collect high-quality information on a large number of patients, thereby allowing elucidation of the pathophysiological mechanisms involved in mortality and morbidity. The registry structure is modular, with a large core data set and the opportunity for research teams to create satellite data sets for observational or interventional studies (eg, cohort multiple randomised controlled trials, cross-sectional studies and short-term and long-term longitudinal outcome studies). The availability of core data will hasten patient recruitment to studies, while also decreasing costs. Importantly, the vast amount of data from a large number of patients will allow valid subgroup analyses, which are expected to identify patient populations requiring specific treatment strategies. The results of the studies will have a broad spectrum of application, particularly given the multidisciplinary approach used by the IctalGroup research network.Ethics and disseminationThe ICTAL Registry protocol was approved by the ethics committee of the French Intensive Care Society (#CE_SRLF 19-68 and 19-68a). Patients or their relatives/proxies received written information to the use of the retrospectively collected and pseudonymised data, in compliance with French law. Prospectively included patients receive written consent form as soon as they recover decision-making competency; if they refuse consent, they are excluded from the registry. Data from the registry will be disseminated via conference presentations and peer-reviewed publications.Trial registration numberNCT03457831.
Published: 2022
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16. Comparison of prognostic factors between bacteraemic and non-bacteraemic critically ill immunocompetent patients in community-acquired severe pneumococcal pneumonia: a STREPTOGENE sub-study

Author: Anne Veinstein, Jean Paul Mira, Benoit Misset, Jean Reignier, Kader Ouchenir, Hugo Bellut, Frédéric Jacobs, Yves Le Tulzo, Anthony Dugard, Shidasp Siami, Raphaël Porcher, Armelle Mathonnet, Sebastien Preau, Jean Philippe Rigaud, Pierre Asfar, Bertrand Souweine, Arnaud Galbois, Joel Cousson, Florent Dewavrin, Bruno Mégarbane, Olivier Baldesi, Jean Pierre Bedos, E. Varon, Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier de Versailles André Mignot (CHV), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'épidémiologie Clinique [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Hôtel Dieu, Université Paris Descartes, Sorbonne Paris Cité, 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), CHI Créteil, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Pontchaillou [Rennes], Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la source, Hôpital Dupuytren [CHU Limoges], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital Louis Pasteur [Chartres], Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Albert Calmette, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier du Pays d'Aix, Service de réanimation polyvalente [Centre Hospitalier de Dieppe], Centre hospitalier de Dieppe, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre hospitalier Saint-Joseph [Paris], AP-HP - Hôpital Antoine Béclère [Clamart], Centre hospitalier [Valenciennes, Nord], Hôpital Cochin [AP-HP], and dormoy, valerian
Subjects: medicine.medical_specialty, Severe community-acquired pneumonia, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Intensive care, Internal medicine, Pneumococcal bacteraemia, Streptococcus pneumoniae, Case fatality rate, medicine, Blood culture, 030212 general & internal medicine, 0303 health sciences, medicine.diagnostic_test, RC86-88.9, 030306 microbiology, business.industry, Research, Pneumococcal pneumonia, Medical emergencies. Critical care. Intensive care. First aid, Odds ratio, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Pneumonia, Macrolides, business, Fluoroquinolones
Abstract: Background The presence of bacteraemia in pneumococcal pneumonia in critically ill patients does not appear to be a strong independent prognostic factor in the existing literature. However, there may be a specific pattern of factors associated with mortality for ICU patients with bacteraemic pneumococcal community-acquired pneumonia (CAP). We aimed to compare the factors associated with mortality, according to the presence of bacteraemia or not on admission, for patients hospitalised in intensive care for severe pneumococcal CAP. Methods This was a post hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France between 2008 and 2012 for pneumococcal CAP. Patients were divided into two groups based on initial blood culture (positive vs. negative) for Streptococcus pneumoniae. The primary outcome was hospital mortality, which was compared between the two groups using odds ratios according to predefined variables to search for a prognostic interaction present in bacterial patients but not non-bacteraemic patients. Potential differences in the distribution of serotypes between the two groups were assessed. The prognostic consequences of the presence or not of initial bi-antibiotic therapy were assessed, specifically in bacteraemic patients. Results Among 614 included patients, 274 had a blood culture positive for S. pneumoniae at admission and 340 did not. The baseline difference between the groups was more frequent leukopaenia (26% vs. 14%, p = 0.0002) and less frequent pre-hospital antibiotic therapy (10% vs. 16.3%, p = 0.024) for the bacteraemic patients. Hospital mortality was not significantly different between the two groups (p = 0.11). We did not observe any prognostic factors specific to the bacteraemic patient population, as the statistical comparison of the odds ratios, as an indication of the association between the predefined prognostic parameters and mortality, showed them to be similar for the two groups. Bacteraemic patients more often had invasive serotypes but less often serotypes associated with high case fatality rates (p = 0.003). The antibiotic regimens were similar for the two groups. There was no difference in mortality for patients in either group given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. Conclusion Bacteraemia had no influence on the mortality of immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, regardless of the profile of the associated prognostic factors.
Published: 2021
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17. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

Author: Kenneth Ekpe, Damien Roux, Olivier Lesieur, Nicolas Pichon, Cédric Bruel, Stéphane Legriel, Olga Cosic, Bertrand Sauneuf, Nathalie Zappella, Laura Crosby, Baptiste Claude, Marc Garnier, Pierrick Cronier, Maxime Mallet, Carole Ruault, Sofia Ortuno, Arnaud Galbois, Julien Labreuche, Antoine Vieillard-Baron, Centre Hospitalier de Versailles André Mignot (CHV), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Lille, Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Groupe de recherche clinique en anesthésie réanimation médecine périopératoire [CHU Pitié-Salpétrière] (GRC ARPE), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Anesthésie réanimation [CHU Tenon], CHU Tenon [AP-HP], Hôpital Ambroise Paré [AP-HP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Hôpital Saint-Louis de La Rochelle (CH La Rochelle), CHU Limoges, Ramsay Générale de Santé - Hôpital Privé La Louvière, Centre hospitalier Saint-Joseph [Paris], Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Public du Cotentin (CHPC), Hôpital Louis Mourier - AP-HP [Colombes], Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire (GRC 29 - ARPE), Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CH Centre Hospitalier Public du Cotentin (CHPC), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Service de Pneumologie - R3S [CHU Pitié-Salpêtrière] (SPMIR-R3S)
Subjects: Liver Cirrhosis, Male, medicine.medical_specialty, Multivariate analysis, Cirrhosis, Science, Peritonitis, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Ascitic Fluid, Humans, In patient, 030304 developmental biology, Aged, Retrospective Studies, 0303 health sciences, Multidisciplinary, Critically ill, business.industry, Mortality rate, Retrospective cohort study, Digestive signs and symptoms, Bacterial Infections, Middle Aged, medicine.disease, 3. Good health, Mycoses, Liver, 030211 gastroenterology & hepatology, Female, business, Secondary Peritonitis, Complication, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm3 (OR 3.70; 95%CI 1.38–9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.
Published: 2021
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18. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

Author: Nigel White, Jenny Lord, Angela Prado Mira, Ala Khaled, Hubert Hymczak, Kristian Strand, Lenneke E M Haas, Mirosław Czuczwar, Lettie van den Berg, Pieter De Buysscher, Małgorzata Lipińska-Gediga, Simon Dubler, Michel Djibré, Ignacio Martin-Loeches, Georgina Randell, Diederik Gommers, Jose Maia, Patrick Meybohm, Wojciech Gola, Lina De Geer, Tom Lawton, Jonas Juul Pedersen, Isabel Amorim Ferreira, Kristina Fuest, Marcus Franz, McDonald Mupudzi, Kounougeri Aikaterini, Zoi Aidoni, Anastasia Koutsikou, Joakim Sivik, Hans Flaatten, Catia Cilloniz, Paweł Zatorski, Sally Humphreys, Henrik Westberg, Eva Rice, Peter de Jager, Helder Filipe, Stefania Brusa, Maria Faulkner, Jan Stefaniak, Cyril Charron, Nuno Candeias, Sten Walther, Nathalie Rolin, Muhammed Elhadi, Marta Serwa, Sebastian Allgäuer, Thomas Elkmann, Philipp Eller, Jean-Luc Chagnon, Gonzalo Navarro Velasco, Raimund Helbok, Catherine Motherway, Dorota Studzińska, Alan Pope, Ahmed Tarek, Cristina Sousa, Natalia Kozera, Michael Horacek, Camilla Brorsson, Tom Dormans, Nuno Catorze, Michael Joannidis, Andrea Neville Cracchiolo, Walter Swinnen, Oscar Hoiting, Africa Lores, Dominic Spray, Vladislav Belskiy, Marijana Mikačić, Rachel Savine, Tim Rahmel, Christoffer Sølling, Fredrik Schiöler, Henning Ebelt, Urszula Kościuczuk, Marek Pietruszko, Alexander D Cornet, Vasiiios Zidianakis, Bogdan Raitsiou, Ana Rita Santos, Nick Spittle Nick Spittle, Jan Peter Jensen, Alena Breidablik Alena Breidablik, Wojciech Szczeklik, Joerg C. Schefold, Karin Kleiven Thiringer, Alexandre Fernandes Pinto, Antoine Romen, Ingeborg D Welters, Nikolaas de Neve, Joanne Jones, Carole Boulanger, Ciaran Hart, Georgios Papathanakos, Jessica Nauska, Gaspar Eixarch, Pål Klepstad, Wesal Ali Belkhair, Ximena Watson, Brian Marsh, Emmanuel Guerot, Michael W. Schuster, Julie North, Bartosz Kudlinski, Alessandro Morandi, Stefan Schering, Fotios Tsimpoukas, Mercedes Ibarz, Ioannis Koutsodimitropoulos, Maurizio Cecconi, David Perez-Torres, Stephan Steiner, Agnieszka Kubisz-Pudelko, Johan Berkius, Phillipa Wakefield, Joanna Zorska, Anne-Karin Rime, Jacobo Bacariza Blanco, Reni Jacob, Guillaume Besch, Jane Evans, Mathilde Hummelmose Enevoldsen, Jasper Haringman, Xavier Valette, Pierre Garçon, Waldemar Cyrankiewicz, Megan Lea-Hagerty, Jason Cupitt, Yolanda Baird, Eberhard Barth, Stylliani Kourelea, Christine Cramer, Gerardo Aguilar, Christophe Vinsonneau, Maud Mousset Hovaere, Hans Frank Strietzel, Patricia Jimeno Cubero, René Schmutz, Aristide Morigi, Jonathan Ball, Raphael Romano Bruno, Kirsti Tøien, Ahmed Elhadi, Susan Dowling, Antonio Artigas, Aleksandra Biernacka, Clare Bolger, Italo Calamai, Dorthe Ørsnes, Giorgos Marinakis, Amy Collins, Leila Hergafi, Didier Thevenin, Michael Spivey, Bård E S Dahle, Willem Dieperink, Lucie Vettoretti, Vryza Konstantinia, Tasioudis Polychronis, Laura Ortiz-Ruiz De Gordoa, Julien Maizel, Louise Bell, Nicholas Love, Christian Frey, Joanna Solek-Pastuszka, Richard Pugh, Stefan J. Schaller, Hervé Mentec, Mercedes Ibarz Villamayor, Ritoo Kapoor, W. Khaliq, Gemma Gomà, Patrick Morgan, Finn H. Andersen, Madhu Balasubramaniam, Irina Grecu, Filippo Boroli, Saad Nseir, Mariusz Piechota, Ana M. Fernandes, Katarzyna Cwyl, Elli Niki Flioni, Jørund Langørgen, Kiran Salaunkey, Jean-Pierre Quenot, Philippe Burtin, Michael Reay, Ryszard Gawda, Ariane Boumendil, Anders Bastiansen, Hazem Ahmed, Evangelia Neou, Ihor Yovenko, Rik T Gerritsen, Bente Jannestad, Tarkeshwari Mane, Richard Innes, Kelly Tiercelet, Christian Jung, Rui Moreno, Maciej Zukowski, Dariusz Maciejewski, Dylan W. de Lange, Jeremy Henning, Paweł Nasiłowski, Estefania Prol-Silva, Tilemachos Zafeiridis, Lukasz J Krzych, Jérémy Rosman, Tobias Graf, Sonia López-Cuenca, Marcela Vizcaychipi, Jeremy Castaneray, Steve Rose, Vongayi Ogbeide, Arnaud Galbois, Yuriy Nalapko, Sandra Oeyen, Joke Nollet, Ismail Yıldız, Chris Read, Philippe Eckert, Ashok Raj, Anita Slapgard, Anna Kluzik, Mirosław Ziętkiewicz, Christian Rabe, Guillaume Savary, Noemí Llamas Fernández, João Teles Carvalho, Nikoletta Rovina, Jakob Edelberg Thomsen, Britt Sjøbøe, Andreas Husted, Jean-Philippe Rigaud, Bertrand Guidet, Piotr Galkin, Marián Irazábal Jaimes, Anders Sjöqvist, Paweł Sendur, Thorben Dieck, A. Vakalos, Enver Rodriguez, Jesper Fjølner, Eva van Boven, Inês Barros, Susannah Leaver, Patricia Williams, Messika Messika, Emilio Maseda, Michael Hahn, Teresa Tomasa, and Critical Care
Subjects: Aging, medicine.medical_specialty, intensive care units, 80 jaar en ouder, Comorbidity, frailty, elderly, law.invention, Sepsis, sepsis, 03 medical and health sciences, intensive care afdelingen, 0302 clinical medicine, law, Intensive care, kwetsbaarheid, sterfte, ouderen, medicine, 80 and over, Humans, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Prospective cohort study, business.industry, Mortality rate, Hazard ratio, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Intensive care unit, mortality, aged, Emergency medicine, SOFA score, Geriatrics and Gerontology, business, aged, 80 and over
Abstract: Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. Design Prospective cohort study. Setting 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. Subjects Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. Methods Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients’ characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. Results Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09–1.25, P 4): HR, 1.34 (95% CI, 1.18–1.51, P Conclusions There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
Published: 2021

19. End of life in the critically ill patient: evaluation of experience of end of life by caregivers (EOLE study)

Author: Frédéric Jacobs, Jean-Paul Mira, Amira Jamoussi, Cécile Lory, Anne Renault, Jean Turc, Philippe Mateu, Cédric Daubin, Estelle Martin, Yannick Brunin, Bertrand Canoville, Jean-Claude Lacherade, Pierre Bouju, Florent Bavozet, Pierre Esnault, Fabien Lambiotte, Martial Thyrault, Sébastien Moschietto, Stephan Ehrmann, Gaëtan Plantefève, Clément Hoffmann, Mathieu Guilbart, Saber Barbar, Sebastien Jochmans, Stéphanie Houcke, Nicholas Heming, Arnaud Galbois, Bertrand Hermann, Frank Chemouni, T. Vanderlinden, Asael Berger, Laurent Poiroux, Alexandre Demoule, Alexandre Herbland, Arnaud Sement, Anne Terrier, Marc Danguy, Sami Hraeich, Pierre-Yvan Simonoviez, Elie Azoulay, Philippe Michel, Virginie Amilien, Nadia Aissaoui, David Couret, Jean-Baptiste Lascarrou, Jean Reignier, Grégoire Muller, Guillaume Louis, Lamia Ouanes-Besbes, Sami Blidi, Michael Piagnarelli, Maguelone Chalies, Florence Boissier, Gwenaëlle Jacq, Jean-Pierre Quenot, Nadiejda Antier, François Philippart, Gabriel Lejour, Atika Youssoufa, Guillaume Decormeille, David Grimaldi, Adrien Auvet, René Robert, Etienne Escudier, Jean-François Llitjos, Gaël Piton, Julien Duvivier, Nancy Kentish-Barnes, and Jonathan Messika
Subjects: medicine.medical_specialty, Withholding treatment, Critically ill, business.industry, RC86-88.9, Research, Correction, Medical emergencies. Critical care. Intensive care. First aid, Critical Care and Intensive Care Medicine, humanities, Critical care, End of life, medicine, Withdrawal treatment, Patient evaluation, Intensive care medicine, business
Abstract: Background The death rate in intensive care units (ICUs) can reach 20%. More than half occurs after a decision of care withholding/withdrawal. We aimed at describing and evaluating the experience of ICU physicians and nurses involved in the end-of-life (EOL) procedure. Primary objective was the evaluation of the experience of EOL assessed by the CAESAR questionnaire. Secondary objectives were to describe factors associated with a low or high score and to examine the association between Numeric Analogic Scale and quality of EOL. Methods Consecutive adult patients deceased in 52 ICUs were included between April and June 2018. Characteristics of patients and caregivers, therapeutics and care involved after withdrawal were recorded. CAESAR score included 15 items, rated from 1 (traumatic experience) to 5 (comforting experience). The sum was rated from 15 to 75 (the highest, the best experience). Numeric Analogic Scale was rated from 0 (worst EOL) to 10 (optimal EOL). Results Five hundred and ten patients were included, 403 underwent decision of care withholding/withdrawal, and among them 362 underwent effective care withdrawal. Among the 510 patients, mean CAESAR score was 55/75 (± 6) for nurses and 62/75 (± 5) for physicians (P P = 0.06). CAESAR score and Numeric Analogic Scale were significantly but weakly correlated. They were significantly higher for both nurses and physicians if the patient died after a decision of withholding/withdrawal. In multivariable analysis, among the 362 patients with effective care withdrawal, disagreement on the intensity of life support between caregivers, non-invasive ventilation and monitoring and blood tests the day of death were associated with lower score for nurses. For physicians, cardiopulmonary resuscitation the day of death was associated with lower score in multivariable analysis. Conclusion Experience of EOL was better in patients with withholding/withdrawal decision as compared to those without. Our results suggest that improvement of nurses’ participation in the end-of-life process, as well as less invasive care, would probably improve the experience of EOL for both nurses and physicians. Registration: ClinicalTrial.gov: NCT03392857.
Published: 2021

20. Comparison of a preventive or curative strategy of fluid removal on the weaning of mechanical ventilation: a study protocol for a multicentre randomised open-label parallel-group trial

Author: Jean-Paul Mira, Jean-Pierre Quenot, Guylaine Labro, François Beloncle, Julien Cousty, Martin Dres, Jordane Lebut, Laurent Guérin, Candice Estellat, Jean-Luc Baudel, Armand Mekontso Dessap, Gwenaël Prat, Vincent Labbé, Arnaud Galbois, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Sud Saint Pierre [Ile de la Réunion], Centre Hospitalier Privé Claude Galien - Ramsay Santé, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], CHU Tenon [AP-HP], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Groupe Hospitalier Nord Essonne [Longjumeau], Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHRU Brest - Département d'Anesthésie Réanimation (CHU - BREST - DAR), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], and Gestionnaire, HAL Sorbonne Université 5
Subjects: medicine.medical_specialty, Critical Illness, medicine.medical_treatment, Subgroup analysis, Context (language use), law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Informed consent, adult cardiology, Intensive care, medicine, Humans, Multicenter Studies as Topic, respiratory medicine (see thoracic medicine), Weaning, adult intensive & critical care, Randomized Controlled Trials as Topic, Mechanical ventilation, Ventilators, Mechanical, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Weight change, Intensive Care, 030208 emergency & critical care medicine, General Medicine, Respiration, Artificial, 3. Good health, Intensive Care Units, 030228 respiratory system, Emergency medicine, Airway Extubation, Medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: IntroductionFluid overload is associated with a poor prognosis in the critically ill patients, especially at the time of weaning from mechanical ventilation as it may promote weaning failure from cardiac origin. Some data suggest that early administration of diuretics would shorten the duration of mechanical ventilation. However, this strategy may expose patients to a higher risk of haemodynamic and metabolic complications. Currently, there is no recommendation for the use of diuretics during weaning and there is an equipoise on the timing of their initiation in this context.Methods and analysisThis study is a multicentre randomised controlled trial comparing two strategies of fluid removal during weaning in 13 French intensive care units (ICU). The preventive strategy is initiated systematically when the fluid balance or weight change is positive and the patients have criteria for clinical stability; the curative strategy is initiated only in case of weaning failure documented as of cardiac origin. Four hundred and ten patients will be randomised with a 1:1 ratio. The primary outcome is the duration of weaning from mechanical ventilation, defined as the number of days between randomisation and successful extubation (alive without reintubation nor tracheostomy within the 7 days after extubation) at day 28. Secondary outcomes include daily and cumulated fluid balance, metabolic and haemodynamic complications, ventilator-associated pneumonia, weaning complications, number of ventilator-free days, total duration of mechanical ventilation, the length of stay in ICU and mortality in ICU, in hospital and, at day 28. A subgroup analysis for the primary outcome is planned in patients with kidney injury (Kidney Disease: Improving Global Outcomes class 2 or more) at the time of randomisation.Ethics and disseminationThe study has been approved by the ethics committee (Comité de Protection des Personnes Paris 1) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT04050007.Protocol versionV.1; 12 March 2019.
Published: 2021
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21. A Prospective Cohort Study to Identify Clinical, Biological, and Imaging Features That Predict the Etiology of Acute Encephalitis

Author: Daniel Da Silva, Vincent Roubeau, Patricia Pavese, Jean-Paul Mira, Rafael Mahieu, Heidi Wille, Lydie Khatchatourian, Charlotte Biron, Geneviève Blanchet-Fourcade, Romain Lefaucheur, Laurent Argaud, Arnaud Seigneurin, Guillaume Baille, Eugénie Mutez, Hélène Brasme, Morgan Matt, Amandine Gagneux-Brunon, Alexandra Mailles, Thibaut Fraisse, Morgane Le Bras, Céline Cazorla, Isabelle Pierre, Anne Bonnetain, Hélène Savini, Nathalie Marin, Isabelle Runge, Pierre Fillatre, Mathilde Reveillon-Istin, Mathieu Godement, Cédric Bruel, Martin Martinot, Xavier Argemi, Saber Touati, Emmanuel Forestier, M. Hentzien, Jérome Honnorat, Capucine Diard-Detoeuf, Nathalie Pansu, Yvon Ruch, Thècle Degroote, Alexandre Mas, Guillaume Louis, Bernard Castan, Thomas Guimard, Aurélien Dinh, Marc-Olivier Vareil, Pierre Jaquet, Aurélie Richard-Mornas, Thibault Challan-Belval, Paul Le Turnier, Aurélie Martin, Frédéric Bourdain, Catherine Chirouze, Pascal Chavanet, Carole Henry, François Goehringer, Alain Makinson, Fabrice Bruneel, Anne Pachart, Manuela Le Cam, Johan Courjon, Elisabeth Botelho-Nevers, Pierre Tattevin, Emilie Piet, Eric Denes, Jean-Louis Herrmann, Philippe Casenave, Rodolphe Buzele, Marion Le Maréchal, Laurence Maulin, Thomas De Broucker, Agnès Riché, Sylvain Rheims, Olivier Epaulard, Solene Patrat-Delon, Aurélie Baldolli, Valentin Greigert, Isabelle Gueit, Anne-Sophie Lecompte, Nicolas Gaillard, Marie Froidure, Guillaune Marc, Dimitri Psimaras, Nathalie Asseray, Charles Cazanave, Etienne Canouï, Jean-Etienne Herbrecht, Alexandre Thibault Jacques Maria, Romain Sonneville, Patrice Morand, Jessica Krause, Jean-Marie Turmel, Tomasz Tchroboczek, Kelly Tiercelet, Gwenael Le Moal, Arnaud de la Blanchardiere, Thomas Baudry, Jean-Paul Stahl, Simon Gravier, Frédéric Méchaï, Diane Ponscarme, Christelle Lucas, Laurent Almoyna-Martinez, Colin Deschanvres, Olivier Lesieur, Véronique Pelonde-Erimée, Raphaël Lecomte, David Boutoille, Sophie Abgrall, Jérémie Orain, Philippe Lesprit, François Raffi, Magalie Vidal-Roux, Mathieu Blot, Michael Bonnan, Arnaud Galbois, V. Vitrat, Olivier Bouchaud, Guillaume Martin-Blondel, Mathieu Zuber, Stéphanie Lejeune, Solen Kernéis, Hélène Pellerin, Isabelle Tyvaert, Mathilde Puges, Xavier Lescure, Philippe Mateu, Marine Delaroche, Fanny Jomier, Julien Biberon, Pascale Goubin, Benjamin Gaborit, Etienne De Montmollin, Centre Hospitalier Universitaire [Grenoble] (CHU), Santé publique France - French National Public Health Agency [Saint-Maurice, France], CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), French Infectious Diseases Society, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Infectious Encephalitis, 0301 basic medicine, Microbiology (medical), Herpesvirus 3, Human, Pediatrics, medicine.medical_specialty, Lymphocytosis, diagnosis, viruses, encephalitis, etiology, [SDV]Life Sciences [q-bio], 030106 microbiology, factor analysis, Context (language use), medicine.disease_cause, Virus, 03 medical and health sciences, 0302 clinical medicine, medicine, Infectious encephalitis, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, business.industry, medicine.disease, herpes simplex virus, 3. Good health, Infectious Diseases, Herpes simplex virus, Etiology, Encephalitis, Herpes Simplex, France, medicine.symptom, business, Encephalitis
Abstract: Background New diagnostic tools have been developed to improve the diagnosis of infectious encephalitis. Using a prospective cohort of encephalitis patients, our objective was to identify possible clusters of patients with similar patterns among encephalitis of unknown cause (EUC) and to describe to what extent a patient’s initial presentation may be predictive of encephalitis etiology, particularly herpes simplex virus (HSV) and varicella-zoster virus (VZV). Methods The National Cohort of Infectious Encephalitis in France is an ongoing prospective cohort study implemented in France in 2016. Patients who present with documented or suspected acute infectious encephalitis were included. Focusing on the variables that describe the initial presentation, we performed a factor analysis of mixed data (FAMD) to investigate a pattern of association between the initial presentation of a patient and the etiologic pathogen. Results As of 1 August 2018, data from 349 patients were analyzed. The most frequent pathogens were HSV (25%), VZV (11%), tick-borne encephalitis virus (6%), Listeria (5%), influenza virus (3%), and EUC (34%). Using the FAMD, it was not possible to identify a specific pattern related to the group of EUC. Age, temporal or hemorrhagic lesions, and cerebral spinal fluid lymphocytosis were significantly associated with HSV/VZV encephalitis. Conclusions No initial clinical/imaging/biology pattern was identified at admission among EUC, despite the improvement in diagnostic tools. In this context, the recommendation for a universal, early, probabilistic, initial treatment against HSV and VZV is still relevant, regardless of the initial clinical presentation of the encephalitis.
Published: 2021
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22. Prognostic Factors of Severe Bacteraemic Pneumococcal Pneumonia in Critically Ill Immunocompetent Patients: A STREPTOGENE Sub-Study

Author: Hugo Bellut, Anne Veinstein, Frédéric Jacobs, Raphaël Porcher, Jean Reignier, Sébastien Preau, Yves Le Tulzo, Jean-Paul Mira, Olivier Baldesi, E. Varon, Jean Pierre Bedos, Kader Ouchenir, Bertrand Souweine, Shidasp Siami, Anthony Dugard, Armelle Mathonnet, Pierre Asfar, Jean Philippe Rigaud, Arnaud Galbois, Bruno Mégarbane, Joel Cousson, Florent Dewavrin, and Benoit Misset
Subjects: medicine.medical_specialty, business.industry, Critically ill, Pneumococcal pneumonia, medicine, medicine.disease, Intensive care medicine, business
Abstract: Background: The presence of bacteraemia in pneumococcal pneumonia in critically ill patient does not appear to be a strong prognostic factor on its own from the existing literature, but there may be a specific pattern of factors associated with mortality in ICU patients with bacteraemic pneumococcal pneumococcal community-acquired pneumonia (CAP).We aimed to identify factors associated with mortality in patients admitted to intensive care for severe bacteraemic CAP. Methods: This is a post-hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France, between 2008 and 2012, for bacteraemic pneumococcal CAP documented by culture and/or urinary antigenuria. Patients were divided into two groups based on initial blood culture positivity for Streptococcus pneumoniae. The primary outcome was hospital mortality. Serotypes of 339 S. pneumoniae strains were determined. Results: Of 614 included patients, 274 did and 340 did not have a blood culture positive for S. pneumoniae at admission. The only baseline difference between the groups was more frequent leukopenia in bacteraemic patients (26% vs. 14%, p =0.0002). Hospital mortality was not significantly different between groups ( p =0.11). The associations between the various prognostic parameters studied and mortality were similar in the two groups. Bacteraemic patients more often had invasive serotypes but less often had serotypes associated with high case-fatality rates ( p =0.003). Antibiotic regimens were similar in the two groups. In neither group was mortality different in patients given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. Interpretation: In immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, bacteraemia had no influence on mortality, regardless of the prognostic factor profile. A prospective randomised trial is warranted to confirm the absence of superiority of one treatment over others.
Published: 2021
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23. Management of liver failure in general intensive care unit

Author: Stéphanie Faure, Richard Moreau, Faouzi Saliba, E. Levesque, Philippe Ichai, Arnaud Galbois, Claire Francoz, Emmanuel Weiss, Catherine Paugam-Burtz, Martine Ferrandière, Gerald Chanques, Samir Jaber, Thomas Lescot, Stéphanie Roullet, Alexandre Louvet, Roland Amathieu, Dominique Thabut, T. Thevenot, Christophe Camus, Thierry Gustot, Lionel Velly, Christophe Bureau, C. Ichai, Service d'Anesthésie-Réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Beaujon, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Henri Mondor, Hôpital Claude Huriez [Lille], CHU Lille, Service d'Hépato-Gastro-Entérologie [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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hospital Group Croix Saint Simon, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Claude Galien Private Hospital, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Service de Réanimation médico-chirurgicale [Nice], Hôpital Saint-Roch [Nice], Nice University Hospital, Paul-Brousse Hospital, AP-HP, CHU Saint-Antoine [AP-HP], Université de Bordeaux (UB), Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Paul Brousse Hospital, AP-HP, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), University Hospital La Timone, 13005 Marseille, Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Beaujon Hospital, DMU Parabol, AP-HP Nord, University of Paris, Hopital Saint-Louis [AP-HP] (AP-HP), Société française d’anesthésie et de réanimation (SFAR) and the Association française pour l’étude du foie (AFEF), MORNET, Dominique, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), 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 de Tours (CHRU Tours), Université de Toulouse (UT), Hôpital de la Timone [CHU - APHM] (TIMONE), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Hospital,Claude Huriez, Service d'Hépato-Gastroentérologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CHU Pitié-Salpêtrière [APHP], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Erasme Hospital, Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique – Hopitaux de Paris, Sorbonne Universités, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Jean Minjoz University Hospital, Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Hopital Saint-Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Beaujon [AP-HP]-Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Liver Cirrhosis, medicine.medical_specialty, Cirrhosis, Consensus, Critical Care, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], Population, MEDLINE, Guidelines as Topic, Guidelines, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Sepsis, Medicine, Humans, Intensive care unit, 030212 general & internal medicine, Intensive care medicine, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, business.industry, 030208 emergency & critical care medicine, General Medicine, Guideline, Evidence-based medicine, Sciences bio-médicales et agricoles, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, Acute-on-chronic liver failure, Anesthesiology and Pain Medicine, Etiology, France, business, Liver Failure, Acute liver failure
Abstract: To produce French guidelines on Management of Liver failure in general Intensive Care Unit (ICU)., info:eu-repo/semantics/published
Published: 2020
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24. Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study

Author: Arnaud Galbois, Bertrand Delafosse, Olivier Barbot, Catherine Paugam, Hélène Barraud, Nicolas Pichon, Clara Locher, Sophie Cayot, Bernard Goubaux, Agnès Bonadona, Laurence Lavayssière, Sébastien Dharancy, Benoit Veber, Alice Quinart, Bruno Souche, Christophe Camus, Faouzi Saliba, Hôpital Pontchaillou, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Paul Brousse, Centre Hospitalier L'archet II, Hôpital la Tronche, Hôpital de Rangueil, CHU Toulouse [Toulouse], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Claude Huriez [Lille], CHU Lille, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Dupuytren, Hôpital Brabois, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Charles Nicolle [Rouen], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, CHU Saint-Eloi, Institut National de la SantÃ© et de la Recherche MÃ©dicale, Inserm, Jonchère, Laurent, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Hôpital Saint Eloi (CHRU Montpellier), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], retrospective study, RC799-869, Liver transplantation, Chronic liver disease, Gastroenterology, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, medicine, MARS albumin dialysis, Survival rate, Hepatic encephalopathy, Dialysis, Hepatology, liver transplantation, business.industry, Original Articles, Diseases of the digestive system. Gastroenterology, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, outcome, 030211 gastroenterology & hepatology, Original Article, business
Abstract: Background and Aim The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real‐life use are lacking. Methods This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injury–hepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44–54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1‐year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P, Because the long‐term outcome of patients treated with the molecular adsorbent recirculating system (MARS) in the real life has not been well assessed, we performed a retrospective multicenter study in all French adult care centers that used MARS between 2004 and 2009. The hospital survival rate was 49% (95% CI: 44–54%) and varied from 25% to 81% depending on the diagnosis of the liver disease and the 1‐year survival rate was markedly better in listed versus not listed patients in the setting of non‐biliary cirrhosis (59% vs 15%), early graft non‐function (80% vs 0%) and late graft dysfunction (72% vs 0%) (all P
Published: 2019
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25. Do Not Use Water Jets on Skin Hematoma

Author: Amélie, Renou, Yoann, Moeuf, Edouard, Obadia, Philippe, Janklewicz, Brigitte, Couturier, Ludivine, Chalumeau-Lemoine, Riad, Chelha, and Arnaud, Galbois
Subjects: Hematoma, Soft Tissue Injuries, Thigh, Humans, Female, Ultrasonography, Doppler, Color, Aged
Abstract: Morel-Lavallée lesions are posttraumatic hemolymphatic collections related to shearing injury of variable mechanism (severe trauma or low-velocity crush injury), resulting in disruption of interfacial planes between subcutaneous soft tissue and muscle and perforating lymphatics and blood vessels. A 69-y-old woman, without medical history, was admitted to the emergency ward for important pain located from her behind to the anterior face of the thighs. Physical examination revealed large semirecent hematoma with a large soft fluctuant area with hypermobility of the skin and cutaneous hyperesthesia, spreading from her behind to the anterior face of her thigs. Her symptoms were typical of a Morel-Lavallée lesion. The ultrasound examination revealed hypoechoic heterogeneous compressible fluid containing fat debris with irregular margins and lobular shape, localized between subcutaneous fat and deep fascia, without flow on color Doppler, confirming the acute Morel-Lavallée lesion. After evacuation by needle puncture, the collection reappearance was probably due to hemolymphatic fluid corresponding to type 1 of the Mellado and Bencardino classification of Morel-Lavallée lesions. Patients and Physicians should be aware of the worsening effects of balneotherapy on skin hematoma to prevent dramatic extension of Morel-Lavallée lesions.
Published: 2019

26. Diagnostic échographique du pneumothorax

Author: Bertrand Guidet, Hafid Ait-Oufella, Claire Pichereau, Simon Bourcier, Arnaud Galbois, Eric Maury, G. Lejour, and Jean-Luc Baudel
Subjects: Pulmonary and Respiratory Medicine, Lung, Diagnostic ultrasound, business.industry, Radiography, Ultrasound, 030208 emergency & critical care medicine, respiratory system, medicine.disease, respiratory tract diseases, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Pneumothorax, Pathognomonic, medicine, Differential diagnosis, Nuclear medicine, business, Thoracic Radiography
Abstract: For a long time the lung has been regarded as inaccessible to ultrasound. However, recent clinical studies have shown that this organ can be examined by this technique, which appears, in some situations, to be superior to thoracic radiography. The examination does not require special equipment and is possible using a combination of simple qualitative signs: lung sliding, the presence of B lines and the demonstration of the lung point. The lung sliding corresponds to the artefact produced by the movement of the two pleural layers, one against the other. The B lines indicate the presence of an interstitial syndrome. The presence of lung sliding and/or B lines has a negative predictive value of 100% and formally excludes a pneumothorax in the area where the probe has been applied. The presence of the lung point is pathognomonic of pneumothorax but the sensitivity is no more than 60%. Ultrasound is therefore a rapid and simple means of excluding a pneumothorax (lung sliding or B lines) and of confirming a pneumothorax when the lung point is visible. The question that remains is whether ultrasound can totally replace radiography in the management of this disorder.
Published: 2016
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27. Long-term quality of life in adult patients surviving purpura fulminans: an exposed-unexposed multicenter cohort study

Author: Damien, Contou, Florence, Canoui-Poitrine, Rémi, Coudroy, Sébastien, Préau, Martin, Cour, François, Barbier, Nicolas, Terzi, Guillaume, Schnell, Arnaud, Galbois, Lara, Zafrani, Benjamin, Zuber, Stephan, Ehrmann, Elodie, Gelisse, Delphine, Colling, Matthieu, Schmidt, Samir, Jaber, Alexandre, Conia, Romain, Sonneville, Gwenhaël, Colin, Laurent, Guérin, Damien, Roux, Sébastien, Jochmans, Nancy, Kentish-Barnes, Etienne, Audureau, Richard, Layese, Aline, Alves, Rachida, Ouedraogo, Christian, Brun-Buisson, Armand, Mekontso Dessap, Nicolas, de Prost, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Laboratoire d'Investigation Clinique (LIC), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Institut de Recherche en Horticulture et Semences (IRHS), Université d'Angers (UA)-Institut National de la Recherche Agronomique (INRA)-AGROCAMPUS OUEST, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Service de réanimation médicale [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), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Critical care center [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), Hôpital Bichat - Claude Bernard, Service de Réanimation, Centre Hospitalier René Dubos [Pontoise], Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique (CEpiA), INSERM U955, équipe 13, Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-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 des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), AGROCAMPUS OUEST, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de la Recherche Agronomique (INRA)-Université d'Angers (UA), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB)
Subjects: Adult, Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Adolescent, SF-36, [SDV]Life Sciences [q-bio], 030106 microbiology, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Interquartile range, law, Internal medicine, Intensive care, medicine, Humans, Survivors, 030212 general & internal medicine, Simplified Acute Physiology Score, Aged, Aged, 80 and over, Septic shock, business.industry, Middle Aged, medicine.disease, Intensive care unit, 3. Good health, Intensive Care Units, Infectious Diseases, Purpura Fulminans, Quality of Life, Female, France, business, Cohort study
Abstract: Background Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated. Methods This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale–Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire. Results Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35–83) months and 44 (IQR, 35–72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36–53] vs 54 [IQR, 36–57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24–38] vs 52 [IQR, 42–56]; P = .001) and IADL scores (7 [IQR, 4–8] vs 8 [IQR, 7–8]; P = .021) compared with nonamputated patients. Conclusions Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health. Clinical Trials Registration NCT03216577.
Published: 2018
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28. Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study

Author: Armelle Mathonnet, Sebastien Preau, Arnaud Galbois, Jean-Pierre Bedos, Frédéric Jacobs, Shidasp Siami, Jean-Paul Mira, E. Varon, Kader Ouchenir, Anne Veinstein, Bertrand Souweine, Jean-Philippe Rigaud, Benoit Misset, Jean Reignier, Raphaël Porcher, Olivier Baldesi, Yves Le Tulzo, Joel Cousson, Florent Dewavrin, Pierre Asfar, Anthony Dugard, Bruno Mégarbane, Unité de Soins Intensifs [Versailles], Centre Hospitalier de Versailles (CHV), Service de microbiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHR), Service d'Accompagnement et Soins Palliatifs [CHU Limoges], CHU Limoges, Urgences médicales, Centre hospitalier universitaire de Poitiers (CHU Poitiers), General Intensive Care Medicine, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Galien Paris-Sud (IGPS), Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation médicale, Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Albert Calmette, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier du Pays d'Aix, De la Préhistoire à l'Actuel : Culture, Environnement et Anthropologie (PACEA), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), CHU Gabriel Montpied (CHU), CHU Clermont-Ferrand, Medical-Surgical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Service de Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], 07/061, ministere de la santé français, Unité de Soins Intensifs [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Ambroise Paré [AP-HP], Université Paris-Sud - Paris 11 (UP11)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), CHU Gabriel Montpied [Clermont-Ferrand], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des urgences [CHU Poitiers], and Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, law, Risk Factors, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, Age Factors, Middle Aged, Prognosis, Intensive care unit, 3. Good health, Community-Acquired Infections, Pneumococcal pneumonia, Pneumococcal serotypes, Host-Pathogen Interactions, Female, Macrolides, Fluoroquinolones, medicine.medical_specialty, Severe community-acquired pneumonia, Critical Care, Critical Illness, [SDV.MP.PRO]Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, 03 medical and health sciences, Sex Factors, Anesthesiology, Internal medicine, medicine, Humans, Aged, Mechanical ventilation, Septic shock, business.industry, Pneumonia, Pneumococcal, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Pneumonia, Logistic Models, 030228 respiratory system, Bacteremia, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8–21.1), McCabe score ≥ 2 (4.58; 1.61–13), age > 65 years (2.92; 1.49–5.74), lactates > 4 mmol/L (2.41; 1.27–4.56), male gender and septic shock (2.23; 1.30–3.83 for each), invasive mechanical ventilation (1.78; 1–3.19), and bilateral pneumonia (1.59; 1.02–2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8–21). In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
Published: 2018
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29. Précarité et réanimation : épidémiologie et pronostic

Author: Arnaud Galbois, A. Caron, E. Maury, Naïke Bigé, B. Guidet, Claire Pichereau, Hafid Ait-Oufella, Vincent Dubée, Simon Bourcier, and Jean-Luc Baudel
Subjects: medicine.medical_specialty, business.industry, Retrospective cohort study, Emergency Nursing, Intensive care unit, law.invention, law, Emergency medicine, Epidemiology, Emergency Medicine, medicine, Surgical emergency, Social isolation, medicine.symptom, Elective surgery, Prospective cohort study, business, Socioeconomic status
Abstract: Over the last thirty years, socioeconomic inequalities in health were reinforced. Socioeconomic deprivation affects access to primary care, increases emergency visits, and is associated with more severe diseases and decreased life expectancy. Also, socioeconomic deprivation might influence epidemiology and prognosis of critically ill patients. Data of the literature, mostly based on retrospective studies, show that uninsured patients, homeless patients and those with low socioeconomic status are younger, more likely to be admitted to intensive care unit, more often admitted for medical reason and surgical emergency than for elective surgery and present with different pathologies. While several American studies found that uninsured critically ill patients are less likely to receive invasive procedures, surgery or post-acute care and more likely to die in ICU or in hospital, most European studies show that socioeconomic status is neither associated with level of care nor with mortality. Moreover, most precarious patients have increased length of stay. However, in homeless subgroup, patients living in street experience higher hospital mortality than sheltered patients. As socioeconomic deprivation definition is complex, a prospective study would be helpful to confirm these results and determine if some of its characteristics are associated with prognosis of critically ill patients. Finally,social isolation raises the question of advance directives including living wills and durable powers of attorney.
Published: 2015
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30. Exploration of skin perfusion in cirrhotic patients with septic shock

Author: Jean-Luc Baudel, Claire Pichereau, Arnaud Galbois, Eric Maury, Naïke Bigé, Simon Bourcier, Bertrand Guidet, Pierre-Yves Boëlle, and Hafid Ait-Oufella
Subjects: Liver Cirrhosis, Male, medicine.medical_specialty, Mean arterial pressure, Time Factors, Cirrhosis, Hemodynamics, Kaplan-Meier Estimate, Model for End-Stage Liver Disease, Internal medicine, Laser-Doppler Flowmetry, medicine, Humans, Knee, Prospective Studies, Aged, Skin, Ultrasonography, Hepatology, Septic shock, business.industry, Microcirculation, Central venous pressure, Middle Aged, medicine.disease, Shock, Septic, Surgery, Oxygen, Cardiology, Female, SOFA score, business, Perfusion
Abstract: Background & Aims Skin perfusion alterations are early and strong predictors of death in patients with septic shock. Cirrhosis is associated with systemic vasodilation and increases mortality from septic shock. We aimed at assessing whether the mottling score and tissue oxygen saturation (StO 2 ) could be used as early predictors of death in cirrhotic patients with septic shock. Methods This observational study included cirrhotic patients with septic shock. Each 6h during the first 24h, we collected data reflecting macrocirculation (mean arterial pressure, heart rate, central venous pressure, and cardiac output) and organ perfusion (arterial lactate, urinary output, ScvO 2 , mottling score, thenar, and knee StO 2 ). Data of 75 non-cirrhotic patients with previously reported septic shock were used as control. Results 42 cirrhotic patients were included. Mortality at day 14 was 71%. At H6, parameters reflecting macrocirculation were not associated with mortality, whereas higher arterial lactate and mottling score were associated with death. Mottling score was the strongest predictor of mortality (sensitivity=0.63, specificity=1, OR=42.4 (2.3–785.9)). At H6, knee StO 2 decreased in non-survivors and predicted death (sensitivity=0.45, specificity=1). In comparison with control, mottling kinetic was different in cirrhotic patients (delayed mottling appearance in non-survivors, earlier mottling disappearance in survivors). Knee StO 2 and skin perfusion, assessed by laser-Doppler, were higher in cirrhotic patients. Conclusions Mottling score and knee StO 2 at H6 were very specific predictors of death in patients with cirrhosis and septic shock. Their sensitivity was lower in cirrhotic patients due to delayed mottling appearance and higher knee StO 2 related to higher skin perfusion.
Published: 2015
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31. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study

Author: Jean-Luc Baudel, Naïke Bigé, Jacques Tankovic, Claire Pichereau, Simon Bourcier, Hafid Ait-Oufella, Arnaud Galbois, Eric Maury, Guillaume Leblanc, Vincent Dubée, Geoffroy Hariri, Pierre-Yves Boëlle, HAL UPMC, Gestionnaire, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de microbiologie [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), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Galien Paris-Sud (IGPS), and Université Paris-Sud - Paris 11 (UP11)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, Carbapenem, Pediatrics, medicine.medical_specialty, Community-acquired pneumonia, 030106 microbiology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, law, Antibiotics, medicine, polycyclic compounds, Intensive care unit, Risk factor, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Extended-spectrum beta-lactamases, business.industry, Research, Retrospective cohort study, Third-generation cephalosporins, Amoxicillin, medicine.disease, 3. Good health, Pneumonia, Amikacin, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: International audience; BackgroundThird-generation cephalosporins (3GCs) are recommended for empirical antibiotic therapy of community-acquired pneumonia (CAP) in patients requiring ICU admission. However, their extensive use could promote the emergence of extended-spectrum beta-lactamases-producing Enterobacteriaceae. Our aim was to assess whether the use of 3GCs in patients with CAP requiring ICU admission was justified.MethodsWe assessed all patients with CAP who required ICU admission during a 7-year period. We recorded empirical and definitive antibiotic therapies and susceptibility of causative pathogens. Amoxicillin, amoxicillin/clavulanate (A/C) susceptibilities as well as amikacin susceptibility of A/C-resistant strains were recorded.ResultsFrom January 2007 to March 2014, 391 patients were included in the study. Empirical 3GCs were used in 215 patients (55%). Among 267 patients with microbiologically documented CAP (68%), 241 received a beta-lactam as definitive therapy, and of those, 3CGs were chosen for 43 patients (18%). Amoxicillin or A/C was active against isolated pathogens in 159 patients (66%), while 39 patients (16%) required a beta-lactam with a broader spectrum than 3GCs. Ninety-four per cent of A/C-resistant strains were amikacin susceptible.ConclusionsIn ICU patients with CAP, 3GCs given on an empirical basis are changed, according to microbiological documentation, for another beta-lactam in 82% of cases especially to A/C in the absence of resistance risk factor. In patients evidencing risk factors for A/C-resistant strains infection, 3GCs or antipseudomonal beta-lactams including carbapenem associated with amikacin in the most severe patients seem a relevant empirical antibiotic therapy. This strategy could decrease 3GCs’ use.
Published: 2017
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32. Improved Prognosis of Septic Shock in Patients With Cirrhosis

Author: Arnaud, Galbois, Philippe, Aegerter, Patricia, Martel-Samb, Chantal, Housset, Dominique, Thabut, Georges, Offenstadt, Hafid, Ait-Oufella, Eric, Maury, Bertrand, Guidet, and H, Mentec
Subjects: Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Comorbidity, Critical Care and Intensive Care Medicine, Severity of Illness Index, Gastroenterology, Internal medicine, Prohibitins, Severity of illness, Prevalence, medicine, Humans, In patient, Hospital Mortality, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Septic shock, Age Factors, Retrospective cohort study, Middle Aged, Prognosis, medicine.disease, Shock, Septic, Surgery, Intensive Care Units, Multicenter study, Shock (circulatory), Female, medicine.symptom, business
Abstract: To determine the evolution of the outcome of patients with cirrhosis and septic shock.A 13-year (1998-2010) multicenter retrospective cohort study of prospectively collected data.The Collège des Utilisateurs des Bases des données en Réanimation (CUB-Réa) database recording data related to admissions in 32 ICUs in Paris area.Thirty-one thousand two hundred fifty-one patients with septic shock were analyzed; 2,383 (7.6%) had cirrhosis.None.Compared with noncirrhotic patients, patients with cirrhosis had higher Simplified Acute Physiology Score II (63.1 ± 22.7 vs 58.5 ± 22.8, p0.0001) and higher prevalence of renal (71.5% vs 54.8%, p0.0001) and neurological (26.1% vs 19.5%, p0.0001) dysfunctions. Over the study period, in-ICU and in-hospital mortality was higher in patients with cirrhosis (70.1% and 74.5%) compared with noncirrhotic patients (48.3% and 51.7%, p0.0001 for both comparisons). Cirrhosis was independently associated with an increased risk of death in ICU (adjusted odds ratio = 2.524 [2.279-2.795]). In patients with cirrhosis, factors independently associated with in-ICU mortality were as follows: admission for a medical reason, Simplified Acute Physiology Score II, mechanical ventilation, renal replacement therapy, spontaneous bacterial peritonitis, positive blood culture, and infection by fungus, whereas direct admission and admission during the most recent midterm period (2004-2010) were associated with a decreased risk of death. From 1998 to 2010, prevalence of septic shock in patients with cirrhosis increased from 8.64 to 15.67 per 1,000 admissions to ICU (p0.0001) and their in-ICU mortality decreased from 73.8% to 65.5% (p = 0.01) despite increasing Simplified Acute Physiology Score II. In-ICU mortality decreased from 84.7% to 68.5% for those patients placed under mechanical ventilation (p = 0.004) and from 91.2% to 78.4% for those who received renal replacement therapy (p = 0.04).The outcome of patients with cirrhosis and septic shock has markedly improved over time, akin to the noncirrhotic population. In 2010, the in-ICU survival rate was 35%, which now fully justifies to admit these patients to ICU.
Published: 2014
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33. Les auteurs

Author: Lerolle, Nicolas, Ehrmann, Stephan, Roux, Damien, Terzi, Nicolas, de Prost, Nicolas, Poissy, Julien, Aissaoui, Nadia, Beloncle, François, Carvelli, Julien, Llitjos, Jean-François, Merdji, Hamid, Caplan, Morgan, Tortuyaux, Romain, de Roquetaillade, Charles, Péju, Edwige, Delcampe, Charlotte, Adda, Imane, Lambour, Alexis, Barbois, Sandrine, Pierre, Alexandre, Ortuno, Sofia, Devautour, Clément, Pape, Sylvain Le, Basse, Pierre, Desquiens, Marion, Hugerot, Antonin, Vasseur, Margot, Sarfati, Sacha, Szychowiak, Piotr, Grosjean, Vincent, Bois, Antoine, Bichon, Amandine, Chantelot, Louise, Sacleux, Sophie-Caroline, Garcia, Bruno, Nadia, Aissaoui, Hafid, Ait Oufella, Djillali, Annane, Laurent, Argaud, Pierre, Asfar, Cécile, Aubron, Elie, Azoulay, François, Beloncle, Gilles, Bernardin, Julien, Bohe, Pierre-Édouard, Bollaert, Lila, Bouadma, Alexandre, Boyer, Emmanuel, Canet, Gilles, Capellier, Guillaume, Carteaux, Vincent, Castelain, Pierre-Emmanuel, Charles, Jean-Daniel, Chiche, Yves, Cohen, Alain, Combes, Rémi, Coudroy, Martin, Cour, Michael, Darmon, Nicolas, De Prost, Jean, Dellamonica, Alexandre, Demoule, Jean-Luc, Diehl, Didier, Dreyfuss, Damien, Du Cheyron, Stéphan, Ehrmann, Jean-Yves, Fagon, Muriel-Sarah, Fartoukh, Marc, Gainnier, Stéphane, Gaudry, Guillaume, Geri, Sébastien, Gibot, Didier, Gruson, Claude, Guérin, Bertrand, Guidet, Antoine, Guillon, Julie, Helms, Gilles, Hilbert, Sami, Hraiech, Olivier, Jonquet, Merce, Jourdain, Boris, Jung, Hatem, Kallel, Antoine, Kimmoun, Kada, Klouche, Alexandre, Lautrette, Yves, Le Tulzo, Nicolas, Lerolle, Bruno, Levy, Erwan, Lher, Charles-Édouard, Luyt, Julien, Maizel, Daniel, Mathieu, Éric, Maury, Bruno, Megarbane, Armand, Mekontso Dessap, Alain, Mercat, Ferhat, Meziani, Jean-Paul, Mira, Benoît, Misset, Pierre, Moine, Xavier, Monnet, Bruno, Mourvillier, Saad, Nseir, Laurent, Papazian, Thierry, Pelaccia, Frédéric, Pène, Sophie, Perinel-Ragey, Gaël, Piton, Julien, Poissy, Sébastien, Preau, Jean-Pierre, Quenot, Jean, Reignier, Jean-Damien, Ricard, Christian, Richard, Jean-Christophe, Richard, René, Robert, Antoine, Roch, Damien, Roux, Philippe, Sauder, Benoît, Schlemmer, Matthieu, Schmidt, Francis, Schneider, Carole, Schwebel, Tarek, Sharshar, Stein, Silva Sifontes, Michel, Slama, Romain, Sonneville, Bertrand, Souweine, Jean-Marc, Tadié, Nicolas, Terzi, Guillaume, Thiery, Arnaud, Thille, Jean-François, Timsit, Frédéric, Vargas, Antoine, Vieillard Baron, Philippe, Vignon, Dominique, Vodovar, Guillaume, Voiriot, Laura, Zafrani, Fabrice, Zeni, Antonio, Alvarez, Davide, Barbar Saber, François, Barbier, Florent, Bavozet, Jean-Pierre, Bedos, Nicolas, Bele, Marcel, Benedit, Laëitia, Bodet-Contentin, Florence, Boissier, Wulfran, Bougouin, Thierry, Boulain, Jérémy, Bourenne, Nicolas, Brechot, Laurent, Brochard, Cédric, Bruel, Fabrice, Bruneel, Alain, Cariou, Jean-Charles, Cartier, Charles, Cerf, Gérald, Choukroun, Raphaël, Clere-Jehl, Cédric, Daubin, Étienne, De Montmollin, Clément, Delmas, Pierre-François, Dequin, Nicolas, Deye, Martin, Dres, Mohamed, Eldeghedy, Raphaël, Favory, Jean-Marie, Forel, Arnaud, Galbois, Maxime, Granier, Emmanuel, Guerot, Max, Guillot, Christophe, Guitton, Olfa, Hamzaoui, Nicholas, Heming, Julien, Jabot, Frédéric, Jacobs, Mathieu, Jozwiak, Pierre, Kalfon, Toufik, Kamel, Khaldoun, Kuteifan, Jean-Baptiste, Lascarrou, Thierry, Lazard, Stéphane, Legriel, David, Luis, Frédéric, Martino, Philippe, Mateu, Mehran, Monchi, Grégoire, Muller, David, Osman, Hervé, Outin, Bernard, Page, Vincent, Peigne, Olivier, Pham Tài, Fabienne, Plouvier, Dominique, Prat, Sylvain, Renolleau, Gandonnière, Salmon, Bertrand, Sauneuf, Frédérique, Schortgen, Benjamin, Sztrymf, Fabienne, Tamion, Xavier, Tchenio, Jean-Louis, Teboul, Bertrand, Texier, Marina, Thirion, der Linden Thierry, Van, Camille, Vinclair, Christophe, Vinsonneau, Bérengère, Vivet, Sébastian, Voicu, Nicolas, Weiss, Jonathan, Zarka, Arvieux, Catherine, Pottecher, Julien, Raux, Matthieu, and Dumas, Florence
Published: 2021
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34. Use of a needle-guided device to facilitate axillary vein cannulation

Author: Hafid Ait-Oufella, Gabriel Preda, Jean Luc Baudel, Mikael Alves, Arnaud Galbois, Eric Maury, Vincent Dubée, Simon Bourcier, Jérémie Joffre, Claire Pichereau, and Naïke Bigé
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, Text mining, business.industry, medicine, business, Axillary vein, Surgery
Published: 2017
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35. Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections

Author: Jean-Luc Baudel, Jean-Rémi Lavillegrand, Bertrand Guidet, Guillaume Leblanc, Naïke Bigé, Pierre-Yves Boëlle, Jalel Tahiri, Safaa Nemlaghi, Claire Pichereau, Vincent Dubée, Gabriel Lejour, Simon Bourcier, Arnaud Galbois, Eric Maury, and Hafid Ait-Oufella
Subjects: medicine.medical_specialty, Resuscitation, Hemodynamics, Critical Care and Intensive Care Medicine, Microcirculation, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Outcome, medicine.diagnostic_test, business.industry, Septic shock, Research, Shock, 030208 emergency & critical care medicine, Temperature gradient, medicine.disease, Capillary refill, Surgery, 030228 respiratory system, Shock (circulatory), Cardiology, medicine.symptom, business, Perfusion
Abstract: Background Microcirculatory disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in severe sepsis and septic shock. As microcirculatory disorders have been identified as strong predictive factors of unfavourable outcome, there is a need to develop accurate parameters at the bedside to evaluate tissue perfusion. We evaluated whether different body temperature gradients could relate to sepsis severity and could predict outcome in critically ill patients with severe sepsis and septic shock. Method We conducted a prospective observational study in a tertiary teaching hospital in France. During a 10-month period, all consecutive adult patients with severe sepsis or septic shock who required ICU admission were included. Six hours after initial resuscitation (H6), we recorded the hemodynamic parameters and four temperature gradients: central-to-toe, central-to-knee, toe-to-room and knee-to-room. Results We evaluated 40 patients with severe sepsis (40/103, 39 %) and 63 patients with septic shock (63/103, 61 %). In patients with septic shock, central-to-toe temperature gradient was significantly higher (12.5 [9.2; 13.8] vs 6.9 [3.4; 12.0] °C, P
Published: 2016
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36. Syndromes carentiels sévères

Author: M. Alves, G. Offenstadt, Jean-Luc Baudel, Bertrand Guidet, Naïke Bigé, Arnaud Galbois, Eric Maury, and Hafid Ait-Oufella
Subjects: Emergency Medicine, Emergency Nursing
Abstract: La prevalence des carences vitaminiques est probablement sous-estimee. Le role du reanimateur est donc de les reconnaitre au cours des situations a risque. Cela est d’autant plus important que certaines carences peuvent etre mortelles, comme le syndrome de Gayet-Wernicke (SGW), le shoshin beriberi et le scorbut, alors que leur evolution peut etre rapidement favorable grâce a une supplementation adaptee.
Published: 2012
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37. Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock

Author: Pierre-Yves Boëlle, Mikael Alves, Bertrand Guidet, Jean-Luc Baudel, Georges Offenstadt, Jérémie Joffre, Dimitri Margetis, Hafid Ait-Oufella, Arnaud Galbois, Eric Maury, and Simon Bourcier
Subjects: Male, medicine.medical_specialty, Critical Care and Intensive Care Medicine, Microcirculation, Oxygen Consumption, Predictive Value of Tests, Internal medicine, Humans, Medicine, Tissue oxygen, Knee, Hospital Mortality, Prospective Studies, Hospitals, Teaching, Prospective cohort study, Aged, Aged, 80 and over, Spectroscopy, Near-Infrared, business.industry, Septic shock, Hemodynamics, Middle Aged, musculoskeletal system, medicine.disease, Shock, Septic, Survival Analysis, Surgery, body regions, Intensive Care Units, Predictive value of tests, Cardiology, Female, France, business, Saturation (chemistry), Perfusion, Thenar eminence
Abstract: Thenar eminence tissue oxygen saturation (StO(2)) was developed to assess organ perfusion. However, mottling, a strong predictor of mortality in septic shock, develops preferentially around the knee. We aimed to evaluate the prognostic value of StO(2) measured around the knee in septic shock patients and compare it to thenar StO(2).This was a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included. Parameters were recorded when vasopressors were started (H0) and every 6 h during 24 h. Their predictive value was assessed on 14-day mortality.Fifty-two patients were included. SOFA score was 11 (9-15) and SAPS II was 56 (40-72). At 6 h after ICU admission (H6), mean arterial pressure, cardiac index, and central venous pressure were not different between non-survivors and survivors; but non-survivors had higher arterial lactate level (8.8 ± 5.0 vs. 2.2 ± 1.5 mmol/l, P0.001), lower urinary output (0.22 ± 0.45 vs. 0.70 ± 0.50 ml/kg/h, P0.001) and ScvO(2) (62 ± 20 vs. 72 ± 9 %, P = 0.03). At H6, StO(2) was lower in non-survivors; this difference was not significant for thenar StO(2) (70 ± 15 vs. 77 ± 12 %, P = 0.10) but was very pronounced for knee StO(2) (39 ± 23 vs. 71 ± 12 %, P0.001). At H6, a low knee StO(2) was associated with a higher mottling score (P0.01), a higher lactate level (P0.002, R (2) = 0.2), and a lower urinary output (P = 0.02, R (2) = 0.12).After initial septic shock resuscitation, StO(2) measured around the knee is a strong predictive factor of 14-day mortality.
Published: 2012
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38. Exploration de la microcirculation cutanée au cours du choc septique

Author: Hafid Ait-Oufella, G. Offenstadt, Dimitri Margetis, Arnaud Galbois, Eric Maury, Jean-Luc Baudel, Bertrand Guidet, and M. Alves
Subjects: Emergency Medicine, Emergency Nursing
Abstract: Au cours des deux dernieres decennies, de grandes avancees ont ete realisees dans la comprehension de la physiopathologie des etats infectieux graves. Les anomalies microcirculatoires ont ete identifiees comme la principale cause de l’hypoperfusion tissulaire et des defaillances viscerales conduisant au deces. Il est donc important de developper des outils simples, utilisables au lit du patient pour evaluer l’etat microcirculatoire. L’analyse clinique de la perfusion cutanee au travers de sa temperature (et/ou gradient), la mesure du temps de recoloration cutanee (TRC) et plus recemment la mesure de l’etendue des marbrures sont des indicateurs interessants d’anomalies microcirculatoires au cours du choc septique.
Published: 2012
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39. Outcome of spontaneous and iatrogenic pneumothoraces managed with small-bore chest tubes

Author: Hafid Ait-Oufella, Bertrand Guidet, S. Kernéis, Jean-Luc Baudel, Dimitri Margetis, M. Alves, S. Meurisse, Georges Offenstadt, Arnaud Galbois, Eric Maury, and L. Zorzi
Subjects: Mechanical ventilation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Treatment outcome, Retrospective cohort study, General Medicine, medicine.disease, Surgery, Chest tube, Anesthesiology and Pain Medicine, Primary outcome, Pneumothorax, Cardiothoracic surgery, medicine, Iatrogenic disease, business
Abstract: Background Little is known about the efficacy of management of iatrogenic pneumothoraces with small-bore chest tubes. The aim of this study was to assess the outcome of iatrogenic pneumothoraces requiring drainage managed with a small-bore chest tube and to compare the results to spontaneous pneumothoraces treated in the same unit with the same device. The primary outcome was requirement of video-assisted thoracoscopic surgery for drainage failure; secondary outcomes were length of drainage and number of inserted chest tubes. Methods Patients with pneumothorax admitted between 1997 and 2007 were retrospectively identified. Traumatic pneumothoraces and those occurring under mechanical ventilation were excluded. All pneumothoraces were drained using the same small-bore chest tube (8 French) according to our local protocol. Results Five hundred sixty-one pneumothoraces were analysed, 431 (76.8%) were spontaneous pneumothoraces and 130 (23.2%) were iatrogenic. Iatrogenic pneumothoraces were associated with less requirement of video-assisted thoracoscopic surgery for drainage failure [adjusted odds ratio= 0.24 (0.04, 0.86)]. Length of drainage of iatrogenic pneumothoraces was longer than for primary spontaneous pneumothoraces (3.8 ± 3.1 vs. 2.7 ± 1.8 days, P
Published: 2011
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40. Mottling score predicts survival in septic shock

Author: Arnaud Galbois, Eric Maury, Jean-Luc Baudel, Bertrand Guidet, Georges Offenstadt, J. Lemant, Hafid Ait-Oufella, Dimitri Margetis, Pierre-Yves Boëlle, S. Lemoinne, and Jérémie Joffre
Subjects: Male, medicine.medical_specialty, Resuscitation, Critical Care and Intensive Care Medicine, Predictive Value of Tests, Intensive care, Internal medicine, medicine, Humans, Prospective Studies, Hospitals, Teaching, Aged, Skin, Aged, 80 and over, Diagnostic Tests, Routine, business.industry, Septic shock, Microcirculation, Mortality rate, Middle Aged, medicine.disease, Shock, Septic, Survival Analysis, Surgery, Intensive Care Units, SAPS II, Shock (circulatory), Predictive value of tests, Cardiology, Female, SOFA score, medicine.symptom, business
Abstract: Experimental and clinical studies have identified a crucial role of microcirculation impairment in severe infections. We hypothesized that mottling, a sign of microcirculation alterations, was correlated to survival during septic shock.We conducted a prospective observational study in a tertiary teaching hospital. All consecutive patients with septic shock were included during a 7-month period. After initial resuscitation, we recorded hemodynamic parameters and analyzed their predictive value on mortality. The mottling score (from 0 to 5), based on mottling area extension from the knees to the periphery, was very reproducible, with an excellent agreement between independent observers [kappa = 0.87, 95% CI (0.72-0.97)].Sixty patients were included. The SOFA score was 11.5 (8.5-14.5), SAPS II was 59 (45-71) and the 14-day mortality rate 45% [95% CI (33-58)]. Six hours after inclusion, oliguria [OR 10.8 95% CI (2.9, 52.8), p = 0.001], arterial lactate level [1.5 OR 1; between 1.5 and 3 OR 3.8 (0.7-29.5);3 OR 9.6 (2.1-70.6), p = 0.01] and mottling score [score 0-1 OR 1; score 2-3 OR 16, 95% CI (4-81); score 4-5 OR 74, 95% CI (11-1,568), p0.0001] were strongly associated with 14-day mortality, whereas the mean arterial pressure, central venous pressure and cardiac index were not. The higher the mottling score was, the earlier death occurred (p0.0001). Patients whose mottling score decreased during the resuscitation period had a better prognosis (14-day mortality 77 vs. 12%, p = 0.0005).The mottling score is reproducible and easy to evaluate at the bedside. The mottling score as well as its variation during resuscitation is a strong predictor of 14-day survival in patients with septic shock.
Published: 2011
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41. Peut-on réduire le nombre de radiographies de thorax en réanimation ?

Author: Bertrand Guidet, Gilles Hejblum, V. Ioos, Arnaud Galbois, Eric Maury, and Ludivine Chalumeau-Lemoine
Subjects: Gynecology, medicine.medical_specialty, business.industry, On demand, Intensive care, Emergency Medicine, Medicine, Emergency Nursing, business
Abstract: Les radiographies de thorax (RT) constituent l’examen d’imagerie le plus frequemment prescrit chez les patients de reanimation. Les variations de leurs indications et modalites de prescription (systematique ou a la demande), d’un service a un autre, refletent l’heterogeneite des pratiques, non conforme aux recommandations actuelles. Celles-ci plaident en effet pour des RT quotidiennes, notamment pour les patients ventiles et/ou souffrant de pathologies cardiopulmonaires aigues, tandis que les etudes de recherche de consensus montrent que les RT sont en realite plus prescrites selon le contexte clinicobiologique des patients que selon des recommandations generales. L’etude « Radio en reanimation: RARE », recemment publiee, a montre qu’une strategie de prescription a la demande plutot que systematique permettait une diminution moyenne d’un tiers du nombre de RT effectuees chez les patients ventiles, sans alteration du pronostic. En outre, des indications plus ciblees, associees a l’emploi d’alternatives diagnostiques efficaces, notamment echographiques, devraient permettre de reduire le nombre de RT pratiquees en reanimation, l’irradiation des patients, les delais diagnostiques et les couts. L’ensemble des donnees actuellement disponibles doit suggerer aux societes savantes d’actualiser leurs recommandations concernant les modalites de prescription des RT en reanimation.
Published: 2010
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42. Ex vivo effects of high-density lipoprotein exposure on the lipopolysaccharide-induced inflammatory response in patients with severe cirrhosis

Author: Nicolas Coant, Annie Bezeaud, Arnaud Galbois, Marika Rudler, Eric Ogier-Denis, Dominique Thabut, Hind Bennani, Didier Lebrec, Richard Moreau, Zéra Tellier, Dominique Bonnefont-Rousselot, Cécile Guichard, Khalid A. Tazi, and Morvarid Shir Mohammadi
Subjects: Adult, Lipopolysaccharides, Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Lipopolysaccharide, medicine.medical_treatment, CD14, Lipopolysaccharide Receptors, Monocytes, Proinflammatory cytokine, chemistry.chemical_compound, Internal medicine, Humans, Medicine, Scavenger receptor, Whole blood, Inflammation, Hepatology, Tumor Necrosis Factor-alpha, business.industry, Monocyte, NF-kappa B, Middle Aged, Scavenger Receptors, Class B, medicine.disease, Interleukin-10, Cholesterol, medicine.anatomical_structure, Cytokine, Endocrinology, chemistry, Cytokines, Female, lipids (amino acids, peptides, and proteins), Lipoproteins, HDL, business
Abstract: High-density lipoproteins (HDL) are known to neutralize lipopolysaccharide (LPS). Because patients with cirrhosis have lower HDL levels, this may contribute to LPS-induced ex vivo monocyte overproduction of proinflammatory cytokines. However, the effects of HDL on cytokine production by monocytes from patients with cirrhosis have never been studied. The aim of this study was to determine the effects of HDL on LPS-induced proinflammatory cytokine production in whole blood and isolated monocytes from patients with severe cirrhosis and controls. Plasma levels of HDL and cytokines were determined. The effects of reconstituted HDL (rHDL) on LPS-induced cytokine production in whole blood were assessed by cytokine array and on tumor necrosis factor alpha (TNF-α) and interleukin-10 (IL-10) production in isolated monocytes. Plasma HDL levels were significantly lower in patients with cirrhosis than in controls. Plasma levels of TNF-α and IL-6 were significantly higher in patients with cirrhosis than in controls. Incubation of rHDL with whole blood prevented LPS-induced TNF-α and IL-6 overproduction in patients with cirrhosis. LPS-induced TNF-α production and CD14 expression were significantly more marked in cirrhotic monocytes than in control monocytes, and both decreased significantly after rHDL incubation. LPS-induced down-regulation of scavenger receptor, class B, type I (SR-BI) expression was abolished in cirrhotic monocytes. Conclusions: This study shows that rHDL abolishes the LPS-induced overproduction of proinflammatory cytokines in whole blood from patients with severe cirrhosis. These results were confirmed in isolated monocytes from these patients. This suggests that administration of rHDL might be a useful strategy for the treatment of cirrhosis to limit LPS-induced cytokine overproduction. (HEPATOLOGY 2009;49:175-184.)
Published: 2008
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43. Impact of AxotrackTM for ultrasound-guided central venous catheter insertion: a randomized controlled study conducted on inanimate manikin

Author: Mikael, Alves, Naike, BIGè, Claire, Pichereau, Jean L, Baudel, Arnaud, Galbois, Hafid, Ait Oufella, and Eric, Maury
Subjects: Adult, Catheterization, Central Venous, Random Allocation, Critical Care, Emergency Medicine, Central Venous Catheters, Humans, Punctures, Manikins, Ultrasonography, Interventional
Published: 2016

44. Is the post-transplant survival the unique Holy Grail?

Author: Nicolas Carbonell, Bertrand Guidet, Arnaud Galbois, and Eric Maury
Subjects: medicine.medical_specialty, Hepatology, business.industry, Graft Survival, 030208 emergency & critical care medicine, Post transplant, Holy Grail, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, 030211 gastroenterology & hepatology, business, Intensive care medicine
Published: 2015

45. Life-threatening bleeding in four patients with an unusual excessive response to dabigatran: Implications for emergency surgery and resuscitation

Author: Georges Offenstadt, Agnès Lillo-Le Louët, Meyer-Michel Samama, Anne-Sylvie Dumenil, Lilia Soufir, Arnaud Galbois, and Martine Wolf
Subjects: Resuscitation, medicine.medical_specialty, Erythrocyte transfusion, Fatal outcome, business.industry, medicine.medical_treatment, Vascular biology, Hematology, 030204 cardiovascular system & hematology, medicine.disease, Thrombosis, Surgery, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Emergency surgery, Emergency medicine, Medicine, 030212 general & internal medicine, business, medicine.drug, Colectomy
Abstract: Life-threatening bleeding in four patients with an unusual excessive response to dabigatran: Implications for emergency surgery and resuscitation
Published: 2012
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46. Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study

Author: Georges Offenstadt, Jean-Luc Baudel, Hafid Ait-Oufella, Jacques Tankovic, Bertrand Guidet, Redouane Dahoumane, Fabrice Carrat, Arnaud Galbois, Eric Maury, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Administateur, HAL Sorbonne Université
Subjects: Bronchoalveolar lavage, medicine.medical_specialty, Pathology, Community-acquired pneumonia, medicine.drug_class, Direct examination, Antibiotics, Critical Care and Intensive Care Medicine, Hospital-acquired pneumonia, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, medicine, 030212 general & internal medicine, Prior antibiotic treatment, Pathogen, 0303 health sciences, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, 030306 microbiology, business.industry, Research, Antibiotic therapy, Multiplex PCR, medicine.disease, 3. Good health, respiratory tract diseases, Pneumonia, Gram staining, Ventilator-acquired pneumonia, business, SeptiFast®, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background In critically ill patients with pneumonia, accurate microorganism identification allows appropriate antibiotic treatment. In patients undergoing bronchoalveolar lavage (BAL), direct examination of the fluid using Gram staining provides prompt information but pathogen identification accuracy is low. Culture of BAL fluid is actually the reference, but it is not available before 24 to 48 h. In addition, pathogen identification rate observed with direct examination and culture is decreased when antibiotic therapy has been given prior to sampling. We therefore assessed, in critically ill patients with suspected pneumonia, the performance of a multiplex PCR (MPCR) to identify pathogens in BAL fluid. This study is a prospective pilot observation. Methods We used a MPCR detecting 20 types of microorganisms. Direct examination, culture, and MPCR were performed on BAL fluid of critically ill patients with pneumonia suspicion. The final diagnosis of infective pneumonia was retained after the medical chart was reviewed by two experts. Pathogen identification rate of direct examination, culture, and MPCR in patients with confirmed pneumonia was compared. Results Among the 65 patients with pneumonia suspicion, the diagnosis of pneumonia was finally retained in 53 cases. Twenty nine (55%) were community-acquired pneumonia and 24 (45%) were hospital acquired. Pathogen identification rate with MPCR (66%) was greater than with culture (40%) and direct examination (23%) (p =0.01 and p p p p Conclusions The results of this pilot study suggest that in critically ill patients, MPCR performed on BAL fluid could provide higher identification rate of pathogens involved in pneumonia than direct examination and culture, especially in patients having received antimicrobial treatment.
Published: 2014
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47. Capillary refill time exploration during septic shock

Author: Hafid Ait-Oufella, Jean-Luc Baudel, Bertrand Guidet, Arnaud Galbois, Eric Maury, Rémi Bertinchamp, Claire Pichereau, Pierre-Yves Boëlle, Mikael Alves, and Naïke Bigé
Subjects: Male, medicine.medical_specialty, Resuscitation, genetic structures, Population, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Severity of Illness Index, Predictive Value of Tests, health services administration, Internal medicine, Medicine, Humans, Lactic Acid, Prospective Studies, education, Aged, Skin, education.field_of_study, medicine.diagnostic_test, business.industry, Septic shock, Microcirculation, Reproducibility of Results, medicine.disease, Capillary refill, Prognosis, Shock, Septic, Surgery, Capillaries, SAPS II, Predictive value of tests, Shock (circulatory), Cardiology, SOFA score, Female, medicine.symptom, business
Abstract: During septic shock management, the evaluation of microvascular perfusion by skin analysis is of interest. We aimed to study the skin capillary refill time (CRT) in a selected septic shock population. We conducted a prospective observational study in a tertiary teaching hospital. After a preliminary study to calculate CRT reproducibility, all consecutive patients with septic shock during a 10-month period were included. After initial resuscitation at 6 h (H6), we recorded hemodynamic parameters and analyzed their predictive value on 14-day mortality. CRT was measured on the index finger tip and on the knee area. CRT was highly reproducible with an excellent inter-rater concordance calculated at 80 % [73–86] for index CRT and 95 % [93–98] for knee CRT. A total of 59 patients were included, SOFA score was 10 [7–14], SAPS II was 61 [50–78] and 14-day mortality rate was 36 %. CRT measured at both sites was significantly higher in non-survivors compared to survivors (respectively 5.6 ± 3.5 vs 2.3 ± 1.8 s, P
Published: 2014

48. Reply to: 'Is skin mottling a predictor of high mortality in non-selected patients with cirrhosis admitted to intensive care unit?'

Author: Hafid Ait-Oufella, Bertrand Guidet, Arnaud Galbois, and Eric Maury
Subjects: Liver Cirrhosis, Male, medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, High mortality, medicine.disease, Shock, Septic, Intensive care unit, law.invention, Skin mottling, law, medicine, Humans, Female, Intensive care medicine, business, Skin
Published: 2015
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49. P0132 : External validation of the CLIF-SOFA in cirrhotic patients admitted to intensive care units (ICUS): A meta-analysis

Author: Evangelos Cholongitas, Bertrand Sauneuf, J. Fichet, Constantine J. Karvellas, V. Di Martino, René Robert, Eric Levesque, Thierry Thevenot, Gilles Capellier, H.-C. Pan, Arnaud Galbois, Rodrigo Cavallazzi, Mark J. W. McPhail, Delphine Weil, Eleni Theocharidou, and Gaël Piton
Subjects: medicine.medical_specialty, Hepatology, business.industry, Clif sofa, Intensive care, Meta-analysis, Emergency medicine, External validation, medicine, business, Intensive care medicine
Published: 2015
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50. Colorimetric Capnometry and Feeding Tube Placement

Author: Arnaud Galbois, Eric Maury, Jean-Rémi Lavillegrand, Bertrand Guidet, and Georges Offenstadt
Subjects: Chromatography, business.industry, Medicine, business, Feeding tube
Published: 2014
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