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1. The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference

Author

Pierre-François Dequin, Cécile Aubron, Henri Faure, Denis Garot, Max Guillot, Olfa Hamzaoui, Virginie Lemiale, Julien Maizel, Joy Y. Mootien, David Osman, Marie Simon, Arnaud W. Thille, Christophe Vinsonneau, and Khaldoun Kuteifan

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Introduction New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRLF organized a consensus conference in December 2022. Methods An ad hoc committee without any conflict of interest (CoI) with the subject identified the molecules (ceftolozane–tazobactam, ceftazidime–avibactam, imipenem–cilastatin–relebactam, meropenem–vaborbactam and cefiderocol); defined 6 generic questions; drew up a list of subquestions according to the population, intervention, comparison and outcomes (PICO) model; and reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Seven experts in the field proposed their own answers to the questions in a public session and answered questions from the jury (a panel of 10 critical-care physicians without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. Due to the frequent lack of powerful studies that have used clinically important criteria of judgment, the recommendations were formulated as expert opinions as often as necessary. Results The jury provided 17 statements answering 6 questions: (1) Is there a place in the ICU for the probabilistic use of new NBs/IBs active against Gram-negative bacteria? (2) In the context of documented infections with sensitivity to several of these molecules, are there pharmacokinetic, pharmacodynamic, ecological or medico-economic elements for prioritization? (3) What are the possible combinations with these molecules and in what context? (4) Should we integrate these new molecules into a carbapenem-sparing strategy? (5) What pharmacokinetic and pharmacodynamic data are available to optimize their mode of administration in critically ill patients? (6) What are the dosage adaptations in cases of renal insufficiency, hepatocellular insufficiency or obesity? Conclusion These recommendations should optimize the use of NBs/BIs in ICU patients.

Published
2023
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2. Associations between Teacher Stress and School Leadership: A Mixed Methods Study with Implications for School Psychologists

Author

Richard Lambert, Christopher McCarthy, Caroline Weppner, Cathy Malerba, David Osman, T. Scott Holcomb, and Bryndle L. Bottoms

Abstract

School psychologists have the psychological and consultative expertise necessary to support teachers who are vulnerable to stress. Transactional theory offers a lens to guide such support, as it posits that each teacher's unique appraisals of their work demands and resources determine the degree to which they are at risk for stress. This study used a multiphase sequential mixed method design with a transactional theory lens to examine the association of leadership quality and stability with teachers' ratings of workplace conditions. The four phases consisted of (a) input from an expert panel, (b) scale development and validation, (c) interviews with key informants, and (d) multilevel modeling informed by all previous phases. Through key informant interviews, district-level administrators provided ratings of the quality and stability of school leadership. The researchers examined the associations between these ratings and teacher appraisals of classroom demands, classroom resources, job satisfaction, and perceived levels of instructional support collected via a district-wide climate survey. Multilevel models with key informant ratings and school characteristics at Level 2 (N[subscript schools] = 47) and teacher characteristics and perceptions at Level 1 (N[subscript teachers] = 1,850) demonstrated that the quality and stability of school leadership were associated with teachers' appraisals of their occupational demands and resources, job satisfaction, and ratings of instructional support. Findings show that the quality and stability of school leadership play an important role in the incidence of stress vulnerability, suggesting important pathways for school psychologists seeking to promote the occupational health of teachers.

Published
2023
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4. Extending fatigue life of aircraft fuselage structures using laser-peening

Author

Busse, David Osman, Irving, Phil E., and Ganguly, Supriyo

Subjects
629.134
Abstract

Fatigue of airframe structures is a constant challenge to aircraft manufacturers when designing, maintaining and repairing new and aging metallic components. Laser-Peening (LP) is a highly flexible and controllable surface treatment and relatively new to manufacturers of large civil aircraft which demonstrated that it can extend the fatigue and crack growth life in aluminium alloys by introducing deep compressive Residual Stresses (RS). Currently there is no application of LP to any components of large civil aircraft. The aim of this research was to demonstrate and explore different LP strategies that can produce significant extension of the fatigue and crack growth performance of aircraft fuselage structures using Laser-Peening. Two representative samples made from 2000 series aluminium alloy were designed to represent features of the fuselage: A Centre Cracked Tension (CCT) panel made of 1.6 mm thick 2524-T3 represented the fuselage skin. Single overlap Lap-Joints (LJ) of 2.5 mm thick 2024-T3 aluminium with titanium Hi-Lok bolts arrayed in 5 columns and 3 rows embodied longitudinal LJ of aircraft fuselages. Both test samples were laser-peened without protective coating (LPwC) using a range of LP strategies in which LP process parameters and spatial arrangements of laser-peened areas were systematically varied. RS fields were measured before fatigue testing under constant amplitude loading. RS measurements used Incremental Centre Hole Drilling (ICHD) and X-ray and Neutron diffraction techniques. Laser-peening produced peak compressive RS of 200 - 350 MPa and compression stress penetration depths between 700-1000 μm. These values are superior to RS profiles induced by Shot-Peening. The value of peak compression stress and penetration depth depends on LP process parameters and on the LP layout. The latter defines the location and size of the laser-peened areas. A study of the effect of different LP strategies to establish the most effective LP treatment to enhance crack growth life of fuselage skins was performed using a Finite Element based crack growth model. The model was first used to introduce balanced RS fields into a cracked CCT sample. The effective stress intensity factor range (ΔKeff) and effective R-ratios (Reff) were then calculated as the crack tip progressed through the sample. Subsequently, fatigue crack growth rates and lives were computed using Walker's empirical crack growth law. The accuracy of the model was demonstrated by comparison with crack growth test results from laser-peened CCT-samples. Results of the parameter study showed that an increase in the level of compression within the LPS increased life most significantly. Increased width of peen stripe increased the life while increasing the distance of the stripe from the starting position of the crack tip decreased the life. Four different LP strategies were applied to LJ samples. Subsequent fatigue testing demonstrated fatigue life improvements of between 1.14 to 3.54, depending on the LP strategy. The LP layout was identified as a key parameter determining the fatigue life. It was found that when small LP areas were used, to leave as much elastic material as possible between the peened areas, larger compressive stresses and minimised balancing tensile stresses were produced. Observations of fatigue fractures on joint samples showed that crack initiation occurred remote from the fastener holes, either in regions of fretting fatigue in peened areas or in regions of balancing tensile stress adjacent to peen boundaries. Optimum fatigue lives occurred when both fracture types occurred in the same sample. Striation spacing measurement and analysis showed that compressive residual stresses had little or no effect on fatigue growth rates at crack lengths < 600 µm. The majority of fatigue life extension was achieved during initiation and crack growth < 600 μm. The obtained results established evidence of how aircraft fuselage structures made of conventional 2000 series aluminium-copper alloys can be effectively laser-peened to produced fatigue life improvements and also of how to avoid any detrimental reductions in fatigue life which can also occur when LP is applied randomly. The generated research conclusions are applicable to other metals, geometries and components.

Published
2017

5. Management of renal replacement therapy among adults in French intensive care units

Author

Florian Jolly, Marine Jacquier, Delphine Pecqueur, Marie Labruyère, Christophe Vinsonneau, Isabelle Fournel, Jean-Pierre Quenot, Bruno Megarbane, Olivier Lesieur, Maxime Leloup, Nicolas Weiss, Fabienne Tamion, Pascal Beuret, Mehran Monchi, Claire Delcourte, Jan Hayon, Kada Klouche, Annabelle Stoclin, Sébastien Gibot, Vincent Peigne, Chaouki Mezher, Frédéric Martino, Maxime Nguyen, Khaldoun Kuteifan, Guillaume Louis, Guillaume Rigault, Michel Masuccio, Aude Garin, Pierre Asfar, Maude Andrieu, Johann Auchabie, Florence Daviet, Guillaume Lacave, Hotman Benhamida, Bérengère Vivet, Claire Chaignat, Maxime Desgrouas, Béatrice La-Combe, Fabienne Plouvier, Jean-Christophe Richard, Clément Haddadi, Dorian Czolnowski, Nicolas Lau, Frédéric Jacobs, Marina Thirion, Antoine Pons, Nicolas Pichon, René-Gilles Patrigeon, Antoine Vieillard-Baron, Fabrice Uhel, Jean-Philippe Rigaud, Yannis Bouhake, Dominique Zagozda, Romain Arrestier, Camille Vinclair, Anne-Laure Fedou, Auguste Dargent, Jean Dellamonica, Brice Rey, Alexandre Gachet, Mathieu Serie, Cédric Bruel, Antoine Troger, Vivien Berthoud, Agathe Delbove, Cyril Goulenok, Wulfran Bouguoin, David Osman, Nadia Anguel, Laurent Guerin, Camille Foucault, Sébastien Preau, Ouriel Saura, Yvonnick Boue, Nicholas Sedillot, Laetitia Covin, Fabien Lambiotte, Carole Guignon, Sophie Perinel-Ragey, Xavier Souloy, Cécile Defaux-Chevillard, Anne Renault, Nadège Mme-Ngapmen, Mercedes Jourdain, Thierry Van Der Linden, Clémentine Levy, François Thouy, Guillaume Degouy, and Center of Experimental and Molecular Medicine

Subjects
Bedside, Renal replacement therapy, Intensive care unit, Practice evaluation, Critical Care and Intensive Care Medicine, Acute kidney injury
Abstract

Background: This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs). Methods: From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit. Results: A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively. Conclusions: Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.

Published
2023

7. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3)

Author

Jean Reignier, Gaetan Plantefeve, Jean-Paul Mira, Laurent Argaud, Pierre Asfar, Nadia Aissaoui, Julio Badie, Nicolae-Vlad Botoc, Laurent Brisard, Hoang-Nam Bui, Delphine Chatellier, Louis Chauvelot, Alain Combes, Christophe Cracco, Michael Darmon, Vincent Das, Matthieu Debarre, Agathe Delbove, Jérôme Devaquet, Louis-Marie Dumont, Olivier Gontier, Samuel Groyer, Laurent Guérin, Bertrand Guidet, Yannick Hourmant, Samir Jaber, Fabien Lambiotte, Christophe Leroy, Philippe Letocart, Benjamin Madeux, Julien Maizel, Olivier Martinet, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Mai-Anh Nay, Saad Nseir, Johanna Oziel, Walter Picard, Gael Piton, Jean-Pierre Quenot, Florian Reizine, Anne Renault, Jack Richecoeur, Jean-Philippe Rigaud, Francis Schneider, Daniel Silva, Michel Sirodot, Bertrand Souweine, Fabienne Tamion, Nicolas Terzi, Didier Thévenin, Guillaume Thiery, Nathalie Thieulot-Rolin, Jean-Francois Timsit, Francois Tinturier, Patrice Tirot, Thierry Vanderlinden, Isabelle Vinatier, Christophe Vinsonneau, Sebastian Voicu, Jean-Baptiste Lascarrou, Amélie Le Gouge, Damien Contou, Olivier Pajot, Paul Jaubert, Nathalie Marin, Marie Simon, Martin Cour, Satar Mortaza, Vincent Souday, Marie Lemerle, Sylvain Malfroy, Fernando Berdaguer Ferrari, Bertrand Rozec, Didier Gruson, Charline Sazio, Suzanne Champion, Florence Boissier, Anne Veinstein, Loredana Baboi, Jean-Christophe Richard, Hodane Yonis, Loïc Le Guennec, Lucie Lefevre, Juliette Chommeloux, Guillaume Hékimian, Virginie Lemiale, Eric Mariotte, Sandrine Valade, Joanna Tirolien, Yannick Fedun, Charles Cerf, Guillaume Tachon, Jérôme Roustan, Sylvie Vimeux, Michel Bonnivard, Nadia Anguel, David Osman, Karim Asehnoune, Antoine Roquilly, Fouad Belafia, Matthieu Conseil, Moussa Cisse, Bouras Chaouki, Rémi Espenel, Christine Brasse, Sébastien Ena, Arnaud Delahaye, Jeremy Castanera, Thierry Dulac, Philippe Petua, Yoann Zerbib, Clément Brault, Djillali Annane, Rania Bounab, Nicholas Heming, Thierry Boulain, Sophie Jacquier, Grégoire Muller, Raphael Favory, Sébastien Préau, Julien Poissy, Alexandre Massri, Floriane Lissonde, Hadrien Winiszewski, Thibault Vieille, Marine Jacquier, Marie Labruyère, Pascal Andreu, Jean-Marc Tadié, Laetitia Bodenes, Danièle Combaux, David Luis, Antoine Marchalot, Jean-Etienne Herbrecht, Raphaël Clere-Jehl, David Schnell, Jérôme Aboad, David Bougon, Etienne Escudier, Elisabeth Coupez, Claire Dupuis, Zoe Demailly, Louis-Marie Galerneau, Jonathan Chelly, Franck Pourcine, Ly Van Vong, Sonia Abid, Etienne De Montmollin, Romain Sonneville, Christophe Guitton, Nicolas Chudeau, Mickaël Landais, Vincent Pages, Caroline Séjourné, Imen Rahmani, Ghada Sbouj, Bruno Megarbane, Nicolas Deye, Isabelle Malissin, Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Nantes Université - UFR des Sciences et Techniques des Activités Physiques et Sportives (Nantes Univ - UFR STAPS), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier Argenteuil (CH Argenteuil), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), 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), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), CH de Saint-Malo [Broussais], Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Service de Réanimation Médicale [CHU Bordeaux], CHU Bordeaux [Bordeaux]-Hôpital Pellegrin, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital de la Croix-Rousse [CHU - HCL], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier d'Angoulême (CH Angoulême), Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Intercommunal André Grégoire [Montreuil] (CHI André Gregoire), Centre hospitalier Saint-Brieuc, Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Hôpital Foch [Suresnes], Hôpital Louis Mourier - AP-HP [Colombes], Hôpitaux de Chartres [Chartres], Centre hospitalier de Montauban (CH Montauban), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Pharmacoépidémiologie et évaluation des soins [iPLesp] (PEPITES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre hospitalier [Valenciennes, Nord], Centre Hospitalier Emile Roux [AP-HP], Hôpital Jacques Puel - Bourran [Rodez] (HJPB), Centre Hospitalier de Bigorre [Tarbes], CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Unité de Soins Intensifs [CHU La Réunion], Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Hôpital Raymond Poincaré [Garches], Infection et inflammation (2I), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche sur l'interculturalité et la circulation médiatique des savoirs (CRICS (EA_3965)), Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional d'Orléans (CHRO), CHU Lille, Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Hôpital Avicenne [AP-HP], Centre hospitalier de Pau, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer (LabEx LipSTIC), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro Dijon, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Université de Montpellier (UM), Département d'épidémiologie, biostatistique et recherche clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Université de Bourgogne (UB), Centre Hospitalier Universitaire [Rennes], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Centre Hospitalier de Beauvais, Centre hospitalier de Dieppe, Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Delafontaine, Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Hypoxie et PhysioPathologie (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier de Lens, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre Hospitalier Le Mans (CH Le Mans), Institut Catholique de Lille (ICL), Université catholique de Lille (UCL), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), and French Ministry of Health.

Subjects
Pulmonary and Respiratory Medicine, [SDV]Life Sciences [q-bio]
Abstract

Also written with the NUTRIREA-3 Trial Investigators and the Clinical Research in Intensive Care and Sepsis (CRICS-TRIGGERSEP) Group; International audience; BackgroundThe optimal calorie and protein intakes at the acute phase of severe critical illness remain unknown. We hypothesised that early calorie and protein restriction improved outcomes in these patients, compared with standard calorie and protein targets.MethodsThe pragmatic, randomised, controlled, multicentre, open-label, parallel-group NUTRIREA-3 trial was performed in 61 French intensive care units (ICUs). Adults (≥18 years) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned to early nutrition (started within 24 h after intubation) with either low or standard calorie and protein targets (6 kcal/kg per day and 0·2–0·4 g/kg per day protein vs 25 kcal/kg per day and 1·0–1·3 g/kg per day protein) during the first 7 ICU days. The two primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality. Key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction. The trial is registered on ClinicalTrials.gov, NCT03573739, and is completed.FindingsOf 3044 patients randomly assigned between July 5, 2018, and 8 Dec 8, 2020, eight withdrew consent to participation. By day 90, 628 (41·3%) of 1521 patients in the low group and 648 (42·8%) of 1515 patients in the standard group had died (absolute difference –1·5%, 95% CI –5·0 to 2·0; p=0·41). Median time to readiness for ICU discharge was 8·0 days (IQR 5·0–14·0) in the low group and 9·0 days (5·0–17·0) in the standard group (hazard ratio [HR] 1·12, 95% CI 1·02 to 1·22; p=0·015). Proportions of patients with secondary infections did not differ between the groups (HR 0·85, 0·71 to 1·01; p=0·06). The low group had lower proportions of patients with vomiting (HR 0·77, 0·67 to 0·89; p

Published
2023
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10. Effects of Laser Shock Peening on Surface Roughness and Residual Stress of AA 7050-T7451

Author

Michele Angelo Attolico, Claudia Barile, Caterina Casavola, Vincenzo Moramarco, Domenico Furfari, and David Osman Busse

Subjects
x-ray diffraction, Mechanics of Materials, Mechanical Engineering, AA 7050-T7451, surface roughness, laser shock peening, AA 7050-T7451, hole drilling method, laser shock peening, residual stress, surface roughness, x-ray diffraction, General Materials Science, residual stress, hole drilling method
Abstract

Surface treatment techniques such as laser shock peening (LSP) represent a consolidated strategy to induce the presence of compressive residual stresses beneath the surface of various metallic alloys. However, surface roughening caused by the process must be monitored, since it may negatively affect fatigue life, resulting in earlier crack initiation. For this reason, the interplay between the key factors affecting both the surface roughness and the development of residual stresses was experimentally examined. The surface roughness was assessed through the determination of roughness average and roughness total height values, whereas residual stresses were assessed using the x-ray diffraction technique and hole drilling method to obtain information about the stress status of the components. Higher values of laser power density resulted in higher values of maximum compressive stress both along scanning and stepping direction and residual stresses remained approximately constant up to a depth of about 0.7-0.8 mm beneath the treated surface. No substantial difference was observed between the residual stress components in the two main LSP directions. Moreover, it was found that the approach to use lower values of nominal power density together with a higher number of layers allows obtaining the same stress condition determined by the use of the highest value of nominal power density but a significantly lower impact on the surface roughness.

Published
2022

12. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

Author

Suzanne Goursaud, Antoine Ausseur, Jérémie Lemarié, Philippe Michel, Gaël Piton, Maximilien Grall, Emmanuelle Mercier, Fabien Lambiotte, Arnaud-Félix Miailhe, Saad Nseir, Nicholas Sedillot, Philippe Guiot, Aurélie Le Thuaut, Maud Jonas, Sébastien Moschietto, Julien Charpentier, Leptorea, Aurelie Gaultier, Jean-Baptiste Lascarrou, Christophe Cracco, Pierre Asfar, Karim Chaoui, Lara Zafrani, Claire Lhommet, Adel Maamar, Nicolas de Prost, Jean Reignier, Marie-Line Eustache, Yoann Zerbib, Michel Sirodot, Laurent Argaud, Jean-Claude Lacherade, Yannick Monseau, Alexis Ferré, Olivier Lesieur, Pascale Bourhy, Vlad Botoc, Jérôme Pillot, Didier Thevenin, Mickael Landais, Adel Ben Salah, David Osman, Elena Gauvin, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service de Réanimation Médicale, CHU d'Angers, France, 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)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Cholet (CHC), Hôpitaux de Chartres [Chartres], Service de réanimation (CH Saint-Malo), Centre hospitalier de Saint-Malo, Centre Hospitalier Cahors, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier d'Angoulême (CH Angoulême), Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre Hospitalier de Versailles André Mignot (CHV), Centre Hospitalier Georges Renon [Niort] (CH Georges Renon Niort), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre Hospitalier de Mulhouse, site du Hasenrain (Mulhouse), Centre hospitalier de Saint-Nazaire, Centre hospitalier [Valenciennes, Nord], Centre Hospitalier Le Mans (CH Le Mans), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier de La Rochelle (CHR), CHU de Saint-Brieuc, Centre Hospitalier René Dubos [Pontoise], Hopital de Périgueux (CH Périgueux), Hopital de Périgueux, Centre Hospitalier Henri Duffaut (Avignon), 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), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier de la Côte Basque (CHCB), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Fleyriat [Bourg en Bresse], Centre Hospitalier d'Annecy, Centre hospitalier d'Annecy, Centre Hospitalier de Lens, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), CHU Amiens-Picardie, Biologie des Spirochètes / Biology of Spirochetes, Institut Pasteur [Paris] (IP), Centre hospitalier de Cahors, Le CHCB, Centre Hospitalier de la Côte Basque, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPC), Institut Pasteur [Paris], Centre Hospitalier Départemental Vendée, Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP)

Subjects
Adult, Male, medicine.medical_specialty, Severe leptospirosis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Multiple Organ Failure, Population, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Risk Factors, Anesthesiology, medicine, Humans, Leptospirosis, Renal replacement therapy, Temperate zone, Hospital Mortality, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Intensive care unit, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, 3. Good health, Intensive Care Units, 030228 respiratory system, Emergency medicine, Outcome, SOFA score, Female, France, business, Mortality
Abstract

International audience; Purpose: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.Methods: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes.Results: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations.Conclusions: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.

Published
2019
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14. Optimised laser peening strategies for damage tolerant aircraft structures

Author

Philip E. Irving, David Osman Busse, Supriyo Ganguly, and Domenico Furfari

Subjects
Materials science, Laser peening, chemistry.chemical_element, 02 engineering and technology, Fatigue crack growth, Industrial and Manufacturing Engineering, Superposition principle, Acceleration, 0203 mechanical engineering, Residual stress, Aluminium, Modified superposition, Residual stress field, General Materials Science, business.industry, Mechanical Engineering, Structural engineering, Paris' law, 021001 nanoscience & nanotechnology, Damage tolerance design, 020303 mechanical engineering & transports, chemistry, Mechanics of Materials, Modeling and Simulation, 0210 nano-technology, business
Abstract

Simulation models were constructed to explore the influence of compressive residual stress on fatigue crack growth rates in aluminium sheet. Balanced residual stress fields resulting from imposition of compressive stresses in laser peen patches were calculated. Growth rates of cracks approaching, traversing and propagating away from peen patches were calculated using modified superposition models. Effects of patch dimensions and position on residual stress fields, growth rates and life were investigated. Overall life varied widely depending on the balance between retardation and acceleration; many peen arrangements had little or no life benefit. Implications of the results for damage tolerant design are discussed.

Published
2020
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15. Épuration extrarénale en réanimation adulte et pédiatrique. Recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF), avec la participation de la Société française d’anesthésie-réanimation (Sfar), du Groupe francophone de réanimation et urgences pédiatriques (GFRUP) et de la Société francophone de dialyse (SFD)

Author

Christophe Vinsonneau, Groupe d’experts, David Osman, and Ly Van Phach Vong

Subjects
business.industry, Emergency Medicine, Medicine, Emergency Nursing, business, Humanities
Published
2014
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16. Drug-induced coma after chemotherapy in intensive care unit: How to make the right diagnosis?

Author

Lysiane Marthey, Alice Boilève, Mathieu Jozwiak, David Osman, and Franck Carbonnel

Subjects
medicine.medical_specialty, Chemotherapy, business.industry, medicine.medical_treatment, Encephalopathy, Hyperammonemia, medicine.disease, Intensive care unit, law.invention, Drug-induced coma, 03 medical and health sciences, 0302 clinical medicine, Neurology, law, 030220 oncology & carcinogenesis, Medicine, Neurology (clinical), business, Intensive care medicine, 030217 neurology & neurosurgery
Published
2018
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17. Growth-Arrest-Specific 6 (GAS6) Protein in ARDS Patients: Determination of Plasma Levels and Influence of PEEP Setting

Author

Christophe Faisy, Ania Nieszkowska, Laurent Brochard, Jack Richecoeur, David Osman, Alain Mercat, Jean-Christophe M. Richard, Jean-Luc Diehl, Mustapha Sebbane, Claude Gervais, Gwenaël Prat, Emmanuel Guerot, Nathalie Coolen, and Delphine Borgel

Subjects
Male, Pulmonary and Respiratory Medicine, Vitamin, medicine.medical_specialty, ARDS, Population, Enzyme-Linked Immunosorbent Assay, Critical Care and Intensive Care Medicine, Gastroenterology, Positive-Pressure Respiration, chemistry.chemical_compound, Internal medicine, medicine, Humans, Prospective Studies, Simplified Acute Physiology Score, education, Pathological, Respiratory Distress Syndrome, education.field_of_study, Ventilators, Mechanical, GAS6, business.industry, Organ dysfunction, General Medicine, Middle Aged, Prognosis, medicine.disease, Vascular endothelial growth factor, chemistry, Immunology, Intercellular Signaling Peptides and Proteins, Female, medicine.symptom, business, Biomarkers, Follow-Up Studies
Abstract

BACKGROUND: Growth-arrest-specific protein 6 (GAS6) is a vitamin K-dependent protein expressed by endothelial cells and leukocytes participating in cell survival, migration and proliferation and involved in many pathological situations. The aim of our study was to assess its implication in ARDS and its variation according to PEEP setting, considering that different cyclic stresses could alter GAS6 plasma levels. METHODS: Our subjects were enrolled in the ExPress study comparing a minimal alveolar distention (low-PEEP) ventilatory strategy to a maximal alveolar recruitment (high-PEEP) strategy in ARDS. Plasma GAS6, interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) levels were measured at day 0 and day 3 by enzyme-linked immunosorbent assay in blood samples prospectively collected during the study for a subset of 52 subjects included in 8 centers during year 2005. RESULTS: We found that GAS6 plasma level was elevated in the whole population at day 0: median 106 ng/mL IQR 77–139 ng/mL, with significant correlations with IL-8, the Simplified Acute Physiology Score II and the Organ Dysfunction and Infection scores. Statistically significant decreases in GAS6 and IL-8 plasma levels were observed between day 0 and day 3 in the high-PEEP group (P = .02); while there were no differences between day 0 and day 3 in the low-PEEP group. CONCLUSIONS: GAS6 plasma level is elevated in ARDS patients. The high-PEEP strategy is associated with a decrease in GAS6 and IL-8 plasma levels at day 3, without significant differences in day 28 mortality between the 2 groups. (Clinicaltrials.gov NCT00188058).

Published
2013
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18. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome*

Author

Christian Richard, Romain Persichini, Xavier Monnet, Stein Silva, Jean L. Teboul, Nadia Anguel, Mathieu Jozwiak, and David Osman

Subjects
Male, medicine.medical_specialty, Prognostic factor, Thermodilution, Acute respiratory distress, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Severity of Illness Index, Capillary Permeability, Positive-Pressure Respiration, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, In patient, Lactic Acid, Intensive care medicine, Diffuse alveolar damage, Lung, Retrospective Studies, Respiratory Distress Syndrome, business.industry, Middle Aged, respiratory system, Prognosis, Extravascular lung water index, Oxygen, Pulmonary vascular permeability, Intensive Care Units, Lung water, ROC Curve, Extravascular Lung Water, Multivariate Analysis, Cardiology, Female, business
Abstract

Acute respiratory distress syndrome might be associated with an increase in extravascular lung water index and pulmonary vascular permeability index, which can be measured by transpulmonary thermodilution. We tested whether extravascular lung water index and pulmonary vascular permeability index are independent prognostic factors in patients with acute respiratory distress syndrome.Retrospective study.Medical intensive care unit.Two hundred consecutive acute respiratory distress syndrome patients (age = 57 ± 17, Simplified Acute Physiology Score II = 57 ± 20, overall day-28 mortality = 54%).Extravascular lung water index and pulmonary vascular permeability index were collected (PiCCO device, Pulsion Medical Systems) at each day of the acute respiratory distress syndrome episode.The maximum values of extravascular lung water index and pulmonary vascular permeability index recorded during the acute respiratory distress syndrome episode (maximum value of extravascular lung water index and maximum value of pulmonary vascular permeability index, respectively) were significantly higher in nonsurvivors than in survivors at day-28 (mean ± SD: 24 ± 10 mL/kg vs. 19 ± 7 mL/kg of predicted body weight, p0.001 [t-test] for maximum value of extravascular lung water index and median [interquartile range]: 4.4 [3.3-6.1] vs. 3.5 [2.8-4.4], p = 0.001 for maximum value of pulmonary vascular permeability index, Wilcoxon's test). In multivariate analyses, maximum value of extravascular lung water index or maximum value of pulmonary vascular permeability index, Simplified Acute Physiology Score II, maximum blood lactate, mean positive end-expiratory pressure, mean cumulative fluid balance, and the minimal ratio of arterial oxygen pressure over the inspired oxygen fraction were all independently associated with day-28 mortality. A maximum value of extravascular lung water index21 mL/kg predicted day-28 mortality with a sensitivity of (mean [95% confidence interval]) 54% (44-63)% and a specificity of 73% (63-82)%. The mortality rate was 70% in patients with a maximum value of extravascular lung water index21 mL/kg and 43% in the remaining patients (p = 0.0003). A maximum value of pulmonary vascular permeability index3.8 predicted day-28 mortality with a sensitivity of (mean [95% confidence interval]) 67% (57-76)% and a specificity of 65% (54-75)%. The mortality rate was 69% in patients with a maximum value of pulmonary vascular permeability index3.8 and 37% in the group with a maximum value of pulmonary vascular permeability index ≤ 3.8 (p0.0001).Extravascular lung water index and pulmonary vascular permeability index measured by transpulmonary thermodilution are independent risk factors of day-28 mortality in patients with acute respiratory distress syndrome.

Published
2013
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19. Prise en charge par le réanimateur des hémorragies digestives de l’adulte et de l’enfant

Author

David Osman, Groupe d’experts, D. Da Silva, Michel Djibré, and Cyril Goulenok

Subjects
media_common.quotation_subject, Emergency Medicine, Art, Emergency Nursing, Humanities, media_common
Abstract

Groupe d’experts : Marc Bardou (Dijon), Sophie Branchereau (Le Kremlin‐Bicetre), Christophe Bureau (Toulouse), Nicolas Carbonell (Paris), Philippe Cluzel (Paris), Emmanuel Guerot (Paris), Pierre‐Francois Laterre (Bruxelles), Gilles Lesur (Boulogne), Emmanuel Mas (Toulouse), Eric Maury (Paris), Stephane Nahon (Montfermeil), Philippe Otal (Toulouse), Dominique Pateron (Paris), Gael Piton (Besancon), Jean‐Pierre Quenot (Dijon), Marika Rudler (Paris), Dominique Thabut (Paris), Pierre Tissieres (Le Kremlin‐Bicetre), Patrice Valleur (Paris).

Published
2012
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20. Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine*

Author

Denis Chemla, Jean-Louis Teboul, Christian Richard, Alexia Letierce, Olfa Hamzaoui, David Osman, Xavier Monnet, and Nadia Anguel

Subjects
Adult, Male, medicine.medical_specialty, Cardiac output, Hemodynamics, Blood Pressure, Critical Care and Intensive Care Medicine, Cohort Studies, Norepinephrine (medication), Norepinephrine, Predictive Value of Tests, Internal medicine, Volume expansion, Intensive care, Outcome Assessment, Health Care, Humans, Vasoconstrictor Agents, Medicine, Cardiac Output, Aged, Arterial pulse pressure, business.industry, Shock, Middle Aged, Pulse pressure, Blood pressure, Anesthesia, Circulatory system, Cardiology, Female, business, Fluid challenge, medicine.drug
Abstract

To evaluate to which extent the systemic arterial pulse pressure could be used as a surrogate of cardiac output for assessing the effects of a fluid challenge and of norepinephrine.Observational study.Medical intensive care unit.Patients with an acute circulatory failure who received a fluid challenge (228 patients, group 1) or in whom norepinephrine was introduced or increased (145 patients, group 2).We measured the systolic, diastolic, and mean arterial pressure, pulse pressure, and the transpulmonary thermodilution cardiac output before and after the therapeutic interventions.In group 1, the fluid challenge significantly increased cardiac output by 24% ± 25%. It significantly increased cardiac output by ≥15% (+35% ± 27%) in 142 patients ("responders"). The fluid-induced changes in cardiac output were correlated with the changes in pulse pressure (r = .56, p.0001), systolic arterial pressure (r = .55, p.0001), diastolic arterial pressure (r = .37, p.0001), and mean arterial pressure (r = .52, p.0001). At multivariate analysis, changes in pulse pressure were significantly related to changes in stroke volume (multiple r = .52) and to age (r = .12). A fluid-induced increase in pulse pressure of ≥17% allowed detecting a fluid-induced increase in cardiac output of ≥15% with a sensitivity of 65[56-72]% and a specificity of 85[76-92]%. The area under the receiver operating characteristic curves for the fluid-induced changes in mean arterial pressure and in diastolic arterial pressure was significantly lower than for pulse pressure. In group 2, the introduction/increase of norepinephrine significantly increased cardiac output by 14% ± 18%. The changes in cardiac output induced by the introduction/increase in the dose of norepinephrine were correlated with the changes in pulse pressure and systolic arterial pressure (r = .21 and .29, respectively, p = .001) but to a significantly lesser extent than in group 1.Pulse pressure and systolic arterial pressure could be used for detecting the fluid-induced changes in cardiac output, in spite of a significant proportion of false-negative cases. By contrast, the changes in pulse pressure and systolic arterial pressure were unable to detect the changes in cardiac output induced by norepinephrine.

Published
2011
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21. Urgences-Réanimation-Anesthésie

Author

David Osman, Marie-Pierre Bonnet, Koceila Bouferrache, Julien Josserand, Pierre GONDRAN, David MONTANI, Gabriel PERLEMUTER, Léon PERLEMUTER, David Osman, Marie-Pierre Bonnet, Koceila Bouferrache, Julien Josserand, Pierre GONDRAN, David MONTANI, Gabriel PERLEMUTER, and Léon PERLEMUTER

Subjects
Anesthesia, Artificial respiration, Emergency medicine
Abstract

Cet ouvrage de cours synthétique traite l'ensemble des items d'urgences-réanimation et d'anesthésie du programme de DCEM/DFASM. Cette troisième édition reste fidèle à l'esprit des précédentes éditions qui lui ont valu son succès : chaque chapitre, consacré à un item, est rédigé suivant un plan identique, original, clair et très didactique qui facilite l'apprentissage. Cette troisième édition comporte une complète mise à jour en parfaite conformité avec le programme de DFASM, avec l'intégration des conférences de consensus, des référentiels et des recommandations officielles les plus récentes des société savantes. De nombreux flashcodes renvoient directement aux recommandations et aux conférences de consensus de la HAS citées ou commentées. Chaque item comportant le nouveau numéro et l'ancien numéro du programme, comprend les éléments systématiques suivants, mis à jour et enrichis : - les conférences de consensus, d'experts et les recommandations existantes ; - des schémas, des algorithmes et de l'iconographie ; - des encadrés sur les notions importantes ; - des repères permettant d'identifier les sujets déjà tombés au concours de l'internat et aux ECN depuis 1995, clairement indiqués en regard du thème tombé avec leur date et un court résumé des Annales ; - des renvois transversaux vers les autres items du programme (intra- et interdisciplinaires) ; - les « zéros » aux questions ; - une « Fiche dernier tour » qui propose un résumé de l'item pour une révision complète et rapide de celui-ci. Cette nouvelle édition propose pour chaque chapitre une série de QCM corrigés.Cet ouvrage de cours synthétique traite l'ensemble des items d'urgences-réanimation et d'anesthésie figurant au programme du DCEM. Dans chaque item, les conférences de consensus sont mises en avant, ainsi que les sujets déjà tombés au concours de l'internat et aux ECN, les renvois transversaux et les zéros aux questions. En fin de chaque item, une fiche'Dernier tour'résume les points essentiels à connaître pour les ECN.

Published
2014

22. Measuring aortic diameter improves accuracy of esophageal Doppler in assessing fluid responsiveness

Author

Michael R. Pinsky, Xavier Monnet, Christian Richard, Nadia Anguel, David Osman, Denis Chemla, and Jean-Louis Teboul

Subjects
Male, Cardiac output, Mean arterial pressure, Plasma Substitutes, Hemodynamics, Aorta, Thoracic, Critical Care and Intensive Care Medicine, Esophagus, Intensive care, medicine.artery, medicine, Humans, Prospective Studies, Aorta, business.industry, Reproducibility of Results, Ultrasonography, Doppler, Blood flow, Middle Aged, medicine.anatomical_structure, Blood pressure, Regional Blood Flow, Anesthesia, Female, business, Artery
Abstract

OBJECTIVE: Fluid responsiveness requires the accurate measurement of cardiac output that can be approached by aortic blood flow (ABF) as measured by esophageal Doppler monitoring (EDM). EDM devices may either include an echo-determination of aortic diameter or estimate aortic diameter from nomograms and thus consider it as constant. However, it is unclear if measuring aortic diameter increases the accuracy of EDM to identify fluid responsiveness. Aortic diameter varies with arterial pressure such that its measure could be essential for assessing the changes in ABF during acute circulatory failure. We attempted to demonstrate that measuring aortic diameter improved the accuracy of EDM to assess fluid responsiveness. DESIGN: Prospective study. SETTING: University hospital intensive care unit. PATIENTS: Seventy-six patients with acute circulatory failure in whom a fluid challenge was given. INTERVENTIONS: Rapid volume expansion (500 mL of NaCl 0.9%). MEASUREMENTS AND MAIN RESULTS: We measured aortic velocity and area by EDM before and after fluid loading and evaluated the effects of fluid challenge on ABF, either measured after fluid infusion (measured ABF ) or estimated assuming an unchanging aortic area (estimated ABF ). If measured ABF was used for assessing fluid response, it was increased above 15% compared with ABF at baseline in 41 patients (responders). Conversely, estimated ABF increased above 15% from ABF at baseline in 27 patients only; that is, the effects of the challenge were underestimated in 14 patients. In these 14 patients, the relative change in mean arterial pressure during volume expansion was of greater magnitude than in patients who were classified as nonresponders by considering measured ABF . CONCLUSIONS: Monitoring the changes in aortic diameter improves the accuracy of EDM in assessing the hemodynamic effects of a fluid challenge, especially if it induces a large increase in arterial pressure. Estimating rather than measuring the aortic diameter may lead to underestimation of fluid responsiveness. Copyright © 2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. after after after after after

Published
2007
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23. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS

Author

Nadia Anguel, Olfa Hamzaoui, Christian Richard, David Osman, Jean-Louis Teboul, and Xavier Monnet

Subjects
Male, ARDS, Thermodilution, Hydrostatic pressure, Pulmonary Edema, Blood volume, Vascular permeability, Critical Care and Intensive Care Medicine, Capillary Permeability, Diagnosis, Differential, Intensive care, Hydrostatic Pressure, Humans, Medicine, Retrospective Studies, Respiratory Distress Syndrome, medicine.diagnostic_test, business.industry, Respiratory disease, Reproducibility of Results, Middle Aged, Pulmonary edema, medicine.disease, Respiration, Artificial, respiratory tract diseases, ROC Curve, Anesthesia, Extravascular Lung Water, Female, business, Chest radiograph
Abstract

To test whether assessing pulmonary permeability by transpulmonary thermodilution enables to differentiate increased permeability pulmonary edema (ALI/ARDS) from hydrostatic pulmonary edema. Retrospective review of cases. A 24-bed medical intensive care unit of a university hospital. Forty-eight critically ill patients ventilated for acute respiratory failure with bilateral infiltrates on chest radiograph, a PaO2/FiO2 ratio

Published
2007
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24. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge*

Author

Christian Richard, Jean-Louis Teboul, Christophe Ridel, Nadia Anguel, David Osman, Xavier Monnet, and Patrick Ray

Subjects
Male, Resuscitation, Central Venous Pressure, Critical Care, Plasma Substitutes, Critical Care and Intensive Care Medicine, Hydroxyethyl Starch Derivatives, Predictive Value of Tests, Sepsis, Intensive care, Humans, Medicine, Pulmonary Wedge Pressure, Artery occlusion, Infusions, Intravenous, Pulmonary wedge pressure, Aged, Monitoring, Physiologic, Retrospective Studies, business.industry, Patient Selection, Central venous pressure, Stroke Volume, Stroke volume, Middle Aged, Respiration, Artificial, Treatment Outcome, Blood pressure, ROC Curve, Shock (circulatory), Anesthesia, Practice Guidelines as Topic, Linear Models, Fluid Therapy, Female, medicine.symptom, business
Abstract

Values of central venous pressure of 8-12 mm Hg and of pulmonary artery occlusion pressure of 12-15 mm Hg have been proposed as volume resuscitation targets in recent international guidelines on management of severe sepsis. By analyzing a large number of volume challenges, our aim was to test the significance of the recommended target values in terms of prediction of volume responsiveness.Retrospective study.A 24-bed medical intensive care unit.All consecutive septic patients monitored with a pulmonary artery catheter who underwent a volume challenge between 2001 and 2004.None.A total of 150 volume challenges in 96 patients were reviewed. In 65 instances, the volume challenge resulted in an increase in cardiac index ofor =15% (responders). The pre-infusion central venous pressure was similar in responders and nonresponders (8 +/- 4 vs. 9 +/- 4 mm Hg). The pre-infusion pulmonary artery occlusion pressure was slightly lower in responders (10 +/- 4 vs. 11 +/- 4 mm Hg, p.05). However, the significance of pulmonary artery occlusion pressure to predict fluid responsiveness was poor and similar to that of central venous pressure, as indicated by low values of areas under the receiver operating characteristic curves (0.58 and 0.63, respectively). A central venous pressure of8 mm Hg and a pulmonary artery occlusion pressure of12 mm Hg predicted volume responsiveness with a positive predictive value of only 47% and 54%, respectively. With the knowledge of a low stroke volume index (30 mL.m), their positive predictive values were still unsatisfactory: 61% and 69%, respectively. When the combination of central venous pressure and pulmonary artery occlusion pressure was considered instead of either pressure alone, the degree of prediction of volume responsiveness was not improved.Our study demonstrates that cardiac filling pressures are poor predictors of fluid responsiveness in septic patients. Therefore, their use as targets for volume resuscitation must be discouraged, at least after the early phase of sepsis has concluded.

Published
2007
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25. Renal replacement therapy in adult and pediatric intensive care: Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD)

Author

Emma Allain-Launay, Lionel Velly, Damien Ducheyron, David Osman, Patrick Vaillant, Christophe Ridel, Annie Lahoche, Etienne Javouhey, Michael Darmon, Christophe Vinsonneau, Ly Van Phach Vong, Matthieu Legrand, Clarisse Blayau, Serge Letacon, T. Gaillot, Patrick M. Honore, René Robert, Frédérique Schortgen, Thierry Krummel, Bertrand Souweine, Mehran Monchi, Centre hospitalier Marc Jacquet (Melun), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Pontchaillou [Rennes], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR T9405), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), CHU Marseille, Inserm U925, équipe avenir, Développement normal et pathologique des lymphocytes et signalisation, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Immunité et cancer (U932), Université Paris Descartes - Paris 5 (UPD5)-Institut Curie-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Institut Curie-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, INSERM U955, équipe 13, Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Supporting clinical sciences, Internal Medicine Specializations, Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ), Biomarqueurs CArdioNeuroVASCulaires ( BioCANVAS ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université de Picardie Jules Verne ( UPJV ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Picardie Jules Verne ( UPJV ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Immunité et cancer ( U932 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut Curie-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut Curie-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT ), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10, Laboratoire Microorganismes : Génome et Environnement ( LMGE ), and Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Université d'Auvergne - Clermont-Ferrand I ( UdA ) -Centre National de la Recherche Scientifique ( CNRS )

Subjects
medicine.medical_specialty, Continuous renal replacement therapy, Kidney Disease, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Clinical Sciences, 030232 urology & nephrology, Renal and urogenital, Review, 030204 cardiovascular system & hematology, Recommendations, Critical Care and Intensive Care Medicine, urologic and male genital diseases, Peritoneal dialysis, 03 medical and health sciences, Anticoagulation, 0302 clinical medicine, Intensive care, Anesthesiology, medicine, Renal replacement therapy, Intensive care medicine, Dialysis, Medicine(all), [ SDV ] Life Sciences [q-bio], business.industry, Dialysis dose, Dialysis catheter, 3. Good health, Renal Replacement Therapy, Catheter, Anesthesia, Hemodialysis, Emergency medicine, recommendations, Public Health and Health Services, business, Citrate
Abstract

International audience; Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice

Published
2015
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26. Predicting fatigue crack growth emanating from cold-expanded holes

Author

Lazzeri, Luigi, Furfari, Domenico, Qiang, Fu, Wetzel, Anja, Biasizzo, Mauro Bruno, and Busse, David Osman

Subjects
fatigue crack growth, cold expansion, fatigue crack growth, residual stress, cold expansion, corner crack, corner crack, residual stress
Published
2015

27. Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients

Author

Jean-Louis Teboul, Christian Richard, Nadia Anguel, Mario Rienzo, Michael R. Pinsky, David Osman, and Xavier Monnet

Subjects
medicine.medical_specialty, Resuscitation, business.industry, Blood flow, Critical Care and Intensive Care Medicine, Surgery, Blood pressure, Internal medicine, Intensive care, Heart rate, medicine, Cardiology, Breathing, Sinus rhythm, Respiratory system, business
Abstract

To test whether fluid responsiveness can be predicted by the respiratory variation in aortic blood flow and/or the flow time corrected for heart rate monitored with esophageal Doppler. Prospective study in a 24-bed medical intensive care unit of a university hospital. 38 mechanically ventilated patients with sinus rhythm and without spontaneous breathing activity in whom volume expansion was planned. The aortic blood flow was measured using an esophageal Doppler monitoring device before and after fluid infusion (500 ml NaCl 0.9% over 10 min). The variation in aortic blood flow over a respiratory cycle between its minimal and maximal values was calculated. The flow time was also measured. Aortic blood flow increased by at least 15% after volume expansion in 20 patients (defined as responders). Before fluid infusion the respiratory variation in aortic flow was higher in responders than in nonresponders (28±12% vs. 12±5%). It significantly decreased after volume expansion (18±11%) in responders only. A respiratory variation in aortic flow before volume expansion of at least 18% predicted fluid responsiveness with a sensitivity of 90% and a specificity of 94%. Flow time increased with fluid infusion in responders and nonresponders. A flow time corrected for heart rate below 277 ms predicted fluid responsiveness with a sensitivity of 55% and a specificity of 94%. The area under the ROC curve generated for variation in aortic blood flow ABF was greater than that generated for flow time. The respiratory variation in aortic blood flow reliably predicts fluid responsiveness in patients with sinus rhythm and without breathing activity.

Published
2005
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28. Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference

Author

Anne-Claire Lukaszewicz, Laurent Argaud, Hervé Mal, Dominique Fletcher, Fabienne Tamion, Eric Maury, Laurence Donetti, Muriel Fartoukh, David Osman, Khaldoun Kuteifan, Jean-Marc Dejode, Christian Richard, Jean-Christophe Richard, Thierry Boulain, Laetitia Contentin, Alice Blet, Sigismond Lasocki, Hervé Outin, Jean-Michel Liet, Agnès Dechartres, Francis Schneider, 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), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Institut National de la Recherche Agronomique (INRA)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Review, Critical Care and Intensive Care Medicine, Extracorporeal, Extracorporeal life support, law.invention, Hypoxemia, Randomized controlled trial, law, Anesthesiology, Extracorporeal membrane oxygenation, Medicine, Intensive care medicine, Mechanical ventilation, Acute respiratory distress syndrome, business.industry, Extracorporeal CO2 removal, 3. Good health, Life support, Observational study, medicine.symptom, business, Protective ventilation
Abstract

International audience; The influenza H1N1 epidemics in 2009 led a substantial number of people to develop severe acute respiratory distress syndrome and refractory hypoxemia. In these patients, extracorporeal membrane oxygenation was used as rescue oxygenation therapy. Several randomized clinical trials and observational studies suggested that extracorporeal membrane oxygenation associated with protective mechanical ventilation could improve outcome, but its efficacy remains uncertain. Organized by the Societe de Reanimation de Langue Francaise (SRLF) in conjunction with the Societe Francaise d'Anesthesie et de Reanimation (SFAR), the Societe de Pneumologie de Langue Francaise (SPLF), the Groupe Francophone de Reanimation et d'Urgences Pediatriques (GFRUP), the Societe Francaise de Perfusion (SOFRAPERF), the Societe Francaise de Chirurgie Thoracique et Cardiovasculaire (SFCTV) et the Sociedad Espanola de Medecina Intensiva Critica y Unidades Coronarias (SEMICYUC), a Consensus Conference was held in December 2013 and a jury of 13 members wrote 65 recommendations to answer the five following questions regarding the place of extracorporeal life support for patients with acute respiratory distress syndrome: 1) What are the available techniques?; 2) Which patients could benefit from extracorporeal life support?; 3) How to perform extracorporeal life support?; 4) How and when to stop extracorporeal life support?; 5) Which organization should be recommended? To write the recommendations, evidence-based medicine (GRADE method), expert panel opinions, and shared decisions taken by all the thirteen members of the jury of the Consensus Conference were taken into account.

Published
2014
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29. Volume Overload in Children

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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30. Ventilator Associated

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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31. Vasoactive Therapy

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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32. Viral Hemorrhagic Fever

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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33. Vascular, Intimal Flap

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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34. Ventricular Catheter

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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35. VAP

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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36. Vitamin K Antagonists

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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37. Vascular, Spasm

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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38. Ventilator-Induced Kidney Injury (VIKI)

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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39. Ventricular End Diastolic Volume (EDV)

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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40. Ventricular Assist Device (VAD)

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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41. Viral Respiratory Illness

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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42. Vascular, True Aneurysms

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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43. Ventricular-Assist Devices

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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44. Venous Oximetry

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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45. Vascular Injury, Classification

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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46. Vascular, Interposition Grafts

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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47. Viral Infection, Severe: Overview

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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48. Virus Disease

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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49. Ventricular Fibrillation

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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50. Vascular Laceration

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012
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