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1. Modeling ventilation of patients with interstitial lung disease at rest and exercise: a bench study

Author: Elise Artaud-Macari, Emeline Fresnel, Adrien Kerfourn, Clémence Roussel, David Debeaumont, Marie-Anne Melone, Francis-Edouard Gravier, Tristan Bonnevie, Mathieu Salaün, Antoine Cuvelier, and Christophe Girault
Subjects: Bench study, Respiratory mechanics, Exercise, Interstitial lung disease, Volo-atelec-trauma, Diseases of the respiratory system, RC705-779
Abstract: Abstract Background The ventilatory physiopathology of patients with interstitial lung disease (ILD) remains poorly understood. We aimed to personalize a mechanical simulator to model healthy and ILD profiles ventilation, and to evaluate the effect of spontaneous breathing on respiratory mechanics at rest and during exercise. Methods In a 2-compartment lung simulator (ASL 5000®), we modeled 1 healthy and 3 ILD profiles, at rest and during exercise, based on physiological data from literature and patients. Measurements were: tidal volume, end-expiratory lung volume, driving pressure, transpulmonary driving pressure, dynamic alveolar strain, mechanical power, and time lag of inspiratory flow between compartments 1 and 2. Results Healthy and ILD models were validated: maximum differences between real and simulated tidal volume were 5% (96 ml) and 6% (54 ml) at rest and during exercise respectively, considered clinically negligible. When we simulated lung inhomogeneity (compliance in compartment 1 > compartment 2), tidal volume, end-expiratory lung volume, driving pressure and mechanical power increased in compartment 1 and decreased in compartment 2. Driving transpulmonary pressure and dynamic alveolar strain increased in compartment 2 and decreased in compartment 1. Time lag of inspiratory flow between compartments 1 and 2 was positively correlated with a difference of compliance between compartments (r = 0.98, CI95% (0.9106; 0.9962), p
Published: 2024
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2. Oxygen therapy and noninvasive respiratory supports in acute hypoxemic respiratory failure: a narrative review

Author: Arnaud W. Thille, Frédéric Balen, Guillaume Carteaux, Tahar Chouihed, Jean-Pierre Frat, Christophe Girault, Erwan L’Her, Nicolas Marjanovic, Mai-Anh Nay, Patrick Ray, Matthieu Reffienna, Leo Retenauer, Antoine Roch, Guillaume Thiery, and Jennifer Truchot
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background This narrative review was written by an expert panel to the members of the jury to help in the development of clinical practice guidelines on oxygen therapy. Results According to the expert panel, acute hypoxemic respiratory failure was defined as PaO2
Published: 2024
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3. Ventilator performances for non-invasive ventilation: a bench study

Author: Maxime Patout, Antoine Cuvelier, Fabienne Tamion, Christophe Girault, Elise Artaud-Macari, Christian Caillard, and Emeline Fresnel
Subjects: Medicine, Diseases of the respiratory system, RC705-779
Abstract: Introduction A wide range of recent ventilators, dedicated or not, is available for non-invasive ventilation (NIV) in respiratory or intensive care units (ICU). We conducted a bench study to compare their technical performances.Methods Ventilators, including five ICU ventilators with NIV mode on, two dedicated NIV ventilators and one transport ventilator, were evaluated on a test bench for NIV, consisting of a 3D manikin head connected to an ASL 5000 lung model via a non-vented mask. Ventilators were tested according to three simulated lung profiles (normal, obstructive, restrictive), three levels of simulated air leakage (0, 15, 30 L/min), two levels of pressure support (8, 14 cmH2O) and two respiratory rates (15, 25 cycles/min).Results The global median Asynchrony Index (AI) was higher with ICU ventilators than with dedicated NIV ventilators (4% (0; 76) vs 0% (0; 15), respectively; p
Published: 2024
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4. Evaluation of non-nutritional calories in intensive care patients with acute respiratory distress syndrome due to coronavirus disease-19: a retrospective observational study

Author: Benjamin Popoff, Emilie Occhiali, Zoé Demailly, Gaëtan Béduneau, Dorothée Carpentier, Christophe Girault, Philippe Gouin, Maximillien Grall, Grégoire Jolly, Thomas Clavier, and Fabienne Tamion
Subjects: Nutritional support, Energy intake, Respiratory distress syndrome, Critical care, Nutrition. Foods and food supply, TX341-641
Abstract: Summary: Background & Aims: Nutrition therapy is a critical component of care for critically ill patients in the intensive care unit (ICU). Caloric intake can be provided by artificial nutrition and also by some treatments providing non-nutritional calories (NNCs). The aim of this study was to assess the contribution of NNCs from propofol and dextrose infusions to daily caloric intake. Methods: A retrospective observational study was carried out in three ICUs of a university hospital. Mechanically ventilated patients admitted to ICU for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) were included. Daily caloric intake, including NNCs from propofol and dextrose infusions, and calories from artificial nutrition was assessed over the initial seven days of ICU admission. Results: A total of 157 patients were included in the analysis. During the early phase of ICU admission, NNCs constituted all the proportion of caloric intake (Day 1: 100% [100–100], Day 2: 100% [100–100], Day 3: 100% [63–100]). This dominance gradually decreased with the introduction of artificial nutrition after a median of 4 days [3–5]. Propofol contributed significantly to NNCs, constituting a median of 26.6% [15.5–54.0] of total daily caloric intake and 66.2% [53.0–76.4] of daily NNCs intake in patients receiving propofol. By Day 7, only 47.3% of patients had reached their caloric target, while 45.8% remained below target and 6.9% were above target. The instances of overnutrition were minimal and were often associated with NNCs, particularly propofol. Mortality at Day 28 in patients who received propofol during the first 7 days was 32/117 (27%) versus 23/40 (57%) in those who did not (P < 0.001). Conclusions: Our study emphasizes the significant role of NNCs in the early nutritional intake of ICU patients suffering from ARDS due to COVID-19. These findings highlight the need for careful nutritional management in these patients, with particular consideration given to NNCs. Future research should investigate strategies to optimize nutritional support in this specific population.
Published: 2024
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5. ROX index performance to predict high-flow nasal oxygen outcome in Covid-19 related hypoxemic acute respiratory failure

Author: Christophe Girault, Michael Bubenheim, Déborah Boyer, Pierre-Louis Declercq, Guillaume Schnell, Philippe Gouin, Jean-Baptiste Michot, Dorothée Carpentier, Steven Grangé, Gaëtan Béduneau, and Fabienne Tamion
Subjects: Acute respiratory failure, Covid-19 patients, High-flow nasal oxygen therapy, ROX index, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Given the pathophysiology of hypoxemia in patients with Covid-19 acute respiratory failure (ARF), it seemed necessary to evaluate whether ROX index (ratio SpO2/FiO2 to respiratory rate) could accurately predict intubation or death in these patients initially treated by high-flow nasal oxygenation (HFNO). We aimed, therefore, to assess the accuracy of ROX index to discriminate between HFNO failure (sensitivity) and HFNO success (specificity). Methods We designed a multicentre retrospective cohort study including consecutive patients with Covid-19 ARF. In addition to its accuracy, we assessed the usefulness of ROX index to predict HFNO failure (intubation or death) via logistic regression. Results Among 218 ARF patients screened, 99 were first treated with HFNO, including 49 HFNO failures (46 intubations, 3 deaths before intubation). At HFNO initiation (H0), ROX index sensitivity was 63% (95%CI 48–77%) and specificity 76% (95%CI 62–87%) using Youden’s index. With 4.88 as ROX index cut-off at H12, sensitivity was 29% (95%CI 14–48%) and specificity 90% (95%CI 78–97%). Youden’s index yielded 8.73 as ROX index cut-off at H12, with 87% sensitivity (95%CI 70–96%) and 45% specificity (95%CI 31–60%). ROX index at H0 was associated with HFNO failure (p = 0.0005) in univariate analysis. Multivariate analysis showed that SAPS II (p = 0.0003) and radiographic extension of pulmonary injuries (p = 0.0263), rather than ROX index, were predictive of HFNO failure. Conclusions ROX index cut-off values seem population-specific and the ROX index appears to have a technically acceptable but clinically low capability to discriminate between HFNO failures and successes in Covid-19 ARF patients. In addition, SAPS II and pulmonary injuries at ICU admission appear more useful than ROX index to predict the risk of intubation.
Published: 2024
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6. Case report: CAR-T cell therapy-induced cardiac tamponade

Author: Sacha Sarfati, Misa Eugène Norbert, Antoine Hérault, Marion Giry, Jade Makké, Maximilien Grall, Arnaud Savouré, Vincent Camus, Mustafa Alani, Fabienne Tamion, Jean-Baptiste Latouche, and Christophe Girault
Subjects: CAR-T cell, pericarditis, cardiac tamponade, pericardial effusion, CRS, ICU, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: CD19-specific chimeric antigen receptor T (CAR-T) cell therapy has recently been shown to improve the prognosis of refractory diffuse large B-cell lymphoma (DLBCL). However, CAR-T cells may induce numerous adverse events, in particular cytokine release syndrome (CRS) which is frequently associated with cardiovascular manifestations. Among the latter, acute pericardial effusion represents less than 1% of cases and cardiac tamponade has only been reported once. The management and outcome of these severe complications are not well established. We report here, a case of cardiac tamponade associated with CRS in a context of CAR-T cell therapy, which required urgent pericardiocentesis.Case summaryA 65-year-old man with refractory DLBCL was treated with CAR-T cell therapy. He had a history of dilated cardiomyopathy with preserved ejection fraction and transient atrial fibrillation. A pericardial localization of the lymphoma was observed on the second relapse. One day after CAR-T cell infusion the patient was diagnosed with grade 1 CRS. Due to hypotension, he was treated with tocilizumab and dexamethasone, and then transferred to intensive care unit (ICU). Echocardiography performed at ICU admission showed acute pericardial effusion with signs of right ventricular heart failure due to cardiac tamponade. It was decided to perform pericardiocentesis despite grade IV thrombocytopenia in a context of aplasia. Analysis of pericardial fluid showed a large number of lymphoma cells and 73% of CAR-T cells amongst lymphocytes, a level that was similar in blood. Hemodynamic status improved after pericardiocentesis, and no recurrence of pericardial effusion was observed. The presence of a high count of activated CAR-T cells in the pericardial fluid as well as the short interval between CAR-T cells injection and the symptoms appear as potential arguments for a direct action of CAR-T cells in the mechanism of this adverse event. The patient was discharged from ICU after two days and initially exhibited a good response to DLBCL treatment. Unfortunately, he died fifty days after starting CAR-T cell therapy due to a new DLBCL relapse.ConclusionPatients with a pericardial localization of DLBCL should be assessed for a risk of cardiac tamponade if receiving CAR-T cell therapy and presenting CRS. In this case, cardiac tamponade seems directly related to CAR-T cell expansion. Pericardiocentesis should be considered as a feasible and effective treatment if the risk of bleeding is well controlled, in association with anti-IL6 and corticosteroids.
Published: 2023
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7. Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial

Author: Maeva Rodriguez, Stéphanie Ragot, Rémi Coudroy, Jean-Pierre Quenot, Philippe Vignon, Jean-Marie Forel, Alexandre Demoule, Jean-Paul Mira, Jean-Damien Ricard, Saad Nseir, Gwenhael Colin, Bertrand Pons, Pierre-Eric Danin, Jérome Devaquet, Gwenael Prat, Hamid Merdji, Franck Petitpas, Emmanuel Vivier, Armand Mekontso-Dessap, Mai-Anh Nay, Pierre Asfar, Jean Dellamonica, Laurent Argaud, Stephan Ehrmann, Muriel Fartoukh, Christophe Girault, René Robert, Arnaud W. Thille, Jean-Pierre Frat, and REVA Network
Subjects: Preoxygenation, Intubation, Non-invasive ventilation, High-flow oxygen, Respiratory failure, Obesity, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. Methods Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m−2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 5 points and respiratory primary failure as reason for admission. Conclusions Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ventilation may not reduce this risk compared with high-flow nasal oxygen. Trial registration Clinical trial number: NCT02668458 ( http://www.clinicaltrials.gov )
Published: 2021
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8. Non-invasive ventilation versus high-flow nasal oxygen for postextubation respiratory failure in ICU: a post-hoc analysis of a randomized clinical trial

Author: Arnaud W. Thille, Grégoire Monseau, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Maxens Decavèle, Romain Sonneville, François Beloncle, Christophe Girault, Laurence Dangers, Alexandre Lautrette, Quentin Levrat, Anahita Rouzé, Emmanuel Vivier, Jean-Baptiste Lascarrou, Jean-Damien Ricard, Keyvan Razazi, Guillaume Barberet, Christine Lebert, Stephan Ehrmann, Alexandre Massri, Jeremy Bourenne, Gael Pradel, Pierre Bailly, Nicolas Terzi, Jean Dellamonica, Guillaume Lacave, René Robert, Stéphanie Ragot, Jean-Pierre Frat, and for the HIGH-WEAN Study Group and the REVA research network
Subjects: Airway extubation, Ventilator weaning, Acute respiratory failure, Noninvasive ventilation, High-flow nasal oxygen, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background In intensive care units (ICUs), patients experiencing post-extubation respiratory failure have poor outcomes. The use of noninvasive ventilation (NIV) to treat post-extubation respiratory failure may increase the risk of death. This study aims at comparing mortality between patients treated with NIV alternating with high-flow nasal oxygen or high-flow nasal oxygen alone. Methods Post-hoc analysis of a multicenter, randomized, controlled trial focusing on patients who experienced post-extubation respiratory failure within the 7 days following extubation. Patients were classified in the NIV group or the high-flow nasal oxygen group according to oxygenation strategy used after the onset of post-extubation respiratory failure. Patients reintubated within the first hour after extubation and those promptly reintubated without prior treatment were excluded. The primary outcome was mortality at day 28 after the onset of post-extubation respiratory failure. Results Among 651 extubated patients, 158 (25%) experienced respiratory failure and 146 were included in the analysis. Mortality at day 28 was 18% (15/84) using NIV alternating with high-flow nasal oxygen and 29% (18/62) with high flow nasal oxygen alone (difference, − 11% [95% CI, − 25 to 2]; p = 0.12). Among the 46 patients with hypercapnia at the onset of respiratory failure, mortality at day 28 was 3% (1/33) with NIV and 31% (4/13) with high-flow nasal oxygen alone (difference, − 28% [95% CI, − 54 to − 6]; p = 0.006). The proportion of patients reintubated 48 h after the onset of post-extubation respiratory failure was 44% (37/84) with NIV and 52% (32/62) with high-flow nasal oxygen alone (p = 0.21). Conclusions In patients with post-extubation respiratory failure, NIV alternating with high-flow nasal oxygen might not increase the risk of death. Trial registration number The trial was registered at http://www.clinicaltrials.gov with the registration number NCT03121482 the 20th April 2017.
Published: 2021
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9. Non-invasive ventilation alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation in COPD patients: a post hoc analysis of a randomized controlled trial

Author: Arnaud W. Thille, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Maxens Decavèle, Romain Sonneville, François Beloncle, Christophe Girault, Laurence Dangers, Alexandre Lautrette, Quentin Levrat, Anahita Rouzé, Emmanuel Vivier, Jean-Baptiste Lascarrou, Jean-Damien Ricard, Keyvan Razazi, Guillaume Barberet, Christine Lebert, Stephan Ehrmann, Alexandre Massri, Jeremy Bourenne, Gael Pradel, Pierre Bailly, Nicolas Terzi, Jean Dellamonica, Guillaume Lacave, René Robert, Stéphanie Ragot, Jean-Pierre Frat, and for the HIGH-WEAN Study Group, for the REVA Research Network
Subjects: Airway extubation, Weaning, Non-invasive ventilation, High-flow nasal oxygen, Chronic obstructive pulmonary disease, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD). We hypothesized that prophylactic NIV after extubation may decrease the risk of reintubation in COPD patients as compared with high-flow nasal oxygen. We performed a post hoc subgroup analysis of COPD patients included in a multicenter, randomized, controlled trial comparing prophylactic use of NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone immediately after extubation. Results Among the 651 patients included in the original study, 150 (23%) had underlying COPD including 86 patients treated with NIV alternating with high-flow nasal oxygen and 64 patients treated with high-flow nasal oxygen alone. The reintubation rate was 13% (11 out of 86 patients) with NIV and 27% (17 out of 64 patients) with high-flow nasal oxygen alone [difference, − 14% (95% CI − 27% to − 1%); p = 0.03]. Whereas reintubation rates were significantly lower with NIV than with high-flow nasal oxygen alone at 72 h and until ICU discharge, mortality in ICU did not differ between groups: 6% (5/86) with NIV vs. 9% (6/64) with high-flow nasal oxygen alone [difference − 4% (95% CI − 14% to 5%); p = 0.40]. Conclusions In COPD patients, prophylactic NIV alternating with high-flow nasal oxygen significantly decreased the risk of reintubation compared with high-flow nasal oxygen alone. Trial registration The study was registered at http://www.clinicaltrials.gov with the trial registration number NCT03121482 (20 April 2017)
Published: 2021
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10. High-flow nasal cannula oxygen therapy: P-SILI or not P-SILI?

Author: Elise Artaud-Macari and Christophe Girault
Subjects: Medicine
Published: 2022
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11. Is COPD associated with increased risk for microaspiration in intubated critically ill patients?

Author: Thècle Degroote, Emmanuelle Jaillette, Jean Reignier, Farid Zerimech, Christophe Girault, Guillaume Brunin, Arnaud Chiche, Jean-Claude Lacherade, Jean-Paul MIRA, Patrice Maboudou, Malika Balduyck, Saad Nseir, and for the MicroCOPD study group
Subjects: COPD, Intubation, Mechanical ventilation, Microaspiration, Pneumonia, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Although COPD patients are at higher risk for aspiration when breathing spontaneously, no information is available on the risk for microaspiration in invasively ventilated COPD patients. The aim of our study was to determine the relationship between COPD and abundant microaspiration in intubated critically ill patients. Methods This was a retrospective analysis of prospectively collected data, provided by 3 randomized controlled trials on microaspiration in critically ill patients receiving invasive mechanical ventilation for more than 48 h. Abundant microaspiration was defined as the presence of pepsin and or alpha-amylase at significant levels in tracheal aspirates. In all study patients, pepsin and alpha-amylase were quantitatively measured in all tracheal aspirates collected during a 48-h period. COPD was defined using spirometry criteria. Results Among the 515 included patients, 70 (14%) had proven COPD. Pepsin and alpha-amylase were quantitatively measured in 3873 and 3764 tracheal aspirates, respectively. No significant difference was found in abundant microaspiration rate between COPD and non-COPD patients (62 of 70 patients (89%) vs 366 of 445 (82%) patients, p = 0.25). Similarly, no significant difference was found in abundant microaspiration of gastric contents (53% vs 45%, p = 0.28), oropharyngeal secretions (71% vs 71%, p = 0.99), or VAP (19% vs 22%, p = 0.65) rates between the two groups. No significant difference was found between COPD and non-COPD patients in duration of mechanical ventilation, ICU length of stay, or ICU mortality. Conclusions Our results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically ill patients.
Published: 2021
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12. Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure

Author: Virginie Lemiale, Guillaume Dumas, Alexandre Demoule, Frederic Pène, Achille Kouatchet, Magali Bisbal, Saad Nseir, Laurent Argaud, Loay Kontar, Kada Klouche, Francois Barbier, Amelie Seguin, Guillaume Louis, Jean-Michel Constantin, Julien Mayaux, Florent Wallet, Vincent Peigne, Christophe Girault, Johanna Oziel, Martine Nyunga, Nicolas Terzi, Lila Bouadma, Alexandre Lautrette, Naike Bige, Jean-Herle Raphalen, Laurent Papazian, Fabrice Bruneel, Christine Lebert, Dominique Benoit, Anne-Pascale Meert, Samir Jaber, Djamel Mokart, Michael Darmon, Elie Azoulay, and The Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH)
Subjects: High-flow nasal oxygen, Immunocompromised, Acute respiratory failure, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. Results In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1–3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69–7.01) vs. 6.10 (4.48–8.68), p
Published: 2021
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13. High-flow oxygen therapy versus noninvasive ventilation: a randomised physiological crossover study of alveolar recruitment in acute respiratory failure

Author: Elise Artaud-Macari, Michael Bubenheim, Gurvan Le Bouar, Dorothée Carpentier, Steven Grangé, Déborah Boyer, Gaëtan Béduneau, Benoit Misset, Antoine Cuvelier, Fabienne Tamion, and Christophe Girault
Subjects: Medicine
Abstract: High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxaemic acute respiratory failure (ARF) patients, while the value of noninvasive ventilation (NIV) remains debated. The primary end-point was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary end-points compared regional EELI, lung volumes (global and regional tidal volume variation (VT)), respiratory parameters, haemodynamic tolerance, dyspnoea and patient comfort between HFNC and NIV, relative to face mask (FM). A prospective randomised crossover physiological study was conducted in patients with hypoxaemic ARF due to pneumonia. They received alternately HFNC, NIV and FM. 16 patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95% CI 857–2646) and 826 (95% CI 399.5–2361), respectively. Global and regional VT increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher pulse oxygen saturation/inspired oxygen fraction ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnoea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1), but was lower with NIV (p=0.001). This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF. In contrast with HFNC, NIV increased lung volumes, which may contribute to overdistension and its potentially deleterious effect in these patients.
Published: 2021
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14. Center effect in intubation risk in critically ill immunocompromised patients with acute hypoxemic respiratory failure

Author: Guillaume Dumas, Alexandre Demoule, Djamel Mokart, Virginie Lemiale, Saad Nseir, Laurent Argaud, Frédéric Pène, Loay Kontar, Fabrice Bruneel, Kada Klouche, François Barbier, Jean Reignier, Annabelle Stoclin, Guillaume Louis, Jean-Michel Constantin, Florent Wallet, Achille Kouatchet, Vincent Peigne, Pierre Perez, Christophe Girault, Samir Jaber, Yves Cohen, Martine Nyunga, Nicolas Terzi, Lila Bouadma, Christine Lebert, Alexandre Lautrette, Naike Bigé, Jean-Herlé Raphalen, Laurent Papazian, Dominique Benoit, Michael Darmon, Sylvie Chevret, and Elie Azoulay
Subjects: Center effect, Intubation, Neutropenia, Leukemia, Hypoxemia, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Acute respiratory failure is the leading reason for intensive care unit (ICU) admission in immunocompromised patients, and the need for invasive mechanical ventilation has become a major clinical endpoint in randomized controlled trials (RCTs). However, data are lacking on whether intubation is an objective criteria that is used unbiasedly across centers. This study explores how this outcome varies across ICUs. Methods Hierarchical models and permutation procedures for testing multiple random effects were applied on both data from an observational cohort (the TRIAL-OH study: 703 patients, 17 ICUs) and a randomized controlled trial (the HIGH trial: 776 patients, 31 ICUs) to characterize ICU variation in intubation risk across centers. Results The crude intubation rate varied across ICUs from 29 to 80% in the observational cohort and from 0 to 86% in the RCT. This center effect on the mean ICU intubation rate was statistically significant, even after adjustment on individual patient characteristics (observational cohort: p value = 0.013, median OR 1.48 [1.30–1.72]; RCT: p value 0.004, median OR 1.51 [1.36–1.68]). Two ICU-level characteristics were associated with intubation risk (the annual rate of intubation procedure per center and the time from respiratory symptoms to ICU admission) and could partly explain this center effect. In the RCT that controlled for the use of high-flow oxygen therapy, we did not find significant variation in the effect of oxygenation strategy on intubation risk across centers, despite a significant variation in the need for invasive mechanical ventilation. Conclusion Intubation rates varied considerably among ICUs, even after adjustment on individual characteristics.
Published: 2019
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15. High-flow nasal cannula therapy: clinical practice in intensive care units

Author: Emmanuel Besnier, Sinad Hobeika, Saad NSeir, Fabien Lambiotte, Damien Du Cheyron, Bertrand Sauneuf, Benoit Misset, Fabienne Tamion, Guillaume Schnell, Jack Richecoeur, Julien Maizel, Christophe Girault, and for the BoReal study group
Subjects: Oxygen therapy, High-flow nasal cannula, Acute respiratory failure, Intensive care unit, Clinical practices, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Despite the extensive use of high-flow nasal cannula (HFNC) therapy in intensive care units (ICU) for acute respiratory failure (ARF), its daily clinical practice has not been assessed. We designed a regional survey in ICUs in North-west France to evaluate ICU physicians’ clinical practice with HFNC. Materials and methods We sent an observational survey to ICU physicians from 34 French ICUs over a 6-month period in 2016–2017. The survey included questions regarding the indications and expected efficiency of HFNC, practical aspects of use (initiation, weaning) and satisfaction. Comparisons between junior and senior ICU physicians were performed using a Fischer exact test. Results Among the 235 ICU physicians contacted, 137 responded (58.3%) all of whom regularly used HFNC. Hypoxemic ARF was considered a good indication for HFNC by all 137, but only 30% expected HFNC success (i.e., avoiding intubation in at least 60% of cases). Among hypoxemic indications, 30% of juniors considered acute pulmonary edema a good indication versus 74% of seniors (p
Published: 2019
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16. Influenza and associated co-infections in critically ill immunosuppressed patients

Author: Ignacio Martin-Loeches, Virginie Lemiale, Pierce Geoghegan, Mary Aisling McMahon, Peter Pickkers, Marcio Soares, Anders Perner, Tine Sylvest Meyhoff, Ramin Brandt Bukan, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Fabio Silvio Taccone, Jorge Salluh, Pleun Hemelaar, Peter Schellongowski, Katerina Rusinova, Nicolas Terzi, Sangeeta Mehta, Massimo Antonelli, Achille Kouatchet, Pål Klepstad, Miia Valkonen, Precious Pearl Landburg, Andreas Barratt-Due, Fabrice Bruneel, Frédéric Pène, Victoria Metaxa, Anne Sophie Moreau, Virginie Souppart, Gaston Burghi, Christophe Girault, Ulysses V. A. Silva, Luca Montini, Francois Barbier, Lene B. Nielsen, Benjamin Gaborit, Djamel Mokart, Sylvie Chevret, Elie Azoulay, and For the Efraim investigators and the Nine-I study group
Subjects: Influenza, Respiratory failure, Sepsis, Critical illness, Immunosuppression, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P
Published: 2019
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17. Experts’ guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF)

Author: Hervé Quintard, Erwan l’Her, Julien Pottecher, Frédéric Adnet, Jean-Michel Constantin, Audrey De Jong, Pierre Diemunsch, Rose Fesseau, Anne Freynet, Christophe Girault, Christophe Guitton, Yann Hamonic, Eric Maury, Armand Mekontso-Dessap, Fabrice Michel, Paul Nolent, Sébastien Perbet, Gwenael Prat, Antoine Roquilly, Karim Tazarourte, Nicolas Terzi, Arnaud W. Thille, Mikael Alves, Etienne Gayat, and Laurence Donetti
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Intubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20–50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure. Results and conclusion In constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithms.
Published: 2019
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18. High-flow nasal oxygen vs. standard oxygen therapy in immunocompromised patients with acute respiratory failure: study protocol for a randomized controlled trial

Author: Elie Azoulay, Virginie Lemiale, Djamel Mokart, Saad Nseir, Laurent Argaud, Frédéric Pène, Loay Kontar, Fabrice Bruneel, Kada Klouche, François Barbier, Jean Reignier, Anabelle Stoclin, Guillaume Louis, Jean-Michel Constantin, Julien Mayaux, Florent Wallet, Achille Kouatchet, Vincent Peigne, Pierre Perez, Christophe Girault, Samir Jaber, Johanna Oziel, Martine Nyunga, Nicolas Terzi, Lila Bouadma, Christine Lebert, Alexandre Lautrette, Naike Bigé, Jean-Herlé Raphalen, Laurent Papazian, Antoine Rabbat, Michael Darmon, Sylvie Chevret, and Alexandre Demoule
Subjects: Acute respiratory failure, Immunosuppression, Immunocompromised Hematology, Mortality, High-flow oxygen, Oxygen, Medicine (General), R5-920
Abstract: Abstract Background Acute respiratory failure (ARF) is the leading reason for intensive care unit (ICU) admission in immunocompromised patients. High-flow nasal oxygen (HFNO) therapy is an alternative to standard oxygen. By providing warmed and humidified gas, HFNO allows the delivery of higher flow rates via nasal cannula devices, with FiO2 values of nearly 100%. Benefits include alleviation of dyspnea and discomfort, decreased respiratory distress and decreased mortality in unselected patients with acute hypoxemic respiratory failure. However, in preliminary reports, HFNO benefits are controversial in immunocompromised patients in whom it has never been properly evaluated. Methods/design This is a multicenter, open-label, randomized controlled superiority trial in 30 intensive care units, part of the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique (GRRR-OH). Inclusion criteria will be: (1) adults, (2) known immunosuppression, (3) ARF, (4) oxygen therapy ≥ 6 L/min, (5) written informed consent from patient or proxy. Exclusion criteria will be: (1) imminent death (moribund patient), (2) no informed consent, (3) hypercapnia (PaCO2 ≥ 50 mmHg), (4) isolated cardiogenic pulmonary edema, (5) pregnancy or breastfeeding, (6) anatomical factors precluding insertion of a nasal cannula, (7) no coverage by the French statutory healthcare insurance system, and (8) post-surgical setting from day 1 to day 6 (patients with ARF occurring after day 6 of surgery can be included). The primary outcome measure is day-28 mortality. Secondary outcomes are intubation rate, comfort, dyspnea, respiratory rate, oxygenation, ICU length of stay, and ICU-acquired infections. Based on an expected 30% mortality rate in the standard oxygen group, and 20% in the HFNO group, error rate set at 5%, and a statistical power at 90%, 389 patients are required in each treatment group (778 patients overall). Recruitment period is estimated at 30 months, with 28 days of additional follow-up for the last included patient. Discussion The HIGH study will be the largest multicenter, randomized controlled trial seeking to demonstrate that survival benefits from HFNO reported in unselected patients also apply to a large immunocompromised population. Trial registration ClinicalTrials.gov, ID: NCT02739451. Registered on 15 April 2016.
Published: 2018
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19. Correction to: Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure

Author: Virginie Lemiale, Guillaume Dumas, Alexandre Demoule, Frederic Pène, Achille Kouatchet, Magali Bisbal, Saad Nseir, Laurent Argaud, Loay Kontar, Kada Klouche, Francois Barbier, Amelie Seguin, Guillaume Louis, Jean-Michel Constantin, Julien Mayaux, Florent Wallet, Vincent Peigne, Christophe Girault, Johanna Oziel, Martine Nyunga, Nicolas Terzi, Lila Bouadma, Alexandre Lautrette, Naike Bige, Jean-Herle Raphalen, Laurent Papazian, Fabrice Bruneel, Christine Lebert, Dominique Benoit, Anne-Pascale Meert, Samir Jaber, Djamel Mokart, Michael Darmon, Elie Azoulay, and The Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH)
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2021
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20. Severe varicella-zoster virus pneumonia: a multicenter cohort study

Author: Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, Guillaume Géri, Pascal Blanc, Christophe Guitton, Claude Guérin, Naïke Bigé, Antoine Rabbat, Aurélie Lefebvre, Keyvan Razazi, Muriel Fartoukh, Eric Mariotte, Lila Bouadma, Jean-Damien Ricard, Amélie Seguin, Bertrand Souweine, Anne-Sophie Moreau, Stanislas Faguer, Arnaud Mari, Julien Mayaux, Francis Schneider, Annabelle Stoclin, Pierre Perez, Julien Maizel, Charles Lafon, Frédérique Ganster, Laurent Argaud, Christophe Girault, François Barbier, Lucien Lecuyer, Jérôme Lambert, and Emmanuel Canet
Subjects: Varicella-Zoster virus, Pneumonia, Steroids, Mechanical ventilation, Intensive care unit, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Pneumonia is a dreaded complication of varicella-zoster virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired pneumonia (VZV-CAP). Methods This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. Results One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32–51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1–3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1–2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) = 150 (80–284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33–2.70); p
Published: 2017
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21. High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol

Author: Rémi Coudroy, Jean-Pierre Frat, Stephan Ehrmann, Frédéric Pène, Nicolas Terzi, Maxens Decavèle, Gwenaël Prat, Charlotte Garret, Damien Contou, Jeremy Bourenne, Arnaud Gacouin, Christophe Girault, Jean Dellamonica, Dominique Malacrino, Guylaine Labro, Jean-Pierre Quenot, Alexandre Herbland, Sébastien Jochmans, Jérôme Devaquet, Dalila Benzekri, Emmanuel Vivier, Saad Nseir, Gwenhaël Colin, Didier Thévenin, Giacomo Grasselli, Mona Assefi, Claude Guerin, David Bougon, Thierry Lherm, Achille Kouatchet, Stéphanie Ragot, and Arnaud W Thille
Subjects: Medicine
Abstract: Introduction Non-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure.Methods and analysis This study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180.Ethics and dissemination The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration number NCT02978300
Published: 2019
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22. Skeletal muscle mass and adipose tissue alteration in critically ill patients.

Author: Marie Mélody Dusseaux, Sami Antoun, Sébastien Grigioni, Gaétan Béduneau, Dorothée Carpentier, Christophe Girault, Steven Grange, and Fabienne Tamion
Subjects: Medicine, Science
Abstract: BackgroundIncreasing numbers of studies in chronic diseases have been published showing the relationship between body composition (BC) parameters (i.e. skeletal muscle mass (SMM) and adipose tissue (AT)) and outcomes. For patients admitted to intensive care unit (ICU), BC parameters have rarely been described as a prognostic marker of outcome. The primary objective was to evaluate the relationship between body composition at ICU admission and major clinical outcomes. Secondary objectives were to assess the relationship between BC parameters and other parameters (systemic inflammatory markers, Sequential Organ Failure Assessment (SOFA) score, albumin level) at ICU admission, and between BC alterations during ICU stay and outcomes.Patients and methodsThis retrospective study enrolled 25 adult patients who had two abdominal CT scans for clinical indication: first, within 48 hours of ICU admission (initial assessment), and second, 7 to 14 days later (late assessment). Skeletal Muscle radiodensity (SMD), cross-sectional area of SMM, Visceral Adipose Tissue (VAT) and Subcutaneous Adipose Tissue (SAT) were measured at the third lumbar vertebra. Cox regression analysis was used to determine the association between these parameters and mortality.ResultsPatients' mean age was 64.6 years. Their mean BMI was 27.7 kg/m2 (SD = 6.0). ICU mortality was 36%. There was no correlation between BC parameters at initial assessment and ICU outcomes. We observed a negative correlation between SMM index and SOFA score at initial assessment (r = -0.458, p = 0.037). There was a significant loss of VAT between two CT assessments which was associated with mortality (-22.34cm2 / m2 in non-survivors versus -6.22 cm2 / m2 in survivors, p = 0.039). Loss of SMD was greater with the occurrence of an infection than without (Delta SMD = -5.642 vs +1.957, p = 0.04).ConclusionsOur results show alterations in body composition during ICU stay with a loss of muscle quality (decreased SMD) and adipose tissue. These findings require confirmation in future studies but already show that BC assessments at ICU admission and BC alterations during ICU stay are important factors for outcome in critically ill patients.
Published: 2019
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23. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review

Author: Antonio M. Esquinas, S. Egbert Pravinkumar, Raffaele Scala, Peter Gay, Arie Soroksky, Christophe Girault, Fang Han, David S. Hui, Peter J. Papadakos, Nicolino Ambrosino, and International NIV Network
Subjects: Diseases of the respiratory system, RC705-779
Abstract: The aim of this article was to review the role of noninvasive ventilation (NIV) in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS), H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on ‘‘clinical trials’’ and ‘‘randomised controlled trials’’. The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1), SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers.
Published: 2014
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24. The accuracy of intensive care nurses' interpretation of chest radiographs to recognise misplacement of endotracheal and nasogastric tubes after a single training session and comparison with residents' interpretation

Author: Toufik Kamel, Brice Sauvage, Karim Lakhal, Grégoire Ottavy, Ralf Janssen-Langenstein, Marine Jacquier, Charlotte Larrat, Gwenaëlle Jacq, Jérôme E. Dauvergne, Diane Maugars, Marie Labruyere, Véronique Simeon, Cécile Cugnart, Christophe Girault, and Thierry Boulain
Subjects: Emergency Nursing, Critical Care Nursing
Published: 2023
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25. Hypercapnie et insuffisance respiratoire aiguë en réanimation

Author: Déborah Boyer and Christophe Girault
Subjects: Emergency Medicine, Emergency Nursing
Abstract: L’hypercapnie est fréquemment rencontrée en réanimation et elle peut être la cause de l’admission en réanimation ou une complication de celle-ci. L’hypercapnie et l’acidose hypercapnique peuvent avoir des répercussions sur les systèmes cardio-vasculaire, respiratoire, nerveux central, immunitaire et l’inflammation. Le syndrome de détresse respiratoire aigu (SDRA) et l’insuffisance respiratoire aiguë hypercapnique (IRAH) sont les deux principales situations d’hypercapnie rencontrées en réanimation. L’hypercapnie dans le SDRA est le plus souvent une conséquence de la ventilation protectrice. Sa prise en charge passe en premier lieu par une optimisation des réglages de la ventilation mécanique invasive et le recours au décubitus ventral. En cas d’échec, le recours aux techniques d’assistance circulatoire extra corporelle (« extracorporeal membrane oxygenation » veino-veineuse : ECMO-VV, « extracorporeal carbon dioxide removal » : ECCO2R) peut être envisagé selon certaines conditions et nécessite encore des études complémentaires pour analyser au mieux le rapport bénéfice-risque. Au cours de l’IRAH, la ventilation non invasive (VNI) reste le traitement de référence. Il existe cependant un rationnel physiologique fort pour proposer l’utilisation de l’oxygénothérapie à haut débit (OHD) dans cette indication, seule ou en association à la VNI, d’après les premières données cliniques, mais les résultats des études prospectives randomisées restent en attente.L’ECCO2R pourrait aussi constituer une technique adjuvante intéressante dans la prise en charge de l’IRAH en prévention de l’intubation en cas d’échec de la VNI ou pour favoriser le sevrage/extubation de la ventilation mécanique chez ces patients. Le réel bénéfice et la sécurité de l’ECCO2R dans ces indications restent cependant encore à démontrer.
Published: 2022
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26. Theophylline adenosine dipyridamole (CTAD) and citrate evaluation to survey unfractionated heparin treatment: a delayed centrifugation validation for anti-Xa measurement?

Author: Véronique Le Cam Duchez, Arnaud Guilbert, Thomas Clavier, Paul Billoir, Marielle Fresel, Caroline Abriou, Virginie Barbay, Christophe Girault, and Marie Hélène Chrétien
Subjects: Adenosine, Time Factors, medicine.drug_class, Thrombin Time, Centrifugation, Chemical Fractionation, Pharmacology, Thrombin time, Citric Acid, Theophylline, medicine, Humans, Blood Specimen Collection, medicine.diagnostic_test, Heparin, Chemistry, Anticoagulant, Anticoagulants, Dipyridamole, General Medicine, Blood Preservation, Factor Xa, Partial Thromboplastin Time, Blood Coagulation Tests, Drug Monitoring, Platelet factor 4, Factor Xa Inhibitors, circulatory and respiratory physiology, medicine.drug
Abstract: Unfractionated heparin (UFH) is the main anticoagulante used in intensive care unit. The anticoagulant effect is monitored by activated partial thrombin time (aPTT) and anti-Xa activity (anti-Xa) measurement. However, delayed centrifugation induces platelet factor 4 (PF4) release and anti-Xa decrease. Several studies have concluded that aPTT and anti-Xa measurement should be performed within 2 hours in citrated anticoagulant but may be delayed longer in citrate theophylline adenosine and dypiridamol (CTAD) anticoagulant. The objective of this study was to compare the stability of both aPTT and anti-Xa in citrate and CTAD samples, and to determine the effect of delayed centrifugation on both aPTT, anti-Xa results, and PF4 release in citrate samples only. Methods aPTT and anti-Xa were measured in citrate and CTAD anticoagulant samples from 93 patients. Delayed centrifugation was performed in citrate samples from 31 additional patients, with hourly aPTT and anti-Xa measurement from 1 to 6 hours. In 14 of these last patients, PF4 release was also evaluated with Human CXCL4/PF4 Quantikine ELISA Kit. Results We observed a significant correlation between citrate and CTAD anticoagulant for aPTT (r2=0.94) and anti-Xa (r2=0.95). With Bland-Altman correlation, a minor bias was observed for anti-Xa (-0.025±0.041). Delayed centrifugation in citrated anticoagulant showed an excellent concordance from 1 to 4 hours for aPTT (-4.0±5.3 s) and anti-Xa (1.10-9±0.058 UI/mL) measurements. Moreover, PF4 release was not different between 1 hour (31.5±14.7 ng/mL) and 4 hours (33.8±11.8 ng/mL). Conclusion We have demonstrated that anti-Xa measurement for unfractionated heparin should be done 4 hours in citrated plasma and that CTAD was not better than citrate. However, these initial findings require confirmation using other aPTT and calibrated anti-Xa assays.
Published: 2020
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27. 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: Rémi Coudroy, Jean-Pierre Frat, Stephan Ehrmann, Frédéric Pène, Maxens Decavèle, Nicolas Terzi, Gwenaël Prat, Charlotte Garret, Damien Contou, Arnaud Gacouin, Jeremy Bourenne, Christophe Girault, Christophe Vinsonneau, Jean Dellamonica, Guylaine Labro, Sébastien Jochmans, Alexandre Herbland, Jean-Pierre Quenot, Jérôme Devaquet, Dalila Benzekri, Emmanuel Vivier, Saad Nseir, Gwenhaël Colin, Didier Thevenin, Giacomo Grasselli, David Bougon, Mona Assefi, Claude Guérin, Thierry Lherm, Achille Kouatchet, Stephanie Ragot, Arnaud W Thille, Chatellier Delphine, Veinstein Anne, Boissier Florence, Reynaud Faustine, Rodriguez Maeva, Joly Florent, Arrivé François, De Roubin Victor, Robert René, Bodet-Contentin Laetitia, Salmon Gandonnière Charlotte, Mercier Emmanuelle, Jaubert Paul, Marin Nathalie, Paul Marine, Faure Morgane, Demiri Suela, Demoule Alexandre, Candille Clara, Dartevel Anaïs, Sigaud Florian, Jean Michel Vanessa, Le Mao Raphaël, Bailly Pierre, Seguin Amélie, Lascarrou Jean-Baptiste, Canet Emmanuel, Plantefève Gaëtan, Cally Radj, Tirolien Joanna, Maamar Adel, Painvin Benoit, Carvelli Julien, Gainnier Marc, Béduneau Gaëtan, Carpentier Dorothée, Malacrino Dominique, Marzouk Mehdi, Saccheri Clément, Mahr Nicolas, Soulier Pauline, Levrat Quentin, Andreu Pascal, Cortier David, and Nay Mai Anh
Subjects: Pulmonary and Respiratory Medicine, Adult, Oxygen, Immunocompromised Host, Respiratory Distress Syndrome, Noninvasive Ventilation, Critical Illness, Oxygen Inhalation Therapy, Settore MED/41 - Anestesiologia, Humans, Respiratory Insufficiency
Abstract: Although non-invasive ventilation (NIV) is recommended for immunocompromised patients with acute respiratory failure in the intensive care unit (ICU), it might have deleterious effects in the most severe patients. High-flow nasal oxygen (HFNO) alone might be an alternative method to reduce mortality. We aimed to determine whether HFNO alone could reduce the rate of mortality at day 28 compared with HFNO alternated with NIV.FLORALI-IM is a multicentre, open-label, randomised clinical trial conducted in 29 ICUs (28 in France and one in Italy). Adult immunocompromised patients with acute respiratory failure, defined as respiratory rate of 25 breaths per min or more and a partial pressure of arterial oxygen to inspired fraction of oxygen ratio of 300 mm Hg or lower, were randomly assigned (1:1) to HFNO alone (HFNO alone group) or NIV alternating with HFNO (NIV group). Key exclusion criteria were severe hypercapnia above 50 mm Hg, patients who could strongly benefit from NIV (ie, those with underlying chronic lung disease, with cardiogenic pulmonary oedema, or who were postoperative), severe shock, impaired consciousness defined as Glasgow coma score ≤12, urgent need for intubation, do not intubate order, and contraindication to NIV. Patients were assigned using computer-generated permuted blocks and were stratified according to centre and to the type of immunosuppression using a centralised web-based management system. In the HFNO alone group, patients were continuously treated by HFNO with a gas flow rate of 60 L/min or the highest tolerated. In the NIV group, patients were treated with NIV with a first session of at least 4 h, and then by sessions for a minimal duration of 12 h a day, with a dedicated ventilator, targeting a tidal volume below 8 mL/kg of predicted bodyweight, and with a positive end-expiratory level of at least 8 cm HBetween Jan 21, 2017 to March 4, 2019, of 497 eligible patients, 300 were randomly assigned but one patient withdrew consent, leaving 299 patients included in the intention-to-treat analysis (154 assigned to the HFNO alone group and 145 assigned to NIV group). Mortality rate at day 28 was 36% (95% CI 29·2 to 44·2; 56 of 154 patients) in the HFNO alone group and 35% (27·9 to 43·2; 51 of 145 patients) in the NIV group (absolute difference 1·2% [95% CI -9·6 to 11·9]; p=0·83). None of the other prespecified secondary outcomes were different between groups except for greater decreased discomfort after initiation of HFNO than with NIV (-4 mm on visual analogic scale [IQR -18 to 4] vs 0 mm [-16 to 17]; p=0·040).In critically ill immunocompromised patients with acute respiratory failure, the mortality rate did not differ between HFNO alone and NIV alternating with HFNO. However, study power was limited, so results should be interpreted with caution.French Ministry of Health.
Published: 2021

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

Author: Arnaud W. Thille, Rémi Coudroy, Mai-Anh Nay, Arnaud Gacouin, Maxens Decavèle, Romain Sonneville, François Beloncle, Christophe Girault, Laurence Dangers, Alexandre Lautrette, Quentin Levrat, Anahita Rouzé, Emmanuel Vivier, Jean-Baptiste Lascarrou, Jean-Damien Ricard, Armand Mekontso-Dessap, Guillaume Barberet, Christine Lebert, Stephan Ehrmann, Alexandre Massri, Jeremy Bourenne, Gael Pradel, Pierre Bailly, Nicolas Terzi, Jean Dellamonica, Guillaume Lacave, René Robert, Jean-Pierre Frat, Stéphanie Ragot, Florence Boissier, Delphine Chatellier, Céline Deletage, Carole Guignon, Florent Joly, Morgane Olivry, Anne Veinstein, Dalila Benzekri-Lefevre, Thierry Boulain, Grégoire Muller, Yves Le Tulzo, Jean-Marc Tadié, Adel Maamar, Suela Demiri, Julien Mayaux, Alexandre Demoule, Lila Bouadma, Claire Dupuis, Pierre Asfar, Marc Pierrot, Gaëtan Béduneau, Déborah Boyer, Benjamin Delmas, Bérénice Puech, Konstantinos Bachoumas, Edouard Soum, Séverin Cabasson, Marie-Anne Hoppe, Saad Nseir, Olivier Pouly, Gaël Bourdin, Sylvène Rosselli, Anthony Le Meur, Charlotte Garret, Maelle Martin, Guillaume Berquier, Abirami Thiagarajah, Guillaume Carteaux, Keyvan Razazi, Antoine Poidevin, Anne-Florence Dureau, Marie-Ange Azais, Gwenhaël Colin, Emmanuelle Mercier, Marlène Morisseau, Caroline Sabatier, Walter Picard, Marc Gainnier, Thi-My-Hue Nguyen, Gwenaël Prat, Carole Schwebel, Matthieu Buscot, Service de Médecine Intensive Réanimation [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Pulmonary and Respiratory Medicine, business.industry, Airway Extubation, Overweight, Critical Care and Intensive Care Medicine, Intensive care unit, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Randomized controlled trial, law, Intensive care, Anesthesia, Post-hoc analysis, Breathing, medicine, 030212 general & internal medicine, medicine.symptom, Underweight, business, ComputingMilieux_MISCELLANEOUS
Abstract: RATIONALE Whereas non-invasive ventilation (NIV) may prevent reintubation in patients at high-risk of extubation failure in intensive care units (ICUs), this oxygenation strategy has not been specifically assessed in obese patients. OBJECTIVES We hypothesized that NIV may decrease the risk of reintubation in obese patients compared with high-flow nasal oxygen (HFNO). METHODS Post-hoc analysis of a multicenter, randomized, controlled trial (not pre-specified) comparing NIV alternating with HFNO versus HFNO alone after extubation, with the aim of assessing NIV effects according to patient body-mass index (BMI). MEASUREMENTS AND MAIN RESULTS Among 623 patients at high-risk of extubation failure, 206 (33%) were obese (BMI≥30 kg/m2), 204 (33%) were overweight (25≤BMI
Published: 2021
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29. Reliability of methods to estimate the fraction of inspired oxygen in patients with acute respiratory failure breathing through non-rebreather reservoir bag oxygen mask

Author: Jean-Pierre Frat, Rémi Coudroy, Christophe Girault, and Arnaud W. Thille
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Rebreather, Partial Pressure, chemistry.chemical_element, Oxygen mask, Oxygen, Fraction of inspired oxygen, Internal medicine, Humans, Multicenter Studies as Topic, Medicine, In patient, Oximetry, Hypoxia, Reservoir bag, Aged, Randomized Controlled Trials as Topic, business.industry, Respiration, Masks, Oxygen Inhalation Therapy, Reproducibility of Results, Mathematical Concepts, Partial pressure, Middle Aged, chemistry, Acute Disease, Breathing, Cardiology, Female, Respiratory Insufficiency, business
Abstract: Severity of hypoxaemia can be assessed using the partial pressure of arterial oxygen to fraction of inspired oxygen ratio (FiO2). However, in patients breathing through non-rebreather reservoir bag oxygen mask, accuracy of bedside FiO2 estimation methods remains to be tested. In a post-hoc analysis of a multicentre clinical trial, three FiO2 estimation methods were compared with FiO2 measured with a portable oxygen analyser introduced in the oxygen mask. Among 262 patients analysed, mean (SD) measured FiO2 was 65% (13). The 3%-formula (21% + oxygen flow rate in L/min × 3) was the most accurate method to estimate FiO2. Other methods overestimated FiO2 and hypoxaemia severity, so they should be avoided.
Published: 2020
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30. Is citrate theophylline adenosine dipyridamole (CTAD) better than citrate to survey unfractionated heparin treatment? Has delayed centrifugation a real impact on this survey?

Author: Marie Hélène Chrétien, Paul Billoir, Virginie Barbay, Thomas Clavier, Véronique Le Cam Duchez, Arnaud Guilbert, Marielle Fresel, Christophe Girault, and Caroline Abriou
Subjects: Time Factors, Phosphodiesterase Inhibitors, medicine.drug_class, Centrifugation, 030204 cardiovascular system & hematology, Pharmacology, Thrombin time, 03 medical and health sciences, 0302 clinical medicine, Theophylline, Humans, Medicine, Citrates, 030212 general & internal medicine, medicine.diagnostic_test, Heparin, business.industry, Anticoagulant, Anticoagulants, Dipyridamole, Hematology, Adenosine, Blood Preservation, Blood Coagulation Tests, Drug Monitoring, Cardiology and Cardiovascular Medicine, business, Platelet factor 4, circulatory and respiratory physiology, medicine.drug
Abstract: Unfractionated heparin (UFH) is the main anticoagulant used in intensive care unit. The anticoagulant effect is monitored by activated partial thrombin time (aPTT) and anti-Xa activity (anti-Xa) measurement. However, delayed centrifugation induces platelet factor 4 (PF4) release and anti-Xa decrease. Several studies have concluded that aPTT and anti-Xa measurement should be performed within 2 h in citrated anticoagulant but may be delayed longer in Citrate Theophylline Adenosine and Dypiridamol (CTAD) anticoagulant. The objective of this study was to compare the stability of both aPTT and anti-Xa in citrate and CTAD samples, and to determine the effect of delayed centrifugation on both aPTT, anti-Xa results, and PF4 release in citrate samples only. aPTT and anti-Xa were measured in citrate and CTAD anticoagulant samples from 93 patients. Delayed centrifugation was performed in citrate samples from 31 additional patients, with hourly aPTT and anti-Xa measurement from 1 to 6 h. In 14 of these last patients, PF4 release was also evaluated with Human CXCL4/PF4 Quantikine ELISA Kit. We observed a significant correlation between citrate and CTAD anticoagulant for aPTT (r2 = 0.94) and anti-Xa (r2 = 0.95). With Bland–Altman correlation, a minor bias was observed for anti-Xa (− 0.025 ± 0.041). Delayed centrifugation in citrated anticoagulant showed an excellent concordance from 1 to 4 h for aPTT (− 4.0 ± 5.3 s) and anti-Xa (1.10−9 ± 0.058 UI/ml) measurements. Moreover, PF4 release was not different between 1 h (31.5 ± 14.7 ng/ml) and 4 h (33.8 ± 11.8 ng/ml). We have demonstrated that anti-Xa measurement for unfractionated heparin should be done 4 h in citrated plasma and that CTAD was not better than citrate. However, these initial findings require confirmation using other aPTT and calibrated anti-Xa assays.
Published: 2019
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31. Covid-19 severe hypoxemic pneumonia: a clinical experience using high-flow nasal oxygen therapy as first-line management

Author: Fabienne Tamion, Benoit Veber, Déborah Boyer, Steven Grangé, Christophe Girault, Pierre-Gildas Guitard, Dorothée Carpentier, Philippe Gouin, and Gaetan Beduneau
Subjects: Male, Pulmonary and Respiratory Medicine, high flow oxygen therapy, medicine.medical_treatment, mechanical ventilation, medicine.disease_cause, outcomes, Article, law.invention, SARS-COV-2 pneumonia, law, Fraction of inspired oxygen, Oxygen therapy, medicine, Humans, Simplified Acute Physiology Score, Retrospective Studies, Mechanical ventilation, hypoxemia, SARS-CoV-2, business.industry, COVID-19, Pneumonia, Middle Aged, Intensive care unit, Oxygen, SAPS II, Anesthesia, Median body, business, Nasal cannula
Abstract: Purpose To report a French experience in patients admitted to Intensive Care Unit (ICU) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring high fractional concentration of inspired oxygen supported by high flow nasal cannula (HFNC) as first-line therapy. Methods Retrospective cohort study conducted in two ICUs of a French university hospital. All consecutive patients admitted during 28-days after the first admission for SARS-CoV-2 pneumonia were screened. Demographic, clinical, respiratory support, specific therapeutics, ICU length-of-stay and survival data were collected. Results Data of 43 patients were analyzed: mainly men (72%), median age 61 (51–69) years, median body mass index of 28 (25–31) kg/m2, median simplified acute physiology score (SAPS II) of 29 (22–37) and median PaO2/fraction of inspired oxygen (FiO2) (P/F) ratio of 146 (100–189) mmHg. HFNC was initiated at ICU admission in 76% of patients. Median flow was 50 (45–50) L/min and median FiO2 was 0.6 (0.5–0.8). 79% of patients presented at least one comorbidity, mainly hypertension (58%). At day (D) 28, 32% of patients required invasive mechanical ventilation, 3 patients died in ICU. Risk factors for intubation were diabetes (10% vs. 43%, P = 0.04) and extensive lesions on chest computed tomography (CT) (P = 0.023). Patients with more than 25% of lesions on chest CT were more frequently intubated during ICU stay (P = 0.012). At ICU admission (D1), patients with higher SAPS II and Sequential Organ Failure Assessment (SOFA) scores (respectively 39 (28–50) vs. 27 (22–31), P = 0.0031 and 5 (2–8) vs. 2 (2–2.2), P = 0.0019), and a lower P/F ratio (98 (63–109) vs. 178 (126–206), P = 0.0005) were more frequently intubated. Among non-intubated patients, the median lowest P/F was 131 (85–180) mmHg. Four caregivers had to stop working following coronavirus 2 contamination, but did not require hospitalization. Conclusion Our clinical experience supports the use of HFNC as first line-therapy in patients with SARS-COV-2 pneumonia for whom face mask oxygen does not provide adequate respiratory support.
Published: 2021

32. Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

Author: Gaël Piton, Arnaud W. Thille, Damien Contou, Laura Federici, Bertrand Guidet, Jean Reignier, Julie Badin, Erwan I'her, Dalila Benzekri-Llefevre, Pascal Beuret, Riad Chelha, Suela Demiri, Christophe Vinsonneau, Michel Djibré, Juliette Masse, Nicolas Terzi, Francois Thouy, Juliette Audibert, Olivier Lesieur, Stephan Ehrmann, Hassene Rahmani, Alexandre Boyer, Saad Nseir, Denis Frasca, Christophe Girault, Jean-Pierre Frat, René Robert, Martial Thyrault, Jean-Pierre Quenot, Laurent Argaud, Christophe Guitton, Didier Thevenin, Nadia Aissaoui, Khaldoune Kuteifan, 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 hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier de Blois (CH Blois), CHU Rouen, Normandie Université (NU), Centre Hospitalier Le Mans (CH Le Mans), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Roanne (CH Roanne), CH de Roanne, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional d'Orléans (CHRO), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Strasbourg (UNISTRA), CHU Strasbourg, 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), Université de Lyon, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire de Traitement de l'Information Medicale (LaTIM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), 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), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, 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 Saint-Louis de La Rochelle (CH La Rochelle), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Lens, Centre Hospitalier Victor Dupouy, CHU Grenoble, Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Groupe Hospitalier Nord Essonne [Longjumeau], Centre Hospitalier de Béthune Beuvry (CH Béthune Beuvry), Hôpital Louis Pasteur [Chartres], Université catholique de Lille (UCL), Groupe hospitalier Pellegrin, CHU Saint-Antoine [AP-HP], Centre Hospitalier Privé Claude Galien - Ramsay Santé, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Blois (CHB), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique (IMT Atlantique), and CarMeN, laboratoire
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], law.invention, 03 medical and health sciences, 0302 clinical medicine, Quality of life, law, Informed consent, Oxygen therapy, medicine, Humans, respiratory medicine (see thoracic medicine), 030212 general & internal medicine, Prospective Studies, Prospective cohort study, adult intensive & critical care, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, Intensive Care, General Medicine, Intensive care unit, 3. Good health, [SDV] Life Sciences [q-bio], Oxygen, Intensive Care Units, 030228 respiratory system, medical ethics, Propensity score matching, Emergency medicine, Quality of Life, Observational study, business, Respiratory Insufficiency, Cohort study
Abstract: IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631
Published: 2021
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33. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

Author: Alexandre Demoule, Massimo Antonelli, Peter Schellongowski, Peter Pickkers, Marcio Soares, Tine Meyhoff, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Virgine Lemiale, David Grimaldi, Ignacio Martin-Loeches, Martin Balik, Sangeeta Mehta, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Jean Reignier, Victoria Metaxa, Anne-Sophie Moreau, Gaston Burghi, Djamel Mokart, Julien Mayaux, Michael Darmon, Elie Azoulay, Karin Amrein, Thomas Staundinger, Gottfried Heinz, Gürkan Sengölge, Christian Zauner, Peter Jaksch, Fabio S. Taccone, Anne Pascale Meert, Dominique Benoît, Ulysses V.A. Silva, Ana Paula Pierre de Moraes, Thiago Lishoa, Jorge Salluh, William Viana, Guilliana Moralez, Thiago Domingos Correa, Umesh Shah, Thomas Karvunidis, Balik Martin, Katerina Russinova, Anders Perner, Tine Sylvest Meyhoff, Nielsen Jonas, Ramin Brandt Bukan, Ann M. Moeller, Lene B. Nielsen, Amélie Seguin, Akli Chermak, Nicolas Terzi, Isabelle Vinatier, Florent Wallet, Kada Klouche, Laura Platon, Benjamin Gaborit, François Barbier, Frederic Pène, Antoine Rabbat, Virginie Lemiale, Martine N'Yunga, Christophe Girault, Caroline Lemaitre, Elise Artaud-Macari, F. Bruneel, Anne Sophie Moreau, Anne Kuitunen, Brian Marsh, Mater Misericordia, Aisling Mc Mahon, Gilda Cinnella, Antonella Cotoia, Ospedali Riuniti, Lucas Montini, Angélique Spoelstra de Man, Precious Pearl Landburg, Dennis Bergmans, Pleun Hemelaar, Thomas Kaufmann, Andreas Barrat-Due, Pål Klepstad, Belen Encina, Gabriel Moreno, Llorenç Socias Crespi, Emilio Rodriguez-Ruiz, Andry Van De Louw, Philippe Bauer, Yadav Hemang, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Medizinische Universität Wien = Medical University of Vienna, Radboud University Medical Centre [Nijmegen, The Netherlands], University of Copenhagen = Københavns Universitet (KU), Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Mayo Clinic [Rochester], Penn State Health Milton S. Hershey Medical Center, Pennsylvania Commonwealth System of Higher Education (PCSHE)-Penn State System, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université libre de Bruxelles (ULB), Trinity College Dublin, Charles Darwin University, University of Toronto, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Oslo University Hospital [Oslo], Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), King's College Hospital (KCH), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Pulmonary and Respiratory Medicine, ARDS, medicine.medical_specialty, MESH: Respiratory Distress Syndrome, medicine.medical_treatment, Population, Respiratory physiology, Neutropenia, Critical Care and Intensive Care Medicine, Acute respiratory failure, MESH: Tidal Volume, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, MESH: Prognosis, 03 medical and health sciences, MESH: Positive-Pressure Respiration, 0302 clinical medicine, Diagnosis, medicine, MESH: Immunocompromised Host, Renal replacement therapy, education, Immunocompromised, Tidal volume, Outcome, MESH: Aged, education.field_of_study, MESH: Humans, MESH: Middle Aged, business.industry, Mortality rate, 030208 emergency & critical care medicine, MESH: Follow-Up Studies, Plateau pressure, medicine.disease, MESH: Male, MESH: Prospective Studies, 3. Good health, 030228 respiratory system, Emergency medicine, Driving pressure, Etiology, MESH: Respiratory Mechanics, Cardiology and Cardiovascular Medicine, business, MESH: Female
Abstract: International audience; Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement.Research question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]).Study design and methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality.Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality.Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
Published: 2020
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34. Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure

Author: Alexandre Massri, Christine Lebert, Claire Dupuis, Carole Guignon, Konstantinos Bachoumas, Saad Nseir, Morgane Olivry, Maelle Martin, Keyvan Razazi, Alexandre Lautrette, Jean-Marc Tadié, Laurence Dangers, G. Barberet, Carole Schwebel, Pierre Bailly, Jean-Damien Ricard, Jeremy Bourenne, Maxens Decavèle, Guillaume Lacave, Thierry Boulain, Caroline Sabatier, Séverin Cabasson, Nicolas Terzi, Olivier Pouly, Thi-My-Hue Nguyen, Gael Bourdin, Matthieu Buscot, Florence Boissier, Suela Demiri, Arnaud Gacouin, Quentin Levrat, Charlotte Garret, Antoine Poidevin, Jean Dellamonica, René Robert, Gael Pradel, Anne-Florence Dureau, Dalila Benzekri-Lefevre, Rémi Coudroy, Benjamin Delmas, Abirami Thiagarajah, Romain Sonneville, Anahita Rouzé, Emmanuelle Mercier, Déborah Boyer, Christophe Girault, Lila Bouadma, Grégoire Muller, Marie-Ange Azais, Walter Picard, Emmanuel Vivier, Sylvène Rosselli, Mai-Anh Nay, Céline Deletage, Julien Mayaux, Adel Maamar, Anthony Le Meur, Pierre Asfar, Marie-Anne Hoppe, François Beloncle, Anne Veinstein, Guillaume Berquier, Alexandre Demoule, Marlène Morisseau, Marc Pierrot, Stéphanie Ragot, Edouard Soum, Gwenhael Colin, Gwenaël Prat, Bérénice Puech, Stephan Ehrmann, Florent Joly, Arnaud W. Thille, Delphine Chatellier, Jean-Pierre Frat, Jean-Baptiste Lascarrou, Marc Gainnier, Gaetan Beduneau, Armand Mekontso-Dessap, Guillaume Carteaux, Yves Le Tulzo, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Régional d'Orléans (CHRO), CHU Pontchaillou [Rennes], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Rouen, Normandie Université (NU), Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Unité de Glycobiologie Structurale et Fonctionnelle UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Centre hospitalier Saint Joseph - Saint Luc [Lyon], Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Louis Mourier - AP-HP [Colombes], CHU Henri Mondor [Créteil], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier de Pau, Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Henri Mondor d'Aurillac, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Grenoble, CHU Nice [Cimiez], Hôpital Cimiez [Nice] (CHU), Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Recherche Agronomique (INRA)-Université de Lille-Centre National de la Recherche Scientifique (CNRS), CHU Henri Mondor, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Pulmonary and Respiratory Medicine, airway extubation, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pressure support ventilation, Airway Extubation, mechanical ventilation, Critical Care and Intensive Care Medicine, law.invention, Spontaneous breathing trial, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Interquartile range, law, Multicenter trial, Post-hoc analysis, medicine, 030212 general & internal medicine, Mechanical ventilation, business.industry, 3. Good health, 030228 respiratory system, Anesthesia, ICU, ventilator weaning, Cardiology and Cardiovascular Medicine, business
Abstract: Background Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs. Research Question We aimed at determining whether initial SBT using pressure-support ventilation (PSV) could increase successful extubation rates among patients at high risk of extubation failure. Study Design and Methods Post hoc analysis of a multicenter trial focusing on reintubation in patients at high-risk of extubation failure. The initial SBT was performed using PSV or T-piece according to the physician/center decision. The primary outcome was the proportion of patients successfully extubated 72 hours after initial SBT, that is, extubated after initial SBT and not reintubated within the following 72 hours. Results Among the 641 patients included in the original study, initial SBT was performed using PSV (7.0 cm H2O in median without positive end-expiratory pressure) in 243 patients (38%) and using a T-piece in 398 patients (62%). The proportion of patients successfully extubated 72 hours after initial SBT was 67% (162/243) using PSV and 56% (223/398) using T-piece (absolute difference 10.6%; 95% CI, 2.8 to 28.1; P = .0076). The proportion of patients extubated after initial SBT was 77% (186/283) using PSV and 63% (249/398) using T-piece (P = .0002), whereas reintubation rates within the following 72 hours did not significantly differ (13% vs 10%, respectively; P = .4259). Performing an initial SBT using PSV was independently associated with successful extubation (adjusted OR, 1.60; 95% CI, 1.30 to 2.18; P = .0061). Interpretation In patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation.
Published: 2020
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35. Intubation et extubation du patient de réanimation

Author: Hervé Quintard, Erwan l’Her, Julien Pottecher, Frédéric Adnet, Jean-Michel Constantin, Audrey Dejong, Pierre Diemunsch, Rose Fesseau, Anne Freynet, Christophe Girault, Christophe Guitton, Yan Hamonic, Eric Maury, Armand Mekontso-Dessap, Fabrice Michel, Paul Nolent, Sébastien Perbet, Gwenaël Prat, Antoine Roquilly, Karim Tazarourte, Nicolas Terzi, Arnaud W. Thille, Mikael Alves, Etienne Gayat, and Laurence Donetti
Subjects: Anesthesiology and Pain Medicine
Published: 2018
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36. Rescue stem cell allograft in intensive care unit patients during septic shock with multi-organ failure

Author: Christophe Girault, Perrine Leprêtre, Steven Grangé, Thomas Clavier, Déborah Boyer, Anne-Lise Ménard, Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université de Rouen Normandie (UNIROUEN), and Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel)
Subjects: Adult, Male, medicine.medical_specialty, Multiple Organ Failure, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Disease, Critical Care and Intensive Care Medicine, law.invention, Norepinephrine (medication), 03 medical and health sciences, 0302 clinical medicine, Recurrence, law, medicine, Humans, Renal replacement therapy, Septic shock, business.industry, Hematopoietic Stem Cell Transplantation, Myeloid leukemia, 030208 emergency & critical care medicine, Aplasia, medicine.disease, Shock, Septic, Intensive care unit, 3. Good health, Lymphoma, Surgery, Renal Replacement Therapy, Intensive Care Units, Leukemia, Myeloid, Acute, Treatment Outcome, 030228 respiratory system, Female, Lymphoma, Large B-Cell, Diffuse, business, medicine.drug
Abstract: Purpose We describe what we believe to be the first two cases of patients who received an allograft in intensive care unit (ICU) despite severe septic shock with multi-organ failure (MOF). Results One patient had aggressive large B-cell lymphoma. After allograft, the patient initially improved after withdrawing norepinephrine and renal replacement therapy but he subsequently died thirty-two days later because of a new relapse of the disease. The second patient had acute myeloid leukemia type 1 with a need for an allograft after a first complete remission. She was discharged from ICU at D23 after allograft and still alive 7 months later with complete remission. For the two patients, allograft conditioning was performed before admission to our ICU. These two cases highlight one major problem in such situations which is to find the best time to perform the allograft, particularly in ventilated patients with septic shock and MOF. We performed the allograft when we thought that the risk-benefit ratio was in favor of restoring immunity. Conclusion Allograft should be considered as a rescue therapy in ICU for patients with aplasia, during septic shock with multi-organ failure, however close multidisciplinary discussion is required between intensivists and onco-hematologists.
Published: 2019
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37. Comment sevrer de la ventilation mécanique ? Sevrage conventionnel et place de la ventilation non invasive pour le sevrage de la ventilation mécanique

Author: Christophe Girault and Arnaud Gacouin
Subjects: Pulmonary and Respiratory Medicine, 03 medical and health sciences, 0302 clinical medicine, Ventilator weaning, 030228 respiratory system, business.industry, Anesthesia, Disease progression, Medicine, 030208 emergency & critical care medicine, Noninvasive ventilation, business
Published: 2017
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38. Place de la trachéotomie et de l’oxygénothérapie humidifiée à haut débit pour le sevrage de la ventilation mécanique

Author: Christophe Girault and Arnaud Gacouin
Subjects: Pulmonary and Respiratory Medicine, Oxygen inhalation therapy, Ventilator weaning, business.industry, medicine.medical_treatment, Disease progression, Pulmonary disease, 030208 emergency & critical care medicine, 03 medical and health sciences, 0302 clinical medicine, Tracheotomy, 030228 respiratory system, Anesthesia, Respiration, Medicine, business
Published: 2017
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39. Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients: a multicenter cluster-randomized cross-over controlled trial

Author: Franck Minacori, Claire Delcourte, Alain Duhamel, Saad Nseir, Emmanuelle Jaillette, Isabelle Alves, Christophe Girault, Emmanuel Delaporte, Julien Labreuche, Damien Thellier, Hélène Behal, Laurent Robriquet, Guillaume Brunin, Céline Broucqsault-Dedrie, Stéphanie Barrailler, Farid Zerimech, Arnaud Chiche, Fabienne Tamion, and Cyril Fayolle
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Enzyme-Linked Immunosorbent Assay, Critical Care and Intensive Care Medicine, Tracheal tube, law.invention, 03 medical and health sciences, Respiratory Aspiration of Gastric Contents, 0302 clinical medicine, Randomized controlled trial, law, Intubation, Intratracheal, medicine, Humans, Intubation, Prospective Studies, Aged, Cross over, Cross-Over Studies, business.industry, Critically ill, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, Equipment Design, Middle Aged, respiratory system, medicine.disease, Respiration, Artificial, Pepsin A, respiratory tract diseases, Surgery, Intensive Care Units, Pneumonia, 030228 respiratory system, Anesthesia, Amylases, Cuff, Female, business, Biomarkers
Abstract: Studies on the impact of tapered-cuff tracheal tubes on rates of microaspiration and ventilator-associated pneumonia (VAP) in intubated patients have reported conflicting results. The aim of this study was to determine the influence of this shape of tracheal cuff on abundant microaspiration of gastric contents in critically ill patients.All patients intubated in the intensive care unit (ICU) and requiring mechanical ventilation for at least 48 h were eligible for this multicenter cluster-randomized controlled cross-over open-label study. The primary outcome was abundant microaspiration of gastric contents, defined by the presence of pepsin at significant level in 30% of tracheal aspirates. Quantitative measurement of pepsin and salivary amylase was performed in all tracheal aspirates during the 48 h following enrollment.A total of 326 patients were enrolled in the ten participating ICUs (162 in the PVC tapered-cuff group and 164 in the standard-cuff group). Patient characteristics were similar in the two study groups. The proportion of patients with abundant microaspiration of gastric contents was 53.5% in the tapered-cuff and 51.0% in the standard-cuff group (odds ratio 1.14, 95% CI 0.72-1.82). While abundant microaspiration of oropharyngeal secretions was not significantly different (77.4 vs 68.6%, p = 0.095), the proportion of patients with tracheobronchial colonization was significantly lower (29.6 vs 43.3%, p = 0.01) in the tapered-cuff than in the standard-cuff group. No significant difference between the two groups was found for other secondary outcomes, including ventilator-associated events and VAP.This trial showed no significant impact of tapered-cuff tracheal tubes on abundant microaspiration of gastric contents.ClinicalTrials.gov, number NCT01948635.
Published: 2017
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40. Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure: A Post-Hoc Analysis of a Clinical Trial

Author: Arnaud W, Thille, Rémi, Coudroy, Mai-Anh, Nay, Arnaud, Gacouin, Alexandre, Demoule, Romain, Sonneville, François, Beloncle, Christophe, Girault, Laurence, Dangers, Alexandre, Lautrette, Quentin, Levrat, Anahita, Rouzé, Emmanuel, Vivier, Jean-Baptiste, Lascarrou, Jean-Damien, Ricard, Keyvan, Razazi, Guillaume, Barberet, Christine, Lebert, Stephan, Ehrmann, Alexandre, Massri, Jeremy, Bourenne, Gael, Pradel, Pierre, Bailly, Nicolas, Terzi, Jean, Dellamonica, Guillaume, Lacave, René, Robert, Stéphanie, Ragot, Jean-Pierre, Frat, and Matthieu, Buscot
Subjects: Male, Airway Extubation, Humans, Female, Treatment Failure, Respiration, Artificial, Risk Assessment, Ventilator Weaning, Aged
Abstract: Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs.We aimed at determining whether initial SBT using pressure-support ventilation (PSV) could increase successful extubation rates among patients at high risk of extubation failure.Post hoc analysis of a multicenter trial focusing on reintubation in patients at high-risk of extubation failure. The initial SBT was performed using PSV or T-piece according to the physician/center decision. The primary outcome was the proportion of patients successfully extubated 72 hours after initial SBT, that is, extubated after initial SBT and not reintubated within the following 72 hours.Among the 641 patients included in the original study, initial SBT was performed using PSV (7.0 cm HIn patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation.
Published: 2019

41. High-flow oxygen therapy vs non invasive ventilation: a prospective randomized cross-over physiological study of alveolar recruitment in acute respiratory failure

Author: Gurvan Le Bouar, Gaetan Beduneau, Christophe Girault, Déborah Boyer, Antoine Cuvelier, Michael Bubenheim, Dorothée Carpentier, Steven Grangé, Fabienne Tamion, Benoit Misset, and Elise Artaud Macari
Subjects: business.industry, medicine.medical_treatment, Hemodynamics, medicine.disease_cause, medicine.disease, Pneumonia, Anesthesia, Oxygen therapy, medicine, Breathing, Clinical endpoint, Lung volumes, Respiratory system, business, Nasal cannula
Abstract: High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while non-invasive ventilation (NIV) remains debated in this indication. We evaluated the effect of HFNC on alveolar recruitment and lung volumes in hypoxemic ARF compared to NIV and facial mask (FM). A prospective randomized cross-over physiological study was conducted. Eligible patients had to present hypoxemic ARF due to pneumonia. The primary endpoint was the comparison of global and regional end-expiratory electrical lung impedance (EELI) between NIV and HFNC. Secondary endpoint was the comparison, between the 3 techniques, of lung volumes (global and regional TV), respiratory parameters, hemodynamic tolerance, dyspnea and comfort. NIV and HFNC significantly increased the global EELI compared to FM (2056 [1070; 2825] vs. 4083 [2928; 5134], p=0.001 and 1448 [1028; 3542] vs 2921 [1706; 4850], p=0.0001, respectively). No global EELI difference was found between NIV and HFNC (4083 [2928; 5134] vs 2921 [1706; 4850], p=0.4). Global and regional TV increased under NIV compared to HFNC (p This study demonstrates a similar benefit of HFNC and NIV on alveolar recruitment. By contrast to HFNC, NIV also increases lung volumes which may contribute to its potentially deleterious effect during hypoxemic ARF.
Published: 2019
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42. Role of Non-Invasive Respiratory Supports in COVID-19 Acute Respiratory Failure Patients with Do Not Intubate Orders

Author: Jean-Marc Fellrath, Alexis Gillet, Dimitri Leduc, Philippe Gouin, Laure Goubert, Marcel Zwahlen, Olivier Contal, Guillaume Prieur, Bouchra Lamia, Nils Correvon, Laurie Lagache, Fairuz Boujibar, Laurence Haesler, Elise Artaud Macari, Jacques Creteur, Olivier Taton, Olivier Van Hove, Michelle Norrenberg, Yann Combret, Clément Medrinal, Jonathan Dugernier, Christophe Girault, and Roger Hilfiker
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, 610 Medicine & health, mechanical ventilation, Article, 03 medical and health sciences, 0302 clinical medicine, 360 Social problems & social services, CPAP, Acute care, medicine, Intubation, 030212 general & internal medicine, Respiratory system, Mechanical ventilation, business.industry, high flow nasal cannula, COVID-19, General Medicine, Sciences bio-médicales et agricoles, 030228 respiratory system, Relative risk, Emergency medicine, Propensity score matching, Breathing, Medicine, oxygenation, business
Abstract: The current gold-standard treatment for COVID-19-related hypoxemic respiratory failure is invasive mechanical ventilation. However, do not intubate orders (DNI), prevent the use of this treatment in some cases. The aim of this study was to evaluate if non-invasive ventilatory supports can provide a good therapeutic alternative to invasive ventilation in patients with severe COVID-19 infection and a DNI. Data were collected from four centres in three European countries. Patients with severe COVID-19 infection were included. We emulated a hypothetical target trial in which outcomes were compared in patients with a DNI order treated exclusively by non-invasive respiratory support with patients who could be intubated if necessary. We set up a propensity score and an inverse probability of treatment weighting to remove confounding by indication. Four-hundred patients were included: 270 were eligible for intubation and 130 had a DNI order. The adjusted risk ratio for death among patients eligible for intubation was 0.81 (95% CI 0.46 to 1.42). The median length of stay in acute care for survivors was similar between groups (18 (10–31) vs. (19 (13–23.5); p = 0.76). The use of non-invasive respiratory support is a good compromise for patients with severe COVID-19 and a do not intubate order., info:eu-repo/semantics/published
Published: 2021
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43. High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol

Author: Damien Contou, Gwenhael Colin, Dalila Benzekri, Gwenaël Prat, Sebastien Jochmans, Rémi Coudroy, Arnaud W. Thille, Nicolas Terzi, Alexandre Herbland, Guylaine Labro, Achille Kouatchet, Stéphanie Ragot, Jean Dellamonica, Giacomo Grasselli, Claude Guérin, Mona Assefi, David Bougon, Jean-Pierre Quenot, Frédéric Pène, T Lherm, Didier Thevenin, Jeremy Bourenne, Emmanuel Vivier, Jean-Pierre Frat, Saad Nseir, Jérôme Devaquet, Maxens Decavèle, Arnaud Gacouin, Charlotte Garret, Christophe Girault, Stephan Ehrmann, Dominique Malacrino, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Pontchaillou [Rennes], Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Centre Hospitalier Universitaire de Nice (CHU Nice), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Centre hospitalier Saint Joseph - Saint Luc [Lyon], Urgence respiratoire et réanimation médicale, Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Réanimation, Centre Hospitalier René Dubos [Pontoise], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bourse de recherche, AADAIRC, Programme Hospitalier de Recherche Clinique Inter-, French Ministry of Health, Le Nouveau Souffle, SOS Oxygène, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Ehrmann, Stephan, and Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158)
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, law.invention, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Randomized controlled trial, law, Informed consent, Oxygen therapy, Intubation, Intratracheal, Protocol, Medicine, Intubation, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, high-flow nasal cannula oxygen therapy, Randomized Controlled Trials as Topic, Noninvasive Ventilation, acute respiratory failure, immunosuppression, business.industry, Mortality rate, non-invasive ventilation, Oxygen Inhalation Therapy, Intensive Care, clinical trial, General Medicine, Intensive care unit, mortality, 3. Good health, Clinical trial, Intensive Care Units, 030228 respiratory system, Respiratory failure, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Respiratory Insufficiency, Ventilator Weaning
Abstract: IntroductionNon-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT02978300
Published: 2019
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44. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial

Author: Jean-Pierre Frat, Jean-Damien Ricard, Jean-Pierre Quenot, Nicolas Pichon, Alexandre Demoule, Jean-Marie Forel, Jean-Paul Mira, Rémi Coudroy, Guillaume Berquier, Benoit Voisin, Gwenhaël Colin, Bertrand Pons, Pierre Eric Danin, Jérome Devaquet, Gwenael Prat, Raphaël Clere-Jehl, Franck Petitpas, Emmanuel Vivier, Keyvan Razazi, Mai-Anh Nay, Vincent Souday, Jean Dellamonica, Laurent Argaud, Stephan Ehrmann, Aude Gibelin, Christophe Girault, Pascal Andreu, Philippe Vignon, Laurence Dangers, Stéphanie Ragot, Arnaud W Thille, Delphine Chatellier, Florence Boissier, Anne Veinstein, René Robert, Céline Deletage-Métreau, Morgane Olivry, Claire Dahyot-Fizelier, Auguste Dargent, Audrey Large, Emmanuelle Begot, Claire Mancia, Maxence Decavele, Martin Dres, Samuel Lehingue, Laurent Papazian, Marine Paul, Nathalie Marin, Matthieu Le Meur, Mohammed Laissy, Anaita Rouzé, Saad Nseir, Matthieu Henry-Lagarrigue, Aihem Yehia, Frédéric Martino, Charles Cerf, Pierre Bailly, Julie Helms, Jean Baptiste Putegnat, Armand Mekontso-Dessap, Thierry Boulain, Pierre Asfar, Séverin Cabasson, Florent Wallet, Kada Klouche, Frédéric Bellec, 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), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie (CIC-P803), Institut National de la Santé et de la Recherche Médicale (INSERM)-Direction Générale de l'Organisation des Soins (DGOS)-Université de Bourgogne (UB), Hôpital Dupuytren [CHU Limoges], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Charles Foix [AP-HP], Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Nord [CHU - APHM], Aix Marseille Université (AMU), GHU AP-HP Centre Université de Paris, Hôpital Cochin [AP-HP], Université Paris Descartes - Paris 5 (UPD5), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier Universitaire de Nice (CHU Nice), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Hôpital Foch [Suresnes], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Nouvel Hôpital Civil de Strasbourg, Université de Strasbourg (UNISTRA), Les Hôpitaux Universitaires de Strasbourg (HUS), Centre hospitalier Saint Joseph - Saint Luc [Lyon], CHU Henri Mondor, 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 Régional d'Orléans (CHRO), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe de Recherche sur le Handicap Ventilatoire (GRHV), Institute for Research and Innovation in Biomedicine (IRIB), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-CHU Rouen, Normandie Université (NU), CHU Rouen, Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Delphine Chatellier, Florence Boissier, Anne Veinstein, René Robert, Céline Deletage-Métreau, Morgane Olivry, Claire Dahyot-Fizelier, Auguste Dargent, Audrey Large, Emmanuelle Begot, Claire Mancia, Maxence Decavele, Martin Dres, Samuel Lehingue, Laurent Papazian, Marine Paul, Nathalie Marin, Matthieu Le Meur, Mohammed Laissy, Anaita Rouzé, Saad Nseir, Matthieu Henry-Lagarrigue, Aihem Yehia, Frédéric Martino, Charles Cerf, Pierre Bailly, Julie Helms, Jean Baptiste Putegnat, Armand Mekontso-Dessap, Thierry Boulain, Pierre Asfar, Séverin Cabasson, Florent Wallet, Kada Klouche, Frédéric Bellec, Delphine Chatellier, Florence Boissier, Anne Veinstein, René Robert, Céline Deletage-Métreau, Morgane Olivry, Maxence Decavele, Martin Dres, Samuel Lehingue, Laurent Papazian, Matthieu Le Meur, Mohammed Laissy, Anaita Rouzé, Saad Nseir, Matthieu Henry-Lagarrigue, Aihem Yehia, Charles Cerf, Armand Mekontso-Dessap, Thierry Boulain, Pierre Asfar, CCSD, Accord Elsevier, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Université de Bourgogne (UB)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Université Nice Sophia Antipolis (1965 - 2019) (UNS), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France, Equipe LIPNESS (LNC - U1231) (LIPNESS), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), Coordination des Prélèvements d’Organes et de Tissus (CHPOT), CHU Limoges, Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire pluridisciplinaire de recherche en ingénierie des systèmes, mécanique et énergétique (PRISME), Université d'Orléans (UO)-Institut National des Sciences Appliquées - Centre Val de Loire (INSA CVL), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Centre d'Etudes Lasers Intenses et Applications (CELIA), Université de Bordeaux (UB)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation Médicale [Strasbourg], Institut universitaire des systèmes thermiques industriels (IUSTI), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [Hôpital de l’Archet], Centre Hospitalier Universitaire de Nice (CHU de Nice)-Hôpital de l'Archet, Service de Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France, parent, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Limoges, Anti-infectieux : supports moléculaires des résistances et innovations thérapeutiques (RESINFIT), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Laboratoire de Génétique Chromosomique et Moléculaire [CHU Dijon], COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), and CHU Henri Mondor [Créteil]
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Nose, medicine.disease_cause, Catheterization, 03 medical and health sciences, 0302 clinical medicine, Fraction of inspired oxygen, Intensive care, Oxygen therapy, medicine, Intubation, Intratracheal, Intubation, Humans, Oximetry, Hypoxia, Noninvasive Ventilation, medicine.diagnostic_test, business.industry, Tracheal intubation, Oxygen Inhalation Therapy, 030208 emergency & critical care medicine, Middle Aged, Respiration, Artificial, 3. Good health, [SDV] Life Sciences [q-bio], Pulse oximetry, 030228 respiratory system, Respiratory failure, Anesthesia, Acute Disease, Female, business, Respiratory Insufficiency, Nasal cannula
Abstract: International audience; BACKGROUND: Non-invasive ventilation has never been compared with high-flow oxygen to determine whether it reduces the risk of severe hypoxaemia during intubation. We aimed to determine if preoxygenation with non-invasive ventilation was more efficient than high-flow oxygen in reducing the risk of severe hypoxaemia during intubation. METHODS: The FLORALI-2 multicentre, open-label trial was done in 28 intensive care units in France. Adult patients undergoing tracheal intubation for acute hypoxaemic respiratory failure (a partial pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FiO2] ratio of \textless/=300 mm Hg) were randomly assigned (1:1; block size, four participants) to non-invasive ventilation or high-flow oxygen during preoxygenation, with stratification by PaO2/FiO2 ratio (\textless/=200 mm Hg vs \textgreater200 mm Hg). Key exclusion criteria were intubation for cardiac arrest, altered consciousness (defined as a Glasgow coma score of less than eight points), other contraindications to non-invasive ventilation (recent laryngeal, oesophageal, or gastric surgery, and substantial facial fractures), pulse oximetry not available, pregnant or breastfeeding women, and refusal to participate. The primary outcome was the occurrence of severe hypoxaemia (pulse oximetry \textless80%) during the procedure, assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02668458. FINDINGS: Between April 15, 2016, and Jan 8, 2017, 2079 patients were intubated in the 28 participating units, and 322 were enrolled. We excluded five patients with no recorded data, two who withdrew consent or were under legal protection, one who was not intubated, and one who had a cardiac arrest. Of the 313 patients included in the intention-to-treat analysis, 142 were assigned to non-invasive ventilation and 171 to high-flow oxygen therapy. Severe hypoxaemia occurred in 33 (23%) of 142 patients after preoxygenation with non-invasive ventilation and 47 (27%) of 171 with high-flow oxygen (absolute difference -4.2%, 95% CI -13.7 to 5.5; p=0.39). In the 242 patients with moderate-to-severe hypoxaemia (PaO2/FiO2 \textless/=200 mm Hg), severe hypoxaemia occurred less frequently after preoxygenation with non-invasive ventilation than with high-flow oxygen (28 [24%] of 117 patients vs 44 [35%] of 125; adjusted odds ratio 0.56, 0.32 to 0.99, p=0.0459). Serious adverse events did not differ between treatment groups, with the most common immediate complications being systolic arterial hypotension (70 [49%] patients in the non-invasive ventilation group vs 86 [50%] patients in the high-flow oxygen group) and chest infiltrate on x-ray (28 [20%] vs 33 [19%]), and the most common late complications being death at day 28 (53 [37%] vs 58 [34%]) and ventilator-associated pneumonia during ICU stay (31 [22%] vs 35 [20%]). INTERPRETATION: In patients with acute hypoxaemic respiratory failure, preoxygenation with non-invasive ventilation or high-flow oxygen therapy did not change the risk of severe hypoxaemia. Future research should explore the effect of preoxygenation method in patients with moderate-to-severe hypoxaemia at baseline. FUNDING: French Ministry of Health.
Published: 2019
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45. Experts' guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF) : In collaboration with the pediatric Association of French-speaking Anaesthetists and Intensivists (ADARPEF), French-speaking Group of Intensive Care and Paediatric emergencies (GFRUP) and Intensive Care physiotherapy society (SKR)

Author: Hervé Quintard, Sébastien Perbet, Laurence Donetti, Audrey De Jong, Christophe Guitton, Arnaud W. Thille, Pierre Diemunsch, Gwenaël Prat, Paul Nolent, Frédéric Adnet, Jean-Michel Constantin, Nicolas Terzi, Julien Pottecher, Armand Mekontso-Dessap, Antoine Roquilly, Yann Hamonic, Erwan L'Her, Eric Maury, Karim Tazarourte, Christophe Girault, Mikael Alves, Fabrice Michel, Rose Fesseau, Anne Freynet, and Etienne Gayat
Subjects: medicine.medical_specialty, Poor prognosis, business.industry, medicine.medical_treatment, Research, MEDLINE, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Emergency situations, Intensive care unit, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, law, Anesthesiology, Intensive care, medicine, Intubation, Intensive care medicine, business
Abstract: Background Intubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20–50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure. Results and conclusion In constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithms.
Published: 2018

46. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial

Author: Christine Lebert, Loay Kontar, Achille Kouatchet, Lilia Berrahil-Meksen, Naïke Bigé, Julien Mayaux, Saad Nseir, Kada Klouche, Samir Jaber, Djamel Mokart, Laurent Papazian, Nicolas Terzi, Elie Azoulay, Jean Reignier, Jean-Michel Constantin, Alexandre Demoule, Laurent Argaud, Alexandre Lautrette, Michael Darmon, Martine Nyunga, Christophe Girault, Lila Bouadma, Guillaume Louis, Igor Théodose, Johanna Oziel, Pierre Perez, Vincent Peigne, François Barbier, Virginie Lemiale, Frédéric Pène, Fabrice Bruneel, Sylvie Chevret, Florent Wallet, and Jean-Herlé Raphalen
Subjects: Adult, Male, Respiratory rate, Critical Care, medicine.medical_treatment, Critical Illness, High-Frequency Ventilation, Nose, law.invention, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, Oxygen therapy, medicine, Humans, 030212 general & internal medicine, Original Investigation, Aged, Mechanical ventilation, Noninvasive Ventilation, Respiratory distress, business.industry, Oxygen Inhalation Therapy, General Medicine, Middle Aged, Intensive care unit, Survival Analysis, 3. Good health, Oxygen, 030228 respiratory system, Anesthesia, SOFA score, Female, business, Respiratory Insufficiency
Abstract: IMPORTANCE: High-flow nasal oxygen therapy is increasingly used for acute hypoxemic respiratory failure (AHRF). OBJECTIVE: To determine whether high-flow oxygen therapy decreases mortality among immunocompromised patients with AHRF compared with standard oxygen therapy. DESIGN, SETTING, AND PARTICIPANTS: The HIGH randomized clinical trial enrolled 776 adult immunocompromised patients with AHRF (Pao(2) 30/min or labored breathing or respiratory distress, and need for oxygen ≥6 L/min) at 32 intensive care units (ICUs) in France between May 19, 2016, and December 31, 2017. INTERVENTIONS: Patients were randomized 1:1 to continuous high-flow oxygen therapy (n = 388) or to standard oxygen therapy (n = 388). MAIN OUTCOMES AND MEASURES: The primary outcome was day-28 mortality. Secondary outcomes included intubation and mechanical ventilation by day 28, Pao(2):Fio(2) ratio over the 3 days after intubation, respiratory rate, ICU and hospital lengths of stay, ICU-acquired infections, and patient comfort and dyspnea. RESULTS: Of 778 randomized patients (median age, 64 [IQR, 54-71] years; 259 [33.3%] women), 776 (99.7%) completed the trial. At randomization, median respiratory rate was 33/min (IQR, 28-39) vs 32 (IQR, 27-38) and Pao(2):Fio(2) was 136 (IQR, 96-187) vs 128 (IQR, 92-164) in the intervention and control groups, respectively. Median SOFA score was 6 (IQR, 4-8) in both groups. Mortality on day 28 was not significantly different between groups (35.6% vs 36.1%; difference, −0.5% [95% CI, −7.3% to +6.3%]; hazard ratio, 0.98 [95% CI, 0.77 to 1.24]; P = .94). Intubation rate was not significantly different between groups (38.7% vs 43.8%; difference, −5.1% [95% CI, −12.3% to +2.0%]). Compared with controls, patients randomized to high-flow oxygen therapy had a higher Pao(2):Fio(2) (150 vs 119; difference, 19.5 [95% CI, 4.4 to 34.6]) and lower respiratory rate after 6 hours (25/min vs 26/min; difference, −1.8/min [95% CI, −3.2 to −0.2]). No significant difference was observed in ICU length of stay (8 vs 6 days; difference, 0.6 [95% CI, −1.0 to +2.2]), ICU-acquired infections (10.0% vs 10.6%; difference, −0.6% [95% CI, −4.6 to +4.1]), hospital length of stay (24 vs 27 days; difference, −2 days [95% CI, −7.3 to +3.3]), or patient comfort and dyspnea scores. CONCLUSIONS AND RELEVANCE: Among critically ill immunocompromised patients with acute respiratory failure, high-flow oxygen therapy did not significantly decrease day-28 mortality compared with standard oxygen therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02739451.
Published: 2018

47. Impact of oversedation prevention in ventilated critically ill patients: a randomized trial-the AWARE study

Author: Thierry Jacques, Bernard De Jonghe, Qin Lu, Jean-Luc Baudel, Vincent Das, Jean Reignier, Guillaume Carteaux, Stephan Ehrmann, Gaëtan Plantefève, Bernard Lambermont, Emmanuelle Gourdin, Jean-Philippe Rigaud, Nadia Aissaoui, Hervé Clavier, Hervé Hyvernat, Michael Piagnerelli, Romain Hernu, Lucas Liaudet, David Grimaldi, Karim Chergui, Annabelle Stoclin, Jean-François Hicter, Jean-Claude Lacherade, François Vincent, Philippe Michel, Grégoire Muller, Aurélie Cravoisy-Popovic, Laurent Guérin, Olfa Hamzaoui, F. Brouard, Emmanuel Vivier, Sébastien Ena, Nicolas Devos, Jugurtha Aliane, Antoine Kimmoun, Laurence Donetti, Pierre-François Laterre, Frédérique Ganster, Antoine Gros, Laetitia Bodet-Contentin, Alexandre Duguet, Jean-Paul Mira, Djillali Annane, Cédric Cleophax, Jean-Damien Ricard, Siu-Ming Au, Alexis Soumer, Stéphane Merat, Walter Picard, Alexandre Cambonie, Charles-Edouard Luyt, Nicolas Deye, Charlotte Quentin, Julie Léger, Frédéric Jacobs, Patrick Girardie, Sandie Dauriac, Isabelle Camilatto, Jean-Luc Desmaretz, Xavier Monnet, Philippe Obbee, René Robert, Daniel da Silva, Christophe Girault, Corinne Audoin, Alain Mercat, D.A. Reuter, Renaud Chouquer, Mohebbi Amoli Abolfazl, Fabienne Plouvier, Elie Azoulay, Thierry Boulain, Maleka Schenck, Bruno Giraudeau, Gilles Troché, Jérôme Aboab, Stéphane Legriel, SRLF Trial Group, de Jonghe, B., Aboab, J., Aissaoui, N., Annane, D., Audoin, C., Baudel, J.L., Brouard, F., Cambonie, A., Camilatto, I., Chergui, K., Das, V., da Silva, D., Devos, N., Deye, N., Ehrmann, S., Ganster, F., Giraudeau, B., Grimaldi, D., Gourdin, E., Gros, A., Hamzaoui, O., Jacobs, F., Kimmoun, A., Lacherade, J.C., Lambermont, B., Laterre, P.F., Leger, J., Legriel, S., Liaudet, L., Luyt, C.E., Michel, P., Mira, J.P., Monnet, X., Muller, G., Piagnerelli, M., Plantefeve, G., Reignier, J., Ricard, J.D., Vincent, F., Aliane, J., Plouvier, F., Mercat, A., Abolfazl, M.A., Cleophax, C., Carteaux, G., Troche, G., Guerin, L., Girardie, P., Vivier, E., Hernu, R., Obbee, P., Donetti, L., Jacques, T., Cravoisy-Popovic, A., Boulain, T., Lu, Q., Reuter, D., Azoulay, E., Clavier, H., Picard, W., Robert, R., Chouquer, R., Girault, C., Merat, S., Quentin, C., Hicter, J.F., Schenck, M., Dauriac, S., Desmaretz, J.L., Hyvernat, H., Soumer, A., Stoclin, A., Rigaud, J.P., Duguet, A., Bodet-Contentin, L., Au, S.M., Ena, S., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, and UCL - (SLuc) Service de soins intensifs
Subjects: medicine.medical_specialty, Sedation, medicine.medical_treatment, Weaning, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Randomized controlled trial, law, medicine, 030212 general & internal medicine, Mortality, Intensive care medicine, Intensive care units, business.industry, Critically ill, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.symptom, business
Abstract: Background Although oversedation has been associated with increased morbidity in ventilated critically ill patients, it is unclear whether prevention of oversedation improves mortality. We aimed to assess 90-day mortality in patients receiving a bundle of interventions to prevent oversedation as compared to usual care. Methods In this randomized multicentre trial, all adult patients requiring mechanical ventilation for more than 48 h were included. Two groups were compared: patients managed according to usual sedation practices (control), and patients receiving sedation according to an algorithm which provided a gradual multilevel response to pain, agitation, and ventilator dyssynchrony with no specific target to alter consciousness and no use of sedation scale and promoted the use of alternatives to continuous infusion of midazolam or propofol (intervention). Results Inclusions were stopped before reaching the planned enrolment. Between 2012 and 2014, 584 patients were included in the intervention group and 590 in the control group. Baseline characteristics were well balanced between groups. Although the use of midazolam and propofol was significantly lower in the intervention group, 90-day mortality was not significantly lower (39.4 vs. 44.2% in the control group, p = 0.09). There were no significant differences in 1-year mortality between the two groups. The time to first spontaneous breathing trial and time to successful extubation were significantly shorter in the intervention group than in the control group. These last results should be interpreted with precaution regarding the several limitations of the trial including the early termination. Conclusions This underpowered study of severely ill patients was unable to show that a strategy to prevent oversedation could significantly reduce mortality. Trial registration NCT01617265
Published: 2018

48. Comparison of high flow nasal cannula oxygen and conventional oxygen therapy on ventilatory support duration during acute-on-chronic respiratory failure: study protocol of a multicentre, randomised, controlled trial. The 'HIGH-FLOW ACRF' study

Author: Jean-Damien, Ricard, Fadia, Dib, Marina, Esposito-Farese, Jonathan, Messika, Christophe, Girault, Lise, Piquilloud, Ecologie et Evolution des Microorganismes (EEM), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), 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), Hôpital Louis Mourier - AP-HP [Colombes], CHU Rouen, Normandie Université (NU), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), and Université d'Angers (UA)
Subjects: Adult, Lung Diseases, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, medicine.disease_cause, law.invention, Hypercapnia, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Oxygen therapy, medicine, Humans, 030212 general & internal medicine, education, Monitoring, Physiologic, education.field_of_study, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, General Medicine, Intensive care unit, 3. Good health, Outcome and Process Assessment, Health Care, 030228 respiratory system, Emergency medicine, Good clinical practice, Breathing, Female, business, Respiratory Insufficiency, Nasal cannula, Respiratory care
Abstract: IntroductionThis study protocol describes a trial designed to investigate whether high-flow heated and humidified nasal oxygen (HFHO) therapy in patients with hypercapnic acute respiratory failure (ARF) reduces the need of non-invasive ventilation (NIV).Methods and analysisThis is an open-label, superiority, international, parallel-group, multicentre randomised controlled two-arm trial, with an internal feasibility pilot phase. 242 patients with hypercapnic ARF requiring NIV admitted to an intensive care unit, an intermediate care or a respiratory care unit will be randomised in a 1:1 ratio to receive HFHO or standard oxygen in between NIV sessions. Randomisation will be centralised and stratified by centre and pH at admission (pH ≤7.25 or >7.25). The primary outcome will be the number of ventilator-free days (VFDs) and alive at day 28 postrandomisation. The secondary outcomes will encompass parameters related to the VFDs, comfort and tolerance variables, hospital length of stay and mortality. VFDs at 28 days postrandomisation will be compared between the two groups by Wilcoxon-Mann-Whitney two-sample rank-sum test in the intention-to-treat population. A sensitivity analysis will be conducted in the population of patients for whom the criteria of switching from NIV to spontaneous breathing, or conversely, are not strictly verified.Ethics and disseminationThe protocol has been approved by theComité de Protection des Personnes(CPP)Sud-Ouest & Outre-Mer IV(ref CPP17-049a/2017-A01830-53) and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A trial steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences, and publication in peer-reviewed journals.Trial registration numberNCT03406572.
Published: 2018
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49. Management of dabigatran after overdosage: two case reports and suggestions for monitoring

Author: Virginie Barbay, Steven Grangé, Véronique Le Cam Duchez, Déborah Boyer, Paul Billoir, Marielle Fresel, Christophe Girault, and Marie Hélène Chrétien
Subjects: medicine.drug_class, Hemorrhage, macromolecular substances, 030204 cardiovascular system & hematology, Antibodies, Monoclonal, Humanized, Antithrombins, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Stroke, Emergency Treatment, business.industry, Anticoagulant, Warfarin, Atrial fibrillation, Idarucizumab, Hematology, General Medicine, medicine.disease, Prothrombin complex concentrate, Blood Coagulation Factors, Embolism, Anesthesia, Drug Monitoring, Drug Overdose, business, medicine.drug
Abstract: Bleeding is the main complication of anticoagulant treatments as dabigatran etexilate. In patients with atrial fibrillation, dabigatran, at certain doses, has been associated with similar rates of stroke and embolism, and a lower rate of major hemorrhage compared to warfarin. Before the recent possibility of reversing the anticoagulant effect of dabigatran with idarucizumab, prothrombin complex concentrate (PCC) was the main available treatment in cases of severe bleeding or emergency surgery . We describe two different cases with very high overdosage in which PCC or idarucizumab was used to reverse the effect of dabigatran etexilate.
Published: 2018

50. Erratum to 'Intubation and extubation of the ICU patient' [Anaesth. Crit. Care Pain Med. 36 (5) (2017) 327-341]

Author: Nicolas Terzi, Y. Hamonic, M. Alves, A. Freynet, Karim Tazarourte, Etienne Gayat, Christophe Girault, A. De Jong, Jean-Michel Constantin, Arnaud W. Thille, Julien Pottecher, Pierre Diemunsch, L. Donetti, P. Nolent, Frédéric Adnet, Armand Mekontso-Dessap, Antoine Roquilly, Sébastien Perbet, Eric Maury, Christophe Guitton, Fabrice Michel, R. Fesseau, Erwan L'Her, Gwenaël Prat, and Hervé Quintard
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, General Medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Emergency medicine, Medicine, Intubation, 030212 general & internal medicine, business
Published: 2018

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139 results on '"Christophe Girault"'

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