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1. Factors associated with cancer treatment resumption after ICU stay in patients with solid tumors

Author

Soraya Benguerfi, Ondine Messéant, Benoit Painvin, Christophe Camus, Adel Maamar, Arnaud Gacouin, Charles Ricordel, Jean Reignier, Emmanuel Canet, Julien Edeline, and Jean-Marc Tadié

Subjects
Neoplasms, Intensive care unit, Cancer treatment, Outcome, Solid tumors, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Post-intensive care syndrome could be responsible for inability to receive proper cancer treatment after ICU stay in patients with solid tumors (ST). Our purpose was to determine the factors associated with cancer treatment resumption and the impact of cancer treatment on the outcome of patients with ST after ICU stay. Methods We conducted a retrospective study including all patients with ST admitted to the ICU between 2014 and 2019 in a French University-affiliated Hospital. Results A total of 219 patients were included. Median SAPS II at ICU admission was 44.0 [IQR 32.8, 66.3]. Among the 136 patients who survived the ICU stay, 81 (59.6%) received cancer treatment after ICU discharge. There was an important increase in patients with poor performance status (PS) of 3 or 4 after ICU stay (16.2% at admission vs. 44.5% of patients who survived), with significant PS decline following the ICU stay (median difference − 1.5, 95% confidence interval [-1.5-1.0], p

Published
2024
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2. Early discontinuation of combination antibiotic therapy in severe community-acquired pneumonia: a retrospective cohort study

Author

Pauline Guillot, Flora Delamaire, Arnaud Gacouin, Benoit Painvin, Caroline Piau, Florian Reizine, Mathieu Lesouhaitier, Jean-Marc Tadié, and Adel Maamar

Subjects
Community-acquired pneumonia, Legionella, Antibiotic stewardship, Critically ill patients, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Severe community-acquired pneumonia (SCAP) is commonly treated with an empiric combination therapy, including a macrolide, or a quinolone and a β-lactam. However, the risk of Legionella pneumonia may lead to a prolonged combination therapy even after negative urinary antigen tests (UAT). Methods We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality. Results Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis. Conclusion Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia.

Published
2023
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3. Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome in the intensive care unit: a case report

Author

Félicie Belicard, Nicolas Belhomme, Simon Bouzy, Clémence Saillard, Fabienne Nedelec, Jean-Baptiste Mear, Samuel Ardois, Cedric Pastoret, Florian Reizine, Christophe Camus, and Benoit Painvin

Subjects
VEXAS syndrome, Vacuoles, Autoinflammatory disease, Cardiac arrest, ICU, Sweet’s syndrome, Medicine
Abstract

Abstract Background Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome is a newly discovered inflammatory disease affecting male subjects, for which few data exist in the literature. Here, we describe the case of a patient with known Sweet’s syndrome admitted to the intensive care unit and for whom a vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome was diagnosed, allowing for appropriate treatment and the patient’s discharge and recovery. Case presentation A 70-year-old male White patient was hospitalized in the intensive care unit following an intrahospital cardiac arrest. History started a year before with repeated deep vein thrombosis and episodes of skin eruption compatible with Sweet’s syndrome. After a course of oral steroids, fever and inflammatory syndrome relapsed with onset of polychondritis, episcleritis along with neurological symptoms and pulmonary infiltrates. Intrahospital hypoxic cardiac arrest happened during patient’s new investigations, and he was admitted in a critical state. During the intensive care unit stay, he presented with livedoid skin lesions on both feet. Vasculitis was not proven; however, cryoglobulinemia screening came back positive. Onset of pancytopenia was explored with a myelogram aspirate. It showed signs of dysmyelopoiesis and vacuoles in erythroid and myeloid precursors. Of note, new deep vein thrombosis developed, despite being treated with heparin leading to the diagnosis of heparin-induced thrombocytopenia. The course of symptoms were overlapping multiple entities, and so a multidisciplinary team discussion was implemented. Screening for UBA1-mutation in the blood came back positive, confirming the vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome. Corticosteroids and anti-IL1 infusion were started with satisfactory results supporting patient’s discharge from intensive care unit to the internal medicine ward. Conclusions Vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome should be suspected in male patients presenting with inflammatory symptoms, such as fever, skin eruption, chondritis, venous thromboembolism, and vacuoles in bone marrow precursors. Patients with undiagnosed vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic syndrome may present with organ failure requiring hospitalization in intensive care unit, where screening for UBA1 mutation should be performed when medical history is evocative. Multidisciplinary team involvement is highly recommended for patient management, notably to start appropriate immunosuppressive treatments.

Published
2023
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4. Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study

Author

Adel Maamar, Clémence Liard, Willelm Doucet, Florian Reizine, Benoit Painvin, Flora Delamaire, Valentin Coirier, Quentin Quelven, Pauline Guillot, Mathieu Lesouhaitier, Jean Marc Tadié, and Arnaud Gacouin

Subjects
Covid-19, Influenza, ARDS, ICU, Agitation, Encephalopathy, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation’s incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy. Methods We included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. Results We included 241 patients (median age 62 years [53–70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p

Published
2022
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5. Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality

Author

Adel Maamar, Pauline Guillot, Vincent Joussellin, Flora Delamaire, Benoit Painvin, Anaëlle Bichon, Océane Bernard de la Jartre, Matteo Mauget, Mathieu Lesouhaitier, Jean Marc Tadié, Nicolas Terzi, and Arnaud Gacouin

Subjects
Medicine
Abstract

Background This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (PaO2)/inspiratory oxygen fraction (FIO2) ≤150 mmHg. Methods We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (Crs), ventilator ratio, corrected minute ventilation (V′Ecorr) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed. Results On day 1 of ARDS, COVID-19 patients had significantly higher PaO2/FIO2 (median (interquartile range) 97 (79–129.2) versus 83 (62.2–114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0–16.0) versus 14.0 (12.0–16.7) cmH2O; p=0.01), ventilatory ratio (2.08 (1.73–2.49 versus 2.52 (1.97–3.03); p

Published
2023
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6. Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France

Author

Benoit Painvin, Hélène Messet, Maeva Rodriguez, Thomas Lebouvier, Delphine Chatellier, Louis Soulat, Stephane Ehrmann, Arnaud W. Thille, Arnaud Gacouin, and Jean-Marc Tadie

Subjects
COVID-19, Intensive care unit, Hospital transport, Mechanical ventilation, ARDS, Mortality, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The COVID-19 pandemic led authorities to evacuate via various travel modalities critically ill ventilated patients into less crowded units. However, it is not known if interhospital transport impacts COVID-19 patient’s mortality in intensive care units (ICUs). A cohort from three French University Hospitals was analysed in ICUs between 15th of March and the 15th of April 2020. Patients admitted to ICU with positive COVID-19 test and mechanically ventilated were recruited. Results Among the 133 patients included in the study, 95 (71%) were male patients and median age was 63 years old (interquartile range: 54–71). Overall ICU mortality was 11%. Mode of transport included train (48 patients), ambulance (6 patients), and plane plus helicopter (14 patients). During their ICU stay, 7 (10%) transferred patients and 8 (12%) non-transferred patients died (p = 0.71). Median SAPS II score at admission was 33 (interquartile range: 25–46) for the transferred group and 35 (27–42) for non-transferred patients (p = 0.53). SOFA score at admission was 4 (3–6) for the transferred group versus 3 (2–5) for the non-transferred group (p = 0.25). In the transferred group, median PaO2/FiO2 ratio (P/F) value in the 24 h before departure was 197 mmHg (160–250) and remained 166 mmHg (125–222) in the first 24 h post arrival (p = 0.13). During the evacuation 46 (68%) and 21 (31%) of the patients, respectively, benefited from neuromuscular blocking agents and from vasopressors. Transferred and non-transferred patients had similar rate of nosocomial infections, 37/68 (54%) versus 34/65 (52%), respectively (p = 0.80). Median length of mechanical ventilation was significantly increased in the transferred group compared to the non-transferred group, 18 days (11–24) and 14 days (8–20), respectively (p = 0.007). Finally, ICU and hospital length of stay did not differ between groups. Conclusions In France, inter-hospital evacuation of COVID-19 ventilated ICU patients did not appear to increase mortality and therefore could be proposed to manage ICU surges in the future.

Published
2021
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7. Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Konstantinos Bachoumas, Albrice Levrat, Aurélie Le Thuaut, Stéphane Rouleau, Samuel Groyer, Hervé Dupont, Paul Rooze, Nathanael Eisenmann, Timothée Trampont, Julien Bohé, Benjamin Rieu, Jean-Charles Chakarian, Aurélie Godard, Laura Frederici, Stephanie Gélinotte, Aurélie Joret, Pascale Roques, Benoit Painvin, Christophe Leroy, Marcel Benedit, Loic Dopeux, Edouard Soum, Vlad Botoc, Muriel Fartoukh, Marie-Hélène Hausermann, Toufik Kamel, Jean Morin, Roland De Varax, Gaetan Plantefève, Alexandre Herbland, Matthieu Jabaudon, Thibault Duburcq, Christelle Simon, Russell Chabanne, Francis Schneider, Frederique Ganster, Cedric Bruel, Ahmed-Saïd Laggoune, Delphine Bregeaud, Bertrand Souweine, Jean Reignier, and Jean-Baptiste Lascarrou

Subjects
Epidural analgesia, Chest trauma, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P

Published
2020
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9. Short-term survival of acute respiratory distress syndrome patients due to influenza virus infection alone: a cohort study

Author

Arnaud Gacouin, Mathieu Lesouhaitier, Florian Reizine, Charlotte Pronier, Murielle Grégoire, Benoit Painvin, Adel Maamar, Vincent Thibault, Yves Le Tulzo, and Jean Marc Tadié

Subjects
Medicine
Abstract

Background Influenza virus (IV)-related pathophysiology suggests that the prognosis of acute respiratory distress syndrome (ARDS) due to IV could be different from the prognosis of ARDS due to other causes. However, the impact of IV infection alone on the prognosis of ARDS patients compared to that of patients with other causes of ARDS has been poorly assessed. Methods We compared the 28-day survival from the diagnosis of ARDS with an arterial oxygen tension/inspiratory oxygen fraction ratio ≤150 mmHg between patients with and without IV infection alone. Data were collected prospectively and analysed retrospectively. We first performed survival analysis on the whole population; second, patients with IV infection alone were compared with matched pairs using propensity score matching. Results The cohort admitted from October 2009 to March 2020 consisted of 572 patients, including 73 patients (13%) with IV alone. On the first 3 days of mechanical ventilation, nonpulmonary Sequential Organ Failure Assessment scores were significantly lower in patients with IV infection than in the other patients. After the adjusted analysis, IV infection alone remained independently associated with lower mortality at day 28 (hazard ratio 0.51, 95% CI 0.26–0.99, p=0.047). Mortality at day 28 was significantly lower in patients with IV infection alone than in other patients when propensity score matching was used (20% versus 38%, p=0.02). Conclusions Our results suggest that patients with ARDS following IV infection alone have a significantly better prognosis at day 28 and less severe nonpulmonary organ dysfunction than do those with ARDS from causes other than IV infection alone.

Published
2020
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10. Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different?

Author

Florian Reizine, Kieran Pinceaux, Mathieu Lederlin, Brice Autier, Hélène Guegan, Arnaud Gacouin, David Luque-Paz, Christelle Boglione-Kerrien, Astrid Bacle, Brendan Le Daré, Yoann Launey, Mathieu Lesouhaitier, Benoit Painvin, Christophe Camus, Alexandre Mansour, Florence Robert-Gangneux, Sorya Belaz, Yves Le Tulzo, Jean-Marc Tadié, Adel Maamar, and Jean-Pierre Gangneux

Subjects
COVID-19, influenza, pulmonary aspergillosis, CAPA, IAPA, corticosteroids, Biology (General), QH301-705.5
Abstract

Invasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern. Influenza-associated acute respiratory distress syndrome (ARDS) and severe COVID-19 patients are both at risk of developing invasive fungal diseases. We used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological, and radiological aspects of IAPA and CAPA in a monocentric retrospective study. A total of 120 patients were included, 71 with influenza and 49 with COVID-19-associated ARDS. Among them, 27 fulfilled the newly published criteria of IPA: 17/71 IAPA (23.9%) and 10/49 CAPA (20.4%). Kaplan–Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0.032), whereas mortality did not differ between CAPA and IAPA patients. Radiological findings showed differences between IAPA and CAPA, with a higher proportion of features suggestive of IPA during IAPA. Lastly, a wide proportion of IPA patients had low plasma voriconazole concentrations with a higher delay to reach concentrations > 2 mg/L in CAPA vs. IAPA patients (p = 0.045). Severe COVID-19 and influenza patients appeared very similar in terms of prevalence of IPA and outcome. The dramatic consequences on the patients’ prognosis emphasize the need for a better awareness in these particular populations.

Published
2021
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11. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial

Author

Delphine, Chatellier, Anne, Veinstein, Florence, Boissier, Faustine, Reynaud, Maeva, Rodriguez, Florent, Joly, François, Arrivé, Victor, De Roubin, René, Robert, Laetitia, Bodet-Contentin, Charlotte, Salmon Gandonnière, Emmanuelle, Mercier, Paul, Jaubert, Nathalie, Marin, Marine, Paul, Morgane, Faure, Suela, Demiri, Alexandre, Demoule, Clara, Candille, Anaïs, Dartevel, Florian, Sigaud, Vanessa, Jean Michel, Raphaël, Le Mao, Pierre, Bailly, Amélie, Seguin, Jean-Baptiste, Lascarrou, Emmanuel, Canet, Gaëtan, Plantefève, Radj, Cally, Joanna, Tirolien, Adel, Maamar, Benoit, Painvin, Julien, Carvelli, Marc, Gainnier, Gaëtan, Béduneau, Dorothée, Carpentier, Dominique, Malacrino, Mehdi, Marzouk, Clément, Saccheri, Nicolas, Mahr, Pauline, Soulier, Quentin, Levrat, Pascal, Andreu, David, Cortier, Mai Anh, Nay, Coudroy, Rémi, Frat, Jean-Pierre, Ehrmann, Stephan, Pène, Frédéric, Decavèle, Maxens, Terzi, Nicolas, Prat, Gwenaël, Garret, Charlotte, Contou, Damien, Gacouin, Arnaud, Bourenne, Jeremy, Girault, Christophe, Vinsonneau, Christophe, Dellamonica, Jean, Labro, Guylaine, Jochmans, Sébastien, Herbland, Alexandre, Quenot, Jean-Pierre, Devaquet, Jérôme, Benzekri, Dalila, Vivier, Emmanuel, Nseir, Saad, Colin, Gwenhaël, Thevenin, Didier, Grasselli, Giacomo, Bougon, David, Assefi, Mona, Guérin, Claude, Lherm, Thierry, Kouatchet, Achille, Ragot, Stephanie, and Thille, Arnaud W

Published
2022
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12. One-Year Mental and Physical Health Assessment in Survivors after Extracorporeal Membrane Oxygenation for COVID-19–related Acute Respiratory Distress Syndrome

Author

Juliette Chommeloux, Simon Valentin, Hadrien Winiszewski, Mélanie Adda, Marc Pineton de Chambrun, Quentin Moyon, Alexis Mathian, Gilles Capellier, Christophe Guervilly, Bruno Levy, Pierre Jaquet, Romain Sonneville, Guillaume Voiriot, Alexandre Demoule, Samia Boussouar, Benoit Painvin, Guillaume Lebreton, Alain Combes, Matthieu Schmidt, Groupe de recherche cinique Réanimation et soins intensifs du patient en Insuffisance respiratoire aigüe (GRC 30 - RESPIRE), Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), 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)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), 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), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and CHU Pontchaillou [Rennes]

Subjects
Pulmonary and Respiratory Medicine, quality of life, [SDV]Life Sciences [q-bio], COVID-19, acute respiratory distress syndrome, Critical Care and Intensive Care Medicine, venovenous–extracorporeal membrane oxygenation, follow-up studies
Abstract

International audience; Rationale: Long-term outcomes of patients with coronavirus disease (COVID-19)-related acute respiratory distress syndrome treated with extracorporeal membrane oxygenation (ECMO) are unknown. Objectives: To assess physical examination, pulmonary function tests, anxiety, depression, post-traumatic stress disorder and quality of life at 6 and 12 months after ECMO onset. Methods: Multicenter, prospective study in patients who received ECMO for COVID-19 acute respiratory distress syndrome from March to June 2020 and survived hospital discharge. Measurements and Main Results: Of 80 eligible patients, 62 were enrolled in seven French ICUs. ECMO and invasive mechanical ventilation duration were 18 (11-25) and 36 (27-62) days, respectively. All were alive, but only 19/50 (38%) returned to work and 13/42 (31%) had recovered a normal sex drive at 1 year. Pulmonary function tests were almost normal at 6 months, except for DlCO, which was still impaired at 12 months. Mental health, role-emotional, and role-physical were the most impaired domain compared with patients receiving ECMO who did not have COVID-19. One year after ICU admission, 19/43 (44%) patients had significant anxiety, 18/43 (42%) had depression symptoms, and 21/50 (42%) were at risk for post-traumatic stress disorders. Conclusions: Despite the partial recovery of the lung function tests at 1 year, the physical and psychological function of this population remains impaired. Based on the comparison with long-term follow-up of patients receiving ECMO who did not have COVID-19, poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation.

Published
2023
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13. SARS-CoV-2-Induced ARDS Associates with MDSC Expansion, Lymphocyte Dysfunction, and Arginine Shortage

Author

Joelle Dulong, Kieran Pinceaux, Claude Bendavid, Benoit Painvin, Mikael Roussel, Pierre Tattevin, Murielle Gregoire, Yoann Launey, Simon Le Gallou, Jean-Marc Tadié, Audrey Le Bot, Thomas Lebouvier, Berengère Cador-Rousseau, Karin Tarte, Christophe Camus, Adel Maamar, Caroline Moreau, Mathieu Lesouhaitier, Mathieu Lederlin, Michel Cogné, Delphine Rossille, Arnaud Gacouin, Matthieu Revest, Florian Reizine, Yves Le Tulzo, Alice Ballerie, Maelle Latour, Clotilde Verdy, Chard-Hutchinson, Xavier, CHU Pontchaillou [Rennes], Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), 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 ), University hospital of Rennes, France, Fondation pour la Recherche MedicaleFondation pour la Recherche Medicale, Agence Nationale de la Recherche (ANR, Flash CoViD 'HARMONICOV ') grantFrench National Research Agency (ANR), Fondation de l'Avenir grant (Prix des donateurs, Mutualite Fonction Publique), 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 ), and ANR-20-COVI-0039,HARMONICOV,Immunomonitoring haute définition & caractérisation d'anticorps spécifiques chez des patients CoV-2 critiques versus en rémission(2020)

Subjects
Male, 0301 basic medicine, ARDS, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Lymphocyte, MDSC, Immunology, Arginine, Severity of Illness Index, law.invention, 03 medical and health sciences, 0302 clinical medicine, Cross infection, law, Lymphopenia, medicine, Humans, Immunology and Allergy, Prospective Studies, Lymphocytes, Aged, Mechanical ventilation, Respiratory Distress Syndrome, SARS-CoV-2, business.industry, Myeloid-Derived Suppressor Cells, Mortality rate, Immunosuppression, Middle Aged, medicine.disease, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Arginase, Pneumonia, 030104 developmental biology, medicine.anatomical_structure, Original Article, Female, Covid-19, business, 030215 immunology
Abstract

Purpose The SARS-CoV-2 infection can lead to a severe acute respiratory distress syndrome (ARDS) with prolonged mechanical ventilation and high mortality rate. Interestingly, COVID-19-associated ARDS share biological and clinical features with sepsis-associated immunosuppression since lymphopenia and acquired infections associated with late mortality are frequently encountered. Mechanisms responsible for COVID-19-associated lymphopenia need to be explored since they could be responsible for delayed virus clearance and increased mortality rate among intensive care unit (ICU) patients. Methods A series of 26 clinically annotated COVID-19 patients were analyzed by thorough phenotypic and functional investigations at days 0, 4, and 7 after ICU admission. Results We revealed that, in the absence of any difference in demographic parameters nor medical history between the two groups, ARDS patients presented with an increased number of myeloid-derived suppressor cells (MDSC) and a decreased number of CD8pos effector memory cell compared to patients hospitalized for COVID-19 moderate pneumonia. Interestingly, COVID-19-related MDSC expansion was directly correlated to lymphopenia and enhanced arginase activity. Lastly, T cell proliferative capacity in vitro was significantly reduced among COVID-19 patients and could be restored through arginine supplementation. Conclusions The present study reports a critical role for MDSC in COVID-19-associated ARDS. Our findings open the possibility of arginine supplementation as an adjuvant therapy for these ICU patients, aiming to reduce immunosuppression and help virus clearance, thereby decreasing the duration of mechanical ventilation, nosocomial infection acquisition, and mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00920-5.

Published
2021
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14. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial

Author

Coudroy, Rémi, primary, Frat, Jean-Pierre, additional, Ehrmann, Stephan, additional, Pène, Frédéric, additional, Decavèle, Maxens, additional, Terzi, Nicolas, additional, Prat, Gwenaël, additional, Garret, Charlotte, additional, Contou, Damien, additional, Gacouin, Arnaud, additional, Bourenne, Jeremy, additional, Girault, Christophe, additional, Vinsonneau, Christophe, additional, Dellamonica, Jean, additional, Labro, Guylaine, additional, Jochmans, Sébastien, additional, Herbland, Alexandre, additional, Quenot, Jean-Pierre, additional, Devaquet, Jérôme, additional, Benzekri, Dalila, additional, Vivier, Emmanuel, additional, Nseir, Saad, additional, Colin, Gwenhaël, additional, Thevenin, Didier, additional, Grasselli, Giacomo, additional, Bougon, David, additional, Assefi, Mona, additional, Guérin, Claude, additional, Lherm, Thierry, additional, Kouatchet, Achille, additional, Ragot, Stephanie, additional, Thille, Arnaud W, additional, Delphine, Chatellier, additional, Anne, Veinstein, additional, Florence, Boissier, additional, Faustine, Reynaud, additional, Maeva, Rodriguez, additional, Florent, Joly, additional, François, Arrivé, additional, Victor, De Roubin, additional, René, Robert, additional, Laetitia, Bodet-Contentin, additional, Charlotte, Salmon Gandonnière, additional, Emmanuelle, Mercier, additional, Paul, Jaubert, additional, Nathalie, Marin, additional, Marine, Paul, additional, Morgane, Faure, additional, Suela, Demiri, additional, Alexandre, Demoule, additional, Clara, Candille, additional, Anaïs, Dartevel, additional, Florian, Sigaud, additional, Vanessa, Jean Michel, additional, Raphaël, Le Mao, additional, Pierre, Bailly, additional, Amélie, Seguin, additional, Jean-Baptiste, Lascarrou, additional, Emmanuel, Canet, additional, Gaëtan, Plantefève, additional, Radj, Cally, additional, Joanna, Tirolien, additional, Adel, Maamar, additional, Benoit, Painvin, additional, Julien, Carvelli, additional, Marc, Gainnier, additional, Gaëtan, Béduneau, additional, Dorothée, Carpentier, additional, Dominique, Malacrino, additional, Mehdi, Marzouk, additional, Clément, Saccheri, additional, Nicolas, Mahr, additional, Pauline, Soulier, additional, Quentin, Levrat, additional, Pascal, Andreu, additional, David, Cortier, additional, and Mai Anh, Nay, additional

Published
2022
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15. Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study

Author

Damien Contou, Gwenhaël Colin, Brendan Travert, Sébastien Jochmans, Marie Conrad, Jean-Baptiste Lascarrou, Benoit Painvin, Alexis Ferré, David Schnell, Béatrice La Combe, Rémi Coudroy, Stephan Ehrmann, Jérôme Rambaud, Arnaud Wiedemann, Pierre Asfar, Pierre Kalfon, Emmanuel Guérot, Sébastien Préau, Laurent Argaud, Florence Daviet, Jean Dellamonica, Audrey Dupont, Muriel Fartoukh, Toufik Kamel, Gaetan Beduneau, Florence Canouï-Poitrine, Emmanuelle Boutin, Gérard Lina, Armand Mekontso Dessap, Anne Tristan, Nicolas de Prost, French m-TSS Study Group, Centre Hospitalier Victor Dupouy, CH Départemental Vendée, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier de Melun (CHM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pontchaillou [Rennes], Laboratoire Lasers, Plasmas et Procédés photoniques (LP3), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier d'Angoulême (CH Angoulême), Université de Bretagne Sud - Lorient (UBS Lorient), Université de Bretagne Sud (UBS), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical Research in Intensive Care and Sepsis - TRIal Group for Global Evaluation and Research in SEPsis [CHU Limoges] (Réseau CRICS-TRIGGERSEP ), Hôpital Dupuytren [CHU Limoges], Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Service de Réanimation polyvalente [Chartres], Hôpital Louis Pasteur [Chartres], 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), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Assistance Publique - Hôpitaux de Marseille (APHM), Unité de Recherche Clinique de la Côte d’Azur (URRIS UR2CA), Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Normandie Université (NU)-Normandie Université (NU), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), 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)-CHU Henri Mondor [Créteil], Unité de Recherche Clinique de la Côte d’Azur [Nice] (URRIS UR2CA), 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, CarMeN, laboratoire, Centre Hospitalier de Melun, Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Charles Nicolle [Rouen]-CHU Rouen, 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, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10

Subjects
0301 basic medicine, Microbiology (medical), Adult, Staphylococcus aureus, medicine.medical_specialty, Adolescent, genetic structures, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030106 microbiology, Disease, law.invention, Sepsis, Menstruation, sepsis, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Intensive care, medicine, Humans, 030212 general & internal medicine, Child, menstrual toxic shock syndrome, Retrospective Studies, Superantigens, Critically ill, business.industry, Medical record, Tracheal intubation, Toxic shock syndrome, Retrospective cohort study, Staphylococcal Infections, tampon, bacterial infections and mycoses, Institutional review board, medicine.disease, Shock, Septic, Intensive care unit, 3. Good health, Anti-Bacterial Agents, [SDV] Life Sciences [q-bio], Infectious Diseases, Icu, Female, Observational study, menstruation, business
Abstract

Background Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. Methods This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between 1 January 2005 and 31 December 2020 in 43 French pediatric (n = 7) or adult (n = 36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as to assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, in critically ill patients with m-TSS. Results In total, 102 patients with m-TSS (median age, 18 years; interquartile range, 16–24 years) were admitted to 1 of the participating ICUs. All blood cultures (n = 102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for superantigenic toxin gene sequences was performed for 76 of the 92 vaginal samples positive for S. aureus (83%), and toxic shock syndrome toxin 1 was isolated from 66 strains (87%). At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS, and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with antitoxin antibiotic therapy, and 8 (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors, and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. Conclusions In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.

Published
2021
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16. Hydroxychloroquine pharmacokinetic in COVID-19 critically ill patients: an observational cohort study

Author

Arnaud Gacouin, Benoit Painvin, Marie-Clémence Verdier, Pauline Guillot, Adel Maamar, CHU Pontchaillou [Rennes], 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), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Letter, Coronavirus disease 2019 (COVID-19), Critical Illness, [SDV]Life Sciences [q-bio], Pneumonia, Viral, Critical Care and Intensive Care Medicine, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Pharmacokinetics, Anesthesiology, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Pandemics, ComputingMilieux_MISCELLANEOUS, Aged, 0303 health sciences, Dose-Response Relationship, Drug, SARS-CoV-2, 030306 microbiology, business.industry, Critically ill, COVID-19, Hydroxychloroquine, Acute Kidney Injury, Middle Aged, COVID-19 Drug Treatment, 3. Good health, Intensive Care Units, Creatinine, Female, Observational study, Drug Monitoring, Coronavirus Infections, business, Half-Life, medicine.drug, Cohort study
Abstract

International audience

Published
2020
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17. Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Loic Dopeux, Christelle Simon, Gaëtan Plantefève, Konstantinos Bachoumas, Bertrand Souweine, Roland De Varax, Thibault Duburcq, Julien Bohé, Francis Schneider, Jean-Baptiste Lascarrou, Alexandre Herbland, Pascale Roques, Marcel Benedit, Delphine Bregeaud, Matthieu Jabaudon, Marie-Hélène Hausermann, Aurélie Godard, Russell Chabanne, Samuel Groyer, Albrice Levrat, Frédérique Ganster, Christophe Leroy, Muriel Fartoukh, Laura Frederici, Benoit Painvin, Stephane Rouleau, Ahmed-Saïd Laggoune, Benjamin Rieu, Edouard Soum, Jean Morin, Paul Rooze, Jean-Charles Chakarian, Aurélie Joret, Hervé Dupont, Stéphanie Gelinotte, Vlad Botoc, Nathanael Eisenmann, Jean Reignier, Aurélie Le Thuaut, Toufik Kamel, Timothée Trampont, Cédric Bruel, CH de Saint-Malo [Broussais], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional d'Orléans (CHRO), 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 hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Victor Dupouy, Hôpital Saint-Louis de La Rochelle (CH La Rochelle), Vanderbilt University Medical Center [Nashville], Vanderbilt University [Nashville], Génétique, Reproduction et Développement (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier de Versailles André Mignot (CHV), Pôle de Médecine Périopératoire [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Les Hôpitaux Universitaires de Strasbourg (HUS), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Service de réanimation polyvalente, Groupe Hospitalier Paris Saint-Joseph (hpsj), Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, Hôtel-Dieu de Nantes, CHU La Roche sur Yon, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service d'Anesthésie - Réanimation, Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Amiens-Picardie, Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), Université de Picardie Jules Verne (UPJV), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Anesthésie Réanimation chirurgicale [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Service des urgences [CHU Limoges], CHU Limoges, Service de Réanimation Médicale Sud, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre hospitalier de Dieppe, Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Reanimation Hôpital de Moulins Yzeure, Moulins, France, Pôle Urgences [CHU Clermont-Ferrand], Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon], 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 Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and DESSAIVRE, Louise

Subjects
medicine.medical_specialty, Flail chest, Epidural analgesia, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Chest trauma, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Medicine, Intubation, Mechanical ventilation, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Intensive care unit, [SDV] Life Sciences [q-bio], 030228 respiratory system, SAPS II, Anesthesia, Injury Severity Score, business
Abstract

Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. Conclusions EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.

Published
2020
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18. Additional file 2 of Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Bachoumas, Konstantinos, Albrice Levrat, Thuaut, Aurélie Le, Rouleau, Stéphane, Groyer, Samuel, Dupont, Hervé, Rooze, Paul, Eisenmann, Nathanael, Trampont, Timothée, Bohé, Julien, Rieu, Benjamin, Jean-Charles Chakarian, Godard, Aurélie, Frederici, Laura, Gélinotte, Stephanie, Joret, Aurélie, Roques, Pascale, Benoit Painvin, Leroy, Christophe, Benedit, Marcel, Loic Dopeux, Soum, Edouard, Botoc, Vlad, Fartoukh, Muriel, Marie-Hélène Hausermann, Kamel, Toufik, Morin, Jean, Varax, Roland De, Plantefève, Gaetan, Herbland, Alexandre, Jabaudon, Matthieu, Duburcq, Thibault, Simon, Christelle, Chabanne, Russell, Schneider, Francis, Ganster, Frederique, Bruel, Cedric, Ahmed-Saïd Laggoune, Bregeaud, Delphine, Souweine, Bertrand, Reignier, Jean, and Lascarrou, Jean-Baptiste

Abstract

Additional file 2: Figure S2. Proportions of patients given epidural analgesia in each study ICU.

Published
2020
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19. Additional file 4 of Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Bachoumas, Konstantinos, Albrice Levrat, Thuaut, Aurélie Le, Rouleau, Stéphane, Groyer, Samuel, Dupont, Hervé, Rooze, Paul, Eisenmann, Nathanael, Trampont, Timothée, Bohé, Julien, Rieu, Benjamin, Jean-Charles Chakarian, Godard, Aurélie, Frederici, Laura, Gélinotte, Stephanie, Joret, Aurélie, Roques, Pascale, Benoit Painvin, Leroy, Christophe, Benedit, Marcel, Loic Dopeux, Soum, Edouard, Botoc, Vlad, Fartoukh, Muriel, Marie-Hélène Hausermann, Kamel, Toufik, Morin, Jean, Varax, Roland De, Plantefève, Gaetan, Herbland, Alexandre, Jabaudon, Matthieu, Duburcq, Thibault, Simon, Christelle, Chabanne, Russell, Schneider, Francis, Ganster, Frederique, Bruel, Cedric, Ahmed-Saïd Laggoune, Bregeaud, Delphine, Souweine, Bertrand, Reignier, Jean, and Lascarrou, Jean-Baptiste

Subjects
human activities, humanities
Abstract

Additional file 4: Table S2. Sensitivity analysis restricted to the 327 patients with an NRS pain score > 3 on ICU day 1.

Published
2020
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20. Additional file 3 of Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

Author

Bachoumas, Konstantinos, Albrice Levrat, Thuaut, Aurélie Le, Rouleau, Stéphane, Groyer, Samuel, Dupont, Hervé, Rooze, Paul, Eisenmann, Nathanael, Trampont, Timothée, Bohé, Julien, Rieu, Benjamin, Jean-Charles Chakarian, Godard, Aurélie, Frederici, Laura, Gélinotte, Stephanie, Joret, Aurélie, Roques, Pascale, Benoit Painvin, Leroy, Christophe, Benedit, Marcel, Loic Dopeux, Soum, Edouard, Botoc, Vlad, Fartoukh, Muriel, Marie-Hélène Hausermann, Kamel, Toufik, Morin, Jean, Varax, Roland De, Plantefève, Gaetan, Herbland, Alexandre, Jabaudon, Matthieu, Duburcq, Thibault, Simon, Christelle, Chabanne, Russell, Schneider, Francis, Ganster, Frederique, Bruel, Cedric, Ahmed-Saïd Laggoune, Bregeaud, Delphine, Souweine, Bertrand, Reignier, Jean, and Lascarrou, Jean-Baptiste

Abstract

Additional file 3: Table S1. Sensitivity analysis restricted to the 526 patients in ICUs where at least 1 study patient received epidural analgesia.

Published
2020
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21. Impact on ICU mortality of moderate alcohol consumption in patients admitted with infection

Author

Benoit Painvin, Yves Le Tulzo, Quentin Quelven, Valentin Coirier, Boris Delange, Arnaud Gacouin, Vincent Joussellin, Félicie Belicard, Floriane L'her, Adel Maamar, Jean Marc Tadié, 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), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, medicine.medical_specialty, Alcohol Drinking, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Communicable Diseases, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, medicine, Humans, In patient, Alcohol consumption, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Mortality, Aged, Proportional Hazards Models, Icu mortality, business.industry, Alcoholic Beverages, Alcohol dependence, Hazard ratio, Middle Aged, Prognosis, Intensive care unit, Confidence interval, 3. Good health, Hospitalization, Intensive Care Units, 030228 respiratory system, Female, business, Cohort study, Critical illness, Infection
Abstract

International audience; Purpose - Alcohol dependence is associated with poor prognosis in the intensive care unit (ICU), but it remains uncertain whether moderate alcohol consumption negatively affects the prognosis of critically ill patients admitted with infection. Materials and methods - In a prospective observational cohort study performed in 478 patients admitted with documented infection, mortality at day 28 in the group of abstainers and nontrauma patients with estimated alcohol consumption lower than 100 g/week was compared with that in non-alcohol-dependent patients with estimated alcohol consumption between 100 and 350 g/week. Results - In 97 patients (20%), alcohol consumption was estimated to be over 100 g/week, and in 391 patients (80%), alcohol consumption was estimated to be 100 g/week or less. The pathogens identified did not significantly differ between the two groups of patients. After adjusted analysis, alcohol consumption between 100 and 350 g/week remained significantly associated with mortality at day 28 (hazard ratio (HR): 1.67; 95% confidence interval (CI): 1.01-2.77; p = .04). Conclusion - Alcohol consumption between 100 and 350 g/week was independently associated with mortality at day 28. Our results suggest that in critically ill patients admitted with infection, moderate alcohol consumption is associated with a poorer prognosis.

Published
2020
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22. At-Risk Drinking Is Independently Associated With Acute Kidney Injury in Critically Ill Patients

Author

Jean Marc Tadié, Mathieu Lesouhaitier, Benoit Painvin, Arnaud Gacouin, Florian Reizine, Aurélien Frérou, Sonia Rafi, Adel Maamar, Yves Le Tulzo, CHU Pontchaillou [Rennes], 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), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, medicine.medical_specialty, Alcohol Drinking, Critical Illness, [SDV]Life Sciences [q-bio], Renal function, Kidney Function Tests, Critical Care and Intensive Care Medicine, Severity of Illness Index, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, Prospective Studies, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, Aged, business.industry, Acute kidney injury, 030208 emergency & critical care medicine, Odds ratio, Acute Kidney Injury, Middle Aged, medicine.disease, Alcohol-Induced Disorders, 3. Good health, Intensive Care Units, 030228 respiratory system, Female, Observational study, business, Cohort study, Kidney disease
Abstract

OBJECTIVES Unhealthy use of alcohol and acute kidney injury are major public health problems, but little is known about the impact of excessive alcohol consumption on kidney function in critically ill patients. We aimed to determine whether at-risk drinking is independently associated with acute kidney injury in the ICU and at ICU discharge. DESIGN Prospective observational cohort study. SETTING A 21-bed polyvalent ICU in a university hospital. PATIENTS A total of 1,107 adult patients admitted over a 30-month period who had an ICU stay of greater than or equal to 3 days and in whom alcohol consumption could be assessed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We assessed Kidney Disease Improving Global Outcomes stages 2-3 acute kidney injury in 320 at-risk drinkers (29%) and 787 non-at-risk drinkers (71%) at admission to the ICU, within 4 days after admission and at ICU discharge. The proportion of patients with stages 2-3 acute kidney injury at admission to the ICU (42.5% vs 18%; p < 0.0001) was significantly higher in at-risk drinkers than in non-at-risk drinkers. Within 4 days and after adjustment on susceptible and predisposing factors for acute kidney injury was performed, at-risk drinking was significantly associated with acute kidney injury for the entire population (odds ratio, 2.15; 1.60-2.89; p < 0.0001) in the subgroup of 832 patients without stages 2-3 acute kidney injury at admission to the ICU (odds ratio, 1.44; 1.02-2.02; p = 0.04) and in the subgroup of 971 patients without known chronic kidney disease (odds ratio, 1.92; 1.41-2.61; p < 0.0001). Among survivors, 22% of at-risk drinkers and 9% of non-at-risk drinkers were discharged with stages 2-3 acute kidney injury (p < 0.001). CONCLUSIONS Our results suggest that chronic and current alcohol misuse in critically ill patients is associated with kidney dysfunction. The systematic and accurate identification of patients with alcohol misuse may allow for the prevention of acute kidney injury.

Published
2019
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