Author: "Jean-Christophe Orban" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Jean-Christophe Orban"' showing total 74 results

Start Over Author "Jean-Christophe Orban"

74 results on '"Jean-Christophe Orban"'

1. SAME day amBulatory Appendectomy (SAMBA): a multicenter, prospective, randomized clinical trial protocol

Author: Catherine Arvieux, Fatah Tidadini, Sandrine Barbois, Eric Fontas, Michel Carles, Victor Gridel, Jean-Christophe Orban, Jean-Louis Quesada, Alison Foote, Coralie Cruzel, Sabine Anthony, Julie Bulsei, Céline Hivelin, and Damien Massalou
Subjects: Appendectomy, Ambulatory surgery, Outpatient surgery, Postoperative morbi-mortality, Randomized controlled trial, Medicine (General), R5-920
Abstract: Abstract Background A recent meta-analysis concluded that outpatient appendectomy appears feasible and safe, but there is a lack of high-quality evidence and a randomized trial is needed. The aim of this trial is to demonstrate that outpatient appendectomy is non-inferior to conventional inpatient appendectomy in terms of overall morbi-mortality on the 30th postoperative day (D30). Methods SAMBA is a prospective, randomized, controlled, multicenter non-inferiority trial. We will include 1400 patients admitted to 15 French hospitals between January 2023 and June 2025. Inclusion criteria are patients aged between 15 and 74 years presenting acute uncomplicated appendicitis suitable to be operated by laparoscopy. Patients will be randomized to receive outpatient care (day-surgery) or conventional inpatient care with overnight hospitalization in the surgery department. The primary outcome is postoperative morbi-mortality at D30. Secondary outcomes include time from diagnosis to appendectomy, length of total hospital stay, re-hospitalization, interventional radiology, re-interventions until D30, conversion from outpatient to inpatient, and quality of life and patient satisfaction using validated questionnaires. Discussion The SAMBA trial tests the hypothesis that outpatient surgery (i.e., without an overnight hospital stay) of uncomplicated acute appendicitis is a feasible and reliable procedure in establishments with a technical platform able to support this management strategy. Trial registration ClinicalTrials.gov NCT05691348. Registered on 20 January 2023.
Published: 2024
Full Text: View/download PDF

2. Correction: SAME day amBulatory Appendectomy (SAMBA): a multicenter, prospective, randomized clinical trial protocol

Author: Catherine Arvieux, Fatah Tidadini, Sandrine Barbois, Eric Fontas, Michel Carles, Victor Gridel, Jean-Christophe Orban, Jean-Louis Quesada, Alison Foote, Coralie Cruzel, Sabine Anthony, Julie Bulsei, Céline Hivelin, and Damien Massalou
Subjects: Medicine (General), R5-920
Published: 2024
Full Text: View/download PDF

3. Effects of cyclosporine A pretreatment of deceased organ donors on kidney graft function (Cis-A-rein): study protocol for a randomized controlled trial

Author: Jean-Christophe Orban, Eric Fontaine, Elisabeth Cassuto, Karine Baumstarck, Marc Leone, Jean-Michel Constantin, Carole Ichai, and for the AzuRéa network
Subjects: Cyclosporine A, Preconditioning, Transplantation, Kidney, Delayed graft function, Medicine (General), R5-920
Abstract: Abstract Background Renal transplantation represents the treatment of choice of end-stage kidney disease. Delayed graft function (DGF) remains the most frequent complication after this procedure, reaching more than 30%. Its prevention is essential as it impedes early- and long-term prognosis of transplantation. Numerous pharmacological interventions aiming to prevent ischemia-reperfusion injuries failed to reduce the rate of DGF. We hypothesize that cyclosporine as an early preconditioning procedure in donors would be associated with decreased DGF. Methods The Cis-A-rein study is an investigator-initiated, prospective, multicenter, double-blind, randomized, controlled study performed to assess the effects of a donor preconditioning with cyclosporine A on kidney grafts function in transplanted patients. After randomization, a brain dead donor will receive 2.5 mg kg−1 of cyclosporine A or the same volume of 5% glucose solution. The primary objective is to compare the rate of DGF, defined as the need for at least one dialysis session within the 7 days following transplantation, between both groups. The secondary objectives include rate of slow graft function, mild and severe DGF, urine output and serum creatinine during the first week after transplantation, rate of primary graft dysfunction, renal function and mortality at 1 year. The sample size (n = 648) was determined to obtain 80% power to detect a 10% difference for rate of DGF at day 7 between the two groups (30% of the patients in the placebo group and 20% of the patients in the intervention group). Discussion Delayed graft function is a major issue after renal transplantation, impeding long-term prognosis. Cyclosporine A pretreatment in deceased donors could improve the outcome of patients after renal transplantation. Trial registration ClinicalTrials.gov, ID: NCT02907554 Registered on 20 September 2016.
Published: 2018
Full Text: View/download PDF

4. Targeted temperature management in the ICU: guidelines from a French expert panel

Author: Alain Cariou, Jean-François Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly, and for the Société de Réanimation de Langue Française (SRLF) and the Société Française d’Anesthésie et de Réanimation (SFAR) In conjunction with the Association de Neuro Anesthésie Réanimation de Langue Française (ANARLF), the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP), the Société Française de Médecine d’Urgence (SFMU), and the Société Française Neuro-Vasculaire (SFNV)
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.
Published: 2017
Full Text: View/download PDF

5. Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia.

Author: Jean-Christophe Orban, Michaël Novain, Florian Cattet, Rémi Plattier, Mohamed Nefzaoui, Hervé Hyvernat, Olivier Raguin, Michel Kaidomar, Sébastien Kerever, and Carole Ichai
Subjects: Medicine, Science
Abstract: AIMS:Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor. But, after cardiac arrest, its interest is still debated. Our study aimed to assess the prognosis value of lactate in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. METHODS:This retrospective observational study included out-of-hospital cardiac arrest patients treated with therapeutic hypothermia in four ICUs. Lactate levels were compared at different times during the first 24 hours according to outcome at ICU discharge and to the type of death (multiorgan or neurologic failure). RESULTS:Two hundred and seventy-two patients were included, 89 good outcome and 183 poor outcome. In the latter group, 171 patients died, from multiorgan failure in 30% and neurologic failure in 70%. Lactate levels were higher in the poor compared to the good outcome patients at admission (5.4 (3.3-9.4) vs. 2.2 (1.5-3.6) mmol/L; p
Published: 2017
Full Text: View/download PDF

6. Incidence and characteristics of acute kidney injury in severe diabetic ketoacidosis.

Author: Jean-Christophe Orban, Eve-Marie Maizière, Anis Ghaddab, Emmanuel Van Obberghen, and Carole Ichai
Subjects: Medicine, Science
Abstract: AIMS: Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued. METHODS: Retrospective study of all cases of severe diabetic ketoacidosis hospitalised consecutively in a medical surgical tertiary ICU during 10 years. Patients were dichotomised in with AKI and without AKI on admission according to the RIFLE classification. Clinical and biological parameters were compared in these populations. Risk factors of presenting AKI on admission were searched for. RESULTS: Ninety-four patients were included in the study. According to the RIFLE criteria, 47 patients (50%) presented acute kidney injury on admission; most of them were in the risk class (51%). At 12 and 24 hours, the percentage of AKI patients decreased to 26% and 27% respectively. During the first 24 hours, 3 patients needed renal replacement therapy. Acute renal failure on admission was associated with a more advanced age, SAPS 2 and more severe biological impairments. Treatments were not different between groups except for insulin infusion. Logistic regression found 3 risk factors of presenting AKI on admission: age (odds ratio 1.060 [1.020-1.100], p
Published: 2014
Full Text: View/download PDF

7. The practice of therapeutic hypothermia after cardiac arrest in France: a national survey.

Author: Jean-Christophe Orban, Florian Cattet, Jean-Yves Lefrant, Marc Leone, Samir Jaber, Jean-Michel Constantin, Bernard Allaouchiche, Carole Ichai, and AzuRéa group
Subjects: Medicine, Science
Abstract: AIMS: Cardiac arrest is a major health concern worldwide accounting for 375,000 cases per year in Europe with a survival rate of
Published: 2012
Full Text: View/download PDF

8. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial

Author: Sophie, Cayot, Thomas, Godet, Renaud, Guerin, Camille, Verlac, Russel, Chabanne, Bernard, Cosserant, Raiko, Blondonnet, Alexandre, Lautrette, Nathanael, Eisenmann, Laurent, Muller, Pablo, Massanet, Caroline, Boutin, Saber, Barbar, Claire, Roger, Fouad, Belafia, Moussa, Cisse, Marion, Monnin, Matthieu, Conseil, Julie, Carr, Audrey, De Jong, Auguste, Dargent, Pascal, Andreu, Thomas, Lebouvrier, Yoann, Launey, Antoine, Roquilly, Raphael, Cinotti, Anne-Charlotte, Tellier, Mathilde, Barbaz, Benjamin, Cohen, Edouard, Lemarche, Pierre-Marie, Bertrand, Charlotte, Arberlot, Laurent, Zieleskiewicz, Emmanuelle, Hammad, Garry, Duclos, Calypso, Mathie, Herve, Dupont, Benoit, Veber, Jean-Christophe, Orban, Hervé, Quintard, Thomas, Rimmele, Julien, Crozon-Clauzel, Marinne, Le Core, Fabien, Grelon, Mona, Assefi, Frank, Petitas, Jerome, Morel, Serge, Molliex, Nanadougmar, Hadanou, Constantin, Jean-Michel, Jabaudon, Matthieu, Lefrant, Jean-Yves, Jaber, Samir, Quenot, Jean-Pierre, Langeron, Olivier, Ferrandière, Martine, Grelon, Fabien, Seguin, Philippe, Ichai, Carole, Veber, Benoit, Souweine, Bertrand, Uberti, Thomas, Lasocki, Sigismond, Legay, François, Leone, Marc, Eisenmann, Nathanael, Dahyot-Fizelier, Claire, Dupont, Hervé, Asehnoune, Karim, Sossou, Achille, Chanques, Gérald, Muller, Laurent, Bazin, Jean-Etienne, Monsel, Antoine, Borao, Lucile, Garcier, Jean-Marc, Rouby, Jean-Jacques, Pereira, Bruno, and Futier, Emmanuel
Published: 2019
Full Text: View/download PDF

9. Guidelines: Anaesthesia in the context of COVID-19 pandemic

Author: Lionel Velly, Etienne Gayat, Hervé Quintard, Emmanuel Weiss, Audrey De Jong, Philippe Cuvillon, Gérard Audibert, Julien Amour, Marc Beaussier, Matthieu Biais, Sébastien Bloc, Marie Pierre Bonnet, Pierre Bouzat, Gilles Brezac, Claire Dahyot-Fizelier, Souhayl Dahmani, Mathilde de Queiroz, Sophie Di Maria, Claude Ecoffey, Emmanuel Futier, Thomas Geeraerts, Haithem Jaber, Laurent Heyer, Rim Hoteit, Olivier Joannes-Boyau, Delphine Kern, Olivier Langeron, Sigismond Lasocki, Yoan Launey, Frederic le Saché, Anne Claire Lukaszewicz, Axel Maurice-Szamburski, Nicolas Mayeur, Fabrice Michel, Vincent Minville, Sébastien Mirek, Philippe Montravers, Estelle Morau, Laurent Muller, Jane Muret, Karine Nouette-Gaulain, Jean Christophe Orban, Gilles Orliaguet, Pierre François Perrigault, Florence Plantet, Julien Pottecher, Christophe Quesnel, Vanessa Reubrecht, Bertrand Rozec, Benoit Tavernier, Benoit Veber, Francis Veyckmans, Hélène Charbonneau, Isabelle Constant, Denis Frasca, Marc-Olivier Fischer, Catherine Huraux, Alice Blet, Marc Garnier, Assistance Publique - Hôpitaux de Marseille (APHM), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-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)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'Anesthésie et Réanimation [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Mutualiste de Montsouris (IMM), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, CHU Toulouse [Toulouse], Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Physiopathologie et Pharmacologie Clinique de la Douleur, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique Juge - Clinique du sport [Marseille], Pôle d'Anesthésie-Réanimation [CHU Rangueil], CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Hôpital de Rangueil, Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département d'Anesthésie Réanimation, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Institut Curie [Paris], Réanimation Médico-Chirurgicale, Service d'Anesthésie Réanimation, CHU Necker - Enfants Malades [AP-HP], Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe d’Anesthésie-Réanimation Chirurgie cardio-thoracique et vasculaire [Toulouse], Clinique Pasteur [Toulouse], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Département d'anesthésiologie [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), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, 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 National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Pôle Anesthésie Réanimation [CHU de Toulouse], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), Histoire et Cultures de l'Antiquité et du Moyen Âge (HISCANT-MA), Université de Lorraine (UL), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Emergency Department, Université Bordeaux Segalen - Bordeaux 2-Hôpital Pellegrin - Bordeaux, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Anaesthesiology, Robert Debré Hospital, Service d'anesthésie réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), 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), Physiopathologie mitochondriale, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherches sur les Herbivores - UMR 1213 (UMRH), Institut National de la Recherche Agronomique (INRA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Anesthésiologie, Université Pierre et Marie Curie - Paris 6 (UPMC), and Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France.
Subjects: Infection prevention and control, [SDV]Life Sciences [q-bio], Psychological intervention, Airway management, Context (language use), Critical Care and Intensive Care Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030202 anesthesiology, Informed consent, Personal protective equipment, Pandemic, Health care, Medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Modalities, SARS-CoV-2, business.industry, COVID-19, 030208 emergency & critical care medicine, General Medicine, Guideline, 3. Good health, Anesthesiology and Pain Medicine, Universal precautions, Anesthesia, Viruses, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: Objectives The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. Results The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. Conclusion We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
Published: 2020
Full Text: View/download PDF

10. Contrôle ciblé de la température en réanimation (hors nouveau-nés)

Author: Laure de Saint-Blanquat, Bernard Vigué, Gilles Francony, Philippe Meyer, Sylvain Renolleau, Alain Cariou, Nicolas Deye, Jean-François Payen de la Garanderie, Cyrille Mathien, Gérard Audibert, Guillaume Debaty, Nicolas Engrand, Karim Asehnoune, Stéphane Legriel, Lionel Velly, Sandrine Deltour, Jean-Christophe Orban, Bruno Levy, Astrid Botte, and Olivier Brissaud
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030208 emergency & critical care medicine, 030217 neurology & neurosurgery
Abstract: Resume Recemment, l’utilisation de l’hypothermie induite a suscite un regain d’interet pour les patients de reanimation, en particulier chez les cerebroleses. Le terme « controle cible de la temperature » (CCT) s’est maintenant impose comme le plus approprie, s’agissant des interventions utilisees pour atteindre et maintenir un niveau specifique de temperature pour chaque individu. Le CCT peut etre utilise pour prevenir la fievre, maintenir la normothermie ou baisser la temperature centrale. Ce traitement est largement utilise dans les services de reanimation, principalement comme methode de neuroprotection primaire. Les indications sont cependant associees a des niveaux de preuve variables fondes sur une litterature inhomogene ou meme contradictoire. Notre but a ete de proceder a une analyse systematique des donnees publiees dans le but de produire des recommandations. Nous presentons ici les recommandations pour l’utilisation du CCT chez l’adulte et l’enfant en reanimation, developpee selon la methode Grading of Recommendations Assessment, Development, and Evaluation (the GRADE). Ces recommandations ont ete realisees par un groupe d’experts de la Societe de reanimation de langue francaise (SRLF), et de la Societe francaise d’anesthesie reanimation (SFAR), avec la participation de la Societe francaise de medecine d’urgence (SFMU), du Groupe francophone de reanimation et urgences pediatriques (GFRUP), de l’Association nationale de neuro-anesthesie reanimation francaise (ANARLF) et de la Societe francaise neurovasculaire (SFNV). Quinze experts et deux coordinateurs se sont mis d’accord pour aborder le CCT et sa mise en pratique dans cinq situations cliniques : l’arret cardiaque, le traumatisme crânien, l’accident vasculaire cerebral, les autres agressions cerebrales et l’etat de choc. Cela a permis de produire 30 recommandations : 3 recommandations sont fortes (grade 1), 13 sont faibles (grade 2) et 14 sont des opinions d’experts. Apres deux tours de vote et plusieurs amendements, un accord fort des participants a ete obtenu pour la totalite des 30 (100 %) des recommandations, qui sont exposees dans le present article.
Published: 2019
Full Text: View/download PDF

11. Alveolar recruitment manoeuvre results in improved pulmonary function in obese patients undergoing bariatric surgery: a randomised trial

Author: Antonio Iannelli, Marc Raucoules-Aimé, Walid Chiali, Jean Gugenheim, Mathilde Severac, Tarek Debs, O. Pérus, Jean-Christophe Orban, François Severac, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Pulmonary Atelectasis, medicine.medical_specialty, Bariatric Surgery, Atelectasis, Critical Care and Intensive Care Medicine, Pulmonary Dysfunction, Pulmonary function testing, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, medicine, Humans, Obesity, Lung, Oxygen saturation (medicine), business.industry, 030208 emergency & critical care medicine, General Medicine, Perioperative, medicine.disease, Intensive care unit, Surgery, Anesthesiology and Pain Medicine, [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], Breathing, business, Body mass index
Abstract: Perioperative ventilation is an important challenge of anaesthesia, especially in obese patients: body mass index is correlated with reduction of the pulmonary volume and they develop significantly more perioperative atelectasis and pulmonary complications. The alveolar recruitment manoeuvre is the most effective technique to reverse atelectasis. However, the clinical benefit on lung function in the perioperative period is not clear. The aim of the present study is to assess the perioperative clinical results of systematic alveolar recruitment manoeuvre associated with protective ventilation in patients undergoing laparoscopic bariatric surgery. It was a single-centre, randomised, double blind, superiority trial: control group with standard protective ventilation and recruitment group with protective ventilation and systematic recruitment manoeuvre. The primary outcome was a composite clinical criterion of pulmonary dysfunction including oxygen saturation, oxygen needs and dyspnoea in recovery room and at day 1. Secondary outcomes were recruitment manoeuvre tolerance, pulmonary and non-pulmonary complications, length of hospital stay and proportion of Intensive Care Unit admission. Two hundred and thirty patients were included: 115 in the recruitment manoeuvre group and 115 in the control group, 2 patients were excluded from the analysis in the control group. Patients in the recruitment manoeuvre group had significantly lower rate of pulmonary dysfunction in the recovery room (73% versus 84% (p = 0.043) and 77% versus 88% at postoperative day 1 (p = 0.043)). No significant differences were found for secondary outcomes. No patient was excluded from the recruitment manoeuvre group for intolerance to the manoeuvre. Recruitment manoeuvre is safe and effective in reducing early pulmonary dysfunction in obese patients undergoing bariatric surgery.
Published: 2021

12. Choice of fluid for critically ill patients: An overview of specific situations

Author: Ségolène Mrozek, Sébastien Mirek, Intensive Care, Matthieu Legrand, Laurent Muller, Antoine Virat, Olivier Langeron, Jean-Christophe Orban, Olivier Joannes-Boyau, Claire Dahyot-Fizelier, Jean-Michel Constantin, Nicolas Mongardon, Antoine Roquilly, Marc Leone, Caroline Duracher-Gout, Service d'anesthésie-réanimation [CHU Bordeaux], CHU Bordeaux [Bordeaux], Université de Nantes (UN), Centre hospitalier universitaire de Nantes (CHU Nantes), Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire (GRC 29 - ARPE), Sorbonne Université (SU), Université Paris Descartes - Paris 5 (UPD5), Département d'Anesthésie Réanimation SMUR [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Henri Mondor, University of California [San Francisco] (UC San Francisco), University of California (UC), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire de Nice (CHU Nice), Clinique Pont-de-Chaume, Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, Groupe de recherche clinique en anesthésie réanimation médecine périopératoire [CHU Pitié-Salpétrière] (GRC ARPE), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université René Descartes, Department of Anesthesiology and Perioperative Care, University of California, CHU Toulouse [Toulouse], Pôle anesthésie réanimation douleur urgence, (CHU de Nîmes), and Assistance Publique - Hôpitaux de Marseille (APHM)
Subjects: medicine.medical_specialty, Critical Care, business.industry, Critically ill, [SDV]Life Sciences [q-bio], Critical Illness, MEDLINE, 030208 emergency & critical care medicine, General Medicine, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, medicine, Fluid Therapy, Humans, 030212 general & internal medicine, Intensive care medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience; No abstract available
Published: 2020
Full Text: View/download PDF

13. High Prevalence of Acquired Thrombophilia Without Prognosis Value in Patients With Coronavirus Disease 2019

Author: Denis Doyen, Anny Appert-Flory, V. Mondain, Emile Ferrari, Jacques Levraut, David Chirio, Pierre Toulon, Florence Fischer, Carole Ichai, Mohamed Labbaoui, Julie Contenti, Fabien Lemoel, Jean Dellamonica, Pamela Moceri, Benjamin Sartre, Baptiste Mossaz, Eric Cua, Fabien Squara, Jean Christophe Orban, Céline Occelli, K. Risso, Hôpital Pasteur [Nice] (CHU), Université Nice Sophia Antipolis - Faculté de Médecine (UNS UFR 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), Service de Réanimation médico-chirurgicale [Nice], Hôpital Saint-Roch [Nice], Centre méditerranéen de médecine moléculaire (C3M), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'infectiologie [CHU Nice], Gestionnaire, HAL Sorbonne Université 5, Université Nice Sophia Antipolis (1965 - 2019) (UNS), 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)-Université Côte d'Azur (UCA)
Subjects: Male, Disease, 030204 cardiovascular system & hematology, Severity of Illness Index, Vascular Medicine, Protein S, 0302 clinical medicine, Risk Factors, Clinical Studies, Prevalence, Original Research, Lupus anticoagulant, medicine.diagnostic_test, biology, Middle Aged, Antiphospholipid Syndrome, Prognosis, Thrombosis, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Antibodies, Antiphospholipid, Female, France, Cardiology and Cardiovascular Medicine, Coronavirus Infections, Partial thromboplastin time, medicine.medical_specialty, Protein S Deficiency, Pneumonia, Viral, Thrombophilia, 03 medical and health sciences, coronavirus disease 2019, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Vascular Biology, Internal medicine, Severity of illness, medicine, Humans, Pathological, Pandemics, thrombosis, Aged, thrombophilia, 030203 arthritis & rheumatology, business.industry, COVID-19, medicine.disease, biology.protein, business, Biomarkers
Abstract: Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID‐19) infection. This characteristic is unusual and seems specific to COVID‐19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon, and report its prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe COVID‐19 infections. Methods and Results In 89 consecutive patients hospitalized for COVID‐19 infection, we found a 20% prevalence of PS (protein S) deficiency and a high (ie, 72%) prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged activated partial thromboplastin time nor with D‐dimer, fibrinogen, or CRP (C‐reactive protein) concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. Conclusions We assess a high prevalence of positive tests detecting thrombophilia in COVID‐19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in COVID‐19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of COVID‐19 and should not systematically modify our strategy on prophylactic anticoagulant treatment, which is already revised upwards in this pathological condition. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04335162.
Published: 2020
Full Text: View/download PDF

14. Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS

Author: Yoann Launey, Olivier Langeron, Claire Roger, Marion Monnin, M. Cisse, Julie A. Bastarache, Matthieu Jabaudon, Audrey De Jong, Emmanuel Futier, Jean-Pierre Quenot, Philippe Seguin, Mathieu Calypso, Matthieu Conseil, Benoit Veber, Garry Duclos, François Legay, Serge Molliex, Raiko Blondonnet, Julie Carr, Pablo Massanet, Mathilde Barbaz, Fabien Grelon, Jean-Etienne Bazin, Caroline Boutin, Céline Lambert, Emmanuelle Hammad, Jules Audard, Mona Assefi, Anne-Charlotte Tellier, Thomas Godet, Alexandre Lautrette, Hadanou Nanadougmar, Bernard Cosserant, Claire Dahyot-Fizelier, Charlotte Arbelot, Hervé Quintard, Jean-Yves Lefrant, Raphael Cinotti, Achile Sossou, Gerald Chanques, Martine Ferrandière, Thomas Lebouvrier, Marc Leone, Marinne Le Core, Renaud Guérin, Frank Petitas, Thomas Crozon, Edouard Lemarche, Saber Barbar, Camille Verlhac, Jean-Christophe Orban, Sigismond Lasocki, Hervé Dupont, Julien Clauzel, Jean-Michel Constantin, Fouad Belafia, Pascal Andreu, Thomas Rimmelé, Carole Ichai, Russell Chabanne, Karim Asehnoune, Jerome Morel, Antoine Roquilly, Nathanael Eisenmann, Pierre-Marie Bertrand, Samir Jaber, Auguste Dargent, Bertrand Souweine, Lorraine B. Ware, Laurent Muller, Bruno Pereira, Benjamin Cohen, Sophie Cayot, and Laurent Zieleskiewicz
Subjects: Pulmonary and Respiratory Medicine, Male, ARDS, Organ Dysfunction Scores, Pulmonary Edema, Critical Care and Intensive Care Medicine, Severity of Illness Index, survival, RALE, Radiographic Assessment of Lung Edema, 03 medical and health sciences, 0302 clinical medicine, radiographic score, medicine, Clinical endpoint, Image Processing, Computer-Assisted, Humans, 030212 general & internal medicine, Simplified Acute Physiology Score, Lung, Survival analysis, sRAGE, soluble receptor for advanced glycation end-products, Proportional Hazards Models, FACTT, Fluid and Catheter Treatment Trial, Respiratory Distress Syndrome, business.industry, Surrogate endpoint, Hazard ratio, treatable trait, LIVE, Lung Imaging for Ventilation sEtting in ARDS, Middle Aged, Pulmonary edema, medicine.disease, Prognosis, SAPS, Simplified Acute Physiology Score, Survival Analysis, HR, hazard ratio, 3. Good health, CHU, Centre Hospitalier Universitaire, Clinical trial, Radiography, Outcome and Process Assessment, Health Care, 030228 respiratory system, Anesthesia, Critical Care: Original Research, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract: Background The Radiographic Assessment of Lung Edema (RALE) score is associated with the severity of ARDS, and treatments targeted at reducing pulmonary edema such as conservative fluid management cause a reduction in RALE score over time. Research Question Are early changes in RALE score over time associated with survival in patients with ARDS? Study Design and Methods Data from patients enrolled in three centers in the Lung Imaging for Ventilation sEtting in ARDS (LIVE) trial with available chest radiographs at baseline (day 0) and days 2 or 3 were used. The RALE was scored by two independent reviewers. The primary end point was death by day 90, considering RALE score both at baseline and as a time-varying covariate in a marginal Cox survival model. Results RALE was scored from 135, 64, and 88 radiographs on days 0, 2, and 3, respectively. Both baseline RALE (hazard ratio [HR] for each one-point increment, 1.04; 95% CI, 1.01-1.08; P = .006) and the change in RALE over time (HR for each one-point decrease per unit of time, 0.99; 95% CI, 0.99-0.99; P = .03) were associated with death by day 90, even after adjustment for age, sex, BMI, Simplified Acute Physiology Score II, vasopressor use, and total volume of fluids received since study entry. Interpretation The change in RALE during the first days after ARDS onset is independently associated with survival and may be useful as a surrogate end point in future clinical trials of new therapeutics in ARDS.
Published: 2020

15. Targeted temperature management in the ICU: Guidelines from a French expert panel

Author: Alain Cariou, Jean-François Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly, for the Société de Réanimation de Langue Française (SRLF) and the Société Française d’Anesthésie et de Réanimation (SFAR) In conjunction with the Association de Neuro Anesthésie Réanimation de Langue Française (ANARLF), the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP), the Société Française de Médecine d’Urgence (SFMU), and the Société Française Neuro-Vasculaire (SFNV), Unité de Soins Intensifs [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Faculté de Médecine [Nancy], Université de Lorraine (UL), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Bordeaux [Bordeaux], Physiologie cardio-Respiratoire Expérimentale Théorique et Appliquée (TIMC-IMAG-PRETA), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Service des Urgences Cérébro-Vasculaires [CHU Pitié-Salpétriêre], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Fondation Ophtalmologique Adolphe de Rotschild, Unité de Soins Intensifs [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CHU Necker - Enfants Malades [AP-HP], Centre Hospitalier Universitaire de Nice (CHU Nice), Neurobiologie des processus adaptatifs (NPA), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service d'Anesthésie Réanimation [CHU Necker], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Assistance Publique - Hôpitaux de Marseille (APHM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], CHU Cochin [AP-HP], Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Service des Urgences cérébrovasculaires [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Unité de Soins Intensifs [Versailles], Centre Hospitalier de Versailles (CHV), Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Henri Poincaré - Nancy 1 (UHP), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-VetAgro Sup (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-VetAgro Sup (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), CHU Pitié-Salpêtrière [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Geometry and Lighting (ALICE), Inria Nancy - Grand Est, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Department of Algorithms, Computation, Image and Geometry (LORIA - ALGO), Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP]
Subjects: medicine.medical_specialty, Critical Care, Critical Illness, medicine.medical_treatment, MEDLINE, Psychological intervention, Review, Guidelines, Targeted temperature management, Critical Care and Intensive Care Medicine, Body Temperature, law.invention, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Hypothermia, Induced, law, Anesthesiology, Intensive care, Humans, Medicine, Intensive care unit, Grading (education), ComputingMilieux_MISCELLANEOUS, business.industry, Critically ill, lcsh:Medical emergencies. Critical care. Intensive care. First aid, French, 030208 emergency & critical care medicine, lcsh:RC86-88.9, General Medicine, Evidence-based medicine, medicine.disease, language.human_language, 3. Good health, Intensive Care Units, Anesthesiology and Pain Medicine, language, France, Medical emergency, business, 030217 neurology & neurosurgery
Abstract: International audience; Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.
Published: 2018
Full Text: View/download PDF

16. Comparison of presumed cardiac and respiratory causes of out-of-hospital cardiac arrest

Author: Hervé Hyvernat, Sébastien Kerever, Mathieu Truc, Florian Cattet, Jean-Christophe Orban, Rémi Plattier, Olivier Raguin, Michel Kaidomar, Carole Ichai, Nicolas Mongardon, Michael Novain, and Mohamed Nefzaoui
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, 030208 emergency & critical care medicine, Retrospective cohort study, 030204 cardiovascular system & hematology, Emergency Nursing, Hypothermia, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, cardiovascular system, Emergency Medicine, medicine, Cardiology, Observational study, Cardiopulmonary resuscitation, medicine.symptom, Young adult, Respiratory system, Cardiology and Cardiovascular Medicine, business, Survival rate
Abstract: Aims of the study Most interventional and observational studies include cardiac arrest from cardiac origin. However, an increasing proportion of cardiac arrest results from an extra-cardiac origin, mainly respiratory. The aim of our study was to compare the characteristics and outcome of cardiac arrest patients according to the presumed cardiac or respiratory causes. Methods This retrospective multicenter observational study included out-of-hospital cardiac arrest patients from presumed cardiac and respiratory origin treated with therapeutic hypothermia. Demographic data (age, sex, initial rhythm as shockable or non-shockable, durations of no-flow and low-flow), clinical evolution in ICU, lactate and outcome (CPC scale at ICU discharge) were compared between patients according to the presumed cardiac or respiratory origin of the cardiac arrest. Results Two hundred and fifty-one cardiac arrest patients were included, 156 from presumed cardiac origin (62%) and 95 from presumed respiratory origin (38%). Patients with presumed cardiac cause presented more frequently a shockable rhythm (68% vs. 5%, p Conclusions Compared to presumed cardiac origin, a worse outcome and a different mode of death are associated with the presumed respiratory origin, resulting from a greater insult preceding cardiac arrest. The presumed cause of cardiac arrest could be integrated in the multimodal prognostication process.
Published: 2018
Full Text: View/download PDF

17. Ventilation mécanique en réanimation : ce qu’il faut savoir en 2017

Author: Jean-Christophe Orban, Arnaud Friggeri, Laurent Muller, Yazine Mahjoub, Jean-Michel Constantin, Christophe Quesnel, Oliver Langeron, Marc Leone, Antoine Roquilly, Sigismond Lasocki, Matthieu Legrand, Caroline Duracher Gout, Antoine Virat, Sébastien Mirek, Olivier Joannes Boyau, and Pierre-François Perrigault
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030212 general & internal medicine
Published: 2018
Full Text: View/download PDF

18. Assessment of oxidative stress after out-of-hospital cardiac arrest

Author: Catherine Garrel, Jean-Christophe Orban, Didier Déroche, Florian Cattet, Patricia Ferrari, Carole Ichai, and Frederic Berthier
Subjects: Adult, Male, Thiobarbituric acid, medicine.medical_treatment, medicine.disease_cause, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, medicine, Humans, Prospective Studies, Cardiopulmonary resuscitation, Prospective cohort study, Aged, chemistry.chemical_classification, business.industry, Glutathione peroxidase, 030208 emergency & critical care medicine, General Medicine, Glutathione, Middle Aged, Hypothermia, Prognosis, Cardiopulmonary Resuscitation, Pathophysiology, Oxidative Stress, chemistry, Anesthesia, Emergency Medicine, Female, medicine.symptom, business, Biomarkers, Out-of-Hospital Cardiac Arrest, 030217 neurology & neurosurgery, Oxidative stress
Abstract: Introduction Pathophysiology of cardiac arrest corresponds to a whole body ischemia-reperfusion. This phenomenon is usually associated with an oxidative stress in various settings, but few data are available on cardiac arrest in human. The aim of the present study was to evaluate different oxidative stress markers in out-of-hospital cardiac arrest (OHCA) patients treated with therapeutic hypothermia. Materials and methods We conducted a prospective study assessing oxidative stress markers (thiobarbituric acid reactive species, carbonyls, thiols, glutathione, and glutathione peroxidase) in OHCA patients treated with therapeutic hypothermia. Measurements were performed during the 4 days after admission and compared between good and poor outcome patients according to Cerebral Performance Category. Results Thirty-four patients were included, 10 good and 24 poor outcomes at 6 months. Thiobarbituric acid reactive species were higher in the poor outcome group on admission and when therapeutic hypothermia was reached. The other markers were not different between groups. No markers seemed modified by the use of therapeutic hypothermia in each group. Conclusions After OHCA, good outcome patients exhibit lower oxidative stress markers than poor outcome patients. Thiobarbituric acid reactive species appears to be an early prognostic parameter. Oxidative stress markers seem not mitigated by therapeutic hypothermia.
Published: 2016
Full Text: View/download PDF

19. French intensive care unit organisation

Author: Claire Dahyot-Fizelier, Matthieu Legrand, Jean-Christophe Orban, Olivier Joannes-Boyau, Ségolène Mrozek, Caroline Duracher-Gout, Antoine Virat, Laurent Muller, Jean-Michel Constantin, Antoine Roquilly, Christophe Quesnel, Yazine Mahjoub, Olivier Langeron, Sébastien Mirek, Marc Leone, Xavier Capdevila, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), CHU Clermont-Ferrand, Service d'Anesthésie Réanimation Chirurgicale [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Bordeaux [Bordeaux], Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal, Université Paris Diderot - Paris 7 (UPD7), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de dermatologie [CHU d'Amiens-Picardie], CHU Amiens-Picardie, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département d'Anesthésie-Réanimation [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire de Nice (CHU Nice), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Pont-de-Chaume, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Pôle Anesthésie Réanimation [CHU de Toulouse], and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
Subjects: Decree, Critical Care, Pain medicine, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Nursing, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intensive care, Medicine, Humans, 030212 general & internal medicine, National health, Terminal Care, Perioperative medicine, business.industry, Nurse staffing, 030208 emergency & critical care medicine, General Medicine, Intensive care unit, 3. Good health, Intensive Care Units, Anesthesiology and Pain Medicine, Institutional research, France, business
Abstract: International audience; Anaesthesia, Critical Care and Pain Medicine is the journal of the French Society of Anaesthesia and Intensive Care Medicine (Societe Francaise d'Anesthe sieet de Reanimation), aimed at promoting the French approach to anaesthesiology, critical care and perioperative medicine. Here, the Intensive Care Committee of the French Society of Anaesthesia and Intensive Care Medicine provides an overview of the organisation of the 400 French Intensive Care Units (ICU), which are polyvalent (50%), surgical (20%), or medical (12%). Around 150,000 patients are admitted to these units each year. Law Decrees govern the frame of practices, including architecture, nurse staffing - two nurses for five patients and one nurseassistant for four patients - and 24/7 medical coverage. The daily cost of ICU hospitalisation is around 1425(sic), entirely ensured by the National Health System. The clinical practices are variable but guidelines produced by intensivists are invited to adhere to guidelines available and freely accessible. End-of-life practices are framed by a Law Decree (Claeys Leonetti) aiming at protecting patients against stubbornly and unreasonable cares. The biomedical research plays a critical role in the French ICU, and practices are performed under the supervision of the JardeLaw. An Institutional Research Board approval is required for prospective studies. In conclusion, the French ICU practice is surrounded by a legal frame. (C) 2018 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Published: 2018
Full Text: View/download PDF

20. Clinical value of automated fibrin generation markers in patients with septic shock: a SepsiCoag ancillary study

Author: Pauline Deras, Jean-Michel Constantin, Eva Cochery-Nouvellon, Jean-Yves Lefrant, Loubna Elotmani, Samir Jaber, Géraldine Lavigne-Lissalde, Jacques Albanèse, Jean-Christophe Orban, Sylvie Bouvier, Jerôme Morel, Jean-Christophe Gris, Marc Leone, Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Clermont-Ferrand, Centre Hospitalier Universitaire de Nice (CHU Nice), Department of Intensive Care, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), 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)-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), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Saint Etienne University Hospital, INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, and INSB-INSB-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, medicine.medical_specialty, fibrin monomers, [SDV]Life Sciences [q-bio], Urology, D-dimers, 030204 cardiovascular system & hematology, Fibrinogen, Disease-Free Survival, Fibrin, law.invention, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, DIC score, 0302 clinical medicine, law, medicine, Humans, Prospective Studies, 030212 general & internal medicine, coagulation, ComputingMilieux_MISCELLANEOUS, Aged, Aged, 80 and over, Disseminated intravascular coagulation, biology, Septic shock, business.industry, Ancillary Study, Hematology, Disseminated Intravascular Coagulation, Middle Aged, medicine.disease, Shock, Septic, Intensive care unit, Fibrin Monomer, Thrombosis, 3. Good health, Survival Rate, biology.protein, septic shock, Female, business, Biomarkers, medicine.drug
Abstract: An ancillary analysis to the SepsiCoag multicentric prospective observational study on patients entering an intensive care unit with septic shock evaluated the prognostic potential of fibrin generation markers (FGMs) tested at inclusion in the study, on survival at day 30. After centralization of samples, three automated FGMs were compared: D-dimers (DDi), fibrin/fibrinogen degradation products (FDP) and fibrin monomers (FM). FM was the single FGM that was significantly higher in non-surviving patients, area under the receiver-operator characteristic curve (AUCROC ): 0·617, P < 0·0001. Significantly higher International Society on Thrombosis and Haemostasis Disseminated Intravascular Coagulation (ISTH DIC) scores were calculated in non-survivors using each of the three FGMs. A dose-effect relationship was observed between ISTH DIC scores and non-survival, with highest significance obtained using FM as the FGM. An overt DIC diagnosis using the ISTH DIC score calculated using FM was a predictor of non-survival at day 30, independently from overt DIC diagnosis based on scores calculated using FDP or DDi. The AUCROC values testing the ability of the ISTH DIC score to predict non-survival were 0·650, 0·624 and 0·602 using FM, DDi and FDP, respectively, as the FGM. In patients with septic shock, among the commercially-available automated assays, automated FM is the FGM best related with late prognosis.
Published: 2018
Full Text: View/download PDF

21. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial

Author: Samir Jaber, Catherine Paugam, Emmanuel Futier, Jean-Yves Lefrant, Sigismond Lasocki, Thomas Lescot, Julien Pottecher, Alexandre Demoule, Martine Ferrandière, Karim Asehnoune, Jean Dellamonica, Lionel Velly, Paër-Sélim Abback, Audrey de Jong, Vincent Brunot, Fouad Belafia, Antoine Roquilly, Gérald Chanques, Laurent Muller, Jean-Michel Constantin, Helena Bertet, Kada Klouche, Nicolas Molinari, Boris Jung, Marion Monnin, Jean-Marc Delay, Moussa Cissé, Marie Geniez, Matthieu Conseil, Bruno Souche, Jean Michel Constantin, Eric Noll, Elise Morawiec, Alexandre Robert, Thibaut Triglia, Malika Mechati, Jean-Michel Arnal, Jacques Durand-Gasselin, Didier Demoly, Sami Hraiech, Laurent Papazian, Vincent Gilles, Thomas Rimmelé, Béatrice Riu, Pierre Cougot, Olivier Fourcade, Philippe Seguin, Jonathan Charbit, Xavier Capdevila, Marc Leone, Laurent Zieleskiewicz, Carole Ichai, Jean Christophe Orban, Michael Darmon, Elie Azoulay, Virginie Lemiale, Lara Zafrani, Karim Debbat, Oliver Mimoz, Claude Guérin, Eric Kipnis, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génétique, Reproduction et Développement (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'anesthésie et réanimation chirurgicale, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), 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 Marseille (APHM), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Clermont-Ferrand, Génétique, Reproduction et Développement - Clermont Auvergne (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Avenue Cheikh Anta Diop, Dakar, Senegal., Anesthesiology, Robert Debré Hospital, PRES Université Nantes Angers Le Mans (UNAM), Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Conservation des espèces, restauration et suivi des populations (CERSP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), sans affiliation, Centre Hospitalier de Toulon-La Seyne, Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], 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), Agressions vasculaires et réponses tissulaires, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service de cardiologie [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Pontchaillou [Rennes], Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Département Imagerie et Simulation pour le Contrôle (DISC), Laboratoire d'Intégration des Systèmes et des Technologies (LIST), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France, Laboratoire de Géologie de Lyon - Terre, Planètes, Environnement [Lyon] (LGL-TPE), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Lille 2 - Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Bicarbonate, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Metabolic alkalosis, law.invention, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, law, Intensive care, Medicine, Humans, 030212 general & internal medicine, Renal replacement therapy, education, Infusions, Intravenous, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Sodium bicarbonate, business.industry, 030208 emergency & critical care medicine, General Medicine, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Hydrogen-Ion Concentration, medicine.disease, Intensive care unit, Survival Analysis, 3. Good health, Renal Replacement Therapy, Intensive Care Units, Intravenous sodium bicarbonate, Sodium Bicarbonate, chemistry, Anesthesia, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Acidosis
Abstract: Summary Background Acute acidaemia is frequently observed during critical illness. Sodium bicarbonate infusion for the treatment of severe metabolic acidaemia is a possible treatment option but remains controversial, as no studies to date have examined its effect on clinical outcomes. Therefore, we aimed to evaluate whether sodium bicarbonate infusion would improve these outcomes in critically ill patients. Methods We did a multicentre, open-label, randomised controlled, phase 3 trial. Local investigators screened eligible patients from 26 intensive care units (ICUs) in France. We included adult patients (aged ≥18 years) who were admitted within 48 h to the ICU with severe acidaemia (pH ≤7·20, PaCO2 ≤45 mm Hg, and sodium bicarbonate concentration ≤20 mmol/L) and with a total Sequential Organ Failure Assessment score of 4 or more or an arterial lactate concentration of 2 mmol/L or more. We randomly assigned patients (1:1), by stratified randomisation with minimisation via a restricted web platform, to receive either no sodium bicarbonate (control group) or 4·2% of intravenous sodium bicarbonate infusion (bicarbonate group) to maintain the arterial pH above 7·30. Our protocol recommended that the volume of each infusion should be within the range of 125–250 mL in 30 min, with a maximum of 1000 mL within 24 h after inclusion. Randomisation criteria were stratified among three prespecified strata: age, sepsis status, and the Acute Kidney Injury Network (AKIN) score. The primary outcome was a composite of death from any cause by day 28 and the presence of at least one organ failure at day 7. All analyses were done on data from the intention-to-treat population, which included all patients who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02476253. Findings Between May 5, 2015, and May 7, 2017, we enrolled 389 patients into the intention-to-treat analysis in the overall population (194 in the control group and 195 in the bicarbonate group). The primary outcome occurred in 138 (71%) of 194 patients in the control group and 128 (66%) of 195 in the bicarbonate group (absolute difference estimate −5·5%, 95% CI −15·2 to 4·2; p=0·24). The Kaplan-Meier method estimate of the probability of survival at day 28 between the control group and bicarbonate group was not significant (46% [95% CI 40–54] vs 55% [49–63]; p=0·09. In the prespecified AKIN stratum of patients with a score of 2 or 3, the Kaplan-Meier method estimate of survival by day 28 between the control group and bicarbonate group was significant (37% [95% CI 28–48] vs 54% [45–65]; p=0·0283). Metabolic alkalosis, hypernatraemia, and hypocalcaemia were observed more frequently in the bicarbonate group than in the control group, with no life-threatening complications reported. Interpretation In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined stratum of patients with acute kidney injury. Funding French Ministry of Health and the Societe Francaise d'Anesthesie Reanimation.
Published: 2018
Full Text: View/download PDF

22. Metabolic Disorders and Critically Ill Patients

Author: Hervé Quintard, Jean-Christophe Orban, and Carole Ichai
Subjects: medicine.medical_specialty, Critically ill, business.industry, medicine, Intensive care medicine, business
Published: 2018
Full Text: View/download PDF

23. Additional file 1: of Effects of cyclosporine A pretreatment of deceased organ donors on kidney graft function (Cis-A-rein): study protocol for a randomized controlled trial

Author: Jean-Christophe Orban, Fontaine, Eric, Cassuto, Elisabeth, Baumstarck, Karine, Leone, Marc, Jean-Michel Constantin, and Ichai, Carole
Abstract: SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 121 kb)
Published: 2018
Full Text: View/download PDF

24. Therapeutic hypothermia after cardiac arrest: We have found the missing piece puzzle!

Author: Vincent Bruckert, Jean-Christophe Orban, and Romain Rozier
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, medicine.medical_treatment, medicine, MEDLINE, General Medicine, Targeted temperature management, Hypothermia, medicine.symptom, Critical Care and Intensive Care Medicine, Intensive care medicine, business
Published: 2019
Full Text: View/download PDF

25. Reply to: Comment on ‘Comparison of presumed cardiac and respiratory causes of out-of-hospital cardiac arrest’

Author: Nicolas Mongardon, Jean-Christophe Orban, Carole Ichai, and Sébastien Kerever
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, MEDLINE, Heart, Emergency Nursing, Cardiopulmonary Resuscitation, Out of hospital cardiac arrest, Emergency medicine, Emergency Medicine, medicine, Humans, Cardiopulmonary resuscitation, Respiratory system, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Published: 2019
Full Text: View/download PDF

26. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial

Author: Constantin, Jean-Michel, primary, Jabaudon, Matthieu, additional, Lefrant, Jean-Yves, additional, Jaber, Samir, additional, Quenot, Jean-Pierre, additional, Langeron, Olivier, additional, Ferrandière, Martine, additional, Grelon, Fabien, additional, Seguin, Philippe, additional, Ichai, Carole, additional, Veber, Benoit, additional, Souweine, Bertrand, additional, Uberti, Thomas, additional, Lasocki, Sigismond, additional, Legay, François, additional, Leone, Marc, additional, Eisenmann, Nathanael, additional, Dahyot-Fizelier, Claire, additional, Dupont, Hervé, additional, Asehnoune, Karim, additional, Sossou, Achille, additional, Chanques, Gérald, additional, Muller, Laurent, additional, Bazin, Jean-Etienne, additional, Monsel, Antoine, additional, Borao, Lucile, additional, Garcier, Jean-Marc, additional, Rouby, Jean-Jacques, additional, Pereira, Bruno, additional, Futier, Emmanuel, additional, Sophie, Cayot, additional, Thomas, Godet, additional, Renaud, Guerin, additional, Camille, Verlac, additional, Russel, Chabanne, additional, Bernard, Cosserant, additional, Raiko, Blondonnet, additional, Alexandre, Lautrette, additional, Nathanael, Eisenmann, additional, Laurent, Muller, additional, Pablo, Massanet, additional, Caroline, Boutin, additional, Saber, Barbar, additional, Claire, Roger, additional, Fouad, Belafia, additional, Moussa, Cisse, additional, Marion, Monnin, additional, Matthieu, Conseil, additional, Julie, Carr, additional, Audrey, De Jong, additional, Auguste, Dargent, additional, Pascal, Andreu, additional, Thomas, Lebouvrier, additional, Yoann, Launey, additional, Antoine, Roquilly, additional, Raphael, Cinotti, additional, Anne-Charlotte, Tellier, additional, Mathilde, Barbaz, additional, Benjamin, Cohen, additional, Edouard, Lemarche, additional, Pierre-Marie, Bertrand, additional, Charlotte, Arberlot, additional, Laurent, Zieleskiewicz, additional, Emmanuelle, Hammad, additional, Garry, Duclos, additional, Calypso, Mathie, additional, Herve, Dupont, additional, Benoit, Veber, additional, Jean-Christophe, Orban, additional, Hervé, Quintard, additional, Thomas, Rimmele, additional, Julien, Crozon-Clauzel, additional, Marinne, Le Core, additional, Fabien, Grelon, additional, Mona, Assefi, additional, Frank, Petitas, additional, Jerome, Morel, additional, Serge, Molliex, additional, and Nanadougmar, Hadanou, additional
Published: 2019
Full Text: View/download PDF

27. Metabolic Disorders and Critically Ill Patients : From Pathophysiology to Treatment

Author: Carole Ichai, Hervé Quintard, Jean-Christophe Orban, Carole Ichai, Hervé Quintard, and Jean-Christophe Orban
Subjects: Critically ill--Treatment, Metabolism--Disorders, Nutrition disorders
Abstract: The purpose of this book is to bring together the latest findings on metabolic disorders that are strongly implicated in various critically ill patients. Since the beginning of the 20th century, maintaining the'milieu intérieur'has been a major challenge for intensivists. In addition to considerable technological developments in intensive care units, important advances in our understanding of metabolic disorders observed in critically ill patients have been made during the 10 last years. Today, the intensivit can't ignore these disorders when selecting the most appropriate treatment for an illness. Cellular metabolic abnormalities are responsible for systems and organ failures, so the modern approach of organ dysfunctions now includes prevention or treatment of such disorders. This book is a comprehensive tool, allowing the physician to understand, diagnose and treat these metabolic disorders. Water, electrolyte, acid-base, glycemic and endocrinologic problems, as well as metabolic abnormalities observed in renal, cerebral and hepatic failure are presented in different chapters. The last part of the book is devoted to modern nutritional concepts, the consequences of energy modifications, mitochondrial dysfunction, hypothermia, oxidative stress and ischemia reperfusion, which open the way for new therapies.
Published: 2018

28. Effect of N-Acetylcysteine Pretreatment of Deceased Organ Donors on Renal Allograft Function

Author: Hervé Quintard, Corine Samat-Long, Jean-Christophe Orban, Elisabeth Cassuto, Carole Ichai, and Patrick Jambou
Subjects: Adult, Male, Brain Death, medicine.medical_specialty, Time Factors, Urology, Delayed Graft Function, Urination, Renal function, Antioxidants, Drug Administration Schedule, law.invention, Acetylcysteine, chemistry.chemical_compound, Randomized controlled trial, Renal Dialysis, law, Humans, Medicine, Single-Blind Method, Prospective Studies, Prospective cohort study, Kidney transplantation, Transplantation, Creatinine, business.industry, Graft Survival, Middle Aged, Allografts, medicine.disease, Kidney Transplantation, Tissue Donors, Original Clinical Science, Cerebral Angiography, Up-Regulation, Surgery, Treatment Outcome, chemistry, Renal allograft, Administration, Intravenous, Female, France, business, Biomarkers, Glomerular Filtration Rate, medicine.drug
Abstract: Background Antioxidant donor pretreatment is one of the pharmacologic strategy proposed to prevent renal ischemia-reperfusion injuries and delayed graft function (DGF). The aim of the study was to investigate whether a donor pretreatment with N-acetylcysteine (NAC) reduces the incidence of DGF in adult human kidney transplant recipients. Methods In this randomized, open-label, monocenter trial, 160 deceased heart-beating donors were allowed to perform 236 renal transplantations from September 2005 to December 2010. Donors were randomized to receive, in a single-blind controlled fashion, 600 mg of intravenous NAC 1 hr before and 2 hr after cerebral angiography performed to confirm brain death. Primary endpoint was DGF defined by the need for at least one dialysis session within the first week or a serum creatinine level greater than 200 μmol/L at day 7 after kidney transplantation. Results The incidence of DGF was similar between donors pretreated with or without NAC (39/118; 33% vs. 30/118; 25.4%; P = 0.19). Requirement for at least one dialysis session was not different between the NAC and No NAC groups (17/118; 14.4% vs. 14/118; 11.8%, P = 0.56). The two groups had comparable serum creatinine levels, estimated glomerular filtration rates, and daily urine output at days 1, 7, 15, and 30 after kidney transplantation as well as at hospital discharge. No difference in recipient mortality nor in 1-year kidney graft survival was observed. Conclusion Donor pretreatment with NAC does not improve delayed graft function after kidney transplantation., A prospective, randomized, single-blind study of donor treatment with N-acetylcysteine prior to procurement shows that antioxidant treatment does not influence early renal allograft function for organs from brain-dead donors. Alternative approaches will be necessary to prevent delayed graft function.
Published: 2015
Full Text: View/download PDF

29. ICU specialists facing terrorist attack: the Nice experience

Author: Hervé Quintard, Carole Ichai, and Jean-Christophe Orban
Subjects: Emergency Medical Services, Accident prevention, Nice, Poison control, Disaster Planning, Critical Care and Intensive Care Medicine, Suicide prevention, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, Emergency medical services, Humans, Mass Casualty Incidents, Medicine, 030212 general & internal medicine, computer.programming_language, business.industry, 030208 emergency & critical care medicine, medicine.disease, Triage, Intensive Care Units, Mass-casualty incident, Terrorism, Wounds and Injuries, France, Medical emergency, business, computer
Published: 2016
Full Text: View/download PDF

30. Oxygen and Oxidative Stress

Author: Jean-Christophe Orban and Mervyn Singer
Subjects: chemistry, Biochemistry, Respiration, medicine, chemistry.chemical_element, Oxidative phosphorylation, medicine.disease_cause, Oxygen, Oxidative stress
Abstract: Oxygen is a structural and functional compound essential to life. Evoking the toxicity of this molecule could seem inappropriate or even provocative. After its discovery by Priestley in 1774, Lavoisier named it “oxygen” from the Greek words oxys and gennan meaning “generating acid”. At the same time, he demonstrated its essential role in respiration. This emphasized immediately the duality of this molecule to which the vast majority of living organisms have had to adapt, especially as, in particular circumstances, oxygen can be harmful because of its oxidative characteristics.
Published: 2017
Full Text: View/download PDF

31. Lactate: Metabolism, Pathophysiology

Author: Jean-Christophe Orban and Carole Ichai
Subjects: business.industry, Lactate metabolism, Lactic acidosis, Medicine, Hyperlactatemia, Metabolism, business, Bioinformatics, medicine.disease, Pathophysiology
Abstract: To understand the pathophysiology of hyperlactatemia requires to know its metabolism. Lactate metabolism is complex and depends on organs and their energetic condition. For a long time, hyperlactatemia was considered as toxic end waste, associated with lactic acidosis and tissue hypoxia-anaerobia. All these notions remain deeply anchored in our spirits but are frequently erroneous. Hyperlactatemia is really a good marker of poor outcome and a warning of energy crisis but is also a witness of a metabolic adaptative response. In many physiological and pathological conditions, lactate appears as an energetic shuttle and an efficient source of fuel.
Published: 2017
Full Text: View/download PDF

32. Sodium Disorders

Author: Carole Ichai and Jean-Christophe Orban
Published: 2017
Full Text: View/download PDF

33. Acute Complications of Diabetes

Author: Jean-Christophe Orban, Carole Ichai, and Emmanuel Van Obberghen
Subjects: Type 1 diabetes, medicine.medical_specialty, business.industry, Insulin deficiency, Incidence (epidemiology), 030209 endocrinology & metabolism, Type 2 diabetes, medicine.disease, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Time of day, Insulin resistance, chemistry, Diabetes mellitus, Internal medicine, medicine, 030212 general & internal medicine, Glycated hemoglobin, business
Abstract: Incidence of diabetes grows continuously in developed and developing countries, so it is considered as an epidemic disease [1]. There are nowadays several possible criteria for diagnosing diabetes [2]: (1) clinical signs evoking diabetes associated with blood glucose level (BGL) ≥ 200 mg/dL (11.1 mmol/L) at any time of day, (2) a fasting BGL ≥ 126 mg/dL (7.0 mmol/L), (3) a 2-h postload BGL ≥ 200 mg/dL during an oral glycemia tolerance test, and (4) a plasma glycated hemoglobin (HbA1c) ≥ 6.5%. Type 1 diabetes is characterized by insulinopenia caused by an autoimmune and irreversible destruction of pancreatic s-cells. Relative insulin deficiency and insulin resistance are the hallmarks of type 2 diabetes which is the most frequent in the world [3, 4].
Published: 2017
Full Text: View/download PDF

34. Alkalosis: Diagnosis and Treatment

Author: Carole Ichai and Jean-Christophe Orban
Subjects: medicine.medical_specialty, Alkalosis, business.industry, Central nervous system, Metabolic alkalosis, medicine.disease, Pathophysiology, Chronic disorders, medicine.anatomical_structure, Respiratory alkalosis, Internal medicine, Hyperventilation, medicine, Cardiology, Tissue hypoxia, medicine.symptom, business
Abstract: Despite its frequency, alkalosis has not been largely studied. The pathophysiology of metabolic alkalosis is rather complex: generating factors cause the trouble, but its maintenance requires the presence of sustained factors. The classical Henderson-Hasselbalch theory is more and more replaced by the Stewart concept for interpreting metabolic alkalosis. The treatment of metabolic alkalosis is based on the simultaneous normalization of the generating and maintaining factors. Respiratory alkalosis is classified into acute and chronic disorders and is caused by alveolar hyperventilation due to central nervous system abnormalities or tissue hypoxia.
Published: 2017
Full Text: View/download PDF

35. Interpretation of Acid-Base Disorders

Author: Hervé Quintard, Jean-Christophe Orban, and Carole Ichai
Subjects: Cognitive science, Biological data, Computer science, Interpretation (philosophy), Context (language use), Plasma bicarbonate, Acid-base disorders
Abstract: The definition of an acid or a base varies largely according to the context. From a physiological point of view, an acid or an alkaline solution is characterized by its capacity to release or conversely to consume them. This chapter will review most of the pathophysiological concepts of acid-base equilibrium and the mechanisms which are involved in its regulation. The history of the patient, the context, and clinical signs are essential to diagnose an acid-base disorder. However, the final interpretation of an acid-base disorder is based on biological data issued from blood samples tools which allow to move on step by step.
Published: 2017
Full Text: View/download PDF

36. Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study

Author: Jean-Christophe, Orban, Yannick, Walrave, Nicolas, Mongardon, Bernard, Allaouchiche, Laurent, Argaud, Frédéric, Aubrun, Geneviève, Barjon, Jean-Michel, Constantin, Gilles, Dhonneur, Jacques, Durand-Gasselin, Hervé, Dupont, Michèle, Genestal, Chloé, Goguey, Philippe, Goutorbe, Bertrand, Guidet, Hervé, Hyvernat, Samir, Jaber, Jean-Yves, Lefrant, Yannick, Mallédant, Jerôme, Morel, Alexandre, Ouattara, Nicolas, Pichon, Anne-Marie, Guérin Robardey, Michel, Sirodot, Alexandre, Theissen, Sandrine, Wiramus, Laurent, Zieleskiewicz, Marc, Leone, Carole, Ichai, Fabien, Lambiotte, Centre Hospitalier Universitaire de Nice (CHU Nice), Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hôpital de la Croix-Rousse [CHU - HCL], Centre Hospitalier Compiègne-Noyon (CHCN), Centre Hospitalier Compiègne-Noyon, CHU Clermont-Ferrand, CHU Amiens-Picardie, Département d'Anesthésie-Réanimation [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Hôpital d'Instruction des Armées Sainte Anne, Service de Santé des Armées, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Service d'anesthésie et de réanimation B, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), CHU Pontchaillou [Rennes], CHU Saint-Etienne, Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Service de Réanimation Polyvalente [CHU Limoges], CHU Limoges, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Hôpital Princesse Grace [Monaco], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Herrada, Anthony, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, Critical Illness, Multiple Organ Failure, Middle Aged, Cohort Studies, Intensive Care Units, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Cause of Death, Humans, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Hospital Mortality, Prospective Studies, ComputingMilieux_MISCELLANEOUS, Aged
Abstract: International audience; Background: Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.Methods: An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest).Results: A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths.Conclusions: In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.
Published: 2017
Full Text: View/download PDF

37. Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia

Author: Rémi Plattier, Olivier Raguin, Sébastien Kerever, Mohamed Nefzaoui, Michael Novain, Jean-Christophe Orban, Carole Ichai, Florian Cattet, Hervé Hyvernat, and Michel Kaidomar
Subjects: Male, Resuscitation, Critical Care and Emergency Medicine, lcsh:Medicine, Hypothermia, 030204 cardiovascular system & hematology, Pathology and Laboratory Medicine, 0302 clinical medicine, Hypothermia, Induced, Risk Factors, Medicine and Health Sciences, Cardiac Arrest, Odds Ratio, Brain Damage, Good outcome, lcsh:Science, Multidisciplinary, Ketones, Middle Aged, Prognosis, Hospitals, Patient Discharge, Intensive Care Units, Chemistry, Treatment Outcome, Neurology, Anesthesia, Physical Sciences, Female, Serum lactate, medicine.symptom, Research Article, Pyruvate, Cardiology, Brain damage, Out of hospital cardiac arrest, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, medicine, Humans, Lactic Acid, Aged, Retrospective Studies, business.industry, lcsh:R, Chemical Compounds, 030208 emergency & critical care medicine, Retrospective cohort study, Odds ratio, Health Care, Health Care Facilities, lcsh:Q, business, Acids, Out-of-Hospital Cardiac Arrest
Abstract: Aims Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor. But, after cardiac arrest, its interest is still debated. Our study aimed to assess the prognosis value of lactate in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Methods This retrospective observational study included out-of-hospital cardiac arrest patients treated with therapeutic hypothermia in four ICUs. Lactate levels were compared at different times during the first 24 hours according to outcome at ICU discharge and to the type of death (multiorgan or neurologic failure). Results Two hundred and seventy-two patients were included, 89 good outcome and 183 poor outcome. In the latter group, 171 patients died, from multiorgan failure in 30% and neurologic failure in 70%. Lactate levels were higher in the poor compared to the good outcome patients at admission (5.4 (3.3–9.4) vs. 2.2 (1.5–3.6) mmol/L; p
Published: 2017

38. Half-molar sodium lactate infusion to prevent intracranial hypertensive episodes in severe traumatic brain injured patients: a randomized controlled trial

Author: Gilles Francony, Jean François Payen, Jean Christophe Orban, Robin Legrand, Hubert Roth, Carole Ichai, Hervé Quintard, Xavier Leverve, Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, ANTE-INSERM U836, équipe 5, Neuroimagerie fonctionnelle et perfusion cérébrale, CIC - Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Pôle Anesthésie Réanimation, CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, Centre Hospitalier Universitaire de Nice (CHU Nice), 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), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Pôle Anesthésie Réanimation, and Centre Hospitalier Universitaire [Grenoble] (CHU)
Subjects: Adult, Male, Adolescent, Traumatic brain injury, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, Sodium Lactate, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, Injury Severity Score, 0302 clinical medicine, Chlorides, Double-Blind Method, Randomized controlled trial, law, Osmotherapy, Sodium lactate, medicine, Humans, Prospective Studies, Infusions, Intravenous, Prospective cohort study, Saline, ComputingMilieux_MISCELLANEOUS, Aged, Intracranial pressure, business.industry, Sodium, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Body Fluids, nervous system diseases, 3. Good health, chemistry, Brain Injuries, Anesthesia, Female, Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract: Preventive treatments of traumatic intracranial hypertension are not yet established. We aimed to compare the efficiency of half-molar sodium lactate (SL) versus saline serum solutions in preventing episodes of raised intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI).This was a double-blind, randomized controlled trial including 60 patients with severe TBI requiring ICP monitoring. Patients were randomly allocated to receive a 48-h continuous infusion at 0.5 ml/kg/h of either SL (SL group) or isotonic saline solution (control group) within the first 12 h post-trauma. Serial measurements of ICP, as well as fluid, sodium, and chloride balance were performed over the 48-h study period. The primary outcome was the number of raised ICP (≥20 mmHg) requiring a specific treatment.Raised ICP episodes were reduced in the SL group as compared to the control group within the 48-h study period: 23 versus 53 episodes, respectively (p 0.05). The proportion of patients presenting raised ICP episodes was smaller in the SL group than in the saline group: 11 (36 %) versus 20 patients (66 %) (p 0.05). Cumulative 48-h fluid and chloride balances were reduced in the SL group compared to the control group (both p 0.01).A 48-h infusion of SL decreased the occurrence of raised ICP episodes in patients with severe TBI, while reducing fluid and chloride balances. These findings suggest that SL solution could be considered as an alternative treatment to prevent raised ICP following severe TBI.
Published: 2013
Full Text: View/download PDF

39. Factors associated with initiation of medical advanced cardiac life support after out-of-hospital cardiac arrest

Author: Jacques Levraut, Nicolas Fraimout, Jean-Christophe Orban, Julie Contenti, Yassine Kabsy, Didier Giolito, Jordan Tosi, Emmanuelle Molinatti, Nicolas Boissier, Thai Se Ung, Franck Le Duff, and Christophe Mamino
Subjects: medicine.medical_specialty, Resuscitation, Out-of-hospital cardiac arrest, Termination of resuscitation rule, business.industry, Research, Advanced cardiac life support, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease, Medical resuscitation, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Emergency medicine, Medicine, Asystole, business, Intensive care medicine, Emergency medical system, Clinical death, Automated external defibrillator
Abstract: Background Termination of resuscitation rule permits to stop futile resuscitative efforts by paramedics. In a different setting, the decision to withhold resuscitation by emergency physician could be based on different factors. We aimed to identify the factors associated with the initiation of a medical ACLS in out-of-hospital cardiac arrest patients. Methods We prospectively collected the characteristics of all out-of hospital cardiac arrest patients occurring in a French district between March 2010 and December 2013 and managed by the emergency medical system. We analyzed the factors associated with the initiation of medical ACLS. Results Medical ACLS was initiated in 69 % of the 2690 patients included in the register. ACLS patients were younger (69 years [55–80] vs. 84 years [77–90]) and more frequently men. A higher percentage of witnessed cardiac arrest and BLS were observed. Duration of no-flow was shorter in the ACLS patients, whereas BLS duration was longer. A higher proportion of shockable rhythm and application of AED were found in this group. Mains factors associated with the initiation of medical ACLS were a suspected cardiac cause (1.73 [1.30–2.30]) and use of an automated external defibrillator (1.59 [1.18–2.16]), whereas factors associated with no medical ACLS were higher age (0.93 [0.92–0.94]), absence of BLS (0.62 [0.52–0.73]), asystole (0.31 [0.18–0.51]) and location in nursing home (0.23 [0.11–0.51]). Conclusions The medical decision to not initiate ACLS in out-of-hospital cardiac arrest patients seems to rely on a complex combination of validated criteria used for termination of resuscitation and factors resulting from an intuitive perception of the outcome.
Published: 2016

40. Survival in Critical Illness Is Associated with Early Activation of Mitochondrial Biogenesis

Author: Patrick Breen, Michael Bauer, Karen Felsmann, Jane E. Carré, Claude A. Piantadosi, Martin Stotz, Hagir B. Suliman, Wiebke Iffert, Lorenza Re, Jean Christophe Orban, Terry M. Mayhew, and Mervyn Singer
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pathology, Mitochondrial Diseases, Time Factors, Critical Illness, Multiple Organ Failure, Mitochondrion, Critical Care and Intensive Care Medicine, Mitochondrial Size, Phosphocreatine, Mitochondrial Proteins, chemistry.chemical_compound, Internal medicine, Intensive care, medicine, Humans, Cytochrome c oxidase, Muscle, Skeletal, Aged, Hip surgery, biology, B. Critical Care, business.industry, Middle Aged, Mitochondria, Muscle, Survival Rate, Respiratory protein, Endocrinology, chemistry, Mitochondrial biogenesis, Case-Control Studies, biology.protein, Female, Energy Metabolism, business, Transcription Factors
Abstract: Rationale: We previously reported outcome-associated decreases in muscle energetic status and mitochondrial dysfunction in septic patients with multiorgan failure. We postulate that survivors have a greater ability to maintain or recover normal mitochondrial functionality. Objectives: To determine whether mitochondrial biogenesis, the process promoting mitochondrial capacity, is affected in critically ill patients. Methods: Muscle biopsies were taken from 16 critically ill patients recently admitted to intensive care (average 1–2 d) and from 10 healthy, age-matched patients undergoing elective hip surgery. Measurements and Main Results: Survival, mitochondrial morphology, mitochondrial protein content and enzyme activity, mitochondrial biogenesis factor mRNA, microarray analysis, and phosphorylated (energy) metabolites were determined. Ten of 16 critically ill patients survived intensive care. Mitochondrial size increased with worsening outcome, suggestive of swelling. Respiratory protein subunits and transcripts were depleted in critically ill patients and to a greater extent in nonsurvivors. The mRNA content of peroxisome proliferator-activated receptor γ coactivator 1-α (transcriptional coactivator of mitochondrial biogenesis) was only elevated in survivors, as was the mitochondrial oxidative stress protein manganese superoxide dismutase. Eventual survivors demonstrated elevated muscle ATP and a decreased phosphocreatine/ATP ratio. Conclusions: Eventual survivors responded early to critical illness with mitochondrial biogenesis and antioxidant defense responses. These responses may partially counteract mitochondrial protein depletion, helping to maintain functionality and energetic status. Impaired responses, as suggested in nonsurvivors, could increase susceptibility to mitochondrial damage and cellular energetic failure or impede the ability to recover normal function. Clinical trial registered with clinical trials.gov (NCT00187824).
Published: 2010
Full Text: View/download PDF

41. Hypovolaemic hypotension after abdominal aortic surgery is predicted by initial distribution volume of glucose

Author: Jean-Christophe Orban, Aurélie Blasin-Chadoutaud, Parjam Zolfaghari, Dominique Grimaud, Carole Ichai, and Hironori Ishihara
Subjects: Blood Glucose, business.industry, Hypovolemia, Middle Aged, medicine.disease, Aortic surgery, Aortic aneurysm, Postoperative Complications, Anesthesiology and Pain Medicine, Volume (thermodynamics), Predictive Value of Tests, Initial distribution, Anesthesia, Predictive value of tests, medicine, Humans, Single-Blind Method, Prospective Studies, Hypotension, business, Aged, Aortic Aneurysm, Abdominal, Abdominal surgery
Abstract: Evaluation of volaemia is a crucial question for the management of patients during anaesthesia and in the ICU. Numerous methods have been described, but there is as yet no single ideal parameter. Another way to approach this problem is to predict the extent of hypovolaemia. The initial distribution volume of glucose (IDVG) has been shown to predict the development of hypovolaemic hypotension following oesophageal surgery. In this study, we evaluated the use of the IDVG in predicting hypovolemic hypotension after abdominal aortic surgery.All patients undergoing elective abdominal aortic surgery had IDVG measured following admission to the ICU. Other haemodynamic parameters, such as heart rate, blood pressure, urine output and central venous pressure, were also collected during the first postoperative day. Patients were divided into two groups depending on the occurrence of hypovolaemic hypotension, indicated by a SBP lower than 90 mmHg rapidly corrected by administration of intravenous fluid boluses.Out of the 27 patients who underwent aortic surgery, 13 developed hypovolaemic hypotension. IDVG was significantly lower in this group when compared with the haemodynamically stable group, that is, 78 (59-122) vs. 120 (63-151) ml kg(-1). This was despite similar haemodynamic parameters between the two groups. The best area under the receiver-operating characteristic curve was obtained for an IDVG value of 91.1 ml kg(-1).In this study, IDVG predicts the occurrence of hypovolaemic hypotension after elective abdominal aortic surgery.
Published: 2010
Full Text: View/download PDF

42. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients

Author: Frederic Berthier, Xavier Leverve, Corine Samat-Long, Dominique Grimaud, Laurent Rami, Guy Armando, Carole Ichai, Jean-Christophe Orban, Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Département d'Informatique Médicale, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital Cimiez [Nice] (CHU), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hamant, Sarah, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)
Subjects: Adult, Male, Traumatic brain injury, medicine.medical_treatment, Brain Edema, Critical Care and Intensive Care Medicine, Cerebral edema, Sodium Lactate, Disability Evaluation, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Osmotherapy, Intensive care, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, medicine, Humans, Glasgow Coma Scale, Mannitol, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Prospective Studies, business.industry, 030208 emergency & critical care medicine, medicine.disease, Diuretics, Osmotic, 3. Good health, Hypertonic saline, Intensive Care Units, Brain Injuries, Anesthesia, Female, Intracranial Hypertension, Diuretic, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: Traumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP).Prospective open randomized study in an adult ICU.Thirty-four patients with isolated severe TBI (Glasgow Coma Scaleor= 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy, consisting of either mannitol or sodium lactate. Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled. The primary endpoint was efficacy in lowering ICP after 4 h, with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension. The analysis was performed with both intention-to-treat and actual treatments provided.Compared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4 mmHg, P = 0.016), more prolonged (fourth-hour-ICP decrease: -5.9 +/- 1 vs. -3.2 +/- 0.9 mmHg, P = 0.009) and more frequently successful (90.4 vs. 70.4%, P = 0.053).Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings.
Published: 2008
Full Text: View/download PDF

43. Practices of end-of-life decisions in 66 southern French ICUs 4years after an official legal framework: A 1-day audit

Author: Samir Jaber, Pierre Bouzat, Bernard Allaouchiche, B Ragonnet, Jean-Yves Lefrant, J. Morel, Emmanuel Futier, Thomas Rimmelé, Nicolas Molinari, Arnaud Friggeri, Stein Silva, Jean-Michel Constantin, Olivier Desebbe, Carole Ichai, Boris Jung, Marc Leone, Jean Christophe Orban, Claire Roger, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hémostase, Inflammation et sepsis (EA 4609), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Réanimation Médico-Chirurgicale, Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service d'anesthésiologie et de soins intensifs, Hospices Civils de Lyon (HCL)-Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Hospices Civils de Lyon, Service d’Anesthésie Réanimation, ANTE-INSERM U836, équipe 5, Neuroimagerie fonctionnelle et perfusion cérébrale, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, Service d’Anesthésie et de Réanimation, Service de Réanimation, Hospices Civils de Lyon (HCL)-Hôpital E. Herriot, Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), 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)-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), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), MORNET, Dominique, Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-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), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Hémostase, Inflammation et sepsis, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-VetAgro Sup ( VAS ), Institut Montpelliérain Alexander Grothendieck ( IMAG ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Gui de Chauliac, Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Hospices Civils de Lyon ( HCL ) -Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon ( HCL ), Grenoble Institut des Neurosciences ( GIN ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Michallon-Hôpital Michallon, Hospices Civils de Lyon ( HCL ) -Hôpital E. Herriot, CHU Nice-Hôpital St Roch, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes ( URMITE ), 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 ) -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 ), and Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS )
Subjects: Male, medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], Clinical Decision-Making, withdrawing, Legislation, end-of-life, Audit, Critical Care and Intensive Care Medicine, 03 medical and health sciences, family communication, 0302 clinical medicine, Intensive care, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, Aged, withholding, Withholding Treatment, Clinical Audit, [ SDV ] Life Sciences [q-bio], business.industry, Medical record, 030208 emergency & critical care medicine, General Medicine, Middle Aged, humanities, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, Anesthesiology and Pain Medicine, SAPS II, Family medicine, Life support, Observational study, Female, France, Guideline Adherence, business, Advance Directives
Abstract: International audience; Since the implementation of two French laws in 2002 and 2005 and the implementation of guidelines about End-of-Life (EoL) decisions, few studies concerning EoL practices in French intensive care units (ICUs) have been reported. This study was aimed at assessing compliance with recommendations and current legislation concerning EoL decisions. Prospective observational study based on 1-day audit conducted from January to May 2009 in 66 southern French ICUs. Six hundred and twenty-five patients were included (median age: 63 [52-76] years, median SAPS II: 46 [34-58]). The written designation of a surrogate decision-maker was reported for 87 (15%) patients. Advance directives were completed for only 4% of patients. The EoL decision-making process consisted in a multidisciplinary approach for 99 (47%) patients and was recorded in the medical chart for 63 (64%) cases. Families were informed about medical decisions in 58% of cases. This proportion was higher (87%) if a decision to forego life-sustaining therapy was made. EoL decisions consisted of withholding treatments for 72 (94%) patients and withdrawal of treatments for 5 (6%) patients. In the multivariate stepwise logistic regression, four variables were independently associated with a decision to forego life support: preexisting dependence on others (P
Published: 2015
Full Text: View/download PDF

44. 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

45. Effects of acetylcysteine and ischaemic preconditioning on muscular function and postoperative pain after orthopaedic surgery using a pneumatic tourniquet

Author: Dominique Grimaud, B. Schlatterer, Carole Ichai, D. Deroche, Jean-Christophe Orban, J. Levraut, and S. Gindre
Subjects: Adult, Male, medicine.medical_specialty, Ischemia, Rhabdomyolysis, Acetylcysteine, Pneumatic tourniquet, medicine, Humans, Orthopedic Procedures, Single-Blind Method, Ischemic Preconditioning, Creatine Kinase, Pain, Postoperative, Tourniquet, Myoglobin, business.industry, Middle Aged, Tourniquets, medicine.disease, Surgery, body regions, Anesthesiology and Pain Medicine, Reperfusion Injury, Anesthesia, Cuff, Orthopedic surgery, Ischemic preconditioning, Female, Reactive Oxygen Species, business, Reperfusion injury, medicine.drug
Abstract: The use of a pneumatic tourniquet can induce muscular and neurological complications in the operated limb. The genesis of these injuries could involve an ischaemia/reperfusion phenomenon and a compression under the cuff. We evaluated effects of an antioxidant, acetylcysteine and ischaemic preconditioning on the rhabdomyolysis and postoperative pain following a knee ligamentoplasty using a pneumatic tourniquet.We included 31 patients scheduled for a knee ligamentoplasty randomly assigned in three groups (control, acetylcysteine 1200 mg the day before and 600 mg at the operative day, ischaemic preconditioning).There was a moderate rise in myoglobin and creatinine phosphokinase with no significant difference between the three groups. The muscular functional parameters were similar in all the groups. However, the morphine consumption within the first 48 h was smaller in the treatment groups (0.22 +/- 0.31 mg kg-1 and 0.22 +/- 0.23 mg kg-1 in the preconditioning and antioxidant groups, respectively) than in the control group (0.47 +/- 0.33 mg kg-1, P0.05).Acetylcysteine and ischaemic preconditioning do not decrease the extent of rhabdomyolysis related to the use of a pneumatic tourniquet and do not improve the postoperative muscle recovery. On the other hand, they allow a significant reduction in the postoperative morphine consumption.
Published: 2006
Full Text: View/download PDF

46. Le glucose : substrat ou poison ?

Author: Jean-Christophe Orban, Carole Ichai, and Didier Déroche
Subjects: Anesthesiology and Pain Medicine, business.industry, Emergency Medicine, Medicine, Emergency Nursing, business
Published: 2005
Full Text: View/download PDF

47. The Gitelman and Classical Bartter Syndromes

Author: Guillaume Favre, Carole Ichai, and Jean-Christophe Orban
Subjects: CLCNKB, medicine.medical_specialty, endocrine system diseases, biology, business.industry, Metabolic alkalosis, Gitelman syndrome, urologic and male genital diseases, medicine.disease, Bartter syndrome, Gastroenterology, Hypocalciuria, Hypokalemia, Hypomagnesemia, Internal medicine, biology.protein, medicine, Hypercalciuria, medicine.symptom, business
Abstract: Both classical Bartter (type III) and Gitelman syndromes are congenital tubulopathies. The diagnosis is usually made on an asymptomatic hypokalemia. Rare symptomatic patients present clinical hypokalemic-related signs, i.e. tetraparesia or cardiac arrhythmias. Symptoms are usually favoured by an extracellular dehydration. Both syndromes are autosomal recessive inheritance illnesses leading to a secondary hyperaldosteronism associated with renal hypokalemia and metabolic alkalosis. Phenotypic presentation of Gitelman syndrome is rather a hypomagnesemia and a hypocalciuria, whereas Bartter syndrome is rather a normal magnesemia and a hypercalciuria, but due to similar phenotypes, these abnormalities are not specific. The exact diagnosis requires genetic tests. Gitelman syndrome is characterized by a mutation that inactivates the gene encoding for the thiazide diuretic sensible-cotransporter Na–Cl (SCL 12A3). The classical Bartter syndrome is due to a mutation that inactivates the gene encoding for the type B chloride channel (CLCNKB). Symptomatic patients must be supplemented with potassium and magnesium if necessary until clinical and electrical signs persist followed by a chronic oral supplementation. There is no etiologic treatment.
Published: 2014
Full Text: View/download PDF

48. Évaluation du lactate comme facteur pronostique du devenir neurologique après arrêt cardiaque extra-hospitalier traité par hypothermie thérapeutique

Author: Florian Cattet, Mohamed Nefzaoui, Olivier Raguin, Michael Novain, Jean-Christophe Orban, Michel Kaidomar, Hervé Hyvernat, Carole Ichai, and Rémi Plattier
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction L’arret cardiaque extra-hospitalier (ACREH) est un probleme majeur de sante publique dont le pronostic neurologique est incertain. L’hypothermie therapeutique a ameliore le devenir de ces patients mais aussi modifie la valeur de divers facteurs pronostiques [1] , [2] . Le lactate est un marqueur pronostique controverse dans l’ACREH [3] . Le but de notre etude etait d’evaluer le caractere pronostique de la lactatemie apres ACREH traite par hypothermie therapeutique. Materiel et methodes Nous avons mene une etude retrospective incluant des patients adultes admis dans 4 services de reanimation pour ACREH beneficiant d’une hypothermie therapeutique. Nous avons collecte les donnees demographiques, les circonstances de l’arret cardiaque ainsi que les lactatemies arterielles durant les 2 premiers jours. Le pronostic neurologique etait etabli sur le score CPC : 1–2 bon devenir et 3–5 mauvais devenir. Les donnees sont exprimees en mediane et intervalle interquartile. Les comparaisons entre groupes ont fait appel a un test de Mann-Whitney ou du Chi2 quand approprie. Une regression logistique a estime les odds-ratio associes au devenir. Un p Resultats Deux cent soixante-douze patients ont ete inclus avec 89 bons et 183 mauvais devenirs. Les patients ayant une bonne evolution presentaient un âge inferieur, des durees de no-flow et low-flow inferieures et plus de rythmes choquables. La lactatemie aux differents temps est rapportee dans le Tableau 1 . En analyse multivariee, la lactatemie initiale (OR 1,304 [1,146–1,483] p Fig. 1 ). Discussion Notre etude semble confirmer l’association de la lactatemie au devenir apres ACREH traite par hypothermie. Cependant, les performances statistiques de lactatemie seule ne sont pas suffisantes pour etablir avec certitude le pronostic neurologique. Des etudes prospectives evaluant les associations de plusieurs parametres pronostiques sont necessaires pour ameliorer la fiabilite de l’evaluation pronostique.
Published: 2015
Full Text: View/download PDF

49. Facteurs associés à l’initiation d’une réanimation cardio-pulmonaire médicale dans l’arrêt cardiaque extra-hospitalier

Author: Yassine Kabsy, Nicolas Fraimout, Didier Giolito, Jacques Levraut, Franck Le Duff, Jean-Christophe Orban, Thai Se Ung, Jordan Tosi, Emmanuelle Molinatti, Nicolas Boissier, and Christophe Mamino
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction Dans les pays anglo-saxons, des regles d’arret de reanimation permettent aux paramedicaux de stopper les manœuvres de reanimation cardio-pulmonaire (RCP) jugees inutiles 0015 ; 0020. Dans le systeme de soins francais, la presence d’un medecin en pre-hospitalier pourrait modifier les criteres de decision d’arret de RCP ou d’initiation de RCP avancee. L’objectif de notre etude etait d’identifier les facteurs associes a l’initiation medicale d’une RCP avancee chez les patients en arret cardiaque extra-hospitalier. Materiel et methodes Nous avons collecte prospectivement les caracteristiques des patients en arret cardiaque extra-hospitalier dans le departement des Alpes-Maritimes entre mars 2010 et decembre 2013 ayant motive une intervention du SMUR. Afin de s’affranchir de facteurs evidents de bon pronostic, nous avons exclu les patients ayant presente un retour a une activite cardiaque spontanee efficace. Nous avons analyse les facteurs associes a l’initiation medicale d’une RCP chez les patients adultes decedes sur place. Les donnees sont exprimees en mediane et intervalle interquartile. Les comparaisons entre groupes ont fait appel a un test de Mann-Whitney ou du Chi2. Une regression logistique a estime les odd-ratios associes a l’initiation d’une RCP medicale. Un p
Published: 2015
Full Text: View/download PDF

50. Causes et caractéristiques des décès en réanimation : une étude nationale

Author: Groupe AzuRéa, Samir Jaber, Yannick Walrave, Jean-Christophe Orban, Jean-Yves Lefrant, Carole Ichai, Jean-Michel Constantin, Bernard Allaouchiche, and Marc Leone
Subjects: Anesthesiology and Pain Medicine
Abstract: Introduction La mortalite des patients de reanimation est un parametre global rapporte dans de nombreuses etudes. Cependant, les causes et circonstances du deces des patients ne sont etudiees que dans des pathologies particulieres telles que le sepsis, l’arret cardiaque ou le SDRA [1] , [2] . Le but de notre etude etait d’analyser les causes et circonstances des deces dans une population non selectionnee de patients de reanimation. Materiel et methodes Il s’agit d’une etude prospective observationnelle. Chaque service participant incluait tous les deces survenant durant une periode de 1 mois randomise sur une annee. Les donnees demographiques habituelles etaient recueillies ainsi que les circonstances entourant le deces (defaillances et suppleances d’organes). Une defaillance d’organe etait definie par un sous-score SOFA ≥ 3. La population de l’etude etait dichotomisee en deces attendu (faisant suite a une limitation ou un arret des therapeutiques ou apres mort encephalique) et non attendu (deces survenant malgre des therapeutiques maximales). Les donnees sont exprimees en mediane et intervalle interquartile. Les comparaisons entre groupes ont fait appel a un test de Mann-Whitney ou du Chi2 quand approprie. Un p Resultats Quatre-vingt seize reanimations ont inclus 698 patients durant la periode d’etude. Les caracteristiques principales de la population et la comparaison de ces parametres dans les groupes deces attendu (n = 473) et non-attendu (n = 225) sont rapportees dans le Tableau 1 . Au moment du deces, 586 (84 %) patients presentaient au moins une defaillance d’organe : hemodynamique (58 %), respiratoire (31 %), renale (33 %), neurologique (30 %), hepatique (8 %) et hematologique (8 %). Au meme moment, une suppleance d’organes etait utilisee chez 440 (63 %) patients : catecholamines (63 %), ventilation mecanique (85 %), epuration extra-renale (28 %) et dialyse hepatique (1 %). La comparaison de ces parametres entre les deux groupes de l’etude est rapportee dans la Fig. 1 . Discussion Notre etude semble montrer que les deces en reanimation font souvent suite a une defaillance viscerale. Les deces attendus presentent essentiellement plus de defaillances neurologiques et respiratoires alors que les deces non-attendus montrent plus de defaillances hemodynamiques. Ces derniers beneficiaient d’un plus grand pourcentage des differentes suppleances d’organes traduisant un engagement therapeutique plus important.
Published: 2015
Full Text: View/download PDF

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Category

Publication Type

Journal

Database

Publisher

74 results on '"Jean-Christophe Orban"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources