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1. Impact of Isolation Time of COVID-19 Patients in Intensive Care Unit on Healthcare Workers Contamination and Nursing Care Intensity

Author

Denis Doyen, Lucas Morand, Mathieu Jozwiak, Didac Aurenche Mateu, Clément Saccheri, Hervé Hyvernat, Marion Cremoni, Vesna Brglez, Nicolas Bèle, Gilles Bernardin, Barbara Seitz-Polski, and Jean Dellamonica

Subjects
COVID-19, isolation, healthcare workers, contamination, nursing care, adverse events, Medicine (General), R5-920
Abstract

BackgroundThe optimal isolation time of COVID-19 patients in intensive care unit (ICU) is debated. We investigated the impact of two different COVID-19 patient isolation time strategies on healthcare workers (HCW) contamination, intensity of nursing care and potential associated adverse events.MethodsWe prospectively included all consecutive COVID-19 patients and HCW in our ICU in the first two pandemic waves (March to May 2020 and August to November 2020). Specific isolation measures for COVID-19 patients were released after two negative RT-PCR assays in the first wave and 14 days after the onset of symptoms in the second wave. Contamination of HCW was assessed at the end of each pandemic wave by combining both a RT-PCR assay and a serological test.ResultsOverall, 117 COVID-19 patients and 73 HCW were included. Despite an earlier release from isolation after ICU admission in the second than in the first wave [6 (4–8) vs. 15 (11–19) days, p < 0.01], the proportion of HCW with a positive serological test (16 vs. 17%, p = 0.94) or with a positive RT-PCR assay (3 vs. 5%, p = 0.58) was not different between the two waves. Although a lower nurse-to-bed ratio, the intensity of nursing care was higher in the second than in the first wave. A longer isolation time was associated with accidental extubation (OR = 1.18, 95%CI:1.07–1.35, p = 0.005) but neither with ventilator-associated pneumonia nor with dysglycemia.ConclusionA shorter isolation time of COVID-19 patients in ICU was not associated with higher HCW contamination, while a longer isolation time seemed to be associated with higher accidental extubation.

Published
2022
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2. Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit

Author

Alexandre Robert, Pierre-Éric Danin, Hervé Quintard, Nicolas Degand, Nihal Martis, Denis Doyen, Céline Pulcini, Raymond Ruimy, Carole Ichai, Gilles Bernardin, and Jean Dellamonica

Subjects
Drowning, Seawater, Pneumonia, Antibiotic, Resistance, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are scarce. The objective of the study is to describe the microorganisms isolated in early respiratory specimens obtained from seawater drowning-associated pneumonia and to provide their antibiotic susceptibility pattern. Methods All patients admitted for seawater drowning between 2003 and 2013 to two intensive care units, from the region in France with the highest drowning rate, were retrospectively included. Demographics, antimicrobial therapy and microbiological data from respiratory samples collected within the first 48 h after admittance were analyzed. Results Seventy-four drowned patients were included, of which 36 (49%) were diagnosed by the clinician as having early pneumonia. Concerning the overall population, the median simplified acute physiology score (version 2) was 45 (30–65), and the mortality was 26%. Twenty-four respiratory samples from different patients were obtained within the first 48 h. Sixteen were positive. The main microorganisms found were Enterobacteriaceae (Enterobacter spp., Klebsiella spp. and Escherichia coli) and Gram-positive aerobic cocci (Streptococcus pneumonia and Staphylococcus aureus) with a low rate of antimicrobial resistance. No MDR bacteria or fungi were identified. However, among the positive respiratory samples collected, 5/16 (31%) grew bacteria with natural resistance to amoxicillin–clavulanate, the first-line antibiotic commonly used in our cohort. Resistance was only found among Gram-negative bacteria and from respiratory samples of patients with a higher drowning grade at admission (p = 0.01). Conclusions This 10-year descriptive study, the largest cohort to date, provides early respiratory samples from seawater drowning patients. The microorganisms retrieved were either mostly part of the human oro-pharyngeal flora or Enterobacteriaceae and displayed low rates of antimicrobial resistance. Respiratory samples should nonetheless be collected at admittance to the ICU to avoid inappropriate treatment. Empiric use of cephalosporin could be restricted to severe patients or if Gram-negative bacilli are found after direct examination.

Published
2017
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3. Toxoplasmosis and Horse Meat, France

Author

Christelle Pomares, Daniel Ajzenberg, Loïc Bornard, Gilles Bernardin, Lilia Hasseine, Marie-Laure Dardé, and Pierre Marty

Subjects
parasites, toxoplasmosis, Toxoplasma gondii, horse meat, atypical strain, foodborne infections, Medicine, Infectious and parasitic diseases, RC109-216
Published
2011
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4. Enquête du centre national des soins palliatifs et de la fin de vie sur la sédation profonde et continue jusqu’au décès (SPCJD) à 3 ans de la loi Claeys-Leonetti

Author

Chloé Prod’homme, Frederic Maillard, Thomas Goncalves, René Robert, Aurélie Lepeintre, Anne Cadier, Francois-Xavier Goudot, Véronique Fournier, Marie-Caroline Meyohas, Vanessa Drure, Elisabeth Grimont, Annick Begue, Olivier Voisin, Erika Parmentier, Nicolas Foureur, Pierre Brillaxis, Gilles Bernardin, Carine Quinto, Sandrine Bretonniere, François Philippart, Laure Moïsi, Marie-Dominique Brette, J. Reignier, Lamia Hachmaoui, Marc-Louis Viallard, Barbara Tourniaire, and Valérie Mesnage

Subjects
business.industry, Medicine, business
Published
2020

5. Incidence, clinical features and outcome of Takotsubo syndrome in the intensive care unit

Author

Jean Dellamonica, Denis Doyen, Hervé Hyvernat, Emile Ferrari, Gilles Bernardin, Pamela Moceri, Fabien Squara, and Sébastien Moschietto

Subjects
Male, medicine.medical_specialty, Time Factors, Cardiac index, 030204 cardiovascular system & hematology, Ventricular Function, Left, law.invention, Sepsis, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Takotsubo Cardiomyopathy, law, Internal medicine, Troponin I, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Aged, Aged, 80 and over, Ejection fraction, medicine.diagnostic_test, business.industry, Incidence, Respiration, Mortality rate, Incidence (epidemiology), Recovery of Function, General Medicine, Middle Aged, medicine.disease, Intensive care unit, Intensive Care Units, Treatment Outcome, Echocardiography, Cardiology, Female, France, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract

Summary Background Most diseases encountered in the intensive care unit are associated with major stress that can potentially trigger Takotsubo syndrome. Many severe cardiovascular complications are associated with Takotsubo syndrome, yet little is known about Takotsubo syndrome in the intensive care unit. Aims We sought to determine the incidence of Takotsubo syndrome, and to describe its clinical features and outcome in an intensive care unit. Methods This prospective single-centre study included all patients admitted consecutively over a 12-month period who had transthoracic echocardiography, electrocardiography and a troponin I assay performed on admission, at 24 and 48 hours after admission, and at discharge and in the case of clinical worsening. Results The incidence of Takotsubo syndrome was 4.6% (13/280 patients) and female sex predominated (69.2%). The median age of the subgroup with Takotsubo syndrome was 64 (56–72) years. Pulmonary disease and sepsis were the most frequent triggers (46.2% and 38.5%, respectively). Median left ventricular ejection fraction was 29.0% (20.0–37.0). Patients with Takotsubo syndrome presented with shock and arrhythmias and needed ventilation more frequently than patients without Takotsubo syndrome (69.2% vs. 36.3%, P = 0.035; 46.2% vs. 13.5%, P = 0.006; and 92.3% vs. 60.7%, P = 0.021), but mortality rates were similar. The median delay to cardiac index recovery, when impaired, was 2.0 (1.0–2.75) days, and that of left ventricular ejection fraction was 12.5 (7–14.75) days. Conclusion Takotsubo syndrome in the intensive care unit is not uncommon and is associated with substantial haemodynamic and respiratory instability. New-onset arrhythmias and respiratory and haemodynamic worsening could arouse suspicion of and prompt screening for Takotsubo syndrome in the intensive care unit.

Published
2020

6. Characteristics of Cardiac Injury in Critically Ill Patients With Coronavirus Disease 2019

Author

Jean-Paul Mira, Mathieu Jozwiak, Emile Ferrari, Matthieu Buscot, Hervé Hyvernat, Pierre Dupland, Denis Doyen, Matthieu Jamme, Etienne Fourrier, Lucas Morand, Clément Saccheri, Jean Dellamonica, Gilles Bernardin, and Alain Cariou

Subjects
Cardiac function curve, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critical Care and Intensive Care Medicine, Pericardial effusion, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Intensive care, Medicine, cardiovascular diseases, 030212 general & internal medicine, biology, business.industry, Critically ill, Incidence (epidemiology), medicine.disease, Troponin, Icu admission, 030228 respiratory system, cardiovascular system, biology.protein, Cardiology, business, Cardiology and Cardiovascular Medicine
Abstract

Background Cardiac injury has been reported in up to 30% of COVID-19 patients. However, cardiac injury was mainly defined by troponin elevation without description of associated structural abnormalities and its time course has never been studied. Research question What are the electrocardiographic and echocardiographic abnormalities as well as their time course in critically ill COVID-19 patients? Study design and methods The cardiac function of 43 consecutive COVID-19 patients admitted in two intensive care units (ICU) was prospectively and repeatedly assessed combining electrocardiographic, cardiac biomarkers and transthoracic echocardiographic analyses from ICU admission (D0) to ICU discharge or death or to a maximum follow-up of 14 days. Cardiac injury was defined by troponin elevation and newly diagnosed electrocardiographic and/or echocardiographic abnormalities. Results At D0, 49% of patients had a cardiac injury and 70% of patients experienced cardiac injury within the first 14 days of ICU stay, with a median time of occurrence of 3[0-7] days. The most frequent abnormalities were electrocardiographic and/or echocardiographic signs of left ventricular (LV) abnormalities (87% of patients with cardiac injury), right ventricular (RV) systolic dysfunction (47%), pericardial effusion (43%), new-onset atrial arrhythmias (33%), LV relaxation impairment (33%) and LV systolic dysfunction (13%). Between D0 and D14, the incidence of pericardial effusion and of new-onset atrial arrhythmias increased, the incidence of electrocardiographic and/or echocardiographic signs of LV abnormalities as well as the incidence of LV relaxation impairment remained stable, whereas the incidence of RV and LV systolic dysfunction decreased. Interpretation Cardiac injury is common and early in critically ill COVID-19 patients. Electrocardiographic and/or echocardiographic signs of LV abnormalities were the most frequent abnormalities and patients with cardiac injury experienced more RV than LV systolic dysfunction.

Published
2021
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7. Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit

Author

Carole Ichai, Hervé Quintard, Nicolas Degand, Alexandre Robert, Céline Pulcini, Pierre-Eric Danin, Nihal Martis, Raymond Ruimy, Gilles Bernardin, Denis Doyen, Jean Dellamonica, Service de Réanimation médico-chirurgicale [Nice], Hôpital Saint-Roch [Nice], Inserm U1065, Centre Méditerranéen de Médecine Moléculaire, Institut de pharmacologie moléculaire et cellulaire (IPMC), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), Service de médecine interne [Nice], Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital l'Archet, Institut de Recherche sur le Cancer et le Vieillissement (IRCAN), and 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)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)

Subjects
0301 basic medicine, medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Antibiotics, Population, Resistance, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, law, Intensive care, Internal medicine, medicine, Seawater, 030212 general & internal medicine, Intensive care medicine, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Drowning, biology, business.industry, Research, Antibiotic, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Enterobacter, Pneumonia, lcsh:RC86-88.9, medicine.disease, Antimicrobial, biology.organism_classification, Intensive care unit, 3. Good health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Background Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are scarce. The objective of the study is to describe the microorganisms isolated in early respiratory specimens obtained from seawater drowning-associated pneumonia and to provide their antibiotic susceptibility pattern. Methods All patients admitted for seawater drowning between 2003 and 2013 to two intensive care units, from the region in France with the highest drowning rate, were retrospectively included. Demographics, antimicrobial therapy and microbiological data from respiratory samples collected within the first 48 h after admittance were analyzed. Results Seventy-four drowned patients were included, of which 36 (49%) were diagnosed by the clinician as having early pneumonia. Concerning the overall population, the median simplified acute physiology score (version 2) was 45 (30–65), and the mortality was 26%. Twenty-four respiratory samples from different patients were obtained within the first 48 h. Sixteen were positive. The main microorganisms found were Enterobacteriaceae (Enterobacter spp., Klebsiella spp. and Escherichia coli) and Gram-positive aerobic cocci (Streptococcus pneumonia and Staphylococcus aureus) with a low rate of antimicrobial resistance. No MDR bacteria or fungi were identified. However, among the positive respiratory samples collected, 5/16 (31%) grew bacteria with natural resistance to amoxicillin–clavulanate, the first-line antibiotic commonly used in our cohort. Resistance was only found among Gram-negative bacteria and from respiratory samples of patients with a higher drowning grade at admission (p = 0.01). Conclusions This 10-year descriptive study, the largest cohort to date, provides early respiratory samples from seawater drowning patients. The microorganisms retrieved were either mostly part of the human oro-pharyngeal flora or Enterobacteriaceae and displayed low rates of antimicrobial resistance. Respiratory samples should nonetheless be collected at admittance to the ICU to avoid inappropriate treatment. Empiric use of cephalosporin could be restricted to severe patients or if Gram-negative bacilli are found after direct examination.

Published
2017

8. Early infectious acute respiratory distress syndrome is characterized by activation and proliferation of alveolar T-cells

Author

Michel Ticchioni, J. Dellamonica, Charles-Hugo Marquette, Pierre-Marie Roger, Céline Sanfiorenzo, K. Risso, Gaurav Kumar, Gilles Bernardin, and F. Guillouet-de Salvador

Subjects
Adult, Male, Microbiology (medical), ARDS, Lymphocyte, Lymphocyte Activation, Immunophenotyping, Flow cytometry, Young Adult, Antigen, Antigens, CD, T-Lymphocyte Subsets, medicine, Humans, Prospective Studies, Aged, Cell Proliferation, Aged, 80 and over, Respiratory Distress Syndrome, medicine.diagnostic_test, business.industry, Pneumonia, General Medicine, Middle Aged, respiratory system, Flow Cytometry, medicine.disease, respiratory tract diseases, Pulmonary Alveoli, Infectious Diseases, medicine.anatomical_structure, Bronchoalveolar lavage, Apoptosis, Immunology, Female, business, Bronchoalveolar Lavage Fluid, CD8
Abstract

Acute respiratory distress syndrome (ARDS) in humans is characterized by the infiltration of polymorphonuclears in the alveolar spaces. However, the role of T-cells in ARDS is unknown. Our aim was to characterize the T-cell phenotype in bronchoalveolar lavage (BAL) during the early phase of acute lung infection(ALI)/ARDS-infected patients in comparison to a control group (CG). BAL lymphocyte phenotypes of two ALI, 16 ARDS, and eight CG were examined by flow cytometry. ALI/ARDS showed a significant increase in CD4 and CD8 T-cell activation as compared to CG. Moreover, a significant level of proliferation was observed using the Ki67 marker in ARDS patients as compared to controls (median): 37 versus 6 % for CD4 T-cells (p = 0.022) and 34 versus 2 % for CD8 T-cells (p = 0.009). In contrast, the percentage of T-regulatory cells and apoptotic T-cells were similar in both groups. Among costimulatory molecules, we observed an overexpression of CTLA-4/CD152 on CD4 T-cells in ALI/ARDS as compared to CG: 30 versus 7 %, respectively (p = 0.063). In further characterizing T-cell subsets expressing high levels of CD152, we found the presence of IL-17 secreting CD4 T-cells in ALI/ARDS. In humans, ALI/ARDS due to infection is associated with a high level of T-cell activation and proliferation, along with the presence of Th17 cells, which are known to attract polymorphonuclears.

Published
2015

9. Monitoring CO2 in shock states

Author

Jacques Levraut, Jean Dellamonica, Gilles Bernardin, Pierre-Eric Danin, Nils Siegenthaler, and Karim Bendjelid

Subjects
Male, Pathology, medicine.medical_specialty, Manometry, Hemodynamics, Health Informatics, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Microcirculation, Ischemia, Intensive care, Humans, Medicine, ddc:617, business.industry, Reproducibility of Results, Shock, Carbon Dioxide, 3. Good health, Organ damage, Anesthesiology and Pain Medicine, Shock (circulatory), Tissue hypoxia, Female, Blood Gas Analysis, medicine.symptom, business, Airway, Perfusion
Abstract

The primary end point when treating acute shock is to restore blood circulation, mainly by reaching macrocirculatory parameters. However, even if global haemodynamic goals can be achieved, microcirculatory perfusion may remain impaired, leading to cellular hypoxia and organ damage. Interestingly, few methods are currently available to measure the adequacy of organ blood flow and tissue oxygenation. The rise in tissue partial pressure of carbon dioxide (CO2) has been observed when tissue perfusion is decreased. In this regard, tissue partial pressure of CO2 has been proposed as an early and reliable marker of tissue hypoxia even if the mechanisms of tissue partial pressure in CO2 rise during hypoperfusion remain unclear. Several technologies allow the estimation of CO2 content from different body sites: vascular, tissular (in hollow organs, mucosal or cutaneous), and airway. These tools remain poorly evaluated, and some are used but are not widely used in clinical practice. The present review clarifies the physiology of increasing tissue CO2 during hypoperfusion and underlines the specificities of the different technologies that allow bedside estimation of tissue CO2 content.

Published
2014

10. Méningo-encéphalite bactérienne secondaire à une sinusite : imputabilité des anti-inflammatoires non stéroïdiens ?

Author

Gilles Bernardin, J. Dellamonica, Guillaume Baudin, Denis Doyen, Raphaël Chambon, and Hervé Hyvernat

Subjects
medicine.medical_specialty, Fatal outcome, business.industry, General Medicine, medicine.disease, Dermatology, 03 medical and health sciences, 0302 clinical medicine, Bacterial etiology, medicine, 030212 general & internal medicine, business, Meningitis, 030217 neurology & neurosurgery
Abstract

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 2 mars 2016

Published
2016

11. Is Inappropriate Response to Cosyntropin Stimulation Test an Indication of Corticosteroid Resistance in Septic Shock?

Author

Hervé Hyvernat, Bernard Goubaux, Patricia Panaïa-Ferrari, Denis Doyen, J. Dellamonica, Michel Kaidomar, Christian Pradier, Gilles Bernardin, and Rémy Barel

Subjects
0301 basic medicine, medicine.medical_specialty, Resuscitation, Hydrocortisone, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Drug Administration Schedule, law.invention, 03 medical and health sciences, 0302 clinical medicine, Bolus (medicine), law, Adrenal Cortex Hormones, Cosyntropin, Adrenal Glands, medicine, Humans, Vasoconstrictor Agents, Etomidate, Septic shock, business.industry, Hazard ratio, medicine.disease, Intensive care unit, Shock, Septic, Confidence interval, Surgery, 030104 developmental biology, Anesthesia, Emergency Medicine, business, medicine.drug
Abstract

We recently published a comparison of two hydrocortisone dosage regimens in patients with septic shock. We compare the results conferred by the two regimens as a function of the response to cosyntropin stimulation test (CST). Patients with septic shock were treated by one of two hydrocortisone regimens: either a 50-mg intravenous bolus every 6 h during 7 days (200 mg group; n = 49), or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days (300 mg group; n = 50). Nonresponders was defined as a CST response of 9 μg/dL or less. Nonresponders had more severe septic shock, greater fluid resuscitation needs, and greater vasopressor dependence than responders. When analyzed only as a function of CST results, there was no difference in survival between responders and nonresponders. However, analyses crossing CST results and the treatment regimens showed that patients who were responders and in the 300 mg group had significantly less intensive care unit mortality compared with responders in the 200 mg group (respective mortality of 24% vs. 55% [relative risk 0.43, 95% confidence interval, 0.20 to 0.94, P = 0.018]). Multivariate analysis identified baseline blood cortisol as an independent prognostic factor for 28-day mortality in all groups (hazard ratio 1.002, 95% confidence interval, 1.001 to 1.002, P ≤ 0.0001). The results suggest that in patients who respond to CST, hydrocortisone can provide a dose-dependent benefit. In contrast, nonresponse may indicate corticosteroid resistance. This heterogeneity of response to hydrocortisone may explain the difficulties encountered when trying to demonstrate its benefit in septic shock.

Published
2017

12. SAT0569 Outcome of patients with systemic rheumatic diseases admitted in intensive care unit: a prognostic study of 98 patients

Author

N. Martis, Viviane Queyrel, H. Hivernat, J-G Fuzibet, A. Malezieux-Picard, and Gilles Bernardin

Subjects
Mechanical ventilation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Mortality rate, Organ dysfunction, Disease, Intensive care unit, law.invention, Respiratory failure, law, Internal medicine, Medicine, medicine.symptom, business, Intensive care medicine, Cohort study, Cause of death
Abstract

Background Systemic rheumatic diseases (SRD) are a rare and heterogeneous group of diseases, associated with a high mortality rate due to the natural evolution of the disease and/or consequences of their specific treatments (infections, toxicity). Objectives To describe the clinical features, outcomes and prognostic factors for patients with SRD admitted to the intensive care unit (ICU). Methods Single-center retrospective observational cohort study of 98 patients with SRD over an 11-year period in an ICU of a French teaching hospital. Results Ninety-eight patients (57% women; median age, 57 years [19–81years]) accounted for 108 admissions. Connective tissue disease (primarily systemic lupus erythematosus) and systemic vasculitides (mainly ANCA-associated vasculitides) represented respectively 55% and 30% of SRD. For nineteen patients, diagnosis of SRD was made at admission. Reasons for admission were: SRD exacerbations (43%), isolated infections (34%), SRD exacerbations associated with infections (12%) or other (11%). Respiratory failure was the most common organ dysfunction. Mechanical ventilation was necessary for 43 patients (44%), vasoactive drugs for 47 (48%) and extra-renal replacement therapy for 38 (39%). The ICU mortality rate was 30% and 37% one year after admission. Infection was the main cause of death (69%). The factors significantly associated with mortality in the ICU were (multivariate analysis): diabetes, cardiovascular diseases and immunosuppressive treatments on admission. At 1 year of follow-up, additional risk factors were: number of organ dysfunction at ICU admission and mechanical ventilation. It is to be noted that at 1 year of follow-up, diabetes was not anymore a prognostic factor. Conclusions Patients with SRD admitted to the ICU have a severe prognosis. Causes of mortality are mainly infections. Our study points out the importance of vaccination and developing new therapeutic strategies. Diagnosis of SRD in the ICU is not rare and should be systematically considered on admission. Prognostic factors of mortality in the ICU were patient comorbidities and immunosuppressive therapy at admission. In addition, mechanical ventilation and multiple organ failure were risk factors for mortality at 1 year. Disclosure of Interest None declared

Published
2017

13. A therapeutic challenge: catastrophic anti-phospholipid syndrome with diffuse alveolar haemorrhage

Author

Denis Doyen, Jean Dellamonica, Hervé Hyvernat, Eléa Blanchouin, Rémi Lazdunski, Sarah Lechtman, Nihal Martis, Alexandre Robert, and Gilles Bernardin

Subjects
Autoimmune disease, medicine.medical_specialty, Allergy, business.industry, medicine.medical_treatment, Immunology, Immunosuppression, Disease, medicine.disease, Surgery, Intravenous Immunoglobulins, Internal medicine, Intensive care, Anti-Phospholipid Syndrome, Medicine, Rituximab, business, medicine.drug
Abstract

Diffuse alveolar haemorrhage (DAH) complicating primary catastrophic anti-phospholipid syndrome (CAPS) was diagnosed in a 50-year-old female patient. Treatment strategies are limited for this often life-threatening autoimmune disease that requires aggressive immunosuppression. In the absence of clinically validated treatment strategies, high-dose steroids associated with plasma exchange and eventually intravenous immunoglobulins were used to manage the disease. Its severity prompted the initiation of rituximab that was administered weekly for four consecutive weeks. Anticoagulation therapy, on the other hand, needed to be discontinued due to the major haemorrhagic episodes. This combination treatment provided an effective control of the CAPS-associated DAH and helped achieve clinical remission.

Published
2015

14. Effect of different seated positions on lung volume and oxygenation in acute respiratory distress syndrome

Author

Laurent Brochard, J. Dellamonica, F. Di Marco, Nicolas Lerolle, Jean-Christophe M. Richard, Alain Mercat, Gilles Bernardin, Gaetan Beduneau, S. Hubert, C. Sargentini, and Jean Luc Diehl

Subjects
Adult, Male, ARDS, Supine position, medicine.medical_treatment, Pulmonary compliance, Critical Care and Intensive Care Medicine, Patient Positioning, Hospitals, University, Functional residual capacity, Humans, Medicine, Lung volumes, Prospective Studies, Aged, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Middle Aged, respiratory system, Verticalization, medicine.disease, Respiration, Artificial, respiratory tract diseases, Oxygen, Intensive Care Units, Anesthesia, Breathing, Female, France, Lung Volume Measurements, business
Abstract

Lung volume available for ventilation is markedly decreased during acute respiratory distress syndrome. Body positioning may contribute to increase lung volume and partial verticalization is simple to perform. This study evaluated whether verticalization had parallel effects on oxygenation and end expiratory lung volume (EELV). Prospective multicenter study in 40 mechanically ventilated patients with ALI/ARDS in five university hospital MICUs. We evaluated four 45-min successive trunk position epochs (supine slightly elevated at 15°; semi recumbent with trunk elevated at 45°; seated with trunk elevated at 60° and legs down at 45°; back to supine). Arterial blood gases, EELV measured using the nitrogen washin/washout, and static compliance were measured. Responders were defined by a PaO2/FiO2 increase >20 % between supine and seated position. Results are median [25th–75th percentiles]. With median PEEP = 10 cmH2O, verticalization increased lung volume but only responders (13 patients, 32 %) had a significant increase in EELV/PBW (predicted body weight) compared to baseline. This increase persisted at least partially when patients were positioned back to supine. Responders had a lower EELV/PBW supine [14 mL/kg (13–15) vs. 18 mL/kg (15–27) (p = 0.005)] and a lower compliance [30 mL/cmH2O (22–38) vs. 42 (30–46) (p = 0.01)] than non-responders. Strain decreased with verticalization for responders. EELV/PBW increase and PaO2/FiO2 increase were not correlated. Verticalization is easily achieved and improves oxygenation in approximately 32 % of the patients together with an increase in EELV. Nonetheless, effect of verticalization on EELV/PBW is not predictable by PaO2/FiO2 increase, its monitoring may be helpful for strain optimization.

Published
2013

15. Effects of Increasing Hydrocortisone to 300 mg Per Day in the Treatment of Septic Shock: a Pilot Study

Author

Jean François Césari-Giordani, Jean Dellamonica, Michel Kaidomar, Bernard Goubaux, Christian Pradier, Annie Freche, Gilles Bernardin, Anne Gentilhomme, Hervé Hyvernat, and Rémy Barel

Subjects
Male, Resuscitation, Surviving Sepsis Campaign, genetic structures, Hydrocortisone, Pilot Projects, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, medicine, Humans, Vasoconstrictor Agents, Etomidate, 030212 general & internal medicine, Prospective Studies, Aged, Septic shock, business.industry, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Shock, Septic, Anesthesia, Emergency Medicine, Female, Hemodynamic stability, business, medicine.drug
Abstract

The Surviving Sepsis Campaign guidelines recommend hydrocortisone in septic shock only when fluid resuscitation and vasopressors fail to restore hemodynamic stability. Hydrocortisone administration modalities are supported only by low-grade recommendations. Our main objective here was to determine differences in 28-day mortality between two low-dose hydrocortisone regimens for the treatment of septic shock.We performed a multicenter, prospective, randomized, double-blind, pilot study in four adult medical intensive care units. Patients presenting septic shock were rapidly administered one of two regimens of hydrocortisone, either a 50-mg intravenous bolus every 6 h during 7 days (200-mg group; n = 59) or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days (300-mg group; n = 63). Hydrocortisone was stopped abruptly at the end of treatment.There were no significant differences between the 200-mg and 300-mg groups as concerns 28-day mortality (respectively 52.5% vs. 44.4% [RR 0.84, 95% CI, 0.58-1.22, P = 0.47]), refractory shock incidence or delay from shock to vasopressor cessation. There were also no differences in adverse events between the groups. Shock relapse after hydrocortisone cessation was independent of hydrocortisone regimens, but it was associated with the persistence of infection and the use of etomidate. The resumption of hydrocortisone due to shock relapse was significantly more frequent in the 300-mg group.We found no differences in mortality or adverse events between the two hydrocortisone administration regimens. Shock relapse was significantly associated with the persistence of infection and the use of etomidate.

Published
2016

16. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study

Author

Odile Fremin-Batteux, Juliette Clarissou-Philippe, Benoît Jauhlac, Severine Guyetand, Jacques Gasnault, Corinne Haioun, Liamine Aissaoui, Marie-Christine Pages, Marie-Pierre Fos, Christian Rose, Didier Hubert, Marie-Rose Rothe, N. Bouziges, Benoît Huc, François Devianne, Sabine Bidart, Anne Forest, Kevin Bertrand, Mohamed Eldeghedy, Annick Verhaeghe, Caroline Malderet, Anne Bertrou, Bernard Guerquin, Catherine Duche, Muriel Archambaud, Rabea Cotteret, Olivier Toullalan, Yves Devaux, Smail Bergheul, Valérie Sivadon-Tardy, Pierre-Gilles Merville, Geneviève Blanchard-Marche, Didier Raoult, Bernard Hory, Florence Richardin, Evelyne Belle, Mohamed Menouar, K Guitteaud, Mohamad Mohty, Ambroise Montcriol, Max Laurin, Aurélia Picard, Jean-Paul Mira, Marie-Charlotte Chopin, Richard Bonnet, Michel Wolff, Sébastien Maillez, Jeanne Maugein, Véronique Leblond, Nicola Walid, Bernard Gauche, Mathieu Evillard, Hassen Jeddi, Anne Bourlet, Isabelle Grawey, Thierry Jault, Sandrine Hiret, Valerie Gaborieau, Véronique Boin-Gay, An Kim, Thierry Constans, Jean-François Gaide, Martine Giraud, Eric Meaudre Desgouttes, Alain Fur, Abdallah Maakaroun, Olivier Matray, Bertrand Maubert, Frédérique Péchinot, Aurelie Garbi, Claire Delbrouck, Benoît Grandclerc, Vincent Cadiergue, Hervé Lécuyer, Bernadette Grignon, Thierry Bensaid, Nicole Constantin, Yannick Chevalier, Hassène Rahmani, Thierry Levent, Joelle Desliers, Florence Van de Velde, Xavier Adhoute, Clara Andriau, Christophe Charasse, Rémi Vatan, Benoît Martha, Alain Lecis, Didier Albert, Romain Jacobs, Hélène Lefranc, Christian Martin, Nasseur Rezgui, Bertrand Pigeon, Catherine Le Henaff, Dominique Cassignard, Françoise Cotes, Eric Pujade Lauraine, Jean-François Gattault, Nicole Ferreira-Maident, Noémie Jourde-Chiche, Hélène Garrec, Olivier Darchen, Carole Schwebel, Marie-Christine Bezian, Patrick Daoud, Tsouria Becaid, Simone Laluque, David Broche, Christine Boisselier, Pascale Martres, Sarah Hammami, Brigitte Olivier, Jean-Marie Nkunzimana, Eric Monlun, Isabelle Marterl-Lafay, Marion Carboni, Marie-Françoise Mattei, Sandrine Castelin, Isabelle Barillot, Marie-Noelle Cufi, Thomas Kaiser, Catherine Herry, Pascal Hutin, Jean-Pierre Bronowicki, Bernard Branger, Pierre Thomas, Elie Zagdoun, Anne Goquelin, Ziad Assaf, Ingrid Croquet, Bruno Pozzetto, Thomas Similowski, Anne-Isabelle Briere, Marie-Thérèse Albertini, Mariam Blaka, Christelle Tassot, Anne Gaschet, Jean-Philippe Lavigne, Antoine Pujol, Philippe Colombat, Edouard Devaud, Hana Talabani-Boizot, François Barière, Anne-Marie Cordier, Philippe Gueudet, Georges Simon, Anne-Sophie Lipovac, Françoise Bandaly, Anne Beauplet-Lepage, Sylvie Prince, Charlotte Jouzel, Jean-Luc Deboutin, Patrick Zavadil, Louis Puybasset, Marie-Cécile Petit, Loïc Guillevin, Kamel Touati, Christophe Ntalu Nkato, Sylvie Carette, Jacques Vaucel, Chantal Delasalle, Marine Gross Goupil, Laurent Gutmann, Christiane Payen, Annick Barboteau, Firouzé Bani-Sadr, Christophe Legendre, Philippe Roulier, Elie Azria, Ibrahim Farah, Isabelle Rouquette-Vincent, Anne-Sophie Erena-Penet, Philippe Labadie, Eric Josien, Aicha Derragui, Mathieu Legrand, Odile Beyne-Rauzy, Jean-Marc Nabholtz, Marie-Joelle Demarcq, Olivier Garosi, Michel Deiber, Fabrice Chaix, Bertrand Souweine, Anne Collignon, Gisèle Renard, Mickael Jego, Gilles Bernardin, Anne Allart, Jocelyn Barrier, Marc Vasse, Philippe Ménager, Marc Wurmser, Abderkader Ouazir, Olivier Gontieron, Yvon Berland, Sébastien Trouiller, David Leysenne, Christophe Ozanon, Fanny Autret, Tahar Saghi, Loïc Dopeux, Sophie Benoit-Coustou, T. Fraisse, Christine Maillard, Karine Nikodijevic, Georges Kaltenbach, Angéline Jamet, Philippe Aucher, Julie Bottero, Marie-Claude Piffaut, Marianne Besnard, Florence Courillon, Marie Bonfils, Christine Ghevaert, Marie Destors, Eliette Jeanmaire, Franck Zerbib, Manuel-Luis Gameiro, T Prazuck, Laurent Mandin, Olivier Guisset, Marguerite Fines, Toufik Feddal, Agnès Jouffret, Louis Mesnard, Thomas Bourrée, Hasinrina Razafimahefa, Sylvestre Tigaud, Vincent Estève, Philippe Malherbe, Jean-Michel Salord, Pascal Adam, Bertrand Rozec, Michel Fuillet, Olivier Lemenand, Denis Quinsat, Ana Danalaché, Véronique Vialette, François Brosset, Patrick Messner Pellenc, Nicolas Heisel, Edouard Girard, Régine Martin, Olivier Garesslin, Catherine Mille, Alexandre Gascon, Marc Nicolino, Laurence Mouly, Claire Fabre, Bénédicte Ponceau, Marie-Etiennette Emeriau, Pascal Cathebras, Bérangère Bernardaud, Michèle Pérouse de Montclos, O. Arsene, Karine Grenet, Yazdan Yazdanpanah, Sten De Witte, Anne Scemla, Laurence Bouillet, Christophe Burucoa, Vincent Loffeier, Séverine Visentin, Luc Desfrere, Miloud Arabi, Frédérique Costa, Sylvie Lechat, Ali Chekroun, Raymond Ruimy, Marie, Jérôme Bizet, Xavier Nassif, Baihas Dib, Patrick Bert-Marcaz, Laurent Martin Lefèvre, Nicholas Sedillot, Blandine Cattier, Emilie Boidin, Daniel Sondag, Aude Bourrouillou, Alain Noirot, Franck Desemerie, Fréderic Heluwaert, Catherine Tamalet, Marc G. Berger, Jean-Daniel Lelièvre, Dominique Perotin, Abdelkader Bemrah, Alain Lozniewski, Bernard Borstein, Hanna Eid, Diana Suatean, Virginie Mignaut, Jean-Claude N'guyen, Valérie Le Goff, Laurent Teillet, Christophe Rolland, Gwenaël Alfonsi, Florence Lachenal, Philippe Bossi, Yves Botreau, Florence Doucet Populaire, Henry Jardel, Nicolas Gallo, Elias Jabre-Sikias, Michel Dupon, Hélène Brihier, Isabelle Patry, Alexandre Leclercq, Bernadette Tourrand, Christophe Roussel, Jean-Emmanuel Kurtz, Bénédicte Paindaveine, Simon Elhadad, Richard Sanchez, Eric Sgro, Pierre Berger, Valérie Murbach, Anne Holstein, Florence Martin, Taoufik Merabet, Amélie Benbara, Milagros Ferreyra, Laure Esposito, Pierre Delobel, Antoine Andremont, Marc Bourlière, Carole-Anne Boudy, Jean-Baptiste Gaulthier, Laurent Tacchini, Olivier Marpeau, Sonia Tesseydre, Marie-Pierre Coulhon, Nathalie Hodee, Marie-Chrsitine Conroy, Pierre Weinbreck, Roland Leclercq, Laurent Souply, Christian Bidault, Annie Elbez, Marie-Annick Lebreton, Patrick Brisou, Agnès Ferroni, Jean-Louis Pourriat, Nadia Anguel, Christian Noel, Philippe Jouvencel, Eric Pichard, Xavier Martin, Mathieu Coste, Pierre Zuber, Catherine Neuwirth, Jean-Pierre Hacot, Paul Aye, Jérôme Guinard, Yves Pean, Jean-Christophe Dengo, Fabrice Petassou, Didier Viole, Thierry Messiaen, Jean Beytout, Philippe Petitjean, Ferdinand Savare, Patrice Cuvillier, Sophie Coignard, Hélène Anglaret, Nassim Kamar, Elisabeth Chachaty, Karine Guimard, Louis Braem, Hacene Fezoui, Pierre Martin, Jean-Paul Viard, Claire Larroche, Nicolai Claudiu-Plesa, Thierry Benoit-Cattin, Olivier Moquet, Thierry Pasdeloup, David Rosay, Rodolphe Jean, Jean-Bernard Mariette, Marc Debouverie, Hervé Peltier, Mustapha Terki, Jacques Daleas, Valérie Dattin-Dorrière, Michel Vergnaud, Emmanuel Grimprel, Sylvène Rosselli, Jean-Marc Didier, Pierre Faurie, Luc Frimat, Aziza Mandjee, Sabine Etchemendy, Pierre Tissières, Jean Nakhleh, Sylvie Mariette, Christian Perronne, Bruno Carbonne, Nathalie Houssiaux-Maisonneuve, Tristan Ferry, S Beague, Anthony Sebban, Marie-Thérèse Hili, Jean-Michel De Kermadec, Lucien Brasme, Gilles Blaison, Caroline Garandeau, Jean-Pierre Sollet, Laurent Tronchon, Thierry Samson, Julien Gesquière, Nicolas Ettahar, Alain Créange, Etienne Laurens, Véronique Equy, Fréderic Bart, Bernard Bouffandeau, Christine Vaillant, Valerie Pesque, Jean-Marc Lalot, Marc Levy, Michel Kaidomar, Mihaela Saplacan, Sterenn Yvenou, Marie-Isabelle Steibach, Emmanuelle Cambau, Agnès Riche, François Fourrier, François Raffi, Mélissa Lalu, Henri Bérard, Danielle Clave, Jean-Claude Mouries, Martine Porcheron, Jean Cabalion, Richard Lamarca, Nathalie Canu, Jean-Baptiste Roseau, Annabelle Stoclin, Luca Luminitan Elena Lupean, Rémi Gebeile, Celia Salanoubat, Carole Marmouset, Pierre Bigot, Anne-Laure Breton, Pierre Kalfon, Colette Vincent, Sophie Marty, Olivier Tandonnet, Alexis Redor, Xavier Valette, Ourida Aoudia, Jacques-Arnaud Seyrig, Bertrand Beaune, Hugues Aumaitre, Georges Pinon, Yann Leveneur, Sylvie Charachon, Raoul Herbrecht, Henriette de Valk, Gary David, Julien Pouyanne, Marc Dommergues, Majed Al Chaar, Véronique Blanc-Amrane, Pascale Guillarmé Grossmann, Bruno Abraham, Yves Morel, Philippe Suel, Denis Sautereau, Olivier Guilloy, Tu Anh Tran, Frédéric Laurent, Zahir Amoura, Jacques-Olivier Bay, Zoubida Elharie-Heraux, Joyce Sibony-Prat, Bernard Guillois, Dominique Rohmer-Heitz, Audrey Barrelet, Jérémie Courouble, Jean-Paul Herry, Daniel Vittecoq, Annie Vermesch-Langlin, Jean Auroux, Claude Aubert, Thierry Harvey, Ghislaine Lamoine-Gimet, J. Riahi, Florence Soraudeau, Bachar Al-Jalaby, Caroline Périsson, Khélifa Ayouz, Florence Cardot, François Maillet, Alain Goux, Théophile Magna, Bertille de Barbeyrac, Adrien May, Dominique Andreotti, Olivier Jonquet, Hélène Dumouchel, Didier Thibaud, Philippe Morlat, Pascal Chevalet, Pascal Ancelin, Guy Chambreuil, Cécile Le Boterff, Anne Ceriez, Olivier Detante, B Pangon, Claude C.A. Bernard, Vincent Cailleaux Pierre-Etienne Cailleux, Jordi Miatello, Pierre-Yves le Berruyer, Sylvain Kouaho, Michel Briaud, Hélène Delaby, Patrick Herbecq, Christine Segonds, Véronique Jault, Pascale Brunel, Christine Dussopt, Jean Thore, Jean-Marc Thouret, Jean-Marc Kerleau, François Le Baron, Slavius Matica, Sophie Leautez-Nainville, Matthieu Pecquet, Laurent Bret, Yacine Sedjelmaci, Pierre Metton, Habiboulaye Diallo, Jany Rey Zermati, Arnaud Delahaye, Hélène Chaussade, Laurent Mandelbrot, Emilie Bessede, Olivier Casanovas, Paul Pierrot, Annick Legras, Dominique Lauque, Hélène Gatti, Jean Catineau, Ebutu Likose, Gilles Capellier, Eric Kibbrecht, Freddy Thibaut, Patrick Valadier, Chantal Lemble, Joël Gaudelus, Joelle Mellier, Joëlle Brochen, Emmanuel Gascou, Stéphane Bonacorsi, Stéphanie Bannier, Bruno Fantin, Didier Raffenot, Valérie Revel, Hakim Amroun, Huguette Negrery, Anne-Laure Fauchais, Paul Mercury, Michel Chuzeville, Christian Zumbo, Nicolas Després, Pascal Roblot, Jérôme Pasche, Jean Claude Boufetteau, Jocelyne Caillon, Julien Boileau, V. Rabier, Benjamin Manéglier, Emilie Jourdes, Franck Ceppa, Christine Recule, Nicolas Degand, Benoît Henry, Thierry Baranger, Dominique Pateron, Agnès Pélaquier, Gérard Bouchet, Hélène Fiette, Ozel Guiden, Dana Ranta, Etienne Ruppé, Nabil Chiouk, Jacques Breuil, Dominique Leduc, Véronique Loustaud, Hervé Métenier, Michel Durand, Isabelle Mahé, Leila Karaoui, Marie-José Collus, Mehran Monchi, Olivier Belmonte, Romain Blondet, Jacques Thierry, Karine Humbert, Gilles Salama, Marie-Noelle Heurtaux, Cécile Goujard, Bruno Sivery, Martial Boisseau, Redouane Dahoumane, Pierre Delour, Christian Niels Meyer, Anne Faudon-Gibelin, Gérard Poulain, Roger-Charles Luciani, J.-C. Souquet, Olivier Grossi, François Vandenesch, Sylvain Mermont, Jacques Bronner, Sonia Dahan, Paul Marzouk, Pascal Pouedras, Noureddine Djafari, François-Xavier Caroli-Bosc, Jean-François Dessin, Brigitte Gruffat, Armelle Morin-Fatome, Sylvie Thoinet, Bano Konate, Jean-Winoc Decousser, Claire Poyart, Patrick Plessis, Olivier Millet, Vincent Cattoir, Françoise Geffroy, Manica Vasseur, Pierre Carli, Isabelle Citony, Christian Richard, Nicolas Sigur, Patrick Marthelet, Luwawu Mbimba, Pierre Feugier, Philippe Sauder, Hama Djerad, Evelyne Bourgerette, Hanen Chahtour, Adrien Lemaignen, Dominique Bechade, Patrick Ochocki, Antoine Vieillard Baron, Dominique Astruc, Marie-Pierre Moiton, Nicolas Dubois, Sylvie Ledru, Corinne Seknazi, Hélène Poupet, Jean-Philippe Brieux, Gérard Barthélémy, Aihem Yehia, Louis-Jean Couderc, Ahmed, Françoise Rigaux, Yohann N'guyen, Philippe Bethery, Damien Corberand, Etienne Auvray, Paul-Louis Woerther, Christian Combe, Sophie Delesalle, Jean-Marie Piala, Faraj Al Freijat, Philippe Juvin, Malcolm Lemyze, Hyacine Rey, Claire Larible, Noel Milpied, Lémia Zgarni, Julia Gaillard, Agnès Juven, Paola Otean, Adrien Melis, André Pechinot, Olivier Bouchaud, Olivier Chassin, Pierre Hausfater, Asma Trabelsi-Jnifen, Vincent Grobost, Didier Lemery, Pierre Soury, Françoise Brevet, Jacques Tankovic, Dominique Sansot, Jean Louis Salomon, Charlotte Cordonnier, Brigitte Lamy, Antoine Maisonneuve, Dominique Pressac, Claude Rémy, Rodolphe Sobesky, Stéphanie Cognet, Pierre Cougoul, Didier Jan, Dominique Perrotin, Cécile Hombrouk-Alet, Thierry André, Gilbert Pochmalicki, Serge Girard, Vincent Zerr, Guillaume Cadiot, Claudine Lasbasses, Michel Slama, Abderrazak El Yamani, Sophie Brovedani, Jean Armengaud, Romain Hernu, Géraldine Mascade, Aurélien Lorléa'ch, Ali Akkari, Mathieu Tourdjman, Christopher Payan, Eric Jullian, Nathalie Fonsale, Frédéric Riehl, Paul Strock, Geneviève Grise, Philippe Mottaz, Christian Floriot, Marie-Noëlle Ungeheuer, Denis Caillot, Arnaud Chalvon-Demersay, Catherine Branger, Stanislas Bruley des Varannes, Marc Paccalin, Marie-Pierre Danjean, Alexandre Mebazaa, Xavier Brunet, Roland De Varax, Laurence Delhoustal, Sophie Haro, Bruno Chabanon-Pouget, Isabelle Goidin, Dominique Chudersky, Corinne Costes, Delphine Chatellier, Maud Gelez, Damien Dassant, Pascal Joly, Jean-Michel Arnal, Zakaria Hamitou, Philippe Rondepierre, Carole Pignon, Valérie Crombe, Amanda Lopes, Chrystelle Kemenar, Olivia Raulin, Anne-Cécile Hochart, Sandrine Gérart Pons, Valérie Zeller, Guillermo Reyes Ortega, Mathilde Guérin, Audrey Migraine Bouvagnet, Florence Eboue, Isabelle Loury-Lariviere, Sophie Leotard, Suzanne Lima, Marie Kassis, Jean-Luc Donay, Jean-Pierre Audié, Guillaume Cartron, Arnaud Ribier, Fanny Buron, Mirela Tuca, Marius Semenescu, Arnaud Serre, Vincent Quentin, Denise Bouyssou-Destriau, Violaine Bresson, Christine Chandesris Joséphine Chapalain-Cagnon, Eric Cua, Henri Courtade, François Bénézit, Sébastien Lamache, Philippe Bonnefoy, Francis Schneider, Richard Monarchi, Adeline Schendel, Paramasiven Mootien, Ghislaine Gardes, Pierre-François Westeel, Jean-François Magny, François Caron, Jocelyn Michon, Didier Eyer, Isabelle Ronda, Pierre-Yves Robillard, Frédéric Renou, Anna Faucher, Jean-Robert Harlé, Anne Debernardi, Grégory Akerman, Benoît Fontenel, Pierre Hourdebaigt-Larrusse, Marie-Noëlle Adam, Aude Lessene, Abdelkader Hrichi, François Blot, Athéna Le Pierres, Romain Lemarie, Françoise Granier, Véronique Tardy, Marc Gatfosse, Pierre-Marie Roger, François Goupil, Saïd Aberrane, Franck Bernardi, Isabelle Plantier, Nathalie Funakoshi, Jean-Gilles Delecalle, Patricia Barbut, Jacques Reynes, Christophe Roy, Sophie Perreve, Michel Garre, David Ribes, Cyrille Ede, Jean-Claude Dausset, Francis Duchene, Jean Caussin, Michelle Becker-Schneider, Gilles Berthelot, Damien Dupont, Jean-Michel Gillot, Aurélie Messager, Jean-Marie Pannecouck, Jean-Christian Roussel, Alain Reynaud, Sylvie Cariou, Anne Dao, François Guillemot, Martin Martinot, Patrick Casali, Anne-Sophie Poirier, Aissa Kerchache, Necera Sakek, Eric Porthault, Christophe Decoene, Chantal Ache-Papillon, Brigitte Bicais, Jean-Claude Feugier, Thierry Masseron, Charles Marty-Ane, Daniele Goldgran Toledano, Jean-Christophe Dubus, Damien du Cheyron, Dominique Decré, Jean-Loup Pennaforte, Ahmed Tigaizin, Bernard Vache, Eric Oswald, Claire Moulinoux, Anne-Christine Jaouen, Caroline Charlier, Anne-Laure Virlouvet, Ali Kara, Jean-Luc Sicsic, Sylvie Goffart, Mathieu Zuber, Claudine Fèbre, Olivier Lortholary, Mathieu Dupont, Annie Vessieres, Thierry Helvadjian, Thomas Signouret, Cedric Daupin, Sandrine Essouri, Jean-Louis Jacob, Pascal Boileau, Caroline Blazejewski, Quentin Lepiller, Juan-Pablo Maureira, Eddy Lebas, Christophe Deschamps, Amévi Ananivi, Clovis Foguem, Daniel Adoue, Abdourahim Chamouine, Alain Michault, Bruno Guérin, Olivier Baud, Clara Vinci, Thierry Weitten, Jean-Marc Eychene, Marie Froidure, Julien Obiols, Patricia Roussellier, Marc Lecuit, André Cabié, Saskia Foucart, Karim Belhadj, Michel Cingotti, Bruno Dumoulard, Jean Puyhardy, Etienne Danquechin Dorval, Lucile Mendes-Martin, Enrique Casalino, Luc Jarrige, Fabien Lambiotte, Philippe Masson, Mohammed Mansouria, Pierre Thouvenot, Katy Jeannot, Martine Nyunga, Valérie Macci, Florent Masia, Claire Briere de la Hosseraye, Wassila Anteur, André Sommabère, Marie-Claude Germain, Isabelle Arnault, Bernard Carbonelle, Philippe Devos, Daniel Protar, Tiphaine Gaillart, Ludovic Lassel, Laurence Hamou-Plotkine, David Trystram, Thierry Bureau, Olivier Collard, Fanny Vuotto, Sophie Malhiere, Frederique Canis, Gillles Plainfosse, Catherine Lechiche, Bertrand Lassere, Martine Chouraqui, Jean Baptiste Michot, Fethi Radhouane-Khanjari, Carole Barbier, Pascal Bonitchi, Abdelaziz Benkhelil, Odile Salmon, Laurent Damaj Gandhi, Bertrand Minguet, Michel Wagner, Odile Falguières, Zahr-Eddine Ali Chaouche, Eric Zaoui, Isabelle Guichard, Bernard Huttin, Apollinaire Karirisi, Gaël Cinquetti, Christophe Plane, Lionel Rostaing, Yanne Henry-Andrieu, Daniel Re, Virginie Verrier, Pascal Bolot, Michel De Biasi, Laurence Vrigneaud, Mathilde Turpin, Marie-Claude Demachy, Etienne Roussel, Michèle Blancs, Olivier Join-Lambert, Yves Ville, Thierry Granger, Gilles Hilbert, Virginie Medeau, Daniel Villers, Benoit Pilmis, François Gouraud, Emmanuel Ardiet, Catherine Heyraud-Blanchet, Alain Devidas, Hélène Dieye, Julie Cremniter, Jean-François Bergmann, Rozenn Le Berre, Virginie Leguen, Daniel Royer, Gilles Le Maout, Christian Harou, Sylvie Gabriel-Soléan, Yves Regouby, Martine Pestel-Caron, Patrick Brunet, David Boutoille, Emmanuelle Bonnin, Patrice Coulon, Marc Sullice, Marianne Barbieux, Gilles Cambonie, Joëlle Tricoire, Marie-Nadège Bachelier, Delphine Briend, Céline Ramanantsoa, Nathalie Bednarek, Didier Lebreton, Julien Lagrandeur, Damien M'Bey, Philippe Audeguy, Elie Saliba, Lena Damaj, Hassan Fallouh, Pascal Couturier, Fabrice Prévost, Yves Domart, Marie-Odile Lafforgue, Anne Le Du, C. Beuscart, Pierre Guillet, Fabrice Larrazet, Marie-Hélène Hausermann, Henri Robert, Nicolas Fanjaud, François Goehringer, Thomas Bachelot Philippe Badia, Jean-Michel Coulaud, Cristel Fissore Magdelein, Renaud Defebvre, Anne-Sohie Moreau, Johan Courjon, Gilles Salles, Michel Mialon, Silvia Iacobelli, Emmanuelle Bille, Marie-Christine Barbier, Yves Aubard, Patrice Badila, Jean-Philippe Rasigade, Alban Deroux, Evelyne Lecaillon-Thibon, Michel Godin, Abdelmajid Djeffal, Viorica Badurescu, Meriem Canitrot, Pierre Blanchard, Antoine Legros, Laurence Got, Françoise Duluc, Mylène M. Maury, Gilles Dassieu, Nordine Khodeir, Jean-Marie Duez, Mathieu Morincomme, Jérôme Lacroix, Mathieu Revest, Koffi Blewoussi, Isabelle Barazer, Françoise Poitevin, Camille Seignovert, Stéphanie Honore Bouakline, Anne Heidt, Brigitte Malbruny, Julien Desblache, Christian Cattoen, Eric Jaunait, Bruno Chaminade, Claude Bazin, Jonathan Chelly, Anne Pottier, Alain Schmitt, Alain Tissot, Karim Dadoun, P. Rebattu, Claudine Contamin, Arnaud Guerard, Nathalie Ravet, Sandrine Khalifa-Thellier, Marlène Chatron, Gaëlle Dörr, Hélène Biessy, Emmanuel Forestier, Bruno Devaux, Jean-Jacques Grelaud, Xavier Tchenio, Marie-Cécile Ploy, Jérémie Violette, Michèle Burdin, Lionel Falchero, Dominique Jacomy, Jean-Christophe Rozé, Damien Labarriere, Stéphane Leroux, Corinne Meregnani, Assia Ferhat Carre, Paul Orode, Jean-Gabriel Paul, Catherine Godon, Agnès Vinay, Régine Barraduc, Dominique Dallay, Alexandre Ampère, Anne-Gaelle Kervegant, Guillaume Louart, Dominique Beal Ardisson, Francoise Leonetti, Jean-Yves Baril, Stéphanie Haiat, Bincy Darre, Jérôme Bay, Yvan Gauthier, Sylvie Radenne, Pierre-Yves Gueugniaud, Philippe Ravaud, Luc Landraud, Guillaume Ranchon, Loïc Chimot, Véronique Duval, Ilhem Agha-Mir, Sabine Camiade, Estelle Wafo, Jean-Patrick Laporte, Mariam Roncato-Saberane, Camille Bron, Patrice Laudat, Samir Kennouche, Nawel Afroukh, Dominique Neri, Hakim Kherouf, Yoar Hichri, Pierre-Edouard Bollaert, Gwenaelle Vary, Denis Castaing, Christine Lefort, Sébastien Rouget, René Robert, Christelle Guillet-Caruba, Catherine Simonin, Alain Vighetto, Severine Cabasson, Alain Brusset, Alexandra Doloy, Christel Cherlet, Ahmed Rouidi, Marina Salvucci, Réginald Pordes, René-Gilles Patrigeon, Emmanuelle Dupre-Narlet, Jacques Minet, Fethi Taleb, Anne-Marie Colingorski, Tahar Hadou, Sylvain Diamantis, Isabelle Glorieux, Thierry May, Jean-Claude Colombani, Anne Berth-Farges, Nicole Desplaces, Renaud de Tayrac, Elisabeth Walter, Fabienne Lorge, Pascal Reboul, Nathalie Dournon, Laurence Estépa, Marie-Lina Toubia, Mathilde Flahault, Thierry Delacour, Dominique Hurel, Hélinoro Andriamaneo, Cécile Bébéar, Denis Grasset, Miloud Serier, Oléna Orléva, Nadine Dubroca, Hervé Gentilhomme, Jean-Luc Baudel, Isabelle Lavenu, Salim Smati, Carlo Saroufim, Eric Placidi, Albert Sotto, Benoît Libeau, Hélène Leroy, François Golfier, Christophe Dollon, Laurence Desnoulez, Eric Barre, Daniel Cohen, Pascal Priollet, Thierry Marsepoil, Benoît Lionnet, Jacques Tebib, Pascale Penn, Antoine Bouissou, Christian Roth, Olivier Martinet, Anna Schmitt, Nathalie Fruleux, Fouzia Radaoui, Jean-Marc Lessinger, Virginie Morando, Jean-Jacques Maillet, Christophe Fruchart, François Boué, François Goffinet, Franck Lellouche, Martin Demarchi, Alain Geissler, Jean-Charles Picaud, David Assouline, Patricia Brazille, Philippe Guimier, Marie-Françoise Dabysing, Bruno Delpeuch, Vanessa Tran, Guy Gengembre, Delphine Deligne, Dominique Vodovar, Yvan Touze, Sabrina Parent, Anne Decoster, Camille Dewitte, Emmanuel Weiss, Thierry Lambert, Thomas Guimard, Vincent Caille, Claude Guérin, Françoise Evreux, Geneviève Barjon, Basile Ondze, Damien Fournier, Olivia Bandin, Sophie Mignart, Henri Demontclos, Didier Perez, Jacques Croize, Nicole Desbois-Nogard, Guenièvre Imbert, Clarisse Dupin, Khalid Ridah, Marie-Christine Varin, Guillaume Arlet, Edith De Clareuil, Marie-Line Eustache, Patricia Le Pimpec, Louise Fortin, Eugène Ngami, Fabrice Mihout, Cecilia Esnault, Vincent Bouden, Véronique Annaix, Yves Poinsignon, Aurélien Lorchleac'h, Jean-Marc Degreff, Marie Garofano, Renaud Mesnage, Anne-Marie Roque-Afonso, Alain Chevailler, Stéphane Hominal, Thierry Charbonnier, Adrianna Bildea, Fabien Fily, Benjamin Davido, Emmanuel Rassiat, Assi Assi, Stéphanie Brunet, Hervé Jacquier, Catherine Claise, Annie Durand, Yannick Monceau, Pierre Blanc, Jean-Marie Sire, Yves Sucin, Jean-Pierre Zarski, Nathalie Bronet, Ingrid Lafon, Philippe Rey, Jacques Markarian, Eric Sennevile, Olivier Wink, Guilène Barnaud, Anne-Sophie Peultier, Sabine Taylor, Rim Savatier, Patrick Valayer, Claude Negrier, Selim Jennane, Edouard Begon, Laura Hyerle, Delphine Bridoux, Claire Daurel, Benoît Dalle, Mathilde Lescat, Philippe Stolidi, Elodie Perrodeau, Xavier Heches, Pierre Castelnau, Philippe Bray, Jean-Claude Texier, Serge Rossignol, Maud Brung-Lefebvre, Jean-François Subra, Jean-Marie Delarbre, Morgane Schneerson, Guyro Jang, Mona Mehri, Nathalie Landgraf, Pierre-Marie Girard, Armand Goll, Zaineb Bekguesmia, Christophe Clement, Michel Collet, Vincent Maze, Amine Benjelloul, Solène Durliat-Ellie, Vincent Letouzey, François Schmitt, Valérie Martinez, Sarah Watson, Abderrezak Bouasria, François Barbier, Raphael Lauretta, Mirana Razafimahery, Cristina Sirbu, Patrick Malherbe, Anne Wuillai, Ludovic Lesecq, Philippe Gaudard, Serge Houssaye, Jacques Monsegu, Gilles Rival, Chantal Chaplain, Jean-Didier Grangé, Oana Zamfiri, Florence Nguyen-Khac, Marc Portneuf, Jean-Michel Pawlotsky, Delphine Bonnet, Laurent Traissac, Sophie Hamon-Charles, Didier Dreyfuss, Louis Bernard, Laurence Detourmignies, Olivier Martineau, François Pettinelli, Marc Zandecki, Michel Dreyfus, Alain Chapelle, Sébastien Sabbat, Anne-Sophie Labussiere, Jean-Louis Gaillard, Chloé Plouzeau-Jayle, Patrick Zoveda, Véronique Leflon, Marie Levy, Aurélie Labé, Bruno Soulie, Raoul Jacques Bensaude, Hecham Moussa, Sylviane Catteu, Nathalie Biron, Loïc Masson, Georges Mourad, Nejla Aissa, Dragos Ciocan, Hubert De Boysson, Jean-Luc Bouyer, Patrick Yeni, Thierry-Pascal Zame, Caroline Thomas, François Cavalié, Laurence Koulmann, Christophe Rioux, Olivier Barraud, François Bricaire, Marguerite Le Poulain, Marie-Noelle Noulard, René Thomas, Guy Semet, Laurent Mosser, Olivier Marret, Brigitte Rivière, Vincent Jarlier, Jean-Philippe Coindre, Marc Villemain, Martin Pierre, Yacine Benkaci, Philippe Chiron, Hoang Vu-Thien, Jérôme Gournay, Andrea Labaune-Kiss, Brigitte Lauzanne, Fanny Lemercier, Souad Silhadi, Imad Kansau, Christophe Poncelet, Olivier Baldesi, Francis Thuet, Olivier Leroy, Aurore Lamberet, Camille Petit Hoang, Sophie Micheli, Ayman Abokasem, Hakima Nesrine, Pierre Lureau, Christian Chidiac, Vincent Piriou, Fabien Zoulim, Dieudonné Nicobaharaye, Anne Tixier, Isabelle Matheron, Soumeth Abasse, Victoria Cacheux, Serge Herson, Christine Fuhrmann, Olivier Proost, Bernard Bedock, Olivier Rogeaux, Mostapha Hajjar, Anne Reverseau, René Courcol, Françoise Carmagnol, Yves Guénard, Céline Ménard, Bouchra Lamia, Bruno Lemmens, Damien Bouhour, L. Lequen, Gaëlle Baty, Cédric Bouet, Dominique Guerrot, Stéphane Blanc, Catherine Chirouze, Anne-Hélène Reboux, A. Vachée, Gregory Taurin, Myriam Mein-Bottini, Jean-Pierre Belot, Alain Lafeuillade, Patricia Gabez-Therou, Philippe Labrousse, Bernard Jarrousse, Philippe Noto, Vincent Brunot, Philippe Condominas, Marion Challier, Béatrice Berçot, Delphine Anuset, Mélanie Daval Cote, François Bernasconi, Y. Costa, Chandrah Goburdhun, Bernard Gressier, Alban Michaud-herbst, Franck Charlier, Moussa Hecham, Luc Boulain, Hélène Corneloup, Alix Greder Belan, Nicolas Boussekey, Claire-Antoinette Dupuy, Yannick Rouquet, Benoit Renard, Benifla Jl, Etienne Javouhey, Michèle Granier, Marie-Christine Jaffarbandjee, Emilie Piet, Benoît Bergues, Claire Malbrunot, Catherine Tiry, Philippe Mérigot, Mouna Ben Soltana, Chantal Roure Sobas, Florian Radenac, Yves Thomas, Agathe Blaise, Sylvie De Martino, Laurence Legout, Gabriel Choukroun, Jean-François Muir, Peggy Dupretz, Patrick Dupont, François Guichart, Julie Jean, Jean-Michel Descamps, Bernard Kittschke, Anne Gruson, Gerard Viquesnel, Marie Keller, Pascal Chavanet, Françis Vallet, Yvan Vaschalde, Jean-Luc Hanouz, Gerard Lina, Françoise Loison, Simon Vincent, Jean-Paul Thellier, Moncef Afi, Dominique Zagozda, Hélène Sokeng-Affoule, Marc Le Bideau, Jean-François Loriferne, Alain Gravet, Sophie Deprecq, Tarik Naceur, Severine Mielczarek, René-Jean Bensadoun, Bernard Karkous, Yves Bléher, Jocelyne Poulain, Véronique Goulet, Laurence Nicolet, Sophie Arista, Antônio Lúcio Teixeira, Jean-François Schved, Laurent Nicolet, Claire Lecomte, Faiza Benddif-Fin, Michel Aumersier, Laurence Burc-Struxiano, Maxime Thouvenin, Samia Harbi, Mathieu Detave, Catherine Rebeyrotte, Jean-Paul Kisterman, Bruno Berdin, Pascal Vincent, Laurent Argaud, Elisabeth Parisi-Duchene, Geneviève Julienne, Fernanda Farto-Bensasson, Georges-Fabrice Blum, Sad Gaizi, Tali-Anne Szwebel, Raphaël Lepeule, Marie-Thérèse Climas, Anne-Françoise Dillies, Amar Boudhane, Umberto Simeoni, Pierre-François Dequin, Gérard Oliviero, Alain Gourlaouen, Caroline Piau, Marie-France Lutz-Murphy, Benoît Claude, Jean-Paul Aubry, Nadine Dubosc-Marchenay, Kamilla Chraibi, Emmanuelle Heusse, Sylvain Le Chevallier, Nathalie Brieu, Farid Sifaoui, Lorraine Letranchant, Hélène Durox, Jean-Pierre Lagasse, Adel Ghedira, Xavier Roubert, Fatma Magdoud, Hélène Jean-Pierre, Etienne Carbonelle, Olivier Dereeper, Lionel Carbillon, Christophe Billy, Mélanie Roblin, Marie-José Kodzin, Philippe Niel, Solène Makdessi, Matteo Vassallo, Maryse Archambaud, Fabian Haccourt, Didier Blaise, Stéphane Bourgeois, Elena Marcu, Charles Kubiak, Brisse Castel, François Guinet, Marie Pouzoullic, Frédérique Nathan-Bonnet, Vincent Gendrin, Céline Becherrawy, Aline Secher, Pierre Abgueguen, Clarence Eloy, Jean-Marc Tourani, Frédéric Klapczynski, Bernard Montmasson, Philippe Real, Joanna Pofelski, Yves Welker, Karim Krechiem, Eric Caumes, Martine Elena-Daumas, Christophe Saigne, Gilles Hittinger, Chantal Delesalle, Jonathan Messika, Fabrice Lesage, Daniela Pop, Daniel Coetmeur, Renato Colamarino, Chetaou Mahaza, Patrick Plésiat, Isabelle Fredenucci, Mylène Baret, Guy Mager, Pascale Chavel, Isabelle Labourdette, Anne-Claude Menguy, Nicolas Fortineau, Ludovic Le Sec, Valérie Gauduchon, Francis Barraud, Nicolas Letellier, Didier Vincent, Janine Frey, Philippe Riegel, Michel Pavic, Jean-Luc Fabre, Jean-Pierre Fauchart, Alain Goudeau, Stéphanie Husson-Wetzel, Philippe Eymerit, Mohamed Camara, Nathalie Seta, Elisabeth Carole Ngo Bell, Philippe Repellin, Laurent Alric, Vincent Leroy, Françoise Delisle Mizon, Jean-Philippe Emond, Marie-Françoise Borie, Lise Crémet, Wladimir Chelle, Elisabeth Brottier-Mancini, Bernard Garrigues, Claire Letellier, Loïc Geffray, Frédéric Méchaï, Julien Bador, Benoit Guery, Alain-Charles Fouilhoux, Corinne Dagada, Pierre Duhaut, Julien Goustille, Arnaud Sément, Francis Carcenac, Isabelle Girard-Buttaz, Claire Chapuzet, Fabienne Jouatte, Bruno Riou, Fabrice Hayoun, Chloé Di Meglio, Youssef Ali, Michel Leneveu, Nathalie Montagne, Yves Garcera, Audrey Moustache, Pierre-Eric Danin, Geneviève Le Lay, Dominique Courouge-Dorcier, Isabelle Worcel, Emmanuel Morelon, Vincent Pestre, Jean-Pierre Vilque, Jean-Christophe Paquet, Lucien Bodson, Anne-Marie Forest, Fabrice Pierre, Christian Pommier, Fabien Dutasta, Pierre Fournel, Stéphanie Courtois, Elodie Dubois, Serge Vanden Einjden, Patrick Honderlick, Pascal Richette, Fabienne Tamion, Véronique Chassy, Richard Megbemado, Anne-Marie Le Reste, Bernard Simian, Henri Osman, Anthony Texier, Badih Ayach, François Simon, Jean-Michel Filloux, Béatrice Dubourdieu, Jean-Claude Semet, Sarah Kubab, Tawfiq Henni, Patrick Dudeffant, Delphine Hequet, Olivier Mimoz, Marc Auburtin, Amélie Chabrol, Mickael Bonnan, Caroline Léonnet, Claire Wintenberger, Serge Ilunga, Patrice Lanba, Sophie Rosello, Alexandre Damage, Flore Bouche, Michel Thibault, Frederic Faibis, Chantal Dhennain, Jean-Philippe Talarmin, Armelle Lamour, Remi Boussier, Fabien Garnier, Marie-Laure Brival, Nourredine Hedjem, Philippe Vande-perre, Raphaël Coint, Jean-Claude Reveil, Eva Weinbronn, Emmanuelle Lavalard, Alexandra Fille, Françoise Le Turdu, Lionel Leroux, Jean-Yves Lefrant, Jean Berthet, Radia Bouaziz, Alain Ravaud, Sylvaine Rousseau, Yacine Merrouche, Alain Le Coustumier, Bertrand Guider, Gisèle Dewulf, Jean-Marc Faucheux, Jacques Piquet, Franck Leibinger, Charles Cerf, Robin Stephan, Jean-Philippe Redonnet, Jean-Paul Stahl, Ella Dzeing, Simona Pavel, Guy Vernet, Ghada Hatem, Samer Kayal, Jacques Deschamps, Dominique Descamps, Marion Levast, Marc Bouiller, Sylvie Dargere, Claire Dingremont, Stéphane Gaudry, François Maillot, Sylvie Odent, Nathalie Cervantes, Hélène Zanaldi, Laurence Gachassin, Olivier Ruyer, David Patin, Benoît Cazenave, Pascal Jacquier, Michelle Boyer, Béatrice Berteaux, Virginie Zarrouk, Jacques Bor, Isabelle Legoff, Hélène Albinet, Florence Rousseau, Gilles Pialoux, Guenaelle Salaun-Beretta, Alexandra Moura, Véronique Vernet Garnier, Didier Lepelletier, Pierre-Alexandre Hauss, Joëlle Belaisch-Amart, Didier Lepeletier, Jacob Xavier, Aline Nare, Annie Motard-Picheloup, Alain Améri, Bertrand Lioger, Jean-Valère Malfuson, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Listeria - National Reference Center Listeria (CNRL), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria (CC-OMS / WHO-CC), Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Département de Médecine interne [Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Biologie des Infections - Biology of Infection, Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources (ICAReB), Institut Pasteur [Paris] (IP), Infectious Disease Department [Saint Maurice], Agence Nationale de la Santé Publique [Saint-Maurice] (ANSP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, MONALISA study group, Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency., ROZIER, marie-Claire, CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections (CNRL), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria - Biologie des Infections (CCOMS), CHU Pitié-Salpêtrière [APHP], Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections ( CNRL ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre collaborateur de l'OMS (CCOMS) des Listeria ( CCOMS ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Biologie des Infections, Institut Pasteur [Paris]-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources ( ICAReB ), Agence Nationale de la Santé Publique [Saint-Maurice] ( ANSP ), Assistance Publique - Hôpitaux de Paris, Assistance publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Paris 5 ( UPD5 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris]-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)

Subjects
Bacteremia/epidemiology/mortality, 0301 basic medicine, Male, Pediatrics, bacteraemia, Infectious Disease Transmission, [SDV]Life Sciences [q-bio], Bacteremia, France/epidemiology, Infant, Newborn, Diseases, Foodborne Diseases, Meningoencephalitis, Pregnancy, Risk Factors, Vertical, Medicine, Listeriosis, Prospective Studies, Pregnancy Complications, Infectious, Prospective cohort study, ddc:618, diabetes, alcoholism, Hazard ratio, Foodborne Diseases/microbiology, immuno suppressive therapies, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Hospitalization, Infectious Diseases, isolates, Population Surveillance, Female, France, Listeria monocytogenes/classification/isolation & purification, Cohort study, Adult, medicine.medical_specialty, 030106 microbiology, Notifiable disease, Listeriosis/diagnosis/epidemiology/microbiology, Context (language use), macromolecular substances, 03 medical and health sciences, Humans, study, Aged, [ SDV ] Life Sciences [q-bio], business.industry, Public health, cirrhosis, Infant, Newborn, Infant, Diseases/epidemiology/microbiology, HIV, Mandatory Reporting, Newborn, medicine.disease, Listeria monocytogenes, infection, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious/epidemiology/microbiology, Meningoencephalitis/epidemiology/microbiology/mortality, Observational study, business, prognostic, mellitus
Abstract

International audience; Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (

Published
2016

17. The early phase of human sepsis is characterized by a combination of apoptosis and proliferation of T cells

Author

Gaurav Kumar, Pierre Marie Roger, Hervé Hyvernat, Jean Dellamonica, Gilles Bernardin, and Michel Ticchioni

Subjects
Adult, Male, Interleukin 2, T-Lymphocytes, T cell, Apoptosis, Lymphocyte Activation, Critical Care and Intensive Care Medicine, Sepsis, Interleukin 21, T-Lymphocyte Subsets, Humans, Medicine, Cytotoxic T cell, Aged, Cell Proliferation, Aged, 80 and over, business.industry, Middle Aged, medicine.disease, Shock, Septic, Up-Regulation, Cross-Sectional Studies, medicine.anatomical_structure, Immunology, Cancer research, Cytokines, Female, Cytokine secretion, business, CD8, medicine.drug
Abstract

T cell activation as well as unresponsiveness has been described in separate studies in sepsis. Our aim was to establish the coexistence of both T cell fate in human sepsis.This is a cross-sectional study of 48 patients presenting with severe sepsis or septic shock and 15 healthy controls. Cytofluorometric techniques were used to quantify T cell activation, apoptosis, proliferation, expression of costimulatory molecules, and cytokine secretion.Patients with sepsis were characterized by a significant increase in the percentage of activated T cell subsets, as measured using CD69 marker, compared with healthy controls (P.05). T cell proliferation as measured through Ki67 expression was obvious in infected patients for both CD4 and CD8 T cell subsets compared with controls (P ≤.006). T cell subset apoptosis as measured using Hoechst dye was also increased in infected patients compared with controls (P ≤.002). CD4 T cell proliferation was correlated with interleukin 2 secretion (R(2)=0.84, P.001), whereas up-regulation of CD4 T cell apoptosis was correlated with CTLA-4 expression (R(2)=0.24, P=.001). No such similar relationship was observed for CD8(+) T cells.Concomitant T cell proliferation and T cell apoptosis are observed in human sepsis, being related to a different pathway.

Published
2012

18. Fatal fulminant primary hepatitis B virus infections with G1896A precore viral mutants in southeastern France

Author

Cyril Nafati, Vincent Thibault, Barbara Doudier, Laure Panassié, Patrick Borentain, Philippe Colson, René Gerolami, and Gilles Bernardin

Subjects
Adult, Male, Hepatitis B virus, Genotype, Fulminant, Virus Replication, medicine.disease_cause, Virus, Fatal Outcome, Humans, Medicine, Hepatitis B e Antigens, Fulminant hepatitis, Hepatology, business.industry, Viral Core Proteins, Mortality rate, Gastroenterology, virus diseases, Liver Failure, Acute, Middle Aged, Hepatitis B, Hepatitis B Core Antigens, Virology, digestive system diseases, Viral replication, HBeAg, Mutation, Immunology, Female, France, business
Abstract

Fulminant hepatitis has been shown to occur in about 1% of acute hepatitis B virus (HBV) infections, and its mortality rate is nearly 70%. Specific HBV genotypic features have been pointed out in fulminant acute hepatitis B worldwide, but these associations remain controversial. We describe all four primary HBV infections diagnosed in 2008 in our institution in Marseille, southeastern France, including two fatal cases. HBV genotypes were D or E. Precore G1896A HBV mutants were detected in both fatal fulminant primary HBV infections. Hepatitis B surface antigen and hepatitis B e antigen (HBeAg) were negative in two and three cases, respectively, despite HBV DNA detection. Primary HBV infection remains a cause of death in France. The impact of the precore G1896A mutation on the severity of AHB deserves to be assessed in larger studies in this country.

Published
2012

19. Antigènuries pneumocoque ou Legionella et antibiothérapie à spectre restreint au cours des pneumonies aiguës communautaires

Author

J. Dellamonica, Pierre-Marie Roger, F. De Salvador, H. Hyvernat, Gilles Bernardin, Eric Cua, K. Risso, Matteo Vassallo, and L. Landraud

Subjects
Gynecology, medicine.medical_specialty, Infectious Diseases, Medical treatment, Lung disease, business.industry, Treatment outcome, Medicine, Hospital mortality, business, Antibacterial agent, Mixed infection, Beta lactam antibiotics
Abstract

Resume Nous realisons les antigenuries pneumocoque et Legionella devant une pneumonie aigue communautaire (PAC), afin d’instituer une antibiotherapie documentee. L’efficacite d’une antibiotherapie a spectre restreint illustrerait l’absence de pertinence des analyses microbiologiques des produits respiratoires. Patients et methode Les patients hospitalises pour PAC etaient repertories par les tableaux de bord de trois services participants, le score de Fine appreciant leur gravite. L’ensemble des prelevements respiratoires etaient listes. Les antibiotherapies a spectre restreint etaient l’amoxicilline pour les infections a pneumocoque, et les macrolides ou les fluoroquinolones inactives sur le pneumocoque pour les legionelloses. Resultats Durant la periode consideree, 675 PAC etaient hospitalisees, 150 presentant une antigenurie positive (23 %), dont 108 infections a pneumocoque (73 %), 40 legionelloses (26 %) et deux infections mixtes. Le score de Fine etait de 106 ± 38. L’amoxicilline etait utilisee 108 fois, une quinolone 24 fois, un macrolide 18 fois. L’evolution etait favorable chez 138 patients (92 %). Quatre-vingt trois prelevements respiratoires isolaient une bacterie chez 58 patients (39 %), dont 24 especes non couvertes par l’antibiotherapie : Haemophilus influenzae six fois, Pseudmomonas aeruginosa six fois, Staphylococcus aureus cinq fois, Klebsiella pneumoniae deux fois et un autre bacille a Gram negatif cinq fois. Ces souches etaient resistantes in vitro a l’antibiotherapie dans 19 cas sur 24 (79 %). Un patient decede sur 12 avait une souche d’ Enterobacter resistante a l’antibiotherapie prescrite. Conclusion L’antibiotherapie a spectre restreint basee sur les antigenuries donne des resultats satisfaisants et met en evidence la colonisation respiratoire par des bacteries usuellement considerees comme pathogenes.

Published
2010

20. Complex partial status epilepticus revealing anti-NMDA receptor encephalitis

Author

Véronique Bourg, C. Bayreuther, M. Borg, Pierre Thomas, Gilles Bernardin, and Jean Dellamonica

Subjects
Adult, Pathology, medicine.medical_specialty, Movement disorders, Complex partial status epilepticus, Status epilepticus, Receptors, N-Methyl-D-Aspartate, Epilepsy, Epilepsy, Complex Partial, Status Epilepticus, Limbic Encephalitis, medicine, Humans, Ovarian Neoplasms, Anti-NMDA receptor encephalitis, business.industry, Limbic encephalitis, Teratoma, Electroencephalography, General Medicine, medicine.disease, Magnetic Resonance Imaging, Neurology, Immunology, Encephalitis, Anticonvulsants, Female, Neurology (clinical), medicine.symptom, Tomography, X-Ray Computed, business
Abstract

Encephalitis with anti-NMDA receptor antibodies is a recently-recognised form of paraneoplastic encephalitis characterized by a prodromal phase of unspecific illness with fever resembling viral disease, followed by memory loss, psychiatric features, seizures, disturbed consciousness, prominent abnormal movements and autonomic imbalance. Association with ovarian teratoma is common. Neurological outcome can be good, especially when surgery is performed at an early stage. Here, we report a case of anti-NMDA receptor encephalitis associated with ovarian teratoma presenting with inaugural complex partial status epilepticus. The nature of abnormal movements at early stages was unclear and abnormal movements were misinterpreted as the recurrence of partial epileptic seizures. Despite its rarity, all clinicians treating epilepsy and movement disorders should be familiar with anti-NMDA receptor encephalitis, that appears to be a very severe but curable disease.

Published
2009

21. Mesure de la capacité résiduelle fonctionnelle chez le patient ventilé : mesures, déterminants, implications cliniques, perspectives

Author

Laurent Brochard, Gilles Bernardin, Jean Dellamonica, and H. Hafidi

Subjects
Emergency Medicine, Emergency Nursing
Abstract

Resume La diminution de volume pulmonaire presente au cours du syndrome de detresse respiratoire aigue (SDRA) a pu etre appreciee grâce au scanner et aux techniques de dilution (Helium). Deux techniques de lavage (oxygene et azote) ont beneficie de l’amelioration technique recente des analyseurs de gaz permettant de simplifier les mesures de volume pulmonaire de fin d’expiration pour les rendre realisables au lit du patient. La diminution du volume ventilable au cours du SDRA est variable. La position allongee, la pathologie pulmonaire notamment le SDRA, la pression abdominale sont au cours de la ventilation mecanique autant de facteurs responsables d’une diminution du volume pulmonaire. La modification ou la correction de ces facteurs peuvent devenir des objectifs therapeutiques. Le monitorage des mesures de volume pulmonaires pourrait avoir un double interet : d’une part affiner la distinction entre recrutement/surdistension et aider au reglage des volumes delivres et d’autre part aider au diagnostic des patients repondeurs aux therapeutiques tels que le positionnement (assis, decubitus ventral), les manœuvres de recrutement ou le reglage de la PEP.

Published
2009

22. Assessment of muscle tissue oxygen saturation after out-of-hospital cardiac arrest

Author

Audrey Scarlatti, Jean-Christophe Orban, Gilles Bernardin, Pierre-Eric Danin, Carole Ichai, and Jean Dellamonica

Subjects
Muscle tissue, Adult, Male, medicine.medical_specialty, Hypothermia, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Out of hospital cardiac arrest, Microcirculation, Young Adult, Patient Admission, Hypothermia, Induced, Medicine, Humans, Prospective Studies, Young adult, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Middle Aged, Prognosis, Pathophysiology, Surgery, Oxygen, medicine.anatomical_structure, Treatment Outcome, Anesthesia, Observational study, Female, medicine.symptom, business, Out-of-Hospital Cardiac Arrest
Abstract

Purpose Pathophysiology of cardiac arrest corresponds to an ischemia-reperfusion syndrome with deep impairment of microcirculation. Muscular tissue oxygen saturation (StO 2 ) is a noninvasive method of evaluation of microcirculation. Our study was aimed at assessing the prognosis value of muscular StO 2 in patients admitted for out-of-hospital cardiac arrest (OHCA) and treated with hypothermia. Materials and methods We conducted a prospective bicentric observational study including OHCA patients treated with therapeutic hypothermia. Baseline StO 2 , derived variables (desaturation and resaturation slopes), and lactate levels were compared at different times between patients with good and poor outcomes. Prognosis was assessed by the Cerebral Performance Category (CPC) score at 6 months after admission (CPC 1-2, good outcome; CPC 3-5, poor outcome). Results Forty-four patients were included, 17 good and 27 poor outcomes at 6 months. At admission, StO 2 and lactate levels were lower in good outcome patients. Desaturation and resaturation slopes did not differ between groups. Conclusions After an OHCA treated with therapeutic hypothermia, StO 2 was correlated with outcome. Further research is needed to better understand the pathophysiological process underlying our results.

Published
2015

23. Factors associated with adherence to infectious diseases advice in two intensive care units

Author

Hervé Hyvernat, Pierre Dellamonica, Pierre-Marie Roger, Corinne Samat-Long, Céline Pulcini, Christian Pradier, Carole Ichai, and Gilles Bernardin

Subjects
Pharmacology, Microbiology (medical), Pediatrics, medicine.medical_specialty, business.industry, Mortality rate, Odds ratio, Intensive care unit, Confidence interval, law.invention, Infectious Diseases, law, Intensive care, medicine, Pharmacology (medical), Medical prescription, Risk factor, business, Antibacterial agent
Abstract

Results: A total of 381 consultations for 195 patients were recorded, 244 (64%) in ward A and 137 (36%) in ward B. The median SAPS score was 45 and the mortality rate was 23%. Infections accounted for 220 (58%) admissions. A diagnostic discrepancy between ID and intensive care specialists was noted in 125 (33%) cases. The ID specialist advised continuation of the same antibiotic therapy in 138 (36%) cases, a change in 154 (41%) and withdrawal in 89 (23%). Adherence to ID therapeutic advice was recorded for 326 (86%) cases. Multivariate analysis identified two factors independently associated with adherence: ward B [odds ratio (OR), 4.9; 95% confidence interval (CI), 2.0–12.1] and proposition to pursue the same therapy (OR, 4.8; 95% CI, 1.6–14.5). Conclusions: Patients’ characteristics and antibiotic therapy modalities do not influence adherence to ID consultation. In contrast, the ward and its characteristics play a major role in adherence to ID advice.

Published
2006

24. Native-valve infective endocarditis caused by Enterobacteriaceae: Report on 9 cases and literature review

Author

Georges Offenstadt, Gilles Bernardin, Jean-Louis Trouillet, Cecile Aubron, Hervé Hyvernat, Julien Charpentier, Alain Mercat, and Michel Wolff

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Salmonella, Heart Valve Diseases, Yersinia, medicine.disease_cause, Enterobacteriaceae, Intensive care, Internal medicine, Epidemiology, medicine, Humans, Endocarditis, General Immunology and Microbiology, biology, business.industry, Mortality rate, valvular heart disease, Enterobacteriaceae Infections, Endocarditis, Bacterial, General Medicine, Middle Aged, medicine.disease, biology.organism_classification, Surgery, Infectious Diseases, Infective endocarditis, Female, business
Abstract

Although the demographic characteristics of patients who develop infective endocarditis (IE) have changed over the last few decades, Enterobacteriaceae remain rarely responsible. We report the clinical and epidemiological characteristics of 9 patients with native-valve Enterobacteriaceae IE from 6 French medical intensive care units over a 10-y period and have identified 29 additional cases in the literature. Nearly a third of the 38 patients were immunocompromised and/or had previously known valvular heart disease. Salmonella spp. and Yersinia spp. were the most frequently isolated microorganisms reported in the literature. The overall mortality rate was 24% (9/38) and was lower for operated patients (10% (1/10)) compared to those who did not undergo valve surgery (31% (8/26)). Our results confirmed the rarity of native-valve endocarditis caused by Enterobacteriaceae, pathogens frequently responsible for nosocomial and community-acquired bacteraemias. This paradox may be explained by susceptibility to the bactericidal action of serum and the inability of these bacteria to colonize the endocardium.

Published
2006

25. Acquiring procedural skills in ICUs: a prospective multicenter study*

Author

Jean Reignier, Alexandre Boyer, Fabrice Zeni, Damien du Cheyron, Michel Wolff, Jean-Daniel Chiche, Marie Thuong, Jean-Damien Ricard, Dominique Perrotin, Francis Schneider, Jean-Luc Diehl, Alain Combes, Guillaume Thiery, Didier Dreyfuss, Jan Hayon, Damien Roux, Laurent Papazian, Alain Mercat, Erwan L'Her, Bertrand Souweine, Gilles Bernardin, Service de Réanimation Polyvalente, CH Départemental Vendée, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hopital Saint-Louis [AP-HP] (AP-HP), 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), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation-Détresses respiratoires et infections sévères, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Service des Soins Intensifs [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Réanimation Médicale, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de médecine d'urgence [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Soins Intensifs [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Interactions hôte et microorganismes des épithéliums, Normandie Université (NU)-Normandie Université (NU), Optimisation continue des actions thérapeutiques par l'intégration d'informations, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHRU Brest - Service de Réanimation Médicale (CHU - BREST - Réa Med), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Université de Tours (UT), Service de Réanimation Médicale [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Delafontaine, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation polyvalente [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Groupe de recherche sur la thrombose, pharmacologie des antithrombotiques et situations à risque (GRT), Université Jean Monnet - Saint-Étienne (UJM), Ecologie et Evolution des Microorganismes (EEM), Service de réanimation médicale [Mourier], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], UFR médecine - Bichat, Université Paris Diderot - Paris 7 (UPD7)-PRES Sorbonne Paris Cité, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Hôpital nord, Université Nice Sophia Antipolis (... - 2019) (UNS), Service de Réanimation Médicale [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Tours (UT)-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Service de réanimation polyvalente, urgences, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Équipe Énergie et Systèmes Embarqués (LAAS-ESE), Laboratoire d'analyse et d'architecture des systèmes [Toulouse] (LAAS), Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UPS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National des Sciences Appliquées - Toulouse (INSA Toulouse), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National Polytechnique [Toulouse] (INP)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UPS), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National Polytechnique [Toulouse] (INP), Université Nice Sophia Antipolis (UNS), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service des soins intensives, CHU Caen, Université de Tours-CHU Tours, Infection, Anti-microbiens, Modélisation, Evolution (IAME), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Cité (USPC)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hopital Louis Mourier - AP-HP [Colombes], Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Hopital Saint-Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Équipe Énergie et Systèmes Embarqués ( LAAS-ESE ), Laboratoire d'analyse et d'architecture des systèmes [Toulouse] ( LAAS ), Centre National de la Recherche Scientifique ( CNRS ) -Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National des Sciences Appliquées - Toulouse ( INSA Toulouse ), Institut National des Sciences Appliquées ( INSA ) -Institut National des Sciences Appliquées ( INSA ) -Institut National Polytechnique [Toulouse] ( INP ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Toulouse III - Paul Sabatier ( UPS ), Institut National des Sciences Appliquées ( INSA ) -Institut National des Sciences Appliquées ( INSA ) -Institut National Polytechnique [Toulouse] ( INP ), 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 ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), CHU Angers, Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ) -CHU Nice-Hôpital l'Archet, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHRU Brest - Service de Réanimation Médicale ( CHU - BREST - Réa Med ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), 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 ), CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] ( UJM ), Groupe de recherche sur la thrombose ( GRT (EA 3065) ), Université Jean Monnet [Saint-Étienne] ( UJM ), Ecologie et Evolution des Microorganismes ( EEM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hopital Louis Mourier - AP-HP [Colombes], and Université Paris Diderot - Paris 7 ( UPD7 ) -PRES Sorbonne Paris Cité

Subjects
Male, Inservice Training, Time Factors, medicine.medical_treatment, MESH : Prospective Studies, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Risk Factors, MESH: Internship and Residency, MESH: Risk Factors, Medicine, Intubation, MESH : Female, 030212 general & internal medicine, Prospective Studies, MESH : Chest Tubes, MESH: Catheterization, Central Venous, MESH: Chest Tubes, MESH : Adult, [ SDV.MP.PRO ] Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, MESH : Risk Factors, MESH: Inservice Training, Intensive Care Units, Pneumothorax, Chest Tubes, Female, MESH : Internship and Residency, Clinical Competence, France, MESH: Clinical Competence, MESH : Intensive Care Units, MESH : Catheterization, Central Venous, Central venous catheter, MESH : Time Factors, Adult, medicine.medical_specialty, Catheterization, Central Venous, MESH : Male, MESH : Inservice Training, [SDV.MP.PRO]Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, Bronchoscopies, 03 medical and health sciences, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Intubation, Intratracheal, Humans, MESH : France, Internal jugular vein, Mechanical ventilation, MESH: Humans, MESH: Intubation, Intratracheal, business.industry, MESH : Humans, MESH: Time Factors, Internship and Residency, 030208 emergency & critical care medicine, MESH: Adult, Arterial catheter, medicine.disease, MESH : Clinical Competence, MESH: Male, MESH: Prospective Studies, Surgery, Chest tube, MESH: France, Emergency medicine, MESH : Intubation, Intratracheal, MESH: Intensive Care Units, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; OBJECTIVES: Providing appropriate training of procedural skills to residents while ensuring patient safety through trainee supervision is a difficult and constant challenge. We sought to determine how effective and safe procedural skill acquisition is in French ICUs and to identify failure and complication risk factors. DESIGN: Multicenter prospective observational study. Invasive procedures performed by residents were recorded during two consecutive semesters. SETTING: Eighty-four residents. SUBJECTS: Eighty-four residents. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Number of invasive procedures performed, failure and complication rates, supervision, and assistance provided. Five thousand six hundred seventeen procedures were prospectively studied: 1,007 tracheal intubations, 1,272 arterial and 2,586 central venous catheter insertions, 457 fiberoptic bronchoscopies, and 295 chest tube insertions. During the semesters, residents performed a median of 10 intubations, 14 arterial catheter insertions, and 26 central venous catheter insertions. Complication rates were low, similar to those in the literature: 8.6% desaturation and 7.4% esophageal placement during intubation; 0.4% and 2.3% pneumothorax with jugular and subclavian central venous catheter insertions, respectively. We identified risk factors for failure and complications. Higher rates of failure and complications for intubation were associated with residents with no or little previous experience (p < 0.001); failure of internal jugular vein catheterization was associated with left-side insertion (p = 0.005) and absence of mechanical ventilation (p = 0.007). Supervision and assistance were more frequent at the beginning of the semester and for intubation and chest tube insertion. Finally, residents had less access to fiberoptic bronchoscopy and chest tube insertion. CONCLUSION: Procedural skills acquisition by residents in the ICU appears feasible and safe with complication rates comparable to what has previously been reported. We identified specific procedures and situations associated with higher failure and complication rates that could require proactive training. Questions still remain regarding minimal numbers of procedures to attain competence and how best to provide procedural training.

Published
2014

26. Place du cathétérisme cardiaque droit et de l’échocardiographie dans la prise en charge du choc septiqueRight heart catheterization and echocardiography in septic shock

Author

M Mattei, Gilles Bernardin, and H Hyvernat

Subjects
Gynecology, Right heart catheterization, medicine.medical_specialty, business.industry, Intensive care, Shock (circulatory), Right heart, Emergency Medicine, Sepsis syndrome, Medicine, Emergency Nursing, medicine.symptom, business
Abstract

Resume La prise en charge therapeutique du choc septique, en particulier l’optimisation du remplissage vasculaire et la necessite d’un traitement inotrope, s’appuie sur le recueil et l’interpretation fiables de variables hemodynamiques pertinentes. Apres une ere d’utilisation extensive et exclusive du catheterisme cardiaque droit, qui a largement contribue a notre connaissance physiopathologique de l’affection, l’attention des cliniciens se tourne maintenant vers des outils non invasifs, en premier lieu l’echocardiographie. Autrefois consideree uniquement comme une technique d’imagerie, l’echocardiographie est devenue un outil d’investigation hemodynamique capable de fournir au clinicien l’ensemble des informations necessaires au traitement. Cependant en raison de leurs specificites, methode de monitorage continue d’un cote et methode de diagnostic hemodynamique ponctuel de l’autre, l’echocardiographie et le catheterisme cardiaque droit doivent etre consideres comme complementaires.

Published
2001

28. Estimating cardiac filling pressure in mechanically ventilated patients with hyperinflation

Author

Jean-Louis Teboul, Gilles Bernardin, Alain Mercat, Jean-Michel Achard, Thierry Boulain, Michael R. Pinsky, Nadia Anguel, and Christian Richard

Subjects
Male, Critical Care, medicine.medical_treatment, Positive pressure, Blood Pressure, Pulmonary Edema, Critical Care and Intensive Care Medicine, Ventricular Function, Left, Positive-Pressure Respiration, Plateau pressure, Diastole, Intensive care, Humans, Medicine, Prospective Studies, Pulmonary Wedge Pressure, Pulmonary wedge pressure, Lung, Aged, Mechanical ventilation, Respiratory Distress Syndrome, Pulmonary gas pressures, business.industry, Middle Aged, Pulmonary Alveoli, Preload, Blood pressure, Anesthesia, Female, Respiratory Insufficiency, business
Abstract

Objective: When positive end-expiratory pressure (PEEP) is applied, the intracavitary left ventricular end-diastolic pressure (LVEDP) exceeds the LV filling pressure because pericardial pressure exceeds 0 at end-expiration. Under those conditions, the LV filling pressure is itself better reflected by the transmural LVEDP (tLVEDP) (LVEDP minus pericardial pressure). By extension, end-expiratory pulmonary artery occlusion pressure (eePAOP), as an estimate of end-expiratory LVEDP, overestimates LV filling pressure when pericardial pressure is >0, because it occurs when PEEP is present. We hypothesized that LV filling pressure could be measured from eePAOP by also knowing the proportional transmission of alveolar pressure to pulmonary vessels calculated as index of transmission = (end-inspiratory PAOP - eePAOP)/ (plateau pressure - total PEEP). We calculated transmural pulmonary artery occlusion pressure (tPAOP) with this equation: tPAOP = eePAOP - (index of transmission x total PEEP). We compared tPAOP with airway disconnection nadir PAOP measured during rapid airway disconnection in subjects undergoing PEEP with and without evidence of dynamic pulmonary hyperinflation. Design: Prospective study. Setting: Medical intensive care unit of a university hospital. Patients: We studied 107 patients mechanically ventilated with PEEP for acute respiratory failure. Patients without dynamic pulmonary hyperinflation (group A; n = 58) were analyzed separately from patients with dynamic pulmonary hyperinflation (group B; n = 49). Intervention: Transient airway disconnection. Measurements and Main Results: In group A, tPAOP (8.5 ± 6.0 mm Hg) and nadir PAOP (8.6 ± 6.0 mm Hg) did not differ from each other but were lower than eePAOP (12.4 ± 5.6 mm Hg; p < .05). The agreement between tPAOP and nadir PAOP was good (bias, 0.15 mm Hg; limits of agreement, -1.5-1.8 mm Hg). In group B, tPAOP (9.7 ± 5.4 mm Hg) was lower than both nadir PAOP and eePAOP (12.1 ± 5.4 and 13.9 ± 5.2 mm Hg, respectively; p

Published
2000

29. ?-adrenergic receptor-dependent and -independent stimulation of adenylate cyclase is impaired during severe sepsis in humans

Author

Arthur Donny Strosberg, Gilles Bernardin, M. Mattei, A. Bernard, and S. Marullo

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Adrenergic, Stimulation, Critical Care and Intensive Care Medicine, Sepsis, chemistry.chemical_compound, Catecholamines, Internal medicine, Receptors, Adrenergic, beta, Cyclic AMP, medicine, Humans, Cyclic adenosine monophosphate, Lymphocytes, Aged, Forskolin, Septic shock, business.industry, Middle Aged, medicine.disease, Shock, Septic, Endocrinology, Cytokine, chemistry, Case-Control Studies, Shock (circulatory), Cytokines, Female, medicine.symptom, business, Adenylyl Cyclases, Signal Transduction
Abstract

Objectives: a) To investigate the functional consequences of sepsis on the β-adrenergic signal transduction in human circulating lymphocytes; b) to appreciate sepsis-associated catecholamine and cytokine release. Design: Experimental, comparative study. Setting: Research laboratory in a university hospital. Subjects: Healthy controls (n = 10); critically ill patients who were not septic (n = 7); septic patients with severe sepsis or septic shock (n = 11). Measurements and main results: Experiments were carried out using freshly isolated peripheral blood mononuclear cells (PBMC). We measured β-adrenergic receptor (βAR) number and affinity, and intracellular cAMP content at baseline and after the pharmacological stimulation of each component of the β -adrenergic complex: βAR with isoproterenol, Gs-protein with sodium fluoride (NaF), adenylate cyclase with forskolin. Catecholamine (adrenaline, noradrenaline) and cytokine (TNFα, IL-1α, IL-1β, IL-6) serum levels were measured. In both septic and non-septic patients we observed a similar 40 % down-regulation of βARs compared to controls, and a reduced basal and isoproterenol-stimulated cAMP accumulation (p < 0.05). The cAMP production elicited by NaF or forskolin was lower in septic patients than in the controls (p < 0.01). Forskolin-stimulated cAMP accumulation was significantly lower in septic patients than it was in non-septic ones (p < 0.001). Catecholamine serum concentrations were increased in the two patient groups without any significant difference. Elevated cytokine serum levels were detected in 45 % of the septic patients (versus 14 % of non-septic patients p < 0.05). Conclusions: Patients presenting with severe sepsis or septic shock have extended postreceptor defects of the β-adrenergic signal transduction. This finding suggests a heterologous desensitization of adenylate cyclase stimulation.

Published
1998

30. Moules bronchiques au cours d’une agranulocytose fébrile post-chimiothérapie

Author

Hervé Hyvernat, F. Burel-Vandenbos, Ph. Deswardt, F. Vandenbos, and Gilles Bernardin

Subjects
Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, medicine, business
Abstract

Resume Les moules bronchiques sont des formations qui moulent et obstruent les bronches. Ils peuvent entrainer des detresses respiratoires, parfois fatales. Ils se rencontrent essentiellement au cours d’affections respiratoires chroniques comme l’asthme, l’aspergillose broncho-pulmonaire allergique ou la mucoviscidose. Chez l’enfant, ils peuvent aussi se developper au cours d’une cardiopathie cyanogene. La survenue de moules bronchiques chez un patient sans pathologie respiratoire chronique est exceptionnelle.

Published
2006

31. Diagnostic accuracy of early urinary index changes in differentiating transient from persistent acute kidney injury in critically ill patients: multicenter cohort study

Author

Bernard Tardy, Bertrand Souweine, Eric Ezingeard, Johanna Oziel, Alexandre Lautrette, Christophe Mariat, Yves Cohen, Fabrice Zeni, Bertrand Pons, Jean Dellamonica, Michael Darmon, Regine Vermesch, François Vincent, Gilles Bernardin, Medical ICU, Avenue Albert Raymond, Saint-Priest en Jarez 42270, France, Saint-Etienne University Hospital, Unité de soins intensifs [Clermont Ferrand], CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Medical-Surgical Intensive Care Unit, Avicenne University Hospital, APHP, 125 rue de Stalingrad, Bobigny 93009, France, Avicenne University Hospital, 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), 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), Service de néphrologie et tranplantation, CHU Saint-Etienne-Hôpital nord, Réanimation Médicale, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Service de réanimation polyvalente, urgences, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Service d'anesthésie-réanimation [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), Service de Réanimation Médico-Chirurgicale [Avicenne], CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Faculté de Médecine-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Nice Sophia Antipolis (... - 2019) (UNS), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Service de Réanimation polyvalente [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Groupe de recherche sur la thrombose, pharmacologie des antithrombotiques et situations à risque (GRT), Université Jean Monnet - Saint-Étienne (UJM), Service de Réanimation Médicale [CHU Saint-Etienne], and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]

Subjects
Male, medicine.medical_specialty, Letter, Fractional excretion of sodium, Critical Illness, Urinary system, Urology, Renal function, Urine, Kidney Function Tests, Critical Care and Intensive Care Medicine, urologic and male genital diseases, Cohort Studies, Excretion, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Creatinine, business.industry, Acute kidney injury, 030208 emergency & critical care medicine, Acute Kidney Injury, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, 3. Good health, Surgery, chemistry, Female, business, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; INTRODUCTION: Urinary indices have limited effectiveness in separating transient acute kidney injury (AKI) from persistent AKI in ICU patients. Their time-course may vary with the mechanism of AKI. The primary objective of this study was to evaluate the diagnostic value of changes over time of the usual urinary indices in separating transient AKI from persistent AKI. METHODS: An observational prospective multicenter study was performed in six ICUs involving 244 consecutive patients, including 97 without AKI, 54 with transient AKI, and 93 with persistent AKI. Urinary sodium, urea and creatinine were measured at ICU admission (H0) and on 6-hour urine samples during the first 24 ICU hours (H6, H12, H18, and H24). Transient AKI was defined as AKI with a cause for renal hypoperfusion and reversal within 3 days. RESULTS: Significant increases from H0 to H24 were noted in fractional excretion of urea (median, 31% (22 to 41%) and 39% (29 to 48%) at H24, P < 0.0001), urinary urea/plasma urea ratio (15 (7 to 28) and 20 (9 to 40), P < 0.0001), and urinary creatinine/plasma creatinine ratio (50 (24 to 101) and 57 (29 to 104), P = 0.01). Fractional excretion of sodium did not change significantly during the first 24 hours in the ICU (P = 0.13). Neither urinary index values at ICU admission nor changes in urinary indices between H0 and H24 performed sufficiently well to recommend their use in clinical setting (area under the receiver-operating characteristic curve ≤0.65). CONCLUSION: Although urinary indices at H24 performed slightly better than those at H0 in differentiating transient AKI from persistent AKI, they remain insufficiently reliable to be clinically relevant.

Published
2013

32. Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock

Author

F Tiger, P. Deloffre, Gilles Bernardin, M Mattei, and C Pradier

Subjects
Adult, Male, medicine.medical_specialty, Mean arterial pressure, Time Factors, Hemodynamics, Blood Pressure, Critical Care and Intensive Care Medicine, Statistics, Nonparametric, Catecholamines, Internal medicine, medicine, Humans, Prospective Studies, Aged, Aged, 80 and over, Septic shock, business.industry, Middle Aged, Prognosis, medicine.disease, Shock, Septic, Survival Analysis, Surgery, Treatment Outcome, Blood pressure, Mean blood pressure, ROC Curve, Shock (circulatory), Lactates, Cardiology, Arterial blood, Female, Hyperlactatemia, medicine.symptom, business
Abstract

To identify early prognostic markers of septic shock among catheterization-derived hemodynamic and metabolic data. Prospective cohort study. A medical intensive care unit in a university hospital. Thirty-two consecutive patients with septic shock, separated into two groups according to shortterm (10-day) evolution: 18 acute survivors and 14 fatalities. Usual hemodynamic and metabolic variables were measured at the onset of shock, i.e. when the catheter was inserted (T0), and 24 h later (T24). The values collected for each group at T0 and T24 and their 24-h changes were compared. On admission, no difference was found between acute survivors and eventual fatalities. After 24 h, fatalities presented with significantly lower mean arterial pressure (p

Published
1996

33. CT-guided percutaneous catheter drainage of acute infectious necrotizing pancreatitis: assessment of effectiveness and safety

Author

Guillaume Baudin, Xavier Hébuterne, Madleen Chassang, Sébastien Novellas, Patrick Chevallier, Eve Gelsi, and Gilles Bernardin

Subjects
Male, medicine.medical_specialty, Percutaneous, Biopsy, Fine-Needle, Hemorrhage, Catheterization, Sepsis, Pancreatic Fistula, Predictive Value of Tests, medicine, Intestinal Fistula, Humans, Radiology, Nuclear Medicine and imaging, Survival rate, Pancreas, Retrospective Studies, Univariate analysis, business.industry, Pancreatitis, Acute Necrotizing, Mortality rate, Retrospective cohort study, General Medicine, Length of Stay, Middle Aged, medicine.disease, Surgery, Radiographic Image Enhancement, Survival Rate, Catheter, C-Reactive Protein, Treatment Outcome, Pancreatitis, Drainage, Female, Radiology, business
Abstract

The purpose of this study is to assess retrospectively the effectiveness and safety of CT-guided percutaneous drainage and to determine the factors influencing clinical success and mortality in patients with infectious necrotizing pancreatitis.From April 1997 to December 2005, 48 consecutive patients (33 men and 15 women; median age, 58.5 years) with proven infectious necrotizing pancreatitis underwent percutaneous catheter drainage via CT guidance. Evaluated factors included clinical, biologic, and radiologic scores; drainage and catheter characteristics; and complications. Clinical success was defined as control of sepsis without requirement for surgery. Univariate analysis was performed to determine factors that could have affected the clinical success and the mortality rates.Clinical success was achieved in 31 of 48 patients (64.6%) and was significantly associated with Ranson score (p = 0.01) and with the delay between admission and the beginning of the drainage (p = 0.005), with a calculated threshold delay of 18 days (p = 0.001). The global mortality rate (14/48 [29%]) was also influenced by the Ranson score (p = 01) and the delay of drainage (p = 0.04) with the same threshold delay (p = 0.01). Only two major nonlethal procedure-related complications were observed.Percutaneous catheter drainage is a safe and effective technique to treat acute infectious necrotizing pancreatitis.

Published
2012

35. Accuracy and precision of end expiratory lung volume measurements by automated nitrogen washout/washin technique in patients with acute respiratory distress syndrome

Author

Alain Mercat, Qin Lu, Jean Dellamonica, Nicolas Lerolle, Jean-Jacques Rouby, Jordi Mancebo, Jean-Luc Diehl, Gaetan Beduneau, Jean-Christophe M. Richard, Gilles Bernardin, Cyril Sargentini, Fabiano Di Marco, Laurent Brochard, 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), Réanimation Médicale, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Groupe de Recherche sur le Handicap Ventilatoire (GRHV), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Pneumologia Ospedale San Paolo, Università degli Studi di Milano = University of Milan (UNIMI), Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), INSERM U955, équipe 13, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Intensive Care Department, University Hospital and University of Geneva-University Hospital and University of Geneva-Department of Intensive Care, Geneva University Hospital and Geneva University-Geneva University Hospital and Geneva University-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), BMC, Ed., Université Nice Sophia Antipolis (... - 2019) (UNS), Institute for Research and Innovation in Biomedicine (IRIB), 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), Normandie Université (NU)-CHU Rouen, Normandie Université (NU), and Università degli Studi di Milano [Milano] (UNIMI)

Subjects
Spirometry, Male, ARDS, Functional Residual Capacity, Nitrogen, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Functional residual capacity, Intensive care, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Medicine, Humans, Lung volumes, Interactive Ventilatory Support, Lung, Aged, Respiratory Distress Syndrome, medicine.diagnostic_test, business.industry, Research, Reproducibility of Results, 030208 emergency & critical care medicine, Middle Aged, respiratory system, medicine.disease, Nitrogen washout, Confidence interval, respiratory tract diseases, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Female, business, Lung Volume Measurements
Abstract

Introduction: End-expiratory lung volume (EELV) is decreased in acute respiratory distress syndrome (ARDS), and bedside EELV measurement may help to set positive end-expiratory pressure (PEEP). Nitrogen washout/washin for EELV measurement is available at the bedside, but assessments of accuracy and precision in real-life conditions are scant. Our purpose was to (a) assess EELV measurement precision in ARDS patients at two PEEP levels (three pairs of measurements), and (b) compare the changes (Delta) induced by PEEP for total EELV with the PEEP-induced changes in lung volume above functional residual capacity measured with passive spirometry (Delta PEEP-volume). The minimal predicted increase in lung volume was calculated from compliance at low PEEP and Delta PEEP to ensure the validity of lung-volume changes. Methods: Thirty-four patients with ARDS were prospectively included in five university-hospital intensive care units. Delta EELV and Delta PEEP volumes were compared between 6 and 15 cm H2O of PEEP. Results: After exclusion of three patients, variability of the nitrogen technique was less than 4%, and the largest difference between measurements was 81 +/- 64 ml. Delta EELV and Delta PEEP-volume were only weakly correlated (r(2) = 0.47); 95% confidence interval limits, -414 to 608 ml). In four patients with the highest PEEP (>= 16 cm H2O), Delta EELV was lower than the minimal predicted increase in lung volume, suggesting flawed measurements, possibly due to leaks. Excluding those from the analysis markedly strengthened the correlation between Delta EELV and Delta PEEP volume (r(2) = 0.80). Conclusions: In most patients, the EELV technique has good reproducibility and accuracy, even at high PEEP. At high pressures, its accuracy may be limited in case of leaks. The minimal predicted increase in lung volume may help to check for accuracy.

Published
2011

36. Toxoplasmosis and horse meat, France

Author

Daniel Ajzenberg, Gilles Bernardin, Christelle Pomares, Pierre Marty, Lilia Hasseine, Marie-Laure Dardé, Loic Bornard, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Centre National de Référence (CNR) Toxoplasmose/Toxoplasma Biological Resource Center (BRC) (CNR Toxoplasmose-Toxoplasma BRC), CHU Limoges, Université de Limoges (UNILIM), Neuroépidémiologie Tropicale et Comparée (NETEC), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM), Réanimation Médicale, Université Nice Sophia Antipolis (... - 2019) (UNS), and COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet

Subjects
MESH: Fatal Outcome, Horse meat, Acquired Toxoplasmosis, lcsh:Medicine, Physiology, atypical strain, 030308 mycology & parasitology, MESH: Amniocentesis, 0302 clinical medicine, MESH: Pregnancy, MESH: DNA Fingerprinting, Respiratory function, MESH: Animals, MESH: Sulfadiazine, ComputingMilieux_MISCELLANEOUS, media_common, MESH: Aged, MESH: Meat, 0303 health sciences, MESH: Toxoplasma, MESH: Immunoglobulin M, 3. Good health, MESH: Introduced Species, MESH: Young Adult, MESH: Toxoplasmosis, France, toxoplasmosis, food.ingredient, Transplacental transmission, MESH: Pyrimethamine, 030231 tropical medicine, letter, Toxoplasma gondii, horse meat, MESH: DNA, Protozoan, parasites, Biology, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, food, medicine, media_common.cataloged_instance, lcsh:RC109-216, European union, Seroconversion, MESH: Antiprotozoal Agents, Letters to the Editor, MESH: Horses, MESH: Humans, lcsh:R, foodborne infections, MESH: Polymerase Chain Reaction, biology.organism_classification, medicine.disease, Toxoplasmosis, MESH: Male, MESH: France, Immunology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Microsatellite Repeats, MESH: Female
Abstract

To the Editor: Toxoplasma gondii parasites are obligate intracellular apicomplexans that can infect virtually all warm-blooded animals; felids are definitive hosts. The most common sources of human infection are ingestion of tissue cysts in undercooked meat or of food or water contaminated with oocysts shed by felids and transplacental transmission. Acquired toxoplasmosis in immunocompetent humans is frequently asymptomatic but is associated with cervical or occipital lymphadenopathy in ≈10% of patients. Severe or fatal outcomes for immunocompetent patients have been attributed to the virulence of specific T. gondii genotypes (1). We describe 3 cases of toxoplasmosis caused by atypical strains probably acquired by from ingestion of raw horse meat imported from Canada and Brazil. Patient 1, a 74-year-old man, was hospitalized locally (Antibes-Juan Les Pins, southern France) in March 2009 for asthenia and persistent febrile bronchitis. His medical history included severe smoking-related chronic obstructive pulmonary disease and coronary artery disease. He received broad-spectrum antimicrobial drugs and methylprednisolone. On day 23 after admission, he was transferred to our teaching hospital in Nice because of clinical deterioration and persistent fever. Disseminated toxoplasmosis was diagnosed on the basis of serologic evidence of recent primary T. gondii parasite infection and quantitative PCR detection of high Toxoplasma DNA levels in peripheral blood. Despite specific antitoxoplasma therapy with sulfadiazine and pyrimethamine, he remained febrile, his respiratory function worsened, and he died on day 27. Patient 2, a 24-year-old pregnant woman, was hospitalized in Draguignan, France, in December 2009 for full-term delivery. Three weeks earlier, routine serologic testing showed T. gondii parasite infection seroconversion. The newborn’s and mother’s ophthalmologic examinations were unremarkable. Congenital toxoplasmosis was diagnosed on the basis immunoglobulin M in the infant’s serum, positive quantitative PCR of samples from the placenta, and strain isolation after inoculation of mice with a placental preparation. Sulfadiazine and pyrimethamine were started. We performed a retrospective epidemiologic investigation of an unusual case of toxoplasmosis that occurred in March 1991. Patient 3, a 21-year-old pregnant woman living in the Nice area, was treated with spiramycine because routine serologic testing had shown T. gondii parasite infection seroconversion at 22 weeks’ gestation. Amniocentesis showed T. gondii tachyzoites in amniotic fluid by microscopic examination. At 26 weeks’ gestation, the woman underwent termination of pregnancy for ultrasonography-detected fetal severe abnormalities. Fetal necropsy showed numerous cerebral, cardiac, and hepatic abscesses with T. gondii tachyzoites. A few days after pregnancy termination, the woman experienced cervical lymphadenopathy, which lasted 3 years. She reported having eaten raw horse meat regularly during her pregnancy. Genetic analyses with microsatellite markers of the Toxoplasma spp. strains isolated from the 3 patients found 3 different atypical genotypes. Atypical strains are common in South America but unusual in France, where >95% of reported strains collected from human and animal toxoplasmosis cases belonged to the type II clonal lineage (2,3). Hence, isolation of an atypical Toxoplasma genotype from a patient in France strongly suggests contamination by a non-European strain, either during residence abroad or after ingestion of imported meat. Epidemiologic investigation of our case-patients that included questioning relatives, patients, and butchers found that eating raw horse meat imported from Canada (patient 1) or Brazil (patient 2) was the most likely source of the parasites. The geographic origin of the horse meat eaten by patient 3 is unknown. Moreover, an atypical T. gondii strain was isolated after mouse inoculation with horse meat from the first patient’s butcher. In all 3 cases, close relatives encouraged the patients to eat raw horse meat regularly because the practice is traditionally thought to reinforce health. Human toxoplasmosis cases associated with horse meat consumption are rarely reported but are probably underestimated (2). In the European Union, France and Italy account for more than two thirds of all horse meat eaten, predominantly raw, thereby increasing the likelihood of infection by various parasites, including Trichinella spp. and Toxoplasma spp (4). Under natural conditions, serologic prevalence of T. gondii parasites in horses worldwide may range from 0% to 80% (5). Many factors could account for this variation, including the sensitivity and specificity of the serologic test, ages of animals, geographic area and hygienic condition of farm management (5). The only prevalence survey of horses slaughtered for food that we are aware of was conducted in Canada and the United States and found antibodies to T. gondii parasites in 124 (6.9%) of 1,788 serum samples (6). T. gondii tissue cysts in meat are immediately killed by reaching an internal temperature of 67°C in all parts of meat during cooking (7). Deep freezing (

Published
2011

37. Impact of an intervention designed to improve the documentation of the reassessment of antibiotic therapies in an intensive care unit

Author

Nicolas Molinari, Gilles Bernardin, Albert Sotto, J. Dellamonica, C. Pulcini, Service d’infectiologie, and Centre Hospitalier Universitaire de Nice (CHU Nice)

Subjects
Male, medicine.medical_specialty, medicine.drug_class, [SDV]Life Sciences [q-bio], Antibiotics, audit, Audit, Drug Prescriptions, law.invention, 03 medical and health sciences, 0302 clinical medicine, Documentation, law, Intervention (counseling), antibiotic, medicine, Humans, quality indicator, 030212 general & internal medicine, Prospective Studies, Medical prescription, Intensive care medicine, 0303 health sciences, 030306 microbiology, business.industry, Medical record, Middle Aged, Intensive care unit, Written Documentation, 3. Good health, Anti-Bacterial Agents, Benchmarking, Intensive Care Units, Infectious Diseases, Emergency medicine, Feasibility Studies, Female, business
Abstract

International audience; Objectives. - The study objectives were: (i) to design an intervention to improve the written documentation of empiric antibiotic prescriptions' reassessment; (ii) and to assess the impact of this intervention on the quality of prescriptions. Patients and methods. - A prospective before and after 7-month intervention study in a medical ICU in a French teaching hospital, using interrupted time-series analysis. The intervention was made to improve the documentation of four process measures in medical records: antibiotic plan, reviewing the diagnosis, adapting to positive microbiological results, and IV-per os switch. Results. - One hundred and fourteen antibiotic prescriptions were assessed, 62 before and 52 after the intervention. The reassessment of antibiotic prescriptions was more often documented in the ICU after the intervention (P = 0.03 for sudden change). The prevalence of appropriate antibiotic prescriptions was not statistically different before and after the intervention, either for sudden change and/or linear trend. Conclusion. - A better documentation of antibiotic prescriptions' reassessment was achieved in this ICU, but it did not improve the quality of antibiotic prescriptions

Published
2011

38. Impact of an assisted reassessment of antibiotic therapies on the quality of prescriptions in a medical intensive care unit

Author

Pierre-Marie Roger, Gilles Bernardin, Albert Sotto, C. Pulcini, Nicolas Molinari, F. Girard-Pipau, H. Hyvernat, L. Bornard, J. Dellamonica, Université de Nice Sophia-Antipolis (UNSA), Faculté de médecine, Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie (MISTEA), Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de la Recherche Agronomique (INRA), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), and Université Montpellier 1 (UM1)

Subjects
Clinical audit, Program evaluation, Male, medicine.medical_specialty, MEDLINE, Inappropriate Prescribing, Unnecessary Procedures, Drug Prescriptions, Microbiology, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intervention (counseling), Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Medical prescription, Intensive care medicine, Prospective cohort study, Hospitals, Teaching, Diagnosis-Related Groups, Aged, Aged, 80 and over, 0303 health sciences, Infectious Disease Medicine, Clinical Audit, 030306 microbiology, business.industry, Bacterial Infections, Middle Aged, Intensive care unit, Quality Improvement, Drug Utilization, 3. Good health, Anti-Bacterial Agents, Intensive Care Units, Infectious Diseases, Ceiling effect, Education, Medical, Continuing, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Program Evaluation
Abstract

Objectives The study's objective was to assess the impact of a professional multifaceted intervention designed to improve the quality of inpatient empirical therapeutic antibiotic courses at the time of their reassessment, i.e. 24 to 96 hours after treatment initiation. Design We conducted a 5-month prospective pre- and post-intervention study in a medical Intensive Care Unit (ICU) in a teaching hospital, using time-series analysis. The intervention was a multifaceted professional intervention combining systematic 3-weekly visits of an infectious diseases specialist to discuss all antibiotic therapies, interactive teaching courses, and daily contact with a microbiologist. Results Eighty-one antibiotic prescriptions were assessed, 37 before and 44 after the intervention. The prevalence of adequate antibiotic prescriptions was high and not statistically different before and after the intervention (73% vs. 80%, P = 0.31), both for sudden change ( P = 0.67) and linear trend ( P = 0.055), using interrupted time-series analysis. The intervention triggered a more frequent reassessment of the diagnosis between day 2 and day 4 (11% vs. 32%, P = 0.02) and slightly improved the adaptation of antibiotic therapies to positive microbiology (25% before vs. 50% after, P = 0.18). Conclusions Our multifaceted intervention may have improved the quality of antibiotic therapies around day 3 of prescription, but the difference did not reach statistical significance, possibly because of a ceiling effect.

Published
2011

39. Diagnostic performance of fractional excretion of urea in the evaluation of critically ill patients with acute kidney injury: a multicenter cohort study

Author

Laurent Brochard, Benoit Schlemmer, Yves Cohen, François Vincent, Fabrice Zeni, Frédéric Gonzalez, Vincent Das, Frédérique Schortgen, Gilles Bernardin, Michael Darmon, Jean Dellamonica, Service de réanimation polyvalente, urgences, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM), 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), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], INSERM U955, équipe 13, Medical-Surgical Intensive Care Unit, Geneva University Hospital (HUG)-Geneva University Hospital (HUG)-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), Financial support consisted of a grant from the Assistance-Publique Hôpitaux de Paris (CRC 07 011), a nonprofit, government-funded organization., Université Paris 13 (UP13)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Nice Sophia Antipolis (... - 2019) (UNS), and BMC, Ed.

Subjects
Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, Critical Care and Intensive Care Medicine, urologic and male genital diseases, Gastroenterology, Cohort Studies, 0302 clinical medicine, Urea, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, MESH: Sepsis, MESH: Cohort Studies, MESH: Aged, MESH: Middle Aged, Acute kidney injury, Acute Kidney Injury, Middle Aged, female genital diseases and pregnancy complications, MESH: Predictive Value of Tests, Intensive Care Units, acute tubular necrosis, MESH: Critical Illness, Female, Cohort study, medicine.medical_specialty, MESH: Hemodynamics, Fractional excretion of sodium, Critical Illness, MESH: Acute Kidney Injury, Sepsis, Excretion, fractional excretion of sodium, 03 medical and health sciences, Predictive Value of Tests, acute kidney failure, Internal medicine, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, MESH: Diuretics, Intensive care medicine, Acute tubular necrosis, MESH: Urea, Aged, MESH: Humans, business.industry, urogenital system, Research, Hemodynamics, MESH: Biological Markers, 030208 emergency & critical care medicine, medicine.disease, diuretics, MESH: Male, MESH: Prospective Studies, sensitivity and specificity, ICU, MESH: Intensive Care Units, Diuretic, business, MESH: Female, Biomarkers
Abstract

International audience; INTRODUCTION: Several factors, including diuretic use and sepsis, interfere with the fractional excretion of sodium, which is used to distinguish transient from persistent acute kidney injury (AKI). These factors do not affect the fractional excretion of urea (FeUrea). However, there are conflicting data on the diagnostic accuracy of FeUrea. METHODS: We conducted an observational, prospective, multicenter study at three ICUs in university hospitals. Unselected patients, except those with obstructive AKI, were admitted to the participating ICUs during a six-month period. Transient AKI was defined as AKI caused by renal hypoperfusion and reversal within three days. The results are reported as medians (interquartile ranges). RESULTS: A total of 203 patients were included. According to our definitions, 67 had no AKI, 54 had transient AKI and 82 had persistent AKI. FeUrea was 39% (28 to 40) in the no-AKI group, 41% (29 to 54) in the transient AKI group and 32% (22 to 51) in the persistent AKI group (P = 0.12). FeUrea was of little help in distinguishing transient AKI from persistent AKI, with the area under the receiver operating characteristic curve being 0.59 (95% confidence interval, 0.49 to 0.70; P = 0.06). Sensitivity was 63% and specificity was 54% with a cutoff of 35%. In the subgroup of patients receiving diuretics, the results were similar. CONCLUSIONS: FeUrea may be of little help in distinguishing transient AKI from persistent AKI in critically ill patients, including those receiving diuretic therapy. Additional studies are needed to evaluate alternative markers or strategies to differentiate transient from persistent AKI.

Published
2011

40. PEEP-induced changes in lung volume in acute respiratory distress syndrome. Two methods to estimate alveolar recruitment

Author

Gilles Bernardin, Qin Lu, J. Dellamonica, Jordi Mancebo, Gaetan Beduneau, Nicolas Lerolle, Laurent Brochard, Jean-Jacques Rouby, Jean-Christophe Richard, F. Di Marco, C. Sargentini, Jean Luc Diehl, A. Mercat, Univ Angers, Okina, 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), Réanimation Médicale, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, 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), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Groupe de Recherche sur le Handicap Ventilatoire (GRHV), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Pneumologia Ospedale San Paolo, Università degli Studi di Milano = University of Milan (UNIMI), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), INSERM U955, équipe 13, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Intensive Care Department, University Hospital and University of Geneva-University Hospital and University of Geneva-Department of Intensive Care, Geneva University Hospital and Geneva University-Geneva University Hospital and Geneva University-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 Nice Sophia Antipolis (... - 2019) (UNS), Institute for Research and Innovation in Biomedicine (IRIB), 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), Normandie Université (NU)-CHU Rouen, Normandie Université (NU), and Università degli Studi di Milano [Milano] (UNIMI)

Subjects
Male, ARDS, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pneumology/Respiratory System, Lung recruitment, Nitrogen washout/washin, Distension, Critical Care and Intensive Care Medicine, Intensive / Critical Care Medicine, Pediatrics, Pain Medicine, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Functional residual capacity, Mechanical ventilation, Anesthesiology, Diffusing capacity, End-expiratory lung volume, medicine, Humans, Lung volumes, Prospective Studies, Positive end-expiratory pressure, Aged, Respiratory Distress Syndrome, Lung, Acute respiratory distress syndrome, business.industry, 030208 emergency & critical care medicine, Middle Aged, respiratory system, medicine.disease, respiratory tract diseases, Pulmonary Alveoli, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Emergency Medicine, Female, business, Lung Volume Measurements, circulatory and respiratory physiology
Abstract

International audience; Purpose Lung volumes, especially functional residual capacity (FRC), are decreased in acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) contributes to increased end-expiratory lung volume (EELV) and to improved oxygenation, but differentiating recruitment of previously nonaerated lung units from distension of previously open lung units remains difficult. This study evaluated simple methods derived from bedside EELV measurements to assess PEEP-induced lung recruitment while monitoring strain. Methods Prospective multicenter study in 30 mechanically ventilated patients with ARDS in five university hospital ICUs. Two PEEP levels were studied, each for 45 min, and EELV (nitrogen washout/washin technique) was measured at both levels, with the difference (Δ) reflecting PEEP-induced lung volume changes. Alveolar recruitment was measured using pressure-volume (PV) curves. High and low recruiters were separated based on median recruitment at high PEEP. Minimum predicted increase in lung volume computed as the product of ΔPEEP by static compliance was subtracted from ΔEELV as an independent estimate of recruitment. Estimated and measured recruitments were compared. Strain induced by PEEP was also calculated from the same measurements. Results FRC was 31 ± 11% of predicted. Median [25th–75th percentiles] PEEP-induced recruitment was 272 [187–355] mL. Estimated recruitment correlated with recruited volume measured on PV curves (ρ = 0.68), with a slope close to identity. The ΔEELV/FRC ratio differentiated high from low recruiters (110 [76–135] vs. 55 [23–70]%, p = 0.001). Strain increase due to PEEP was larger in high recruiters (p = 0.002). Conclusion PEEP-induced recruitment and strain can be assessed at the bedside using EELV measurement. We describe two bedside methods for predicting low or high alveolar recruitment during ARDS.

Published
2011

42. Idiopathic acute eosinophilic pneumonia demanding ECMO for a teenager smoking tobacco and cannabis

Author

Emilie Sauvaget, Bernard Padovani, Laurent Viard, Kévin Arlaud, Céline Sanfiorenzo, J. Dellamonica, Jean-Christophe Dubus, Gilles Bernardin, Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital l'Archet, Médecine Infantile [Hôpital Nord - APMH], and Hôpital Nord [CHU - APHM]

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pediatrics, Adolescent, medicine.medical_treatment, education, Marijuana Smoking, Methylprednisolone, Hypoxemia, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, medicine, Eosinophilic pneumonia, Extracorporeal membrane oxygenation, Humans, 030212 general & internal medicine, Pulmonary Eosinophilia, Hypoxia, Intensive care medicine, Glucocorticoids, biology, business.industry, Smoking Tobacco, Smoking, Respiratory disease, biology.organism_classification, medicine.disease, 3. Good health, 030228 respiratory system, El Niño, Acute Disease, Pediatrics, Perinatology and Child Health, Medicine, Radiography, Thoracic, Cannabis, medicine.symptom, Tomography, X-Ray Computed, business, Rare disease
Abstract

International audience; We describe what we believe is an entirely novel case of a 15-year-old boy with idiopathic acute eosinophilic pneumonia and unusual, resistant hypoxaemia which necessitated extracorporeal membrane oxygenation. Response to corticosteroids was excellent and a full recovery was observed. Smoking cigarettes and cannabis on the day the symptoms began may have contributed to the occurrence of this rare disease.

Published
2010

43. Fatal peritonitis caused by Rhizopus microsporus

Author

Fanny Burel-Vandenbos, Hervé Hyvernat, Martine Gari-Toussaint, Gilles Bernardin, Sarah Guidicelli, and Brigitte Dunais

Subjects
medicine.medical_specialty, Pathology, Rhizopus microsporus, Antifungal Agents, Colon, Perforation (oil well), Peritonitis, Microbiology, Descending colon, Fatal Outcome, Rhizopus, Crohn Disease, medicine, Humans, Mucormycosis, biology, Peritoneal fluid, fungi, General Medicine, Middle Aged, Triazoles, biology.organism_classification, medicine.disease, Infectious Diseases, medicine.anatomical_structure, Pyrimidines, Intestinal Perforation, Histopathology, Female, Voriconazole, Zygomycosis
Abstract

A 52-year-old woman with a history of Crohn's disease was admitted due to peritonitis which followed an intestinal perforation. After transitory treatment with voriconazole, resolution of the infection was complicated by recurring peritonitis resulting from necrosis and perforation of the left colon which ultimately lead to the death of the patient. Microscopic examination of the peritoneal fluid revealed the presence of broad, irregular hyphae and culture of the fluid yielded Rhizopus microsporus. The identification of the fungus was confirmed by its characteristic microscopic morphology and sequencing of the ITS region of the rDNA. The histopathologic examination of the colon tissue demonstrated the presence of broad, non-septate hyphae and the same fungus was again isolated in culture.

Published
2010

44. Fatal Staphylococcus aureus haemorrhagic pneumonia producing Panton-Valentine leucocidin

Author

Céline Pulcini, Philippe Lucas, Paul Hofman, Gilles Bernardin, Véronique Hofman, Adrien Roques, Danielle Carles, and Hervé Hyvernat

Subjects
Microbiology (medical), Adult, Male, medicine.medical_specialty, Staphylococcus aureus, Population, Bacterial Toxins, Exotoxins, Hemorrhage, medicine.disease_cause, Fatal Outcome, Leukocidins, Internal medicine, Pneumonia, Bacterial, Medicine, Humans, education, education.field_of_study, Haemorrhagic pneumonia, General Immunology and Microbiology, business.industry, Mortality rate, Respiratory disease, General Medicine, Staphylococcal Infections, bacterial infections and mycoses, medicine.disease, Anti-Bacterial Agents, Pneumonia, Infectious Diseases, Immunology, Panton valentine leucocidin, Female, Panton–Valentine leukocidin, business
Abstract

We present 2 cases of community acquired S. aureus pneumonia carrying Panton Valentine leucocidin (PVL). These cases illustrate this clinical entity characterized by a younger and healthier population than usual staphylococcal pneumonias and complicated by a 75% mortality rate. We also discuss the diagnosis and therapeutic difficulties.

Published
2007

45. [Acute obstructive kidney failure during sulfadiazine treatment]

Author

Hervé, Hyvernat, Philippe, de Swardt, Véronique, Mondain, and Gilles, Bernardin

Subjects
Male, Anti-Infective Agents, Renal Dialysis, Acute Disease, Humans, Sulfadiazine, Renal Insufficiency, Middle Aged, Toxoplasmosis
Abstract

Acute obstructive kidney failure can occur during sulfadiazine treatment of cerebral toxoplasmosis in immunocompromised patients.Six days after the patient began sulfadiazine treatment for toxoplasmosis, he developed low back pain radiating into the abdomen and kidney failure with obstructive uropathy, followed by anuria. Abdominal computed tomography found bilateral pyelocaliceal distention. Six hours after a hemodialysis session, the pain stopped abruptly and abundant diuresis resumed.During acute renal failure due to sulfadiazine, simply stopping the drug treatment does not suffice. The massive alkalinization induced by hemodialysis, however, is effective.

Published
2006

47. Péritonite à Candida après gastrostomie percutanée. Echec du traitement par fluconazole ; existence d'une lymphopénie CD4 non liée au virus de l'immunodéficience humaine

Author

M. Mattei, P. M. Roger, D. Milhaud, M. Gari-Toussaint, and Gilles Bernardin

Subjects
Gynecology, medicine.medical_specialty, CD4+ lymphopenia, business.industry, Peritoneal fluid, Human immunodeficiency virus (HIV), medicine.disease_cause, Surgery, Flucytosine, Specific antibody, Infectious Diseases, Percutaneous gastrostomy, Amphotericin B, medicine, business, Fluconazole, medicine.drug
Abstract

Summary We report a case of peritoneal candidiosis following percutaneous gastrostomy. Specific antibodies were detected in peritoneal fluid. A severe but transient CD4 lymphopenia was found in this patient non-infected by HIV. Despite adequate fluconazole concentrations in ascitis, treatment failed. Combination of amphotericin B with flucytosine resultes in successful outcome.

Published
1993

49. Influence of alveolar ventilation changes on calculated gastric intramucosal pH and gastric-arterial PCO2 difference

Author

Gilles Bernardin, P. Deloffre, M Mattei, H. Hyvernat, and P. Lucas

Subjects
Artificial ventilation, Male, Cardiac output, Manometry, medicine.medical_treatment, Critical Illness, Hemodynamics, Critical Care and Intensive Care Medicine, Severity of Illness Index, Intensive care, Hyperventilation, Medicine, Humans, Prospective Studies, Tidal volume, Mechanical ventilation, business.industry, Carbon Dioxide, Hydrogen-Ion Concentration, Middle Aged, Respiration, Artificial, Gastric Mucosa, Anesthesia, Breathing, Female, medicine.symptom, Blood Gas Analysis, business
Abstract

Objective: To evaluate the influence of changes in alveolar ventilation on the following tonometry-derived variables: gastric intramucosal CO2 tension (PtCO2), gastric arterial CO2 tension difference (PgapCO2), gastric intramucosal pH (pHi) and arterial pH-pHi difference (pHgap). Design: Clinical prospective study. Setting: A medical intensive care unit in a university hospital. Patients: Ten critically ill, mechanically ventilated patients requiring hemodynamic monitoring with pulmonary artery catheter. Interventions: Gastric tonometer placement. A progressive increase in tidal volume (VT) from 7 to 10 ml/kg followed by an abrupt return to baseline VT level. Measurements and main results: Tonometer saline PtCO2 and hemodynamic data were collected hourly at various VT levels: H0 and H0' (baseline VT = 7 ml/kg), H1 (VT = 8 ml/kg), H2 (VT = 9 ml/kg), H3 (VT = 10 ml/kg), H4 (baseline VT). During the “hyperventilation phase” (H0-H3), pHi (p < 0.01) and pHgap (p < 0.05) increased but PgapCO2 remained unchanged. Cardiac output (CO) was not affected by ventilatory change. During the “hypoventilation phase” (H3-H4), pHi fell from 7.27 ± 0.11 to 7.23 ± 0.09 (p < 0.01) and PgapCO2 decreased from 16 ± 5 mmHg to 13 ± 4 mmHg (p < 0.05). VT reduction was associated with a significant cardiac output elevation (p < 0.05). Conclusions: PaCO2 and PtCO2 are similarly influenced by the changes in alveolar ventilation. Unlike pHi, the PgapCO2 is not affected by ventilation variations unless CO changes are associated.

Published
1999

50. Continuous noninvasive measurement of aortic blood flow in critically ill patients with a new esophageal echo-Doppler system

Author

Gilles Bernardin, Fabrice Tiger, Mathieu Mattéi, and Renaud Fouché

Subjects
medicine.medical_specialty, Cardiac output, medicine.medical_treatment, Coefficient of variation, Critical Illness, Thermodilution, Critical Care and Intensive Care Medicine, law.invention, symbols.namesake, law, Internal medicine, medicine, Humans, Prospective Studies, Cardiac Output, Aorta, Monitoring, Physiologic, Observer Variation, Critically ill, business.industry, Reproducibility of Results, Ultrasonography, Doppler, Blood flow, Middle Aged, Intensive care unit, Surgery, Preload, Cardiology, symbols, Linear Models, Feasibility Studies, Fluid Therapy, business, Fluid replacement, Doppler effect, Blood Flow Velocity, Echocardiography, Transesophageal
Abstract

Purpose: Determination of aortic blood flow (ABF) using esophageal Doppler has been proposed as a low invasive hemodynamic monitoring method. The esophageal echo-Doppler Dynemo 3000 (Sometec Inc., Paris, France) system, recently available on the market, is an original device measuring simultaneously, and at the same anatomic level, aortic diameter, and blood flow velocity. Until now, this material has been used exclusively for peroperative monitoring. The objectives of the study were to assess the feasibility and reliability of use for continuous measurements of ABF in hemodynamically compromised intensive care unit patients; and to compare ABF values and its change induced by preload manipulation with the cardiac output (CO) values measured simultaneously by the standard thermodilution method. Materials and Methods: Sixty simultaneous measurements of ABF and CO were performed in 22 intensive care unit patients. In 16 hypovolemic patients, Doppler and thermodilution measurements were repeated after fluid replacement. Results: Applicability of the method was 84.6% (failure of the echo-Doppler method in 4 of 26 eligible patients). Coefficient of variation of echo-Doppler-derived ABF was 3.25 ± 2.26%. Interobserver variability was 3.3 ± 1.6%. Close linear relationship was found between ABF and CO (r = 0.92). Average ABF/CO ratio was 73 ± 10%, but significant variation was observed after fluid replacement. Conclusions: The echo-Doppler Dynemo 3000 system allows reliable continuous measurements of ABF in intensive care unit patients, both easily and safely.

Published
1998

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